Assessment of High-Sensitivity C-Reactive Protein (hs-CRP) Changes Following One Anastomosis Gastric Bypass (OAGB) in Patients with Obesity: A Prospective Cohort Study

Assessment of High-Sensitivity C-Reactive Protein (hs-CRP) Changes Following One Anastomosis Gastric Bypass (OAGB) in Patients with Obesity: A Prospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of High-Sensitivity C-Reactive Protein (hs-CRP) Changes Following One Anastomosis Gastric Bypass (OAGB) in Patients with Obesity: A Prospective Cohort Study Nriman Mehrnia, Ali Jaliliyan, Hesam Mosavari, Pantea Khalili, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4667357/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jan, 2025 Read the published version in Obesity Surgery → Version 1 posted 17 You are reading this latest preprint version Abstract Background Obesity, characterized by excessive adipose tissue, is associated with chronic low-grade inflammation and elevated inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP). This inflammation is linked to obesity-associated medical problems, including cardiovascular diseases. One Anastomosis Gastric Bypass (OAGB) has emerged as an effective metabolic and bariatric surgical procedure to address severe obesity and its associated inflammatory state. This study aims to evaluate the changes in hs-CRP levels following OAGB in patients with obesity. Methods In this prospective cohort study, 71 participants with BMI > 35 kg/m², with or without obesity-associated medical problems, underwent OAGB. The hs-CRP levels were measured at baseline, one day, five days, thirty days, and six months post-surgery. Results The median baseline hs-CRP level was 8.5 mg/L, initially increasing post-surgery to 19 mg/L, but significantly decreased to 3.5 mg/L at six months (p < 0.001). Significant reductions in weight and BMI were also observed, with median total weight loss (%TWL) of 29% and excess weight loss (%EWL) of 68.2% over six months. Pre-operative hs-CRP levels were the only significant predictor of CRP reduction post-surgery. Conclusion OAGB significantly reduces systemic inflammation by decreasing hs-CRP levels, alongside substantial weight loss. These findings support OAGB as a beneficial intervention for mitigating inflammation and improving metabolic conditions in patients with obesity. Further long-term studies are warranted to evaluate the sustained impact of OAGB on inflammatory markers and obesity-associated medical problems. One Anastomosis gastric bypass C-reactive protein high-sensitive C-reactive protein inflammation obesity Figures Figure 1 Key points OAGB significantly reduced hs-CRP levels from a median of 8.5 mg/L pre-operatively to 3.5 mg/L at 6 months post-surgery, indicating a decrease in systemic inflammation. Substantial weight loss was achieved, with median total weight loss (%TWL) of 29% and excess weight loss (%EWL) of 68.2% over 6 months following OAGB. Pre-operative hs-CRP levels were the only significant predictor of hs-CRP reduction at 6 months post-surgery, suggesting patients with higher baseline inflammation may benefit more. No significant correlation was found between weight loss outcomes and hs-CRP reduction, indicating OAGB may reduce inflammation through mechanisms beyond just weight loss. Introduction Obesity has reached epidemic proportions globally, with over one billion people classified as individuals with obesity [ 1 ]. It is a significant risk factor for numerous medical problems, including cardiovascular disease (CVD), stroke, type 2 diabetes (T2DM), and cancer [ 2 ]. One of the critical mechanisms thought to link obesity to its associated medical problems is chronic low-grade inflammation [ 3 ]. Adipose tissue dysfunction in obesity leads to abnormal production of proinflammatory cytokines and reduced secretion of anti-inflammatory factors [ 4 ]. This maintains systemic inflammation, which can initiate or exacerbate cardiometabolic disease processes [ 5 ]. In a healthy state, anti-inflammatory molecules such as adiponectin predominate suppressing chronic inflammation. However, in obesity, hypertrophic adipocytes and infiltrating proinflammatory macrophages in adipose tissue generate increased levels of cytokines such as TNF-alpha, IL-6, and IL-1beta [ 6 – 8 ]. This dysregulation leads to the dominance of proinflammatory signals over anti-inflammatory signals, creating a state of chronic low-grade inflammation both locally in adipose tissue and systemically throughout the body. The chronic inflammatory response generated by dysfunctional adipose tissue is thought to be involved in the pathogenesis of insulin resistance, atherosclerosis, and other cardiometabolic complications associated with obesity [ 9 ]. C-reactive protein (CRP) is a circulating inflammatory marker the liver produces in response to IL-6 and other proinflammatory cytokines. In individuals with obesity, the proinflammatory state created by dysfunctional adipose tissue stimulates increased hepatic synthesis of CRP. Therefore, serum CRP levels are elevated in individuals with obesity and positively correlate with Body Mass Index (BMI) [ 10 ]. Elevated CRP levels in obesity signify the presence of systemic inflammation driven by adipose tissue dysfunction. Moreover, prospective epidemiological studies have shown high CRP levels predict the severity of obesity-related medical problems, including liver steatosis [ 11 ]. we specifically focused on CRP rather than IL-6 and TNF-α due to its superior reliability and sensitivity as a marker of inflammation, as supported by evidence indicating that CRP, unlike IL-6 and TNF-α, consistently reflects the reduction in systemic inflammation and correlates closely with improvements in metabolic parameters post-surgery [ 12 ]. Thus, CRP is a marker of obesity-related inflammation and is associated with the development of obesity complications. Interventions targeting weight loss and inflammation may help reduce circulating CRP [ 13 ]. For patients with severe obesity, lifestyle interventions like diet and exercise alone often fail to achieve adequate, sustained weight loss outcomes. Metabolic and Bariatric Surgery (MBS) has become an effective treatment option for weight loss and reducing obesity-related complications and CVD-associated biomarkers when non-surgical approaches are unsuccessful [ 14 , 15 ]One promising technique is the One-Anastomosis Gastric Bypass (OAGB). Procedures like OAGB may work partly by resolving the chronic inflammatory state associated with obesity. However, only a limited number of studies have examined this issue. Therefore, this prospective cohort study aims to assess the effects of OAGB surgery on high-sensitivity C-Reactive Protein (hs-CRP) levels over six months of follow-up. Demonstrating sustained reduction in CRP could help explain the cardiometabolic benefits observed after MBS and support the role of decreasing chronic inflammation in alleviating obesity-related complications. Material and Methods Study design The study was designed as a prospective cohort, following patients throughout six months post-OAGB to assess changes in hs-CRP levels. This study has received approval from the Ethics Committee of the *****. Informed consent was obtained from all participants before enrollment, and the study was conducted according to ethical principles outlined in the Declaration of Helsinki. Participants According to the study of Pakiet et al. considering an estimated effect size of 30% for the reduction in CRP levels before and after OAGB, with a margin of error of 5%, 80% power, and a confidence interval (CI) of 95%, and accounting for a 5% dropout rate, the sample size was estimated to be 60 patients [16]. Participants were recruited from the *** [17]. The inclusion criteria were adult patients over 18 years old with a BMI ≥35 kg/m 2 with or without obesity-associated medical problems, who had not achieved the desired weight loss through lifestyle changes and medical treatment, and who were scheduled for OAGB. Patients were excluded if they had previous MBS, known systematic inflammatory diseases such as autoimmune conditions, active viral or bacterial infections, pregnancy, or taking medications known to affect inflammatory status, such as systemic steroids. Finally, 71 patients were included from September 2022 to September 2023. No patients were lost to follow-up. Study Setting Board-certified bariatric surgeons performed all OAGB surgeries at the bariatric surgery center of *****, a high-volume bariatric surgery center with a dedicated multidisciplinary team aligned with the International Federation for the Surgery of Obesity (IFSO) guidelines