Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.7)
Index Copernicus  – 161.11; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 4, July-August, p. 755–761

doi: 10.17219/acem/42414

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Effect of a 3-Week Low-Calorie Diet and Balneological Treatment on Selected Coagulation Parameters in Morbidly Obese Patients

Agnieszka Firszt-Adamczyk1,A,B,C, Barbara Ruszkowska-Ciastek1,D,E, Przemysław Adamczyk1,B,C, Robert Szafkowski2,B, Mirosława Firszt3,C, Irena Ponikowska2,E, Kristoffer Moe1,C, Iza Iwan-Ziętek4,E, Barbara Góralczyk1,B, Krzysztof Góralczyk1,C, Danuta Rość1,F

1 Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland

2 Clinic of Balneology and Physical Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland

3 Faculty of Mathematics and Computer Science, Nicolaus Copernicus University in Toruń, Poland

4 Department of Dermatology and Venerology, Pomeranian Medical University, Szczecin, Poland

Abstract

Background. The most common cause of death among people with obesity are cardiovascular complications as a result of a hypercoagulability state.
Objectives. The purpose of the study was to assess the potential of coagulation system activation depending on the tissue factor and to analyze of the influence of a 3-week low-calorie diet and balneological treatment on selected coagulation parameters in morbidly obese patients.
Material and Methods. The study included 36 patients (28 females and 8 males; mean age 46) with the value of BMI > 40 kg/m2. The study was designed in two stages: baseline and after 21-days. The evaluation of tissue factor (TF), tissue factor pathway inhibitor (TFPI), von Willebrand factor (vWF), fibrinogen, D-dimer, thrombin-antithrombin complexes (TAT), and the activity of antithrombin (AT) was performed in patients before and after the treatment. The control group consisted of 24 healthy volunteers (16 females and 8 males) at a mean age of 39 with BMI . 24.9 kg/m2.
Results. There were significantly higher levels of TF, TFPI, fibrinogen, TAT complexes and D-dimer in the study group as compared to the controls. Moreover, there were no significant changes in the parameters studied before and after the treatment. In the group of obese patients, there were significant positive correlations between the concentrations of vWF and BMI and BMI changes and a significant negative correlation between the WHR changes and TFPI concentration.
Conclusion. The study confirmed that morbidly obese patients represent a high risk of hypercoagulability state, despite no clinical evidence, which could be due to the great inhibitory potential of TFPI in suppressing the extrinsic pathway of the coagulation system. However, the lack of effect of the 3-week exposure to the LCD and balneological treatment in morbidly obese subjects indicates that substantial fat mass must be reduced before adequate hemostasis is re-established.

Key words

morbid obesity, low-calorie diet, balneotherapy, tissue factor, tissue factor pathway inhibitor

References (25)

