Cortisol/DHEA ratio in morbidly obese patients before and after bariatric surgery: Relation to metabolic parameters and cardiovascular performance

• Published in: International Journal of Obesity Vol. 46; no. 2; pp. 381 - 392
• Main Authors: El-Zawawy, Hanaa Tarek, El-Aghoury, Aliaa Aly, Katri, Khaled Mohamed, El-Sharkawy, Eman Mohamed, Gad, Samar Mohamed Samy
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-02-2022; Nature Publishing Group
• Subjects: 692/163; 692/163/2743/393; Adult; Bariatric Surgery - methods; Bariatric Surgery - statistics & numerical data; Blood pressure; Cortisol; Dehydroepiandrosterone; Dehydroepiandrosterone - analysis; Dehydroepiandrosterone - blood; Doppler effect; Echocardiography; Echocardiography - methods; Epidemiology; Fasting; Female; Gastrectomy; Gastrointestinal surgery; Health Promotion and Disease Prevention; Heart; Hormones; Humans; Hydrocortisone - analysis; Hydrocortisone - blood; Independent variables; Insulin; Internal Medicine; Lipids; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolic Syndrome; Metabolism; Middle Aged; Obesity; Obesity, Morbid - blood; Obesity, Morbid - metabolism; Obesity, Morbid - surgery; Parameters; Patients; Public Health; Septum; Steroid hormones; Surgery; Thickness; Velocity; Ventricle
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/s41366-021-00997-x

Introduction
Bariatric surgery (BS) is the most effective therapy for morbid obesity. Cortisol and DHEA are steroid hormones with opposing effects, thus using Cortisol/DHEA ratio (C/D) rather than the use of either hormone alone has been found to predict health outcomes more reliably. It was interesting to study C/D as an indicator of favorable metabolic and cardiovascular outcomes after BS.
Objective
To assess C/D in morbidly obese patients before and after BS in relation to metabolic parameters and cardiovascular performance.
Patients and methods
Forty morbidly obese patients were followed prospectively for 1 year after BS. Fasting blood glucose (FBG), fasting insulin (FI), C/D, lipid profile, high-sensitive CRP (hs-CRP), and echocardiography were done before BS and at 3 months and 1 year post BS.
Results
A total of 40 morbidly obese patients undergone sleeve gastrectomy. Blood pressure, FBG, FI, hs-CRP, C/D were significantly decreased after BS (
p
 < 0.001). At 1 year post BS; significant reduction in left ventricular posterior wall thickness (LVPW) (
p
 < 0.001), left ventricular mass (LVM) (
p
 = 0.003), relative wall thickness (RWT) (
p
 < 0.001) with a significant improvement in early diastolic velocity (
E
) (
p
 < 0.001), early diastolic velocity/late diastolic velocity (E/A) (
p
 = 0.01). After BS; C/D significantly positively correlated with FBG (
p
 = 0.019), hs-CRP (
p
 = 0.008), interventricular septum thickness (IVS) (
p
 = 0.028), LVPW (
p
 = 0.028), relative wall thickness (RWT) (
p
 = 0.022), early diastolic velocity /early diastolic velocity (
E
′) measured by pulsed tissue Doppler imaging (
E
/
E
′) (
p
 = 0.001), and significantly negatively correlated with
E
′ (
p
 = 0.032). C/D was the single significant independent variable affecting
E
′ and
E
/
E
′ post BS.
Conclusion
C/D can be used as a surrogate marker of the improved FBG and the resolution of inflammation post BS. C/D is an independent predictor of diastolic function improvement post BS.