for metabolic and bariatric surgery [18]. The team includes bariatric physicians, nutritionists, psychiatrists, and nurses who specialize in caring for MBS patients. Standardized surgical protocols were utilized for all participants. Surgical Technique OAGB involved creating a 60 -75 cc gastric pouch and 150 -200 cm limb lengths. The anastomosis was made using a 45 mm linear cutter stapler, maintaining a 2 -3 cm diameter. The anastomotic orifices were sutured with 2/0 PDS. All participants underwent the OAGB performed by one surgical team using the mentioned technique. Additional details of the surgical technique were described in our previous publications [19]. Data Collection Hs-CRP levels in serum were quantified using commercially available high-sensitivity ELISA kits (IBL International, Catalog #EU59151) at designated time points before, one day, five days, 30 days, and six months after OAGB. Blood samples were collected the day before surgery to establish baseline hs-CRP levels. Trained staff followed standard phlebotomy techniques to obtain blood samples immediately processed for serum isolation via centrifugation. Follow-up blood samples were obtained at the mentioned timeline post-surgery and processed using the same standardized protocols. Serum hs-CRP testing was performed in batches using the ELISA kits according to the manufacturer's instructions. In addition to hs-CRP testing, demographic information, including age, gender, and body mass index, was extracted from *****. BMI values were also retrieved from the ***** at the follow-up intervals. The same standardized procedures for data collection were followed for all study participants. Data Analysis All statistical analyses were conducted using SPSS Statistics software version 27 (IBM Corp; NY, USA). Continuous variables were presented as mean and standard deviation (SD) for normally distributed and median and Interquartile Range (IQR) for non-normally distributed variables. Categorical variables were presented as numbers and percentages. We first assessed the normality of all the constant data using Smirnov-Kolmogorov test. Serum hs-CRP was measured before and after surgery at the designated time points for the primary outcome. Then, we assessed the alternation of serum hs-CRP levels using the Friedman test. The impact of various categorical and continuous variables on post-operative hs-CRP reduction in 6 months was also assessed using a Mann-Whitney U and Kendall’s correlation test, respectively. Finally, using a linear regression model, we predicted hs-CRP reduction in the six months. Results Participant Characteristics We recruited 71 participants for the study. All the participants were successful in completing the follow-up. The median (IQR) age of the participants was 41 (14) years. A total of 62 participants were female, and 9 participants were male. The participants' median (IQR) pre-operative weight and BMI were 117.5 kg (25.6) and 43.43 (7.17) kg/m 2 , respectively. The characteristics of the participants are detailed in Table 1. Primary outcome: hs-CRP Serum hs-CRP levels were measured with highly sensitive ELISA kits at the designated time points. (pre-operative, one day, five days, 30 days, and six months after OAGB). The median serum hs-CRP level was 8.5 mg/L before OAGB, initially increased at days one and five after OAGB, then decreased over the six months and reached below the baseline level. The median serum CRP level 6 months after the surgery was 3.50 mg/L. Figure 1 and Table 2 demonstrate the pattern of alterations in serum hs-CRP levels before and following OAGB. Figure 1 - Mean rank of hs-CRP levels over time Based on the Friedman test, the mean serum hs-CRP levels differed significantly between the examined time points (Χ²= 97.99; p < 0.001). Weight Loss outcomes The weight and BMI of the participants were investigated in the 1 st month and the 6 th month. A significant decrease in weight (χ² = 134.11, p < 0.001) and BMI (χ² = 134.11, p < 0.001) was observed after six months. The median (IQR) of Total Weight Loss (%TWL) and Excess Weight Loss (%EWL) were 29% (6.5) and 68.2% (21.2), respectively. The weight loss outcomes of the participants are outlined in Table 3 and Table 4. Changes in hs-CRP The median (IQR) reduction in hs-CRP levels was 2.9 (13.9) mg/L over the six months. We considered the changes in hs-CRP to be the primary dependent variable. Therefore, the effects of various factors, including age, gender, obesity-associated medical problems, weight loss outcomes, and preoperative indices such as BMI, on the extent of CRP reduction over the six months have been measured using statistical analysis methods. In this regard, the impact of the mentioned factors on the 6-month changes in CRP is detailed and observable in Table 5 and Table 6 . As mentioned in Table 6, the only variable capable of predicting hs-CRP reduction in six months was the pre-operative serum hs-CRP level (Correlation Coefficient= 0.495, p<0.001). Table 7 represents the results of a univariate linear regression model, predicting serum CRP reduction in the six months by the pre-operative serum hs-CRP (adjusted R 2 =0.24; p<0.01). Discussion In this prospective cohort study, we aimed to assess the changes in hs-CRP levels following OAGB in patients with obesity. Our findings demonstrated a significant reduction in hs-CRP levels from the pre-operative baseline to six months post-surgery. Initially, there was an expected increase in hs-CRP levels immediately post-surgery, likely due to the acute inflammatory response to the surgical intervention. However, this was followed by a significant decrease over the subsequent one and six-month follow-ups, indicating a significant decrease in systemic inflammation. A recent meta-analysis found a significant reduction in several inflammatory markers, including CRP and hs-CRP, after MBS [20]. Although the meta-analysis did not include a subgroup analysis specifically for OAGB regarding CRP changes, previous studies have reported outcomes consistent with our findings, indicating OAGB, like other MBS, can significantly decrease CRP levels and improve metabolic health in patients with obesity [21–24]. The significant reduction in hs-CRP levels in the present study aligns with the understanding that weight loss and improved metabolic profiles post-MBS can alleviate systemic inflammation. MBS has been shown to reduce adipose tissue mass, decrease macrophage infiltration, lower the secretion of pro-inflammatory cytokines, and significantly impact comorbidities associated with chronic inflammation [25]. Conditions such as T2DM, CVD, and metabolic syndrome, which are often exacerbated by inflammatory processes, tend to improve following MBS [25–27]. Furthermore, reducing inflammatory cytokines following MBS is associated with a lower risk of asthma, Alzheimer’s disease, and certain cancers [28]. Although this study aimed to evaluate the short- and mid-term effects of OAGB on hs-CRP levels, several studies have reported sustained long-term improvements in inflammatory markers following MBS. A retrospective cohort study of 163 patients who underwent Roux-en-Y Gastric Bypass (RYGB) or Laparoscopic Sleeve Gastrectomy (LSG) over four years reported significant declines in CRP and hs-CRP levels, correlating with weight loss and T2DM remission. Inflammatory markers followed a U-shaped curve, with the lowest levels at two years post-MBS and a slight, non-significant increase at four years, normalizing in 84% of patients [29]. Another study of 1,180 patients post-RYGB found CRP levels dropped from 1.01 mg/L pre-surgery to 0.18 mg/L at two years, with a slight increase at seven years but remaining below pre-surgery levels. Only 3.2% had elevated CRP at seven years, compared to 32.9% pre-surgery. Factors such as higher pre-surgery CRP, BMI, smoking, and diabetes were linked to less favorable CRP trajectories, indicating the need for ongoing monitoring in these subgroups [30]. Although MBS significantly decreases CRP levels, concerns exist regarding the potential resurgence of inflammatory markers following recurrent weight gain, a common occurrence after MBS. Nevertheless, studies indicate that the anti-inflammatory benefits of MBS, including reduced CRP levels, persist even after recurrent weight gain. Specifically, a study on the metabolic profile of women after RYGB and LSG revealed that despite recurrent weight gain, the biochemical benefits, such as improved insulin sensitivity and lower CRP levels, were maintained compared to preoperative levels [31]. Considering the sustained weight loss and low percentage of recurrent weight gain