Obesity Surgery (2023) 33:789–806

https://doi.org/10.1007/s11695-022-06444-8

ORIGINAL CONTRIBUTIONS

Change in Adipokines and Gastrointestinal Hormones After Bariatric

Surgery: a Meta‑analysis
Jiayun Huang1 · Yanya Chen1,2 · Xuan Wang1 · Cunchuan Wang3 · Jingge Yang3 · Bingsheng Guan3 

Received: 30 June 2022 / Revised: 21 December 2022 / Accepted: 27 December 2022 / Published online: 6 January 2023
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023

Abstract
Purpose  The study aimed to perform a meta-analysis about the change in adipokines and gastrointestinal hormones after
bariatric surgery in patients with obesity.
Materials and Methods  We searched the Cochrane Central Register of Controlled Trials, EMBASE, and PubMed for related
articles and used Review Manager 5.4 for data aggregation. Sensitivity and subgroup analysis were also conducted when
feasible.
Results  As a result, 95 articles involving 6232 patients were included in the meta-analysis. After bariatric surgery, the levels
of leptin, ghrelin, C-reactive protein (CRP), interleukin-6 (IL-6), high-sensitivity C-reactive protein (Hs-CRP), tumor necro-
sis, factor-α (TNF-α), and interleukin-1β (IL-1β) reduced, while adiponectin, glucagon-like peptide-1 (GLP-1), and peptide
YY (PYY) levels increased significantly. Subgroup analysis indicated that there was a more significant reduction in leptin
level with a longer follow-up time. OAGB had a greater effect on increasing adiponectin level compared with other proce-
dures. SG procedure would bring about reduced ghrelin, while BPD resulted in increased ghrelin. Meta-regression analysis
found that publication year, study design, number of patients, preoperative age, preoperative BMI, and quality assessment
score were not significantly related to change in leptin, adiponectin, and ghrelin levels.
Conclusion  Bariatric surgery was associated with a significant decrease in leptin, ghrelin, CRP, IL-6, Hs-CRP, TNF-α, and
IL-1β, as well as increase in adiponectin, GLP-1, and PYY levels.

Keywords  Bariatric surgery · Adipokine · Gastrointestinal hormone · Meta-analysis · Obesity

Introduction

Nowadays, obesity has become a global health problem,

Jiayun Huang, Yanya Chen, and Bingsheng Guan contributed
equally to this work.
Key Points  wide are suffering from obesity [2]. Several clinical studies
1. Bariatric surgery was associated with a significant decrease in
leptin, ghrelin, CRP, IL-6, Hs-CRP, TNF-α, and IL-1β levels.
2. The levels of adiponectin, GLP-1, and PYY increased after
bariatric surgery.
3. Publication year, study design, number of patients, preoperative
age, preoperative BMI, and quality assessment score were not
significantly related to change in leptin, adiponectin, and ghrelin
levels.
* Jingge Yang
dryangjg@126.com
* Bingsheng Guan
guanbingshengxy@163.com
Extended author information available on the last page of the article
which can bring about a range of obesity-related metabolic
diseases and a substantial economic burden to humans [1].
It was reported that more than 650 million people world-
showed that bariatric surgery is one of the most effective
treatment methods for morbid obesity, which can help to lose
weight and relieve related metabolic diseases [3–5].
Although the clinical effect of bariatric surgery has been
studied a lot, the mechanism behind bariatric surgery has
not been well-known yet. Some potential mechanisms have
been proposed, including change in the intestinal flora, bile
acid metabolism, and small intestine refactoring [6]. Moreo-
ver, the change in adipokines and gastrointestinal hormones
have also been reported as a mechanism of action. How-
ever, there are different research outcomes in the literature;

