Table of Contents
ISRN Obesity
Volume 2013, Article ID 910586, 5 pages
Clinical Study

Surgical Stress Induces an Amplified Inflammatory Response in Patients with Type 2 Diabetes

1Emory Endosurgery Unit Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA
2Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47907-2059, USA

Received 5 December 2012; Accepted 30 December 2012

Academic Editors: S. J. Pintauro and J. Saleh

Copyright © 2013 Edward Lin and Nana Gletsu-Miller. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Morbid obesity is believed to be an extreme of the metabolic spectrum. Moreover, diabetes is hypothesized to be associated with a chronic inflammatory state that is not observed in nondiabetic healthy individuals. We investigated the differences in expression of inflammatory cytokines induced by surgical stress between diabetic and nondiabetic individuals. Method. 39 morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (9 with type 2 diabetes mellitus) were compared with 8 nonobese euglycemic patients undergoing laparoscopic antireflux surgery. Cytokine levels for IL-6, IL-10, and IL-18 were measured 15 minutes before surgery and immediately after surgery. Results. IL-6 and IL-10 levels were elevated from baseline following surgery, but morbidly obese patients exhibited a much higher elevation than lean patients. Individuals with type 2 diabetes had the most pronounced IL-6 and IL-10 elevations. Baseline IL-18 levels were significantly higher in diabetic patients compared with nondiabetic or lean patients. However, IL-18 levels were not changed in response to surgery. Conclusions. Diabetes and morbid obesity are associated with augmented cytokine expression in response to surgical trauma that is several folds higher than in nonobese euglycemic patients. Diabetic patients exhibit a chronic elevation in IL-18 that is not changed by surgical stress.