observed after OAGB [32], it is a promising approach to improving inflammation. Consistently reducing excess body weight can significantly improve inflammatory markers, contributing to better overall health outcomes for patients undergoing this procedure. In our study, we did not find any significant correlation between age, gender, and obesity-associated medical problems such as dyslipidemia, hypertension, diabetes status, ischemic heart disease, obstructive sleep apnea, and changes in hs-CRP levels following OAGB. Moreover, no significant correlation was found between weight loss outcomes (e.g., preoperative BMI, weight loss, BMI loss, %TWL, %EWL) and changes in hs-CRP. Although there are some discrepancies in the literature on the relationship between weight loss and reduction of hs-CRP and CRP after different bariatric surgery methods other than OAGB [29], our findings align with previous studies showing no significant correlation between weight outcomes and reductions in hs-CRP or CRP after OAGB surgery [22,24]. Furthermore, a recent meta-analysis found no relationship between baseline BMI and changes in CRP levels after MBS. It proposed that alternative mechanisms might contribute to this reduction, such as lower caloric intake, reduced nutrient absorption, or a decreased need for the liver to detoxify ingested substances [33]. Our study highlighted substantial weight loss and reduction in BMI among participants over six months, with a median %TWL of 29% and a median %EWL of 68.2%. The significant weight loss and reduction in BMI achieved through OAGB underscore its efficacy as a metabolic and bariatric procedure. The lack of a linear relationship between baseline BMI and hs-CRP reduction suggests that OAGB can benefit a broad range of patients, regardless of initial BMI. OAGB has shown similar efficacy to RYGB in terms of weight loss and remission of obesity-related medical problems [34], with advantages including shorter operative time, fewer early postoperative complications, and a more straightforward surgical learning curve [35]. Finally, a significant correlation was observed between preoperative hs-CRP levels and hs-CRP reduction following OAGB. Considering the significant correlation between elevated CRP and hs-CRP levels and the risk of coronary artery disease, ischemic stroke, and cardiovascular mortality [36,37], this finding indicates that patients with higher hs-CRP levels stand to benefit more from OAGB. These results underscore the importance of OAGB as a valuable intervention for mitigating obesity-related systemic inflammation and reducing cardiovascular risk. Clinical trials are needed to elucidate if high hs-CRP could be an additional indication for MBS. Moreover, the effect of different MBS surgeries on hs-CRP should be compared to identify which procedures provide the most significant and sustained reduction in inflammatory markers. This comparative analysis could help tailor surgical interventions to individual patient profiles, optimizing outcomes and improving cardiovascular health in patients undergoing MBS. Strengths and Limitations This study boasts several strengths, including its prospective cohort design and the comprehensive six-month follow-up, which provides robust data on the short- to mid-term effects of OAGB on both hs-CRP levels and weight loss outcomes. Standardized surgical and post-operative care protocols ensure consistency, reducing potential biases and variability. Despite its strengths, the study has notable limitations. The six-month follow-up period, while valuable, does not capture the long-term sustainability of hs-CRP reduction and weight loss. The lack of a control group limits the ability to directly compare OAGB outcomes with other interventions. Additionally, while efforts were made to standardize protocols and control variables, other unmeasured confounding factors could influence the observed outcomes. Future Directions Future research should prioritize extending the follow-up period and comparing different types of MBS to delineate the specific advantages and potential drawbacks of OAGB. Moreover, examining differences within the cohort, particularly between patients who achieve significant weight loss and those who experience insufficient weight loss or recurrent weight gain, will provide valuable insights. Finally, Future research should focus on evaluating the broader implications of inflammatory markers reduction on overall health, CVD risk, and quality of life in the long term. Conclusion In conclusion, the study demonstrates a significant decrease in hs-CRP levels six months after OAGB. The only predictor of the hs-CRP reduction was the pre-operative hs-CRP levels. Pre-operative BMI and weight loss outcomes did not significantly correlate with hs-CRP reduction. The findings highlight the potential role of OAGB in resolving the obesity-derived inflammatory state in individuals with obesity. Declarations Conflict of Interest The authors declare no conflicts of interest related to this manuscript. Ethical Approval The Ethics Committee of ***** has registered and approved the study (*****) Funding Statement No financial support was received from any resource for this project. Author Contribution N.M., A.J., H,M, and P.K. wrote the main manuscript text.A.J. did the statistical analysis of the data.A.J., H.M., and P.K. prepared the tables and figures of the manuscript.N.M., F.H., M.MA., T.T., E.F., and M.M. cooperated in collecting the data including extracting the query from INOSD and following up the individuals in the period of the study.A.H., M.K., and F.E. supervised the project and revised and prepared the final edition of the manuscript. Data Availability Data that support the findings of this study is available from the corresponding author upon reasonable request. References Preda A, Carbone F, Tirandi A, Montecucco F, Liberale L. Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management. Rev Endocr Metab Disord. 2023;24:901–19. Kachur S, Lavie CJ, De Schutter A, Milani RV, Ventura HO. Obesity and cardiovascular diseases. Minerva Med [Internet]. 2017 [cited 2024 Jun 5];108. 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C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. The Lancet. 2010;375:132–40. Wang A, Liu J, Li C, Gao J, Li X, Chen S, et al. Cumulative Exposure to High‐Sensitivity C‐Reactive Protein Predicts the Risk of Cardiovascular Disease. J Am Heart Assoc. 2017;6:e005610. Tables Table 1-Baseline characteristics and obesity-associated medical problems of the participants Characteristics Value Age (years) - Median (IQR) 41 (14) Female- n (%) 62 (87.4%) Pre-operative weight (kg) - Median (IQR) 117.5 (25.6) Pre-operative BMI (kg/m 2 ) - Median (IQR) 43.43 (7.17) Dyslipidemia - n (%) 12 (16.9%) Hypertension - n (%) 15 (21.1%) T2DM - n (%) 5 (7.1%) IGT - n (%) 5 (7.1%) Ischemic heart disease - n (%) 2 (2.8%) Obstructive sleep apnea - n (%) 5 (7.1%) BMI, Body Mass Index; IQR, Interquartile Range; T2DM, Type 2 Diabetes Mellitus; IGT, Impaired Glucose Tolerance. Table 2-Friedman test to evaluate the pattern of alterations in serum hs-CRP Timepoint Median (IQR) - mg/L Mean Rank p-value Pre-operative 8.5 (11.6) 2.48 Post-operative, day 1 19 (15.4) 3.97 Post-operative, day 5 18.5 (17) 3.96 Post-operative, month 1 13.4 (7.6) 2.68 Post-operative month 6 3.5 (10.4) 1.91 < 0.001* * Statistically significant Table 3 - Weight loss outcomes in 6 months Weight loss outcome Six months - Median (IQR) Weight loss - kg 33 (11) BMI loss - kg/m 2 12.7 (3.2) %TWL 29 (6.5) %EWL 68.2 (21.2) BMI, Body Mass Index; %TWL, Total Weight Loss; %EWL, Excess Weight Loss. Table 4 - Friedman test to evaluate the pattern of alterations in weight and BMI Timepoint Median (IQR) Mean Rank p-value Weight - kg Pre-operative 117.5 (25.6) 2.97 Post-operative, month 1 103.3 (24.3) 2 Post-operative, month 6 83 (17.8) 1.03 <0.001* BMI - kg/m 2 Pre-operative 43.4 (7.1) 2.97 Post-operative, month 1 39.1 (6.7) 2 Post-operative, month 6 31.2 (5.5) 1.03 <0.001* * Statistically significant BMI, Body Mass Index. Table 5 - Mann-Whitney U and Kruskal-Wallis test to investigate the effect of gender and obesity-related medical problems on serum hs-CRP level reduction in 6 months Groups Mean Rank Z score* H score† p-value Gender Male (n=9) 38.3 Female (n=62) 35.6 -0.36 - 0.717 Dyslipidemia Yes (n=12) 34.9 No (n= 59) 36.2 -0.19 - 0.848 Hypertension Yes (n=15) 43.6 No (n=56) 33.9 -1.59 - 0.110 Diabetes status T2DM (n=5) 32.8 IGT (n=5) 42.1 No DM (n=61) 35.8 - 0.56 0.754 Ischemic heart disease Yes (n=2) 30.5 No (n=69) 36.2 -0.38 - 0.702 Obstructive sleep apnea Yes (n=5) 28.3 No(n=66) 36.6 -0.86 - 0.387 *Mann-Whiteny U Z score †Kruskal-Wallis H score T2DM: Type 2 Diabetes Mellitus; IGT: Impaired Glucose Intolerance. Table 6 - Kendall’s correlation test to evaluate the correlation of continuous variables with serum hs-CRP reduction in 6 months Variable Correlation Coefficient P-value Age 0.006 0.941 Pre-operative BMI 0.086 0.290 Weight loss 0.056 0.493 BMI Loss 0.099 0.220 %TWL 0.069 0.393 %EWL -0.036 0.659 Serum hs-CRP level Pre-operative 0.495 < 0.001* Post-operative, day 1 -0.023 0.777 Post-operative, day 5 0.023 0.777 Post-operative, month 1 -0.109 0.182 * Statistically significant BMI, Body Mass Index; %TWL, Total Weight Loss; %EWL, Excess Weight Loss. Table 7- Final model from the univariate linear regression analysis, predicting serum CRP reduction in 6 months Predictor β SE p-value Pre-operative serum hs-CRP (Adjusted R 2 =0.24) 1.06 0.22 < 0.001* * Statistically significant Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Jan, 2025 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 05 Oct, 2024 Reviews received at journal 04 Oct, 2024 Reviews received at journal 03 Oct, 2024 Reviews received at journal 29 Sep, 2024 Reviewers agreed at journal 20 Sep, 2024 Reviewers agreed at journal 19 Sep, 2024 Reviewers agreed at journal 19 Sep, 2024 Reviews received at journal 19 Sep, 2024 Reviews received at journal 18 Sep, 2024 Reviewers agreed at journal 18 Sep, 2024 Reviews received at journal 18 Sep, 2024 Reviewers agreed at journal 18 Sep, 2024 Reviewers agreed at journal 17 Sep, 2024 Reviewers invited by journal 15 Jul, 2024 Editor assigned by journal 15 Jul, 2024 Submission checks completed at journal 15 Jul, 2024 First submitted to journal 01 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Kermansaravi","suffix":""},{"id":329604906,"identity":"0b5ab81c-157d-44f3-b993-222befbfe94d","order_by":11,"name":"Foolad Eghbali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBAC9gYGxgMMbAxyIM6BB8Ro4TkAVAnUYgzWkkCKlsQGEI84LezNBw78KLNJnx92+CHQFjs53QZCWniOJRzsOZeWu/F2mgFQS7Kx2QECWuwlcgwO8LYdzt04OwGk5UDiNkJaeIBaDv5t+59uODv9A/FaDvO2HUiQl84h1hagXw7LnEs23CCdU3AgwYAIvwBD7ODDN2V28vKz0zd/+FBhJ0dQCxwYgFUaEKscBOQbSFE9CkbBKBgFIwoAAMRiSO6CfaXMAAAAAElFTkSuQmCC","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Foolad","middleName":"","lastName":"Eghbali","suffix":""}],"badges":[],"createdAt":"2024-07-01 10:38:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4667357/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4667357/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-024-07570-1","type":"published","date":"2025-01-04T15:57:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62222395,"identity":"505f20a6-f749-4867-ba74-b54840f4c90a","added_by":"auto","created_at":"2024-08-11 12:36:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":656638,"visible":true,"origin":"","legend":"\u003cp\u003eMean rank of hs-CRP levels over time\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4667357/v1/2c50bb588401e09b0b55c670.jpg"},{"id":73093316,"identity":"467a8671-c107-4e95-8ea7-c0c0fff805a6","added_by":"auto","created_at":"2025-01-06 16:13:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1226884,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4667357/v1/0b7c36ee-2891-4fc9-9214-95b9e9552eb3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of High-Sensitivity C-Reactive Protein (hs-CRP) Changes Following One Anastomosis Gastric Bypass (OAGB) in Patients with Obesity: A Prospective Cohort Study","fulltext":[{"header":"Key points","content":"\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eOAGB significantly reduced hs-CRP levels from a median of 8.5 mg/L pre-operatively to 3.5 mg/L at 6 months post-surgery, indicating a decrease in systemic inflammation.\u003c/li\u003e\n \u003cli\u003eSubstantial weight loss was achieved, with median total weight loss (%TWL) of 29% and excess weight loss (%EWL) of 68.2% over 6 months following OAGB.\u003c/li\u003e\n \u003cli\u003ePre-operative hs-CRP levels were the only significant predictor of hs-CRP reduction at 6 months post-surgery, suggesting patients with higher baseline inflammation may benefit more.\u003c/li\u003e\n \u003cli\u003eNo significant correlation was found between weight loss outcomes and hs-CRP reduction, indicating OAGB may reduce inflammation through mechanisms beyond just weight loss.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eObesity has reached epidemic proportions globally, with over one billion people classified as individuals with obesity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a significant risk factor for numerous medical problems, including cardiovascular disease (CVD), stroke, type 2 diabetes (T2DM), and cancer [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. One of the critical mechanisms thought to link obesity to its associated medical problems is chronic low-grade inflammation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Adipose tissue dysfunction in obesity leads to abnormal production of proinflammatory cytokines and reduced secretion of anti-inflammatory factors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This maintains systemic inflammation, which can initiate or exacerbate cardiometabolic disease processes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In a healthy state, anti-inflammatory molecules such as adiponectin predominate suppressing chronic inflammation. However, in obesity, hypertrophic adipocytes and infiltrating proinflammatory macrophages in adipose tissue generate increased levels of cytokines such as TNF-alpha, IL-6, and IL-1beta [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This dysregulation leads to the dominance of proinflammatory signals over anti-inflammatory signals, creating a state of chronic low-grade inflammation both locally in adipose tissue and systemically throughout the body. The chronic inflammatory response generated by dysfunctional adipose tissue is thought to be involved in the pathogenesis of insulin resistance, atherosclerosis, and other cardiometabolic complications associated with obesity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eC-reactive protein (CRP) is a circulating inflammatory marker the liver produces in response to IL-6 and other proinflammatory cytokines. In individuals with obesity, the proinflammatory state created by dysfunctional adipose tissue stimulates increased hepatic synthesis of CRP. Therefore, serum CRP levels are elevated in individuals with obesity and positively correlate with Body Mass Index (BMI) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Elevated CRP levels in obesity signify the presence of systemic inflammation driven by adipose tissue dysfunction. Moreover, prospective epidemiological studies have shown high CRP levels predict the severity of obesity-related medical problems, including liver steatosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. we specifically focused on CRP rather than IL-6 and TNF-α due to its superior reliability and sensitivity as a marker of inflammation, as supported by evidence indicating that CRP, unlike IL-6 and TNF-α, consistently reflects the reduction in systemic inflammation and correlates closely with improvements in metabolic parameters post-surgery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, CRP is a marker of obesity-related inflammation and is associated with the development of obesity complications. Interventions targeting weight loss and inflammation may help reduce circulating CRP [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor patients with severe obesity, lifestyle interventions like diet and exercise alone often fail to achieve adequate, sustained weight loss outcomes. Metabolic and Bariatric Surgery (MBS) has become an effective treatment option for weight loss and reducing obesity-related complications and CVD-associated biomarkers when non-surgical approaches are unsuccessful [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]One promising technique is the One-Anastomosis Gastric Bypass (OAGB). Procedures like OAGB may work partly by resolving the chronic inflammatory state associated with obesity. However, only a limited number of studies have examined this issue. Therefore, this prospective cohort study aims to assess the effects of OAGB surgery on high-sensitivity C-Reactive Protein (hs-CRP) levels over six months of follow-up. Demonstrating sustained reduction in CRP could help explain the cardiometabolic benefits observed after MBS and support the role of decreasing chronic inflammation in alleviating obesity-related complications.