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Pre-Surgery Leptin Level and Weight Loss in Female Bariatric Surgery Patients

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Pre-Surgery Leptin Level and Weight Loss in Female Bariatric Surgery Patients University of Connecticut OpenCommons@UConn Master's Theses University of Connecticut Graduate School 5-10-2020 Pre-Surgery Leptin Level and Weight Loss in Female Bariatric Surgery Patients Miriam Katz [email protected] Follow this and additional works at: https://opencommons.uconn.edu/gs_theses Recommended Citation Katz, Miriam, "Pre-Surgery Leptin Level and Weight Loss in Female Bariatric Surgery Patients" (2020). Master's Theses. 1496. https://opencommons.uconn.edu/gs_theses/1496 This work is brought to you for free and open access by the University of Connecticut Graduate School at OpenCommons@UConn. It has been accepted for inclusion in Master's Theses by an authorized administrator of OpenCommons@UConn. For more information, please contact [email protected]. Pre-Surgery Leptin Level and Weight Loss in Female Bariatric Surgery Patients Miriam Esther Katz B.S., University of Connecticut, 2019 A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Public Health At the University of Connecticut 2020 ii Copyright © by Miriam Esther Katz 2020 iii Approval Page Master of Public Health Thesis Pre-Surgery Leptin Level and Weight Loss in Female Bariatric Surgery Patients Presented by Miriam Esther Katz, B.S. Major Advisor: __________________________________________________________ Dr. Helen Swede, Ph.D. Associate Advisor: ______________________________________________________ Dr. Pavlos Papasavas, M.D. Associate Advisor: ______________________________________________________ Dr. Valerie Duffy, Ph.D. Associate Advisor: ______________________________________________________ Dr. Stacey Brown, Ph.D. University of Connecticut 2020 iv Acknowledgements Correspondence: Supervisor: Miriam Katz Dr. Helen Swede, PhD, MS, PStat Program in Applied Public Health Sciences [email protected] University of Connecticut Health Center Farmington, CT 06030 [email protected] This study was approved by the Institutional Review Board under Approval No. 15-038- 6, Submission Reference No. 011696. I would like to acknowledge the unwavering support I’ve received in conducting this research project. A sincere thank you to Dr. Helen Swede, a co-Principal Investigator of this study, as well as my primary thesis advisor and a source of constant encouragement. I would also like to thank Dr. Pavlos Papasavas, the other co-Principal Investigator of this study, as well as the staff at Hartford Hospital who helped us collect this data. Additionally, Dr. Valerie Duffy has generously contributed her dataset and statistics guidance, and I would like to thank her and her graduate students for their help with this study. Thank you as well to Dr. Stacey Brown for her support and advising for this thesis, and to Dr. David Gregorio and Barbra Case for their extraordinary mentorship throughout this graduate program. This study would not have been possible without generous funding from the Connecticut Institute for Clinical and Translational Science. v Table of Contents Abstract ........................................................................................................................... vi Competencies Addressed ............................................................................................... vi Systems Thinking Framework .......................................................................................... 2 Background ...................................................................................................................... 5 Materials and Methods ................................................................................................... 11 Research Results ........................................................................................................... 14 Discussion ...................................................................................................................... 23 Summary and Conclusion .............................................................................................. 29 vi Abstract Background: Improving weight loss after bariatric surgery remains a clinical concern. An unstudied factor is the role of leptin, the appetite control hormone, as a pre-surgical predictor of weight loss. High serum levels, often seen in obesity, are an indicator of leptin resistance as the brain no longer responds to satiety signaling. Methods: Leptin levels were ascertained in female bariatric patients (n=28) prior to surgery at a large tertiary care hospital. We calculated Pearson Correlation Coefficients (r) and unstandardized β coefficients using multivariate linear regression. Primary outcome: Percent Excess Weight Loss (%EWL) evaluated at 6- and 12-months post- surgery. Independent variables were: baseline leptin and, potential confounders, Healthy Eating Behavioral Index (HEBI) and age. Results: Pearson correlation coefficients showed inverse associations baseline leptin with %EWL at 6-months (r=-.45, p<.01) and 12 months (r=-.21, p>,05). In Linear Regression, baseline leptin was inversely associated with %EWL at 6-months (adjusted β=-.12, p=.03) but the relationship was attenuated at 12-months (adjusted β=-.07. p=.47). HEBI was positively associated with %EWL at both 6-months (adjusted β=.19, p=.04) and 12-months (adjusted β=.26, p=.07). Conclusion and Discussion: Findings suggest that higher baseline leptin might impede weight loss in the first 6 months after surgery possibly due to reduced appetite control, which held when controlling for age and healthy eating. The effect at 6-months (adjusted β = -.12) denotes that a 75 ng/mL increase in leptin might incur about 10 vii percentage points less EWL. Longitudinal investigations in larger studies containing an array of potential explanatory variables are recommended. 1 Competencies Addressed Foundational Competencies 3. Analyze quantitative and qualitative data using biostatistics, informatics, computer-based programming and software, as appropriate 4. Interpret results of data analysis for public health research, policy, or practice 21. Perform effectively on interprofessional teams Concentration-specific Competencies 3. Demonstrate high personal and professional ethical conduct in contributing to team-based activities 2 Systems Thinking Framework Obesity is one of the most pressing and complex public health issues in the United States today. Understanding the physiological mechanisms of obesity, specifically barriers to weight loss success, are of vital importance. This research focuses on baseline plasma leptin levels as an indicator of successful postoperative outcomes in females undergoing bariatric weight loss surgery. While healthy outcomes cannot be predicted by leptin levels alone, baseline leptin values may play a role in informing patient care by predicting when patients may need additional weight loss guidance and support, and what the nature of that support may entail. Baseline plasma leptin was identified as an area of interest because of its relation to the relatively novel phenomenon of leptin resistance. In short, this phenomenon is characterized by a malfunction in the metabolic hormone leptin, which normally indicates satiety via high plasma levels after meals. In many individuals with obesity, the brain does not properly respond to plasma leptin levels and the individual will continue to consume food. Individuals with leptin resistance are therefore prone to overeating and often find it extremely difficult to lose weight. Since leptin is secreted by adipocytes, individuals with a higher BMI often secrete more leptin, leading to consistently high plasma leptin levels. The causes of leptin resistance are unknown, but this can pose a significant barrier to weight loss as well as weight management. Therefore, it is important that physicians understand leptin resistance and consider this condition when treating patients with obesity. This novel research will contribute to the knowledge base 3 surrounding leptin resistance. In the future, it would be beneficial to develop a clinical definition of leptin resistance and methods to increase leptin sensitivity. Until that point, comprehension and awareness of leptin resistance can help healthcare workers understand barriers to weight loss success and may inform treatment. For instance, a leptin resistant patient may have difficulty adhering to advice regarding portion control, and instead may benefit from advice focusing on the quality of food consumed rather than the quantity. These findings can be extrapolated to the public health level. Weight loss success is equally psychological as it is physiological, if not more. After investing effort in weight loss, individuals that do not achieve success may be prone to giving up, especially if they are being misdirected or even blamed by healthcare professionals. Many people, including those in the healthcare fields, view obesity as a lack of self- discipline, especially with dietary nonadherence. The stigma surrounding obesity is still very present despite the growing prevalence of obesity, so it is more important now than ever before that healthcare professionals and public health professionals alike understand its complex nature and work alongside the public to combat this issue. To effectively translate this research into meaningful change, it is important to examine the current systems and framework related to obesity, bariatric surgery, leptin resistance. As one of the fastest-growing public health crises in America, patients grappling with obesity will become increasingly prevalent, and
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