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790
some reported decreased leptin level after Roux-en-Y gas-
tric bypasses (RYGB) and no significant change after gastric
banding (GB) [7]. Some said reduced ghrelin after sleeve
gastrectomy (SG) [8], while others found elevated ghrelin
after RYGB [9]. There are also opposite results in interleu-
kin-6 (IL-6) change after RYGB and biliopancreatic diver-
sion (BPD) [10, 11]. Given this inconsistent evidence, it
is difficult to conclude the exact change in adipokines and
gastrointestinal hormones after bariatric surgery.
Although a previous meta-analysis had pooled the change
in glucagon-like peptide-1 (GLP-1) after RYGB, it included
only one gastrointestinal hormone and one type of bariatric
surgery [12]. Many other kinds of adipokines, gastrointesti-
nal hormones, and bariatric surgeries have yet to be pooled.
Therefore, this study aimed to make a meta-analysis regard-
ing the change in various adipokines and gastrointestinal
hormones after bariatric surgery.
Methods
The meta-analysis was performed in accordance with some
guidelines, including the meta-analysis of observational
studies in epidemiology (MOOSE), the Cochrane Handbook,
and the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA). Because the completion of
this article does not include clinical intervention for patients,
informed consent and ethical approval can be exempted.
Literature Search
A literature search was made on the Cochrane Central Reg-
ister of Controlled Trials (CENTRAL), EMBASE, and Pub-
Med from inception to 14 October 2022, with no language
restrictions. Free terms and subject headings were applied
to search literature flexibly, including (bariatric surgery OR
metabolic surgery OR weight loss surgery OR obesity sur-
gery OR gastric bypass OR sleeve gastrectomy OR gastric
banding OR biliopancreatic diversion OR duodenojejunal
bypass) AND (obese OR obesity) AND (adipocyte factor
OR adipocytokines OR cytokines OR inflammatory factor
OR gut hormone OR leptin OR PYY OR ghrelin OR gluca-
gon-like peptide-1 OR adiponectin OR insulin-like growth
factor-1 OR IL-1 OR IL-6 OR TNF OR CRP). In addition,
we also searched for other possible articles based on the
references of screened articles.
Inclusion and Exclusion Criteria
Studies that met the following inclusion criteria would be
included: (1) patients with obesity who underwent bariatric
surgery and (2) providing baseline and postoperative data
for at least one of the following adipokine or gastrointestinal
13
Obesity Surgery (2023) 33:789–806
hormone, including leptin, peptide YY (PYY), ghrelin,
glucagon-like peptide-1 (GLP-1), adiponectin, insulin-like
growth factor-1 (IGF-1), interleukin-1β (IL-1β), IL-6, tumor
necrosis factor-α (TNF-α), C-reactive protein (CRP), and
high-sensitivity C-reactive protein (Hs-CRP). If more than
one postoperative adipokine/gastrointestinal hormone level
was provided, we only selected the measurement value at the
longest follow-up time.
We excluded non-English articles, conference abstracts,
reviews, and studies on laboratory animals, studies with
patients aged < 18 years, and studies with fewer than 30
participants. The threshold number of 30 was chosen for
practicality and to avoid the small study effects potentially
distorting the pooled results of this meta-analysis.
Data Extraction and Quality Assessment
After a literature search and deleting the duplicated articles,
we screened the titles and abstracts of each article for pre-
liminary evaluation. And then, we downloaded the full text
for further evaluation if necessary. For all the included litera-
ture, we used a pre-specified data extraction form to extract
the following data: the first author, publication year, country,
study design, surgical procedure, number of patients, age,
body mass index (BMI), follow-up duration, and outcomes.
For the missing data, we would contact the authors by email
for complete information if possible. The quality of included
trials was assessed by the Newcastle–Ottawa Scale (NOS),
which consists of three dimensions (patient selections, com-
parability, and the assessment of outcomes). And the score
for this scale ranged from 0 to 9.
Statistical Analysis
We used Review Manager 5.4 and Stata (version 12.0) for
statistical analysis. For continuous variables, calculate the
mean difference (MD) or standardized mean difference
(SMD) with a corresponding 95% confidence interval (95%
CI) as appropriate, depending on whether the same scale
measurement is used. Cochran Q- = statistic and I2 statistics
were adopted to evaluate the between-study heterogeneity,
with P < 0.1 and I2 > 50% representing significant heteroge-
neity. A random-effects model would be used to pool data
when significant heterogeneity was found. Otherwise, we
would use a fixed effects model. When necessary and feasi-
ble, subgroup analyses would be performed to identify pos-
sible sources of between-study heterogeneity. Pre-specified
subgroup analyses included surgical type (SG, RYGB, BPD,
GB, one-anastomosis gastric bypass), region (America,
Europe, Asia, Africa), and follow-up time (≤ 6  months,
6–12  months, > 12  months). A meta-regression analysis
was conducted to evaluate if the change in adipokine and
gastrointestinal hormone levels was affected by publication
Obesity Surgery (2023) 33:789–806 791
year, study design, number of patients, preoperative age, pre-
operative BMI, and NOS score. Regarding the sensitivity
analyses, the methods of changing the pooled model (fixed
effects model or random-effects model) and removing one
study were conducted. The possible publication was evalu-
ated with Begg and Egger tests through Stata software.
Results
Search Process, Study Characteristics, and Quality
Assessment
Primary database searches provided a total of 7057 related
articles, and additional manual search did not provide
any other new trials that met the inclusion criteria. After
removing duplicate surveys, 5984 titles and abstracts were
reserved. Subsequently, 780 articles were retained, and the
full text was downloaded for further evaluation. Finally,
a total of 6232 patients from 95 articles were included in
the meta-analysis [7–11, 13–102]. Of the included studies,
twelve had two arms, six had three arms, and one had four
arms; these arms were analyzed separately in the meta-anal-
ysis. Figure 1 shows the detailed process of study selection.
The study characteristics are shown in Table 1. Among
these studies, the types of bariatric surgeries were not con-
sistent, including malabsorptive surgery (e.g., BPD), restric-
tive surgery (e.g., SG, GB), and mixed surgery (e.g., RYGB,
one-anastomosis gastric bypass). The follow-up period
ranged from 3 weeks to 60 months. The quality of the stud-
ies is assessed in Table 1.
Meta‑analysis of Leptin
Seventy-one trials involving 3501 patients reported results
for leptin. Because there was significant heterogeneity
between these studies (P < 0.00001, I2 = 95%), the data was
pooled using a random-effects model. The result showed
that bariatric surgery could significantly reduce leptin lev-
els in patients with obesity (SMD =  − 2.46, 95% CI − 2.73
to − 2.19, P < 0.00001) (Fig. 2).
For the purpose of exploring the possible source of het-
erogeneity, we conducted subgroup analyses according to
different types of bariatric surgery, patient region, and fol-
low-up duration (Table 2). Among these types of bariatric
surgery, SG, RYGB, BPD, and GB procedures could lead
to significant leptin reduction, while one-anastomosis gas-
tric bypass (OAGB) had no significant effect on leptin level
(SMD =  − 9.98, 95% CI − 24.90 to 4.94, P = 0.19). Among
patients in different regions, African patients seem to gain
the most significant influence (SMD =  − 5.75, 95% CI − 7.45
to − 4.04, P < 0.00001). The subsequent analysis showed a
more substantial leptin level reduction with a longer fol-
low-up time. Meta-regression analysis showed that publica-
tion year (P = 0.198), study design (P = 0.093), number of
patients (P = 0.528), preoperative age (P = 0.651), preopera-
tive BMI (P = 0.529), and NOS score (P = 0.062) were not
significantly associated with leptin change.
In sensitivity analysis, the pooled results did not sig-
nificantly alter when excluding one research in turn, with
a range from − 2.48 (95% CI − 2.76 to − 2.20) to − 2.32
(95% CI − 2.57 to − 2.07). Also, the change in leptin level
was confirmed by changing the random-effects model to a
fixed effects model (SMD =  − 1.85, 95% CI − 1.91 to − 1.79,
P < 0.00001).
Furthermore, potential publication bias was seen with
Begg (P = 0.000) and Egger (P = 0.000) tests. Therefore, we
conducted a trim and filled analysis with the software Stata
and found that both the pooled results before and after trim
and fill analysis were statistically significant (both P < 0.05),
indicating that the pooled estimate for leptin was robust.
Meta‑analysis of Adiponectin
Forty-three trials involving a total of 2197 patients dem-
onstrated the result of adiponectin. Due to the significant
heterogeneity between the studies (P < 0.00001, I2 = 92%),
we chose a random-effects model to summarize the data
and found that bariatric surgery is effective in raising
adiponectin levels (SMD = 1.35, 95% CI 1.1 to 1.61,
P < 0.00001) (Fig. 3).
Regarding subgroup analysis, we found that the change
in adiponectin level was not statistically significant in
different subgroups of follow-up duration (P = 0.94).
Compared with other surgical modalities, OAGB had a
more considerable impact on the elevation of adiponectin
(SMD = 3.08, 95% CI 2.56 to 3.61, P < 0.00001). Addi-
tionally, patients from America and Africa had more
remarkable adiponectin reduction than Europe and Asia
(P < 0.00001).
Meta-regression analysis showed that publication year
(P = 0.372), study design (P = 0.257), number of patients
(P = 0.325), preoperative age (P = 0.698), preoperative
BMI (P = 0.683), and NOS score (P = 0.844) were not sig-
nificantly associated with adiponectin change. Concern-
ing sensitivity analysis, the pooled result remained similar
when removing one study in turn. And changing the ran-
dom-effects analysis into fixed effects model (SMD = 0.93,
95% CI 0.87 to 1.00, P < 0.00001) also did not significantly
impact the pooled result. There was significant publication
bias with Begg (P = 0.000) or Egger (P = 0.000) test. We
tried to conduct trim and fill analysis, but no trimming could
be performed, and the data was unchanged, which meant that
the pooled estimate for adiponectin was robust.
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792 Obesity Surgery (2023) 33:789–806