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eThe study was designed as a prospective cohort, following patients throughout six months post-OAGB to assess changes in hs-CRP levels. This study has received approval from the Ethics Committee of the *****. Informed consent was obtained from all participants before enrollment, and the study was conducted according to ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eAccording to the study of Pakiet et al. considering an estimated effect size of 30% for the reduction in CRP levels before and after OAGB, with a margin of error of 5%, 80% power, and a confidence interval (CI) of 95%, and accounting for a 5% dropout rate, the sample size was estimated to be 60 patients\u0026nbsp;[16].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants were recruited from the ***\u0026nbsp;[17].\u0026nbsp;The inclusion criteria were adult patients over 18 years old with a BMI \u0026ge;35 kg/m\u003csup\u003e2\u003c/sup\u003e with or without obesity-associated medical problems, who had not achieved the desired weight loss through lifestyle changes and medical treatment, and who were scheduled for OAGB. Patients were excluded if they had previous MBS, known systematic inflammatory diseases such as autoimmune conditions, active viral or bacterial infections, pregnancy, or taking medications known to affect inflammatory status, such as systemic steroids. Finally, 71 patients were included from September 2022 to September 2023. No patients were lost to follow-up.\u003c/p\u003e\n\u003ch2\u003eStudy Setting\u003c/h2\u003e\n\u003cp\u003eBoard-certified bariatric surgeons performed all OAGB surgeries at the bariatric surgery center of *****, a high-volume bariatric surgery center with a dedicated multidisciplinary team aligned with the International Federation for the Surgery of Obesity (IFSO) guidelines for metabolic and bariatric surgery\u0026nbsp;[18]. The team includes bariatric physicians, nutritionists, psychiatrists, and nurses who specialize in caring for MBS patients. Standardized surgical protocols were utilized for all participants.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eSurgical Technique\u003c/h2\u003e\n\u003cp\u003eOAGB involved creating a 60 -75 cc gastric pouch and 150 -200 cm limb lengths. The anastomosis was made using a 45 mm linear cutter stapler, maintaining a 2 -3 cm diameter. The anastomotic orifices were sutured with 2/0 PDS. \u0026nbsp;All participants underwent the OAGB performed by one surgical team using the mentioned technique. Additional details of the surgical technique were described in our previous publications\u0026nbsp;[19].\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData Collection\u003c/h2\u003e\n\u003cp\u003eHs-CRP levels in serum were quantified using commercially available high-sensitivity ELISA kits (IBL International, Catalog #EU59151) at designated time points before, one day, five days, 30 days, and six months after OAGB.\u003c/p\u003e\n\u003cp\u003eBlood samples were collected the day before surgery to establish baseline hs-CRP levels. Trained staff followed standard phlebotomy techniques to obtain blood samples immediately processed for serum isolation via centrifugation. Follow-up blood samples were obtained at the mentioned timeline post-surgery and processed using the same standardized protocols. Serum hs-CRP testing was performed in batches using the ELISA kits according to the manufacturer\u0026apos;s instructions.\u003c/p\u003e\n\u003cp\u003eIn addition to hs-CRP testing, demographic information, including age, gender, and body mass index, was extracted from *****. BMI values were also retrieved from the ***** at the follow-up intervals. The same standardized procedures for data collection were followed for all study participants.\u003c/p\u003e\n\u003ch2\u003eData Analysis\u003c/h2\u003e\n\u003cp\u003eAll statistical analyses were conducted using SPSS Statistics software version 27 (IBM Corp; NY, USA). Continuous variables were presented as mean and standard deviation (SD) for normally distributed and median and Interquartile Range (IQR) for non-normally distributed variables. Categorical variables were presented as numbers and percentages. We first assessed the normality of all the constant data using Smirnov-Kolmogorov test. \u0026nbsp;Serum hs-CRP was measured before and after surgery at the designated time points for the primary outcome. Then, we assessed the alternation of serum hs-CRP levels using the Friedman test. The impact of various categorical and continuous variables on post-operative hs-CRP reduction in 6 months was also assessed using a Mann-Whitney U and Kendall\u0026rsquo;s correlation test, respectively. Finally, using a linear regression model, we predicted hs-CRP reduction in the six months.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eParticipant Characteristics\u003c/h2\u003e\n\u003cp\u003eWe recruited 71 participants for the study. All the participants were successful in completing the follow-up. The median (IQR) age of the participants was 41 (14) years. A total of 62 participants were female, and 9 participants were male. The participants\u0026apos; median (IQR) pre-operative weight and BMI were 117.5 kg (25.6) and 43.43 (7.17) kg/m\u003csup\u003e2\u003c/sup\u003e, respectively. The characteristics of the participants are detailed in\u0026nbsp;Table 1.\u003c/p\u003e\n\u003ch2\u003ePrimary outcome: hs-CRP\u003c/h2\u003e\n\u003cp\u003eSerum hs-CRP levels were measured with highly sensitive ELISA kits at the designated time points. (pre-operative, one day, five days, 30 days, and six months after OAGB). The median serum hs-CRP level was 8.5 mg/L before OAGB, initially increased at days one and five after OAGB, then decreased over the six months and reached\u0026nbsp;below the baseline level. The median serum CRP level 6 months after the surgery was 3.50 mg/L.\u0026nbsp;Figure 1\u0026nbsp;and\u0026nbsp;Table 2\u0026nbsp;demonstrate the pattern of alterations in serum hs-CRP levels before and following OAGB.\u003c/p\u003e\n\u003ch3\u003eFigure 1\u0026nbsp;- Mean rank of hs-CRP levels over time\u003c/h3\u003e\n\u003cp\u003eBased on the Friedman test, the mean serum hs-CRP levels differed significantly between the examined time points (\u0026Chi;\u0026sup2;= 97.99; p \u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eWeight Loss outcomes\u003c/h2\u003e\n\u003cp\u003eThe weight and BMI of the participants were investigated in the 1\u003csup\u003est\u003c/sup\u003e month and the 6\u003csup\u003eth\u003c/sup\u003e month. A significant decrease in weight (\u0026chi;\u0026sup2; = 134.11, p \u0026lt; 0.001) and BMI (\u0026chi;\u0026sup2; = 134.11, p \u0026lt; 0.001) was observed after six months. The median (IQR) of Total Weight Loss (%TWL) and Excess Weight Loss (%EWL) were 29% (6.5) and 68.2% (21.2), respectively. The weight loss outcomes of the participants are outlined in\u0026nbsp;Table 3\u0026nbsp;and\u0026nbsp;Table 4.\u003c/p\u003e\n\u003ch2\u003eChanges in hs-CRP\u003c/h2\u003e\n\u003cp\u003eThe median (IQR) reduction in hs-CRP levels was 2.9 (13.9) mg/L over the six months. We considered the changes in hs-CRP to be the primary dependent variable. Therefore, the effects of various factors, including age, gender, obesity-associated medical problems, weight loss outcomes, and preoperative indices such as BMI, on the extent of CRP reduction over the six months have been measured using statistical analysis methods. In this regard, the impact of the mentioned factors on the 6-month changes in CRP is detailed and observable in\u0026nbsp;Table 5\u0026nbsp;and\u0026nbsp;Table 6 .\u003c/p\u003e\n\u003cp\u003eAs mentioned in Table 6, the only variable capable of predicting hs-CRP reduction in six months was the pre-operative serum hs-CRP level (Correlation Coefficient= 0.495, p\u0026lt;0.001).\u0026nbsp;Table 7\u0026nbsp;represents the results of a univariate linear regression model, predicting serum CRP reduction in the six months by the pre-operative serum hs-CRP (adjusted R\u003csup\u003e2\u003c/sup\u003e=0.24; p\u0026lt;0.01).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this prospective cohort study, we aimed to assess the changes in hs-CRP levels following OAGB in patients with obesity. Our findings demonstrated a significant reduction in hs-CRP levels from the pre-operative baseline to six months post-surgery. Initially, there was an expected increase in hs-CRP levels immediately post-surgery, likely due to the acute inflammatory response to the surgical intervention. However, this was followed by a significant decrease over the subsequent one and six-month follow-ups, indicating a significant decrease in systemic inflammation. A recent meta-analysis found a significant reduction in several inflammatory markers, including CRP and hs-CRP, after MBS\u0026nbsp;[20]. Although the meta-analysis did not include a subgroup analysis specifically for OAGB regarding CRP changes, previous studies have reported outcomes consistent with our findings, indicating OAGB, like other MBS, can significantly decrease CRP levels and improve metabolic health in patients with obesity\u0026nbsp;[21\u0026ndash;24].