Changing the Metabolic Profile by Large-Volume Liposuction: A Clinical Study Conducted with 123 Obese Women Francesco DÕAndrea, M.D., 1 Roberto Grella, M.D., 1 Maria Rosaria Rizzo, M.D., 2 Elisa Grella, M.D., 1 RodolfoGrella,M.D., 2 GianfrancoNicoletti,M.D., 1 MichelangelaBarbieri,M.D., 2 andGiuseppePaolisso,M.D. 2 1 Department of Plastic and Reconstructive Surgery, Second University of Naples, Naples, Italy 2 Department of Geriatric Medicine and Metabolic Disease, Second University of Naples, Naples, Italy Abstract. Adipose tissue is a metabolically active tissue. The hypertrophic fat cells of obese patients produce in- creased quantities of leptin and tumor necrosis factor-a (TNF-a) and are less sensitive to insulin. This study aimed to determine whether aspirating large amounts of these subcutaneous fat cells by large-volume liposuction (LVL), could change the metabolic profile in 123 obese women. All the patients had a main central body fat distribution (waisthip ratio, 0.91±0.01) and a body mass index of 32.8 ± 0.8 kg/m). They were studied for 90 days after LVL to determine their changes in insulin sensitivity, resting metabolic rate, serum adipocytokines, and inflammatory marker levels. During 3 months of follow-up evaluation, LVL resulted in a significantly improved insulin sensitivity, resting metabolic rate, serum adipocytokines, and inflam- matory marker levels. Such parameters correlate with a decrease in fat mass and waisthip ratio. Interestingly, no significant changes were seen between the first (21 days) and second (90 days) metabolic determinations after LVL. However, these findings, confirm other preliminary data published previously, and could change the actual role of LVL in the multidisciplinary treatment of obesity. Key words: Adipocytokines—Hypertrophic fat cells— Inflammatory state—Insulin resistance—Large-volume liposuction—Leptin—Obesity—RMR In recent years, we have begun to realize that adipose tissue is more than just a passive depot for excess energy [1]. Indeed, as several studies have shown, adipose tissue is a metabolically active tissue that expresses and secretes a large number of proteins. Such molecules, called adipocytokines, have a hor- mone-like action and interfere with basal and glucose metabolism [6,18,28,29]. The most important secreted products of fat cells are leptin, resistin, tumor necrosis factor-a (TNF-a), and adiponectin. The first three products are in- creased in obese patients as a result of increased production by enlarged fat cells. In contrast, adipo- nectin, which improves glucose handling by periph- eral tissues, is present at lower levels in obese patients [4,5,11,26]. Hypertrophic fat cells present in the subcutaneous tissue of obese patients generally produce increased quantities of secreted products such as leptin [13] and TNF-a [19], but are less sensitive to insulin invivo and in vitro [8,24]. Indeed, hypertrophic adipocytes in the subcutaneous abdominal repository is a marker for the risk of developing type 2 diabetes [20,23]. The evidence that adipose tissue is a metabolically active tissue has generated a large debate on the effectiveness of liposuction as a means of improving insulin sensitivity and lowering plasma leptin levels in obese patients [7,1416,21,27], but the results are conflicting (Table 1). Many of the cited studies assert that excising a large amount of subcutaneous fat by large-volume liposuction (LVL) is metabolically safe [1416,27] and associated with improvement in inflammatory markers and insulin sensitivity in obese [15,16] and nonobese women [27]. Unfortunately, the size of the Correspondence to R. Grella M.D., Department of Plastic and Reconstructive Surgery, VIA L. Decrecchio 4, 80100 Naples, Second University of Naples, Naples, Italy; email: rrgrella@hotmail.com Aesth. Plast. Surg. 29:472478, 2005 DOI: 10.1007/s00266-005-0089-x