Fig. 1  PRISMA flow diagram

of the study selection

Meta‑analysis of Ghrelin related to CRP change. By means of moving one study out
in turn and changing the analysis model, sensitivity analysis
Ghrelin from 40 articles involving 1480 patients was revealed that the pooled result for ghrelin is robust.
included for analysis. Because of significant heterogeneity
between the included studies (P < 0.00001, I2 = 95%), we
Meta‑analysis of CRP
chose a random-effects model to pool the data. According to
the final results, the level of ghrelin reduced after bariatric
Thirty-six trials involving 1690 patients were included
surgery (SMD =  − 0.50, 95% CI − 0.88 to − 0.12, P = 0.009)
in the meta-analysis on CRP. We used a random-effects
(Fig. 4).
model to aggregate results because of the high heteroge-
Regarding various types of bariatric surgery, we found
neity between studies (P < 0.00001, I2 = 83%). The result
that SG procedure would bring about reduced ghrelin
showed that bariatric surgery was effective in reducing
(SMD =  − 1.35, 95% CI − 2.00 to − 0.69, P < 0.00001),
the level of CRP (SMD =  − 1.04, 95% CI − 1.23 to − 0.85,
while BPD resulted in increased ghrelin (SMD = 0.59, 95%
P < 0.00001) (Fig. 5).
CI 0.25 to 0.94, P = 0.0007). When looking at the region’s
There was no statistically significant difference between
impact, it was shown that patients from America and Africa
the data obtained by subgroup analysis based on the type of
had significant ghrelin change (P < 0.05), while Europe and
surgery (P = 0.21) and follow-up duration (P = 0.22). The
Asia had no. Compared with preoperative data, there was
differences between the data caused by different regions
no statistically significant change in ghrelin level in short-
were statistically significant (P < 0.00001), and partici-
term postoperative follow-up (≤ 6  months). However, it
pants from Africa gained more reduction in CRP level
turned out to be statistically significant in longer follow-up
(SMD =  − 1.97, 95% CI − 2.25 to − 1.70, P < 0.00001)
(> 6 months). Meta-regression analysis found that publica-
when compared with participants from America, Europe,
tion year, study design, number of patients, preoperative age,
and Asia. In sensitivity analysis, the pooled data was not
preoperative BMI, and NOS score were not significantly

13
 Table 1  Characteristics of included trails
Authors Year Country Study design Intervention Number Age (years) BMI (kg/m2) Follow-up (months) Outcomes NOS

El-Zawawy 2022 Egypt Prospective SG 40 33.22 ± 10.32 49.30 ± 8.85 12 Hs-CRP 9

Farup 2022 Norway Retrospective RYGB, SG 62 44.7 ± 8.5 39 ± 2 12 Leptin, adiponectin, ghrelin 9
Frühbeck (1) 2022 Spain NA RYGB 31 47 ± 2 42.0 ± 1.2 7 Leptin 9
Frühbeck (2) 2022 Spain NA RYGB 63 46.7 ± 15.6 32.3 ± 6.3 12 CRP, leptin, adiponectin 9
Hany 2022 Egypt Prospective SG 70 33.8 ± 11.45 45.17 ± 6.61 12 Leptin, PYY, GLP-1, ghrelin 9
Khanaghaei 2022 Iran Prospective RYGB 35 18—54 42.06 4 CRP 8
Obesity Surgery (2023) 33:789–806