\u003c/p\u003e\n\u003cp\u003eThe significant reduction in hs-CRP levels in the present study aligns with the understanding that weight loss and improved metabolic profiles post-MBS can alleviate systemic inflammation. MBS has been shown to reduce adipose tissue mass, decrease macrophage infiltration, lower the secretion of pro-inflammatory cytokines, and significantly impact comorbidities associated with chronic inflammation\u0026nbsp;[25]. Conditions such as T2DM, CVD, and metabolic syndrome, which are often exacerbated by inflammatory processes, tend to improve following MBS\u0026nbsp;[25\u0026ndash;27]. Furthermore, reducing inflammatory cytokines following MBS is associated with a lower risk of asthma, Alzheimer\u0026rsquo;s disease, and certain cancers\u0026nbsp;[28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough this study aimed to evaluate the short- and mid-term effects of OAGB on hs-CRP levels, several studies have reported sustained long-term improvements in inflammatory markers following MBS. A retrospective cohort study of 163 patients who underwent Roux-en-Y Gastric Bypass (RYGB) or Laparoscopic Sleeve Gastrectomy (LSG) over four years reported significant declines in CRP and hs-CRP levels, correlating with weight loss and T2DM remission. Inflammatory markers followed a U-shaped curve, with the lowest levels at two years post-MBS and a slight, non-significant increase at four years, normalizing in 84% of patients\u0026nbsp;[29]. Another study of 1,180 patients post-RYGB found CRP levels dropped from 1.01 mg/L pre-surgery to 0.18 mg/L at two years, with a slight increase at seven years but remaining below pre-surgery levels. Only 3.2% had elevated CRP at seven years, compared to 32.9% pre-surgery. Factors such as higher pre-surgery CRP, BMI, smoking, and diabetes were linked to less favorable CRP trajectories, indicating the need for ongoing monitoring in these subgroups\u0026nbsp;[30].\u003c/p\u003e\n\u003cp\u003eAlthough MBS significantly decreases CRP levels, concerns exist regarding the potential resurgence of inflammatory markers following recurrent weight gain, a common occurrence after MBS. Nevertheless, studies indicate that the anti-inflammatory benefits of MBS, including reduced CRP levels, persist even after recurrent weight gain. Specifically, a study on the metabolic profile of women after RYGB and LSG revealed that despite recurrent weight gain, the biochemical benefits, such as improved insulin sensitivity and lower CRP levels, were maintained compared to preoperative levels\u0026nbsp;[31]. Considering the sustained weight loss and low percentage of recurrent weight gain observed after OAGB\u0026nbsp;[32], it is a promising approach to improving inflammation. Consistently reducing excess body weight can significantly improve inflammatory markers, contributing to better overall health outcomes for patients undergoing this procedure.\u003c/p\u003e\n\u003cp\u003eIn our study, we did not find any significant correlation between age, gender, and obesity-associated medical problems such as dyslipidemia, hypertension, diabetes status, ischemic heart disease, obstructive sleep apnea, and changes in hs-CRP levels following OAGB. Moreover, no significant correlation was found between weight loss outcomes (e.g., preoperative BMI, weight loss, BMI loss, %TWL, %EWL) and changes in hs-CRP. Although there are some discrepancies in the literature on the relationship between weight loss and reduction of hs-CRP and CRP after different bariatric surgery methods other than OAGB\u0026nbsp;[29], our findings align with previous studies showing no significant correlation between weight outcomes and reductions in hs-CRP or CRP after OAGB surgery\u0026nbsp;[22,24]. Furthermore, a recent meta-analysis found no relationship between baseline BMI and changes in CRP levels after MBS. It proposed that alternative mechanisms might contribute to this reduction, such as lower caloric intake, reduced nutrient absorption, or a decreased need for the liver to detoxify ingested substances\u0026nbsp;[33].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study highlighted substantial weight loss and reduction in BMI among participants over six months, with a median %TWL of 29% and a median %EWL of 68.2%. The significant weight loss and reduction in BMI achieved through OAGB underscore its efficacy as a metabolic and bariatric procedure. The lack of a linear relationship between baseline BMI and hs-CRP reduction suggests that OAGB can benefit a broad range of patients, regardless of initial BMI. OAGB has shown similar efficacy to RYGB in terms of weight loss and remission of obesity-related medical problems\u0026nbsp;[34], with advantages including shorter operative time, fewer early postoperative complications, and a more straightforward surgical learning curve\u0026nbsp;[35].\u003c/p\u003e\n\u003cp\u003eFinally, a significant correlation was observed between preoperative hs-CRP levels and hs-CRP reduction following OAGB. Considering the significant correlation between elevated CRP and hs-CRP levels and the risk of coronary artery disease, ischemic stroke, and cardiovascular mortality\u0026nbsp;[36,37], this finding indicates that patients with higher hs-CRP levels stand to benefit more from OAGB. These results underscore the importance of OAGB as a valuable intervention for mitigating obesity-related systemic inflammation and reducing cardiovascular risk. Clinical trials are needed to elucidate if high hs-CRP could be an additional indication for MBS. Moreover, the effect of different MBS surgeries on hs-CRP should be compared to identify which procedures provide the most significant and sustained reduction in inflammatory markers. This comparative analysis could help tailor surgical interventions to individual patient profiles, optimizing outcomes and improving cardiovascular health in patients undergoing MBS.\u003c/p\u003e\n\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\n\u003cp\u003eThis study boasts several strengths, including its prospective cohort design and the comprehensive six-month follow-up, which provides robust data on the short- to mid-term effects of OAGB on both hs-CRP levels and weight loss outcomes. Standardized surgical and post-operative care protocols ensure consistency, reducing potential biases and variability. \u0026nbsp;Despite its strengths, the study has notable limitations. The six-month follow-up period, while valuable, does not capture the long-term sustainability of hs-CRP reduction and weight loss. The lack of a control group limits the ability to directly compare OAGB outcomes with other interventions. Additionally, while efforts were made to standardize protocols and control variables, other unmeasured confounding factors could influence the observed outcomes.\u003c/p\u003e\n\u003ch2\u003eFuture Directions\u003c/h2\u003e\n\u003cp\u003eFuture research should prioritize extending the follow-up period and comparing different types of MBS to delineate the specific advantages and potential drawbacks of OAGB. Moreover, examining differences within the cohort, particularly between patients who achieve significant weight loss and those who experience insufficient weight loss or recurrent weight gain, will provide valuable insights. Finally, Future research should focus on evaluating the broader implications of inflammatory markers reduction on overall health, CVD risk, and quality of life in the long term.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the study demonstrates a significant decrease in hs-CRP levels six months after OAGB. The only predictor of the hs-CRP reduction was the pre-operative hs-CRP levels. Pre-operative BMI and weight loss outcomes did not significantly correlate with hs-CRP reduction. The findings highlight the potential role of OAGB in resolving the obesity-derived inflammatory state in individuals with obesity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this manuscript.\u003c/p\u003e\n\u003ch2\u003eEthical Approval\u003c/h2\u003e\n\u003cp\u003eThe Ethics Committee of ***** has registered and approved the study (*****)\u003c/p\u003e\n\u003ch2\u003eFunding Statement\u003c/h2\u003e\n\u003cp\u003eNo financial support was received from any resource for this project.