Mendes Cláudia, Carvalho Manuel, Bravo Jorge, Martins Sandra, Raimundo Armando
Unidade Local Saúde Alentejo Central - Hospital Espírito Santo de Évora, EPE, Évora, Portugal.
CRI.COM - Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal.
Sci Rep. 2025 Feb 12;15(1):5188. doi: 10.1038/s41598-025-89806-3.
The role of obesity in contributing to inflammation is an influential factor in the progression of obesity-associated medical issues. Metabolic and bariatric surgery has been proven as effective in obtaining weight loss and associated conditions remission. The Systemic Immune Inflammation Index (SII) was developed to offer more comprehensive data on inflammation and is presented as a prognostic indicator regarding many adverse conditions. The present study aimed to investigate the association between SII and bariatric surgery in patients with sarcopenic obesity and evaluate the eventual impact of exercise on SII. All participants were sarcopenic patients with obesity, underwent bariatric surgery - RYGP - and were randomized to participate in a structured physical exercise or to control group. The assessments were performed following standardized procedures, with the data evaluated during routine clinic follow-up at preoperative and 20-weeks postoperative after the exercise program. At baseline, before surgery, patients in both groups had similar anthropometrics, body composition, muscle strength variables and percentage of comorbidities. SII was also similar in both groups. To better understand the association of SII with the different variables, a Pearson correlation test was performed at baseline using SII. There was an inverse association of SII with BMC, handgrip strength and ASMM at baseline, which was maintained 5 months after surgery. At the end of the study, the combined results of the two groups showed that weight, BMI, % of body fat, muscle mass and muscle strength, the 30s sit-to-stand test and bone mineral density all decreased significantly as expected, along with the SII that also decreased significantly. The intervention group showed higher ASMM, handgrip strength, 30s Sit-to-stand test and 400-m walk test and bone mineral density when compared with the control group. However, SII showed no difference between both groups (p > 0.05). The results of the current research show a positive impact of bariatric surgery on weight and associated conditions control and a negative impact on muscle mass and function. SII responded very favorably to surgery with or without exercise, with a clear decrease in its score. Higher SII is associated with lower muscle mass and function, and this may be a reflex of the compromise that obesity causes on health, in this case, increasing systemic inflammation and decreasing muscle mass and function. The role of physical exercise in the management of surgical bariatric patients is still not clear. After surgery, the patients in the physical exercise program group had better results in muscle mass and function when compared to the patients in the control group (without exercise). However, there were no differences in SII score between the two groups, which may be interpreted as a lack of positive effect of physical exercise per se in the short-term on the systemic inflammatory condition present in obesity.
肥胖在引发炎症方面所起的作用是肥胖相关医学问题进展中的一个重要影响因素。代谢和减重手术已被证明在实现体重减轻及相关病症缓解方面是有效的。全身免疫炎症指数（SII）的提出是为了提供更全面的炎症数据，并作为许多不良状况的预后指标。本研究旨在调查肌肉减少性肥胖患者中SII与减重手术之间的关联，并评估运动对SII的最终影响。所有参与者均为肌肉减少性肥胖患者，接受了减重手术—— Roux-en-Y胃旁路术（RYGP），并被随机分为参加有组织的体育锻炼组或对照组。评估按照标准化程序进行，数据在术前以及运动计划实施后术后20周的常规门诊随访期间进行评估。在基线期，即手术前，两组患者的人体测量学指标、身体成分、肌肉力量变量和合并症百分比相似。两组的SII也相似。为了更好地理解SII与不同变量之间的关联，在基线期使用SII进行了Pearson相关性检验。在基线期，SII与骨矿物质含量（BMC）、握力和四肢骨骼肌质量（ASMM）呈负相关，这种相关性在术后5个月仍持续存在。在研究结束时，两组的综合结果显示，体重、体重指数（BMI）、体脂百分比、肌肉质量和肌肉力量、30秒坐立试验和骨矿物质密度均如预期显著下降，SII也显著下降。与对照组相比，干预组的ASMM、握力、30秒坐立试验和400米步行试验以及骨矿物质密度更高。然而，两组之间的SII没有差异（p＞0.05）。当前研究结果表明，减重手术对体重及相关病症的控制有积极影响，对肌肉质量和功能有消极影响。无论是否进行运动，SII对手术反应良好，其评分明显降低。较高的SII与较低的肌肉质量和功能相关，这可能反映了肥胖对健康造成的损害，在这种情况下，肥胖会增加全身炎症并降低肌肉质量和功能。体育锻炼在减重手术患者管理中的作用仍不明确。手术后，与对照组（未进行运动）患者相比，参加体育锻炼计划组的患者在肌肉质量和功能方面有更好的结果。然而，两组之间的SII评分没有差异，这可能被解释为体育锻炼本身在短期内对肥胖患者存在的全身炎症状况缺乏积极影响。