Moriconi (1) 2022 Italy NA RYGB 30 44 ± 10 46.1 ± 5.5 6 CRP, IL-1β 8

Moriconi (2) 2022 Italy NA RYGB 8 40 ± 6 49.0 ± 6.1 6 CRP, IL-1β 9
Moriconi (3) 2022 Italy NA RYGB 8 41 ± 8 50.1 ± 7.0 6 CRP, IL-1β 9
Pacheco (1) 2022 Spain NA BPD 37 50.0 ± 5.2 46.7 ± 5.1 36 Leptin, adiponectin 9
Pacheco (2) 2022 Spain NA BPD 75 49.6 ± 6.1 46.5 ± 4.3 36 Leptin, adiponectin 9
Pacheco (3) 2022 Spain NA BPD 37 49.8 ± 6.1 46.3 ± 4.1 36 Leptin, adiponectin 9
Sachan (1) 2022 India Prospective SG, gastric bypass 30 38.33 ± 1.99 46.11 ± 1.18 6 CRP, TNF-α, IL-6, adiponectin 8
Salman (2) 2022 Egypt NA SG 54 44.3 ± 7.0 41.6 ± 2.6 12 GLP-1, Hs-CRP 9
Tas 2022 Turkey NA SG 60 40.72 ± 9.27 45.09 ± 2.97 12 Leptin 8
Zhou 2022 China Retrospective SG 72 29 ± 9.43 39.6 ± 6.30 6.7 CRP 9
Lautenbach 2021 Germany Retrospective RYGB, SG 163 41.3 ± 11.6 51.63 ± 8.02 48 CRP, Hs-CRP 8
Salman 2021 Egypt Prospective SG 120 43.7 ± 8.5 43.8 ± 5.2 12 CRP 8
Tabasi 2021 Iran Prospective SG 126 37.3 ± 6.3 43.27 ± 5.40 12 IL-1β, IL-6 8
Carmona-Maurici 2020 Spain Prospective RYGB, SG 66 20—65  ≥ 35 12 CRP, TNF-α, adiponectin, leptin, IL-6 8
Salman (1) 2020 Egypt Prospective SG 50 41.8 ± 8.6 44.2 ± 3.3 12 Leptin, ghrelin 8
Salman (2) 2020 Egypt Prospective RYGB 50 42.5 ± 8.8 43.79 ± 3.4 12 Leptin, ghrelin 8
Salman (3) 2020 Egypt Prospective OAGB 62 43.9 ± 6.8 42.2 ± 2.9 12 Adiponectin, leptin, Hs-CRP, IL-6, 9
TNF-α
Sharma 2019 India NA SG 90 24—68 49.25 ± 3.96 6 Ghrelin 9
Yin 2019 China Prospective SG 60 35.9 42.0 ± 8.9 12 Leptin, ghrelin 7
Arhire 2018 Romania Prospective SG 75 42.11 ± 11.45 45.16 ± 6.78 12 Ghrelin, leptin, adiponectin 8
Demerdash 2018 Egypt Prospective SG 92 42.6 ± 5.4 47.36 ± 5.45 12 Ghrelin, leptin 8
Belligoli 2017 Italy Prospective SG 180 43 ± 11 47.4 ± 7.3 12 Hs-CRP, IL-6, TNF-α, leptin 8
Chen 2017 China Retrospective RYGB 33 47.7 ± 11.6 30.9 ± 4.6 12 Leptin 8
de Luis 2017 Spain Prospective BPD 64 46.5 ± 8.2 48.9 ± 5.8 36 Adiponectin 9
Kalinowski (1) 2017 Poland Prospective SG 36 44.9 ± 10.6 46.1 ± 5.9 12 Ghrelin, leptin 9
Kalinowski (2) 2017 Poland Prospective RYGB 36 43.9 ± 10.8 48.6 ± 5.4 12 Ghrelin, leptin 9
Piche 2017 Canada Prospective BPD 73 NA 49.8 ± 7.1 12 Hs-CRP, IL-6, TNF-α, leptin, adiponec- 8
tin
Rao (1) 2017 USA Prospective GB 9 43.4 ± 3.4 42.5 ± 2.7 7 Leptin, PYY 9
Rao (2) 2017 USA Prospective RYGB 22 43.1 ± 2.4 47.8 ± 1.7 7 Leptin, PYY 9

13
793

Rao (3) 2017 USA Prospective SG 11 39.9 ± 2.9 46.4 ± 1.7 7 Leptin, PYY 9



Table 1  (continued)
794

Authors Year Country Study design Intervention Number Age (years) BMI (kg/m2) Follow-up (months) Outcomes NOS