  1. World Health Organization (2000) Obesity: Preventing and managing the global epidemic. WHO Obesity Technical report series 894]. 2000. World Health Organization, Geneva, Switzerland.
  2. Lanthier N, Leclercq IA: Adipose tissues as endocrine target organs: Best Pract Res Clin Gastroenterol 2014, 28, 545–558.
  3. Bays HE, Gonzalez-Campoy JM, Bray GA, Kitabchi AE, Bergman DA, Schorr AB, Rodbard HW, Henry RR: Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity. Expert Rev Cardiovasc Ther 2008, 6, 343–368.
  4. Switzer N, Mangat H, Karmali S: Current trends in obesity: Body composition assessment, weight regulation, and emerging techniques in managing severe obesity. J Interv Gastroenterol 2013, 3, 34–36.
  5. Adamczyk P, Szafkowski R, Rość D, Ponikowska I, Chojnowski J, Firszt-Adamczyk A: Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type-1 (PAI-1) in morbid obesity. Med Biol Sci 2007, 21, 31–36.
  6. Świątkowska-Stodulska R, Kazimierska E, Sworczak K, Częstochowska E: Hemostatic disturbances in obesity. Wiad Lek 2007, 60, 185–188.
  7. Chu AJ: Tissue factor, blood coagulation, and beyond: An overview. Int J Inflam 2011, 2011, 367284.
  8. Kopp CW, Kopp HP, Steiner S, Kriwanek S, Krzyżanowska K, Bartok A, Roka R, Minar E, Schernthaner G: Weight loss reduces tissue factor in morbidly obese patients. Obes Res 2003, 11, 950–956.
  9. Vazquez LA, Pazos F, Berrazueta JR, Fernandez-Escalante C, Garcia-Unzueta MT, Freijanes J, Amado JA: Effects of changes in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery. J Clin Endocrinol Metab 2005, 90, 316–322.
  10. Ay L, Kopp HP, Brix JM, Ay C, Quehenberger P, Schernthaner GH, Pabinger I, Schernthaner G: Thrombin generation in morbid obesity: Significant reduction after weight loss. J Thromb Haemost 2010, 8, 759–765.
  11. Darvall KAL, Sam RC, Silverman SH, Bradbury AW, Adam DJ: Obesity and thrombosis. Eur J Vasc Endovasc Surg 2007, 33, 223.233.
  12. El-Hagracy RS, Kamal GM, Sabry IM, Saad AA, Abou El Ezz NF, Nasr HA: Tissue factor, tissue factor pathway inhibitor and factor VII activity in cardiovascular complicated type 2 diabetes mellitus. Oman Med J 2010, 25, 173.178.
  13. Kern PA, Ranganathan S, Wood L, Ranganathan G: Adipose tissue tumor necrosis factor and interleukin6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab 2001, 280, 745.751.
  14. Goyal R, Faizy AF, Siddiqui SS, Singhai M: Evaluation of TNF-ƒż and IL-6 levels in obese and non-obese diabetics: Preand postinsulin effects. N Am J Med Sci 2012, 4, 180.184.
  15. Kotschy M, Kotschy D. Witkiewicz W: The role of tissue factor and tissue factor pathway inhibitor in blood coagulation and in thrombotic complications. Kardiol Pol 2010, 68, 1158.1162.
  16. Szotowski B, Antoniak S, Poller W, Schultheiss HP, Rauch U: Procoagulant soluble tissue factor is released from endothelial cells in response to inflammatory cytokines. Circ Res 2005, 96, 1233.1239.
  17. Lwaleed BA, Bass PS: Tissue factor pathway inhibitor: Structure, biology and involvement in disease. J Pathol 2006, 208, 327.339.
  18. Radziwon P, Bielawiec M, K.oczko J, Giedroj. J, Mazgajska K, Galar M, Klimiuk M: Tissue pathway inhibitor (TFPI) in patients with occlusive arterial diseases in consideration with risk factors and conservative treatment of the disease. Acta Angiol 2001, 7, 43.54.
  19. Kopp CW, Kopp HP, Steiner S, Kriwanek S, Krzyzanowska K, Bartok A, Roka R, Minar E, Schernthaner G: Weight loss reduces tissue factor in morbidly obese patients. Obes Res 2003, 11, 950.956.
  20. Bladbjerg EM, Larsen TM, Due A, Stender S, Astrup A, Jespersen J: Effects on markers of inflammation and endothelial cell function of three ad libitum diets differing in type and amount of fat and carbohydrate: A 6-month randomised study in obese individuals. Br J Nutr 2011, 106, 123.129.
  21. Batist G, Bothe A, Bern M, Bistrian BR, Blackburn GL: Low antithrombin III in morbid obesity return to normal with weight reduction. J Parenter Enteral Nutr 1983, 7, 447.449.
  22. Bowles LK, Cooper JA, Howarth DJ, Miller GJ, MacCallum PK: Associations of haemostatic variables with body mass index: a community-based study. Blood Coagul Fibrinolysis 2003, 14, 569.573.
  23. Ten Cate H: Thrombin generation in clinical conditions. Thromb Res 2012, 129, 367.370.
  24. Fanari P, Somazzi R, Nasrawi F, Ticozzelli P, Grugni G, Agosti R, Longhini E: Haemorheological changes in obese adolescents after short term diet. Int J Obes Relat Metab Disord 1993, 17, 484.494.
  25. Koiou E, Tziomalos K, Katsikis I, Dinas K, Tsourdi EA, Kandaraki EA, Delkos D, Papadakis E, Panidis D: Plasma von Willebrand factor antigen levels are elevated in the classic phenotypes of polycystic ovary syndrome. Hormones (Athens) 2012, 11, 77.85.
© Wroclaw Medical University