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eN.M., A.J., H,M, and P.K. wrote the main manuscript text.A.J. did the statistical analysis of the data.A.J., H.M., and P.K. prepared the tables and figures of the manuscript.N.M., F.H., M.MA., T.T., E.F., and M.M. cooperated in collecting the data including extracting the query from INOSD and following up the individuals in the period of the study.A.H., M.K., and F.E. supervised the project and revised and prepared the final edition of the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eData that support the findings of this study is available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePreda A, Carbone F, Tirandi A, Montecucco F, Liberale L. 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Obes Surg. 2008;18:84\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eZhang C, Zhang J, Liu Z, Zhou Z. More than an Anti-diabetic Bariatric Surgery, Metabolic Surgery Alleviates Systemic and Local Inflammation in Obesity. Obes Surg. 2018;28:3658\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eXu G, Song M. Recent advances in the mechanisms underlying the beneficial effects of bariatric and metabolic surgery. Surg Obes Relat Dis. 2021;17:231\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eVan Veldhuisen SL, Gorter TM, Van Woerden G, De Boer RA, Rienstra M, Hazebroek EJ, et al. Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J. 2022;43:1955\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eBiobaku F, Ghanim H, Monte SV, Caruana JA, Dandona P. Bariatric Surgery: Remission of Inflammation, Cardiometabolic Benefits, and Common Adverse Effects. J Endocr Soc. 2020;4:bvaa049. \u003c/li\u003e\n\u003cli\u003eLautenbach A, Stoll F, Mann O, Busch P, Huber TB, Kielstein H, et al. Long-Term Improvement of Chronic Low-Grade Inflammation After Bariatric Surgery. Obes Surg. 2021;31:2913\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eHinerman AS, Barinas-Mitchell EJM, El Khoudary SR, Courcoulas AP, Wahed AS, King WC. Change in C-reactive protein after Roux-en-Y gastric bypass through 7 years of follow-up. Surg Obes Relat Dis. 2022;18:902\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eSantos AL, Silva SAD, Cavalcante-E-Silva LM, Le\u0026atilde;o LHDA, Coutinho LR, Oliveira FDSC, et al. WEIGHT REGAIN AND THE METABOLIC PROFILE OF WOMEN IN THE POSTOPERATIVE PERIOD OF BARIATRIC SURGERY: A MULTIVARIATE ANALYSIS. ABCD Arq Bras Cir Dig S\u0026atilde;o Paulo. 2023;36:e1755. \u003c/li\u003e\n\u003cli\u003ePlamper A, Lingohr P, Nadal J, Trebicka J, Brol MJ, Woestemeier A, et al. A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy. J Gastrointest Surg. 2023;27:47\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eAskarpour M, Khani D, Sheikhi A, Ghaedi E, Alizadeh S. Effect of Bariatric Surgery on Serum Inflammatory Factors of Obese Patients: a Systematic Review and Meta-Analysis. Obes Surg. 2019;29:2631\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eRobert M, Poghosyan T, Maucort-Boulch D, Filippello A, Caiazzo R, Sterkers A, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study. Lancet Diabetes Endocrinol. 2024;12:267\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eLi X, Hu X, Fu C, Han L, Xie M, Ouyang S. Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Meta-analysis and Systematic Review. Obes Surg. 2023;33:611\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eKaptoge S. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. The Lancet. 2010;375:132\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eWang A, Liu J, Li C, Gao J, Li X, Chen S, et al. Cumulative Exposure to High‐Sensitivity C‐Reactive Protein Predicts the Risk of Cardiovascular Disease. J Am Heart Assoc. 2017;6:e005610. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ch3\u003eTable 1-Baseline characteristics and obesity-associated medical problems of the participants\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years) - Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e41 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eFemale- n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e62 (87.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative weight (kg) - Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e117.5 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative BMI (kg/m\u003csup\u003e2\u003c/sup\u003e) - Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e43.43 (7.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eDyslipidemia - n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e12 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension - n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e15 (21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eT2DM - n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e5 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eIGT - n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e5 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eIschemic heart disease - n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e2 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eObstructive sleep apnea - n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e5 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, Body Mass Index; IQR, Interquartile Range; T2DM, Type 2 Diabetes Mellitus; IGT, Impaired Glucose Tolerance.\u003c/p\u003e\n\u003ch3\u003eTable 2-Friedman test to evaluate the pattern of alterations in serum hs-CRP\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTimepoint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR) - mg/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Rank\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e8.5 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, day 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e19 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, day 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e18.5 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, month 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e13.4 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.807692307692307%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative month 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.5 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.153846153846153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Statistically significant\u003c/p\u003e\n\u003ch3\u003eTable 3\u0026nbsp;- Weight loss outcomes in 6 months\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight loss outcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSix months - Median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eWeight loss - kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e33 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eBMI loss - kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e12.7 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e%TWL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e29 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e%EWL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e68.2 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, Body Mass Index; %TWL, Total Weight Loss; %EWL, Excess Weight Loss.\u003c/p\u003e\n\u003ch3\u003eTable 4\u0026nbsp;- Friedman test to evaluate the pattern of alterations in weight and BMI\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTimepoint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Rank\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight - kg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e117.5 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, month 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e103.3 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, month 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e83 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI - kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e43.4 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, month 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e39.1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.70786516853933%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, month 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.077046548956663%\" valign=\"top\"\u003e\n \u003cp\u003e31.2 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" valign=\"top\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.064205457463885%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Statistically significant\u003c/p\u003e\n\u003cp\u003eBMI, Body Mass Index.