13
Sans 2017 France Prospective RYGB 103 40.6 ± 11.2 43.3 ± 4.9 12 CRP 8
Schmatz (1) 2017 Brazil Prospective RYGB 20 36.7 ± 10.5 43.09 ± 1.95 12 Ghrelin, IL-6, IL-1β, TNF-α, adiponec- 9
tin
Schmatz (2) 2017 Brazil Prospective RYGB 20 52.0 ± 10.7 43.40 ± 3.65 12 Ghrelin, IL-6, IL-1β, TNF-α, adiponec- 9
tin
Sell 2017 France Prospective RYGB, GB 53 44.8 ± 10.6 47.0 ± 6.3 12 Adiponectin, CRP, IL-6 8
Thereaux 2017 France Prospective RYGB, SG 37 44.0 ± 10.4 45.2 ± 5.5 12 CRP 8
Tirado 2017 Spain Prospective RYGB, SG 66 42.3 ± 10.2 45.6 ± 6.19 12 Adiponectin, CRP, IL-6, TNF-α, IL-1β 8
Urbanavicius 2017 Lithuania Retrospective GB 103 45.9 ± 11.7 47.5 ± 7.3 48 Leptin, adiponectin 8
Yadav 2017 UK Prospective RYGB 37 49 52 ± 9 12 CRP, leptin, adiponectin, TNF-α 8
Zhu (1) 2017 China Retrospective RYGB 35 39.5 ± 11.8 36.7 ± 4.6 6 GLP-1, ghrelin 9
Zhu (2) 2017 China Retrospective SG 32 42.3 ± 12.8 36.5 ± 6.3 6 GLP-1, ghrelin 9
Adami 2016 Italy Prospective BPD 30 NA 36.3 ± 8.4 60 Leptin, adiponectin 9
Dogan 2016 Turkey NA SG 30 41.23 ± 10.37 49.30 ± 7.92 6 Ghrelin 9
Gentili 2016 Italy NA SG 80 43 ± 11 44.6 ± 7.2 10 Leptin, adiponectin 9
Illan 2016 Spain Prospective VBG-RYGB 73 38.53 ± 10.00 47.56 ± 7.02 12 Hs-CRP, IL-6 8
Molin 2016 Brazil NA RYGB 39 39.4 ± 10.9 44.3 ± 6.4 6 Leptin, RYY​ 9
Morshed 2016 Egypt Prospective SG 30 40.3 ± 8.5 42.71 ± 4.3 12 CRP 8
Nosso (1) 2016 Italy Prospective RYGB 14 49 ± 7 42 ± 6 12 GLP-1, ghrelin 9
Nosso (2) 2016 Italy Prospective SG 19 44 ± 10 46 ± 9 12 GLP-1, ghrelin 9
Pelascini 2016 France Retrospective RYGB 102 45.6 ± 10 45 ± 6.6 24 CRP 9
Richette 2016 France Prospective RYGB, SG, GB 154 41.5 ± 12.3 47.8 ± 7.2 6 Leptin, adiponectin, IL-6, Hs-CRP 9
Shih 2016 China Prospective RYGB, VBG 93 18—65  > 30 12 CRP, IL-6 8
Yu 2016 China Retrospective RYGB 42 46.3 ± 12.8 31.6 ± 4.8 12 Adiponectin 8
Alosco 2015 USA Prospective RYGB 84 43.86 ± 10.39 46.88 ± 6.08 12 Leptin, ghrelin 8
Fellici 2015 Brazil Prospective RYGB 36 18—60 32.1 ± 0.3 12 Hs-CRP, adiponectin 9
Ferrer 2015 Spain Prospective RYGB 32 21—61  > 35 12 Leptin, adiponectin, ghrelin 8
Flores 2015 Spain Prospective RYGB, SG 37 52 ± 8 45 ± 5 12 Leptin 8
Gandolfini 2015 France Prospective RYGB 34 36 ± 11 46.3 ± 5.9 16 GLP-1 9
Hawkins 2015 America Prospective RYGB 77 43.4 ± 10.6 46.7 ± 5.3 12 CRP 8
Netto 2015 Brazil Prospective RYGB 41 39.4 ± 10.9 44.6 ± 6.3 6 Adiponectin, TNF-α, leptin 8
Abdennour 2014 USA Prospective RYGB 345 42 ± 12 47.9 ± 7.4 12 Leptin, adiponectin, IL-6, Hs-CRP 8
Auguet 2014 Spain Prospective RYGB, SG 30 47.2 ± 8.9 46.5 ± 5.0 12 CRP 8
Bužga 2014 Czech Prospective SG 37 43.5 ± 10.2 43.0 ± 4.9 12 Ghrelin, leptin, adiponectin 9
Carrasco (1) 2014 Chile Prospective SG 20 33.5 ± 8.6 37.4 ± 2.9 12 Ghrelin, adiponectin 9
Carrasco (2) 2014 Chile Prospective RYGB 23 36.9 ± 8.4 42.0 ± 3.8 12 Ghrelin, adiponectin 9
Obesity Surgery (2023) 33:789–806
 Table 1  (continued)
Authors Year Country Study design Intervention Number Age (years) BMI (kg/m2) Follow-up (months) Outcomes NOS

Ferrannini 2014 USA Prospective BPD, RYGB 182 41 ± 103 48.0 ± 7.8 12 Leptin 8
Lips (1) 2014 Netherlands Retrospective GB 11 46.3 ± 1.9 43.1 ± 0.9 3 weeks GLP-1, PYY, ghrelin 9
Lips (2) 2014 Netherlands Retrospective RYGB 16 48.6 ± 1.6 44.2 ± 0.8 3 weeks GLP-1, PYY, ghrelin 9
Lips (3) 2014 Netherlands Retrospective RYGB 15 51.3 ± 1.9 43.5 ± 1.1 3 weeks GLP-1, PYY, ghrelin 9
Rojano-Rodríguez 2014 Mexico Retrospective RYGB, SG 36 37 ± 7.94 42.48 ± 5.97 6 CRP 9
Yang 2014 China Prospective RYGB, GB, SG, OAGB 178 32.9 ± 10.0 42.0 ± 6.6 12 Hs-CRP 8
Obesity Surgery (2023) 33:789–806

Caron-Cantin 2013 Canada Prospective BPD 70 41.3 ± 10.7 50.0 ± 7.2 12 CRP, IL-6, TNF-α 8
Jimene 2013 Spain Retrospective RYGB, SG 104  ≥ 18  ≥ 35 12 Hs-CRP 8
Terra 2013 Spain NA RYGB, SG 30 47.2 ± 8.9 46.5 ± 5.0 12 Ghrelin, leptin 9
Hady 2012 Poland NA SG 100 NA 52.15 ± 8.5 6 Ghrelin 9
Pardina 2012 Spain Prospective RYGB 34 21–61 48.8 12 Leptin, ghrelin 8
Saleh 2012 Brazil Prospective RYGB 47 41 47.1 ± 5.5 10 Hs-CRP 9
Breitman 2011 USA Prospective RYGB 30 46.9 ± 8.4 43.3 ± 4.1 8 weeks CRP, IL-6, IGF-1, leptin, ghrelin, GLP-1 9
Dalmas 2011 France Prospective RYGB 51 NA 49.8 ± 1.1 12 IL-6, Hs-CRP, leptin, adiponectin 8
Tschoner 2011 Austria Prospective GB, Gastric bypass 36 21—53 42.95 ± 4.22 18 Hs-CRP, TNF-α, IL-6, leptin, adiponec- 9
tin
Broch 2010 Spain Prospective RYGB 63 45.0 ± 9.3 49.7 ± 8.0 12 CRP, adiponectin 8
de Luis 2010 Spain Prospective BPD 41 42.9 ± 10.1 50.6 ± 7.5 12 Leptin, adiponectin, IL-6, TNF-α 8
Handisurya 2010 Austria Prospective RYGB 33 43.75 ± 11.95 47.12 ± 6.78 12 CRP, leptin 8
Ress 2010 Austria Prospective GB, gastric bypass 32 34.6 ± 8.7 42.65 ± 3.99 18 Leptin, adiponectin, Hs-CRP 9
Carroll 2009 USA NA RYGB 34 NA 43.4 ± 5.0 6 CRP, leptin, ghrelin, GLP-1 9
Korner (1) 2009 USA Prospective GB 15 47.1 ± 2.5 41 ± 1 12 Ghrelin, GLP-1, leptin, PYY 8
Korner (2) 2009 USA Prospective RYGB 28 45.0 ± 2.0 48 ± 1 12 Ghrelin, GLP-1, leptin, PYY 8
Moschen 2009 Austria Prospective GB 30 37.5 ± 58.61 42.6 ± 3.86 12 CRP, TNF-α 8
Garcia-Fuentes (1) 2008 Spain NA BPD 38 43.2 ± 11.5 54.0 ± 5.9 7 Leptin, PYY, ghrelin 9
Garcia-Fuentes (2) 2008 Spain NA RYGB 13 42.8 ± 7.4 53.0 ± 9.1 7 Leptin, PYY, ghrelin 9
Karamanakos (1) 2008 Greece Prospective RYGB 16 37 ± 8.25 46.6 ± 3.7 12 Ghrelin, PYY 9
Karamanakos (2) 2008 Greece Prospective SG 16 30.6 ± 7.8 45.1 ± 3.6 12 Ghrelin, PYY 9
Liou 2008 China Prospective OAGB 68 31.6 ± 8.9 39.7 ± 7.2 12 Leptin, ghrelin, CRP 8
Riedl (1) 2008 Austria Prospective RYGB 30 42.9 ± 10.95 47.7 ± 6.02 12 Leptin 8
Riedl (2) 2008 Austria Prospective GB 10 43.9 ± 14.23 47.6 ± 6.64 12 Leptin 8
Czupryniak 2007 Poland Prospective RYGB 68 36.4 ± 10.2 44.4 ± 6.8 24 Leptin 9
Couce 2006 Austria Prospective GB 31 40 ± 11 46 ± 5 6 Leptin, adiponectin 9
Morínigo (1) 2006 Spain Prospective RYGB 12 41.8 ± 2.7 49.7 ± 1.7 6 weeks GLP-1 9
Morínigo (2) 2006 Spain Prospective RYGB 12 46.8 ± 3.2 48.6 ± 1.8 6 weeks GLP-1 9
Morínigo (3) 2006 Spain Prospective RYGB 10 50.5 ± 3.0 49.0 ± 2.1 6 weeks GLP-1 9

13
795

796 Obesity Surgery (2023) 33:789–806

significantly changed when removing any study in turn.

SG, sleeve gastrectomy; RYGB, Roux-en-Y gastric bypass; BPD, biliopancreatic diversion; GB, gastric banding; OAGB, one-anastomosis gastric bypass; VBG-RYGB, vertical banded gastro-
plasty-Roux-en-Y gastric bypass; VBG, vertical banded gastric; NA, not available, CRP, C-reactive protein; IL-6, interleukin-6; Hs-CRP, high-sensitivity C-reactive protein; TNF-α, tumor necro-
NOS Additionally, a fixed effects model yielded a similar result

8
9
9
9
8
8
9
8

8
8
9
Leptin, adiponectin, IL-6, TNF-α, Hs- (SMD =  − 1.03, 95% CI − 1.11 to − 0.96, P < 0.00001) with
the random-effects analysis.

Meta‑analysis of IL‑6

Adiponectin, IL-6, leptin

Twenty-six studies with a total of 1796 patients providing
CRP, adiponectin, IL-6

IL-6 data were included in the meta-analysis. We adopted a

sis factor-α; PAI-1, plasminogen activator inhibitor-1; MCP-1, chemoattractant protein-1; IL-10, interleukin-10; NOS, Newcastle–Ottawa Quality Assessment Scale
random-effects model to aggregate the data because of the
Leptin, ghrelin

high between-study heterogeneity (P < 0.00001, I2 = 90%).

CRP, IL-6
BMI (kg/m2) Follow-up (months) Outcomes

The final summary showed that bariatric surgery could

Leptin
Leptin
Leptin
Leptin
Leptin
Leptin
CRP

reduce patients’ IL-6 levels (SMD =  − 0.59, 95% CI − 0.82

to − 0.35, P < 0.00001) (Fig. 6).
There was no statistically significant difference between
the data obtained by subgroup analysis according to the type
of surgery (P = 0.19) and follow-up duration (P = 0.22).
Although the studies with follow-up duration ≤ 6 months
pooled a non-significant change in IL-6 level, the studies
45.8 ± 7.6 24
41.8 ± 0.8 24
54.1 ± 9.1 12
50.7 ± 9.67 12
47.2 ± 8.5 12
12
17
42.5 ± 4.9 12
12

34.6 ± 13.03 53.01 ± 5.14 6
35.1 ± 13.1 54.24 ± 6.36 6

with > 6 months follow-up led to significant IL-6 reduction.