\u003c/p\u003e\n\u003ch3\u003eTable 5\u0026nbsp;- Mann-Whitney U and Kruskal-Wallis test to investigate the effect of gender and obesity-related medical problems on serum hs-CRP level reduction in 6 months\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Rank\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ score*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eH score\u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eMale (n=9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eFemale (n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e-0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyslipidemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n=12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eNo (n= 59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e-0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e0.848\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n=15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eNo (n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e-1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eT2DM (n=5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eIGT (n=5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eNo DM (n=61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIschemic heart disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n=2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eNo (n=69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e-0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstructive sleep apnea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eYes (n=5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.01605136436597%\" valign=\"top\"\u003e\n \u003cp\u003eNo(n=66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.80577849117175%\" valign=\"top\"\u003e\n \u003cp\u003e36.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.248796147672552%\" valign=\"top\"\u003e\n \u003cp\u003e-0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.409309791332264%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Mann-Whiteny U Z score\u003c/p\u003e\n\u003cp\u003e\u0026dagger;Kruskal-Wallis H score\u003c/p\u003e\n\u003cp\u003eT2DM: Type 2 Diabetes Mellitus; IGT: Impaired Glucose Intolerance.\u003c/p\u003e\n\u003ch3\u003eTable 6\u0026nbsp;- Kendall\u0026rsquo;s correlation test to evaluate the correlation of continuous variables with serum hs-CRP reduction in 6 months\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative BMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eBMI Loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e%TWL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e%EWL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eSerum hs-CRP level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, day 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, day 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative, month 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e-0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Statistically significant\u003c/p\u003e\n\u003cp\u003eBMI, Body Mass Index; %TWL, Total Weight Loss; %EWL, Excess Weight Loss.\u003c/p\u003e\n\u003ch3\u003eTable 7- Final model from the univariate linear regression analysis, predicting serum CRP reduction in 6 months\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.432973805855163%\" valign=\"top\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.49306625577812%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03697996918336%\" valign=\"top\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03697996918336%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.432973805855163%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative serum hs-CRP\u003c/p\u003e\n \u003cp\u003e(Adjusted R\u003csup\u003e2\u003c/sup\u003e=0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.49306625577812%\" valign=\"top\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03697996918336%\" valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03697996918336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Statistically significant\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"One Anastomosis gastric bypass, C-reactive protein, high-sensitive C-reactive protein, inflammation, obesity","lastPublishedDoi":"10.21203/rs.3.rs-4667357/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4667357/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eObesity, characterized by excessive adipose tissue, is associated with chronic low-grade inflammation and elevated inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP). This inflammation is linked to obesity-associated medical problems, including cardiovascular diseases. One Anastomosis Gastric Bypass (OAGB) has emerged as an effective metabolic and bariatric surgical procedure to address severe obesity and its associated inflammatory state. This study aims to evaluate the changes in hs-CRP levels following OAGB in patients with obesity.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this prospective cohort study, 71 participants with BMI\u0026thinsp;\u0026gt;\u0026thinsp;35 kg/m\u0026sup2;, with or without obesity-associated medical problems, underwent OAGB. The hs-CRP levels were measured at baseline, one day, five days, thirty days, and six months post-surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe median baseline hs-CRP level was 8.5 mg/L, initially increasing post-surgery to 19 mg/L, but significantly decreased to 3.5 mg/L at six months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Significant reductions in weight and BMI were also observed, with median total weight loss (%TWL) of 29% and excess weight loss (%EWL) of 68.2% over six months. Pre-operative hs-CRP levels were the only significant predictor of CRP reduction post-surgery.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOAGB significantly reduces systemic inflammation by decreasing hs-CRP levels, alongside substantial weight loss. These findings support OAGB as a beneficial intervention for mitigating inflammation and improving metabolic conditions in patients with obesity. Further long-term studies are warranted to evaluate the sustained impact of OAGB on inflammatory markers and obesity-associated medical problems.\u003c/p\u003e","manuscriptTitle":"Assessment of High-Sensitivity C-Reactive Protein (hs-CRP) Changes Following One Anastomosis Gastric Bypass (OAGB) in Patients with Obesity: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-11 12:36:52","doi":"10.21203/rs.3.rs-4667357/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-05T13:56:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-04T10:54:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-03T18:21:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-29T12:55:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101172479498117043942001933572725547611","date":"2024-09-20T10:46:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55472711500202029945611484536650831141","date":"2024-09-20T03:59:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182624083147034003242631071139719785666","date":"2024-09-19T08:25:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-19T07:26:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-18T19:26:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264356791348338362581600376029000075442","date":"2024-09-18T19:15:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-18T11:40:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288767087422390357440565141426254439377","date":"2024-09-18T11:05:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42857756175817383568320321622357422243","date":"2024-09-17T07:47:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-15T22:28:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-15T18:01:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-15T07:49:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2024-07-01T10:37:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c44361e8-4ada-4ce1-b346-10e973af4c28","owner":[],"postedDate":"August 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T16:01:29+00:00","versionOfRecord":{"articleIdentity":"rs-4667357","link":"https://doi.org/10.1007/s11695-024-07570-1","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2025-01-04 15:57:28","publishedOnDateReadable":"January 4th, 2025"},"versionCreatedAt":"2024-08-11 12:36:52","video":"","vorDoi":"10.1007/s11695-024-07570-1","vorDoiUrl":"https://doi.org/10.1007/s11695-024-07570-1","workflowStages":[]},"version":"v1","identity":"rs-4667357","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4667357","identity":"rs-4667357","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}