In addition, sensitivity analysis, through changing analy-
49.8 ± 8.2

48 ± 7
48 ± 7

sis model and one-study-out method, displayed the robust

pooled estimate for I-6.
39.8 ± 10.1
41.3 ± 8.87
Number Age (years)

39.7 ± 6.3
42.7 ± 8.7
42.2 ± 9.3

42.0 ± 10
42 ± 11

Meta‑analysis of Hs‑CRP, TNF‑α, MLP‑1, PYY,

40 ± 9

34

and IL‑1β

Twenty-one articles on Hs-CRP involving 1687 patients

were included for meta-analysis. We chose a random-effects
154
43
40
20
45
65
20
36
30
41
60

model to aggregate the result because of high heterogene-

ity (P < 0.00001, I2 = 83%). The final result demonstrated
a statistically significant reduction of Hs-CRP level after
GB, gastric bypass

bariatric surgery (SMD =  − 1.15, 95% CI − 1.35 to − 0.96,

VBG-RYGB

P < 0.00001).
Intervention

Totally, 439 patients from 17 trials were included in the

meta-analysis of GLP-1. A random-effects model was used
BPD
BPD

GB
GB
GB
GB
GB
GB

SG

to pool the data by reason of between-study heterogene-

ity (P < 0.00001, I2 = 74%). The pooled result showed that
Study design

Prospective
Prospective
Prospective
Prospective
Prospective
Prospective
Prospective
Prospective
Prospective

bariatric surgery was related to the change in ghrelin level

(SMD = 0.30, 95% CI 0.02 to 0.58, P = 0.04).
NA
NA

A total of 794 patients in 16 articles reported TNF-α

results. Because of the heterogeneity between studies
Switzerland

(P < 0.00001, I2 = 97%), we adopted a random-effects model

Year Country

German
Austria

Turkey
Turkey
France
France
2006 France

Brazil
Spain

to summarize the result. The result showed that bariatric sur-

Italy

gery could reduce TNF-α level (MD =  − 0.63, 95% CI − 1.11

1998
2003
2001
2005
2004
2004
2005
2005
2005
2005

to − 0.15, P = 0.01).
Fourteen articles on PYY involving 318 patients were
Table 1  (continued)

included for meta-analysis. We chose a random-effects

García-Unzueta

model to aggregate the result because of high heterogene-

ity (P < 0.00001, I2 = 84%). The final result demonstrated a
Geloneze
Uzun (1)
Uzun (2)
Coupaye

Infanger
Authors

Laimer

statistically significant increase in PYY level after bariatric

Adami
Poitou
Poitou

Kopp

surgery (SMD = 0.63, 95% CI 0.20 to 1.06, P = 0.004).

13
Obesity Surgery (2023) 33:789–806 797

Fig. 2  Forest plots showing change in leptin

Seven articles involved 278 patients reporting the result analyze the result. According to the analysis result, bariatric sur-
of IL-1β. Because of the high heterogeneity of the study gery has a statistically significant effect on the change in MCP-1
(P < 0.00001, I2 = 99%), a random-effects model was adopted to level (MD =  − 9.02, 95% CI − 11.32 to − 6.73, P < 0.00001).

13

798 Obesity Surgery (2023) 33:789–806

Table 2  Subgroup analyses of some adipokines and gastrointestinal hormones

Subgroup Stratification No. of studies P value for I2 Pooled standardized P value
heterogeneity mean differences for pooled
results

Leptin
Bariatric surgery
SG 12  < 0.00001 95%  − 2.87 [− 3.54, − 2.21]  < 0.00001
RYGB 23  < 0.00001 91%  − 2.16 [− 2.53, − 1.78]  < 0.00001
BPD 10  < 0.00001 94%  − 2.46 [− 3.25, − 1.67]  < 0.00001
GB 12  < 0.00001 97%  − 2.42 [− 3.48, − 1.36]  < 0.00001
OAGB 2  < 0.00001 99%  − 9.98 [− 24.90, 4.94] 0.19
Region
America 14  < 0.00001 90%  − 2.21 [− 2.64, − 1.78]  < 0.00001
Europe 44  < 0.00001 94%  − 2.19 [− 2.51, − 1.87]  < 0.00001
Asia 5  < 0.00001 91%  − 1.74 [− 2.54, − 0.94]  < 0.00001
Africa 7  < 0.00001 97%  − 5.75 [− 7.45, − 4.04]  < 0.00001
Follow-up duration
 ≤ 6 months 8  < 0.00001 82%  − 1.61 [− 2.04, − 1.18]  < 0.00001
 > 6 months and ≤ 12 months 51  < 0.00001 93%  − 2.40 [− 2.70, − 2.11]  < 0.00001
 > 12 months 12  < 0.00001 98%  − 3.08 [− 4.15, − 2.01]  < 0.00001
Adiponectin
Bariatric surgery
SG 5  < 0.0001 86% 1.07 [0.55, 1.60]  < 0.0001
RYGB 14  < 0.00001 93% 1.75 [1.24, 2.27]  < 0.00001
BPD 9  < 0.00001 94% 2.03 [1.26, 2.79]  < 0.00001
GB 4 0.80 0% 0.42 [0.21, 0.62]  < 0.0001
OAGB 1 - - 3.08 [2.56, 3.61]  < 0.00001
Region
America 8  < 0.00001 96% 2.80 [1.84, 3.75]  < 0.00001
Europe 31  < 0.00001 90% 1.13 [0.87, 1.39]  < 0.00001
Asia 2 0.18 44% 1.17 [0.64, 1.69]  < 0.00001
Africa 1 - - 3.08 [2.56, 3.61]  < 0.00001
Follow-up duration
 ≤ 6 months 4  < 0.00001 97% 1.44 [0.08, 2.80] 0.04
 > 6 months and ≤ 12 months 28  < 0.00001 92% 1.36 [1.07, 1.66]  < 0.00001
 > 12 months 11  < 0.00001 92% 1.26 [0.75, 1.78]  < 0.00001
Ghrelin
Bariatric surgery
SG 13  < 0.00001 96%  − 1.35 [− 2.00, − 0.69]  < 0.00001
RYGB 20  < 0.00001 93%  − 0.20 [− 0.71, 0.30] 0.43
BPD 2 0.59 0% 0.59 [0.25, 0.94] 0.0007
GB 2 0.25 25% 0.29 [− 0.35, 0.93] 0.38
OAGB 1 - -  − 0.22 [− 0.56, 0.12] 0.20
Region
America 9  < 0.00001 96%  − 1.38 [− 2.36, − 0.40] 0.006
Europe 21  < 0.00001 86% 0.04 [− 0.28, 0.36] 0.80
Asia 6  < 0.00001 97%  − 0.41 [− 1.55, 0.73] 0.48
Africa 4  < 0.00001 98%  − 1.91 [− 3.57, − 0.24] 0.02
Follow-up duration
 ≤ 6 months 10  < 0.00001 96%  − 0.30 [− 1.10, 0.49] 0.46
 > 6 months and ≤ 12 months 30  < 0.00001 95%  − 0.57 [− 1.01, − 0.13] 0.01
CRP

13
Obesity Surgery (2023) 33:789–806 799

Table 2  (continued)
Subgroup Stratification No. of studies P value for I2 Pooled standardized P value
heterogeneity mean differences for pooled
results

Bariatric surgery
SG 4  < 0.00001 89%  − 1.46 [− 2.08, − 0.84]  < 0.00001
RYGB 17  < 0.00001 81%  − 1.17 [− 1.47, − 0.86]  < 0.00001
BPD 1 - -  − 0.81 [− 1.16, − 0.47]  < 0.00001
GB 2 0.04 77%  − 0.80 [− 1.52, − 0.07] 0.03
Region
America 4 0.03 66%  − 0.94 [− 1.36, − 0.52]  < 0.0001
Europe 23  < 0.00001 78%  − 1.05 [− 1.27, − 0.84]  < 0.00001
Asia 6  < 0.00001 89%  − 0.80 [− 1.33, − 0.26] 0.003
Africa 2 0.93 0%  − 1.97 [− 2.25, − 1.70]  < 0.00001
Follow-up duration
 ≤ 6 months 8  < 0.00001 80%  − 0.68 [− 1.18, − 0.18] 0.008
 > 6 months and ≤ 12 months 24  < 0.00001 86%  − 1.15 [− 1.40, − 0.91]  < 0.00001
 > 12 months 4 0.22 32%  − 1.00 [− 1.24, − 0.76]  < 0.00001
IL-6
Bariatric surgery
SG 3  < 0.00001 98%  − 0.88 [− 2.01, 0.25] 0.13
RYGB 5  < 0.00001 95%  − 1.31 [− 2.24, − 0.38] 0.006
BPD 4 0.78 0%  − 0.40 [− 0.61, − 0.19] 0.0002
GB 2 0.71 0.0%  − 0.32 [− 0.58, 0.05] 0.02
Region
America 6  < 0.00001 94%  − 1.02 [− 1.65, − 0.39] 0.002
Europe 15  < 0.00001 73%  − 0.54 [− 0.72, − 0.35]  < 0.00001
Asia 4  < 0.00001 97%  − 0.34 [− 1.54, 0.86] 0.58
Follow-up duration
 ≤ 6 months 3 0.0002 88% 0.21 [− 0.54, 0.96] 0.59
 > 6 months and ≤ 12 months 21  < 0.00001 91%  − 0.71 [− 0.98, − 0.44]  < 0.00001
 > 12 months 2 0.81 0%  − 0.53 [− 0.85, − 0.21] 0.001

SG, sleeve gastrectomy; RYGB, Roux-en-Y gastric bypass; BPD, biliopancreatic diversion; GB, gastric banding; OAGB, one-anastomosis gastric
bypass; CRP, C-reactive protein; IL-6, interleukin-6

Discussion leptin can induce a high metabolic rate, thermogenesis,

Given that bariatric surgery is becoming increasingly
widely used, sufficient knowledge about its underlying
mechanism is essential, which can help to choose the
most suitable surgical procedure for patients. Change in
adipokines and gastrointestinal hormones after bariatric
surgery has been proposed with inconsistent results. To our
knowledge, this is the first study that took a series of adi-
pokines and gastrointestinal hormones into meta-analysis.
We found that the levels of leptin, ghrelin, CRP, IL-6, Hs-
CRP, TNF-α, and IL-1β reduced significantly after bari-
atric surgery, while adiponectin, GLP-1, and PYY levels
increased significantly.
This study’s most reported adipokine was leptin, a poly-
peptide hormone secreted by adipose tissues and stomach
fundus cells. By acting centrally in the hypothalamus,
and anorexic status [103]. After high-calorie food con-
sumption, serum leptin level would be increased to keep
the balance of energy control and body weight. Generally
speaking, the amount of leptin is proportional to body fat
content; patients with obesity would have higher leptin lev-
els than patients with normal weight [104]. But it is worth
noting that high leptin level in patients with obesity was
not related to anorexia or body fat loss, possibly explained
by the effect of endogenous leptin resistance [105]. Our
pooled results showed that after weight reduction caused
by bariatric surgery, serum leptin level would decrease
significantly (P < 0.05). Some previous studies reported
comparable, significant reduction in serum leptin levels
after either RYGB or SG [74, 106]; our subgroup analy-
ses also had similar results. The fact that OAGB had no
significant effect on leptin level may be attributed to few

13

800
Fig. 3  Forest plots showing change in adiponectin
included studies. Regarding the region’s impact, patients
from Africa have more substantial leptin reduction than
patients from other regions, revealing that ethnic factors
may be related to the change in leptin level.
As the highest content of adipokines in peripheral blood,
adiponectin is expressed exclusively by adipocytes. Pre-
vious literature demonstrated low circulating adiponec-
tin level in obesity [43], which was proved by our meta
results that an increased level of adiponectin was found
after bariatric surgery. Adiponectin is an insulin-sensitizing
hormone; increased adiponectin after surgery can partly
explain why blood glucose status can be improved after
bariatric surgery in patients with diabetes [43]. In addition,
adiponectin was reported as the most crucial adipokine that
is negatively connected with bone mineral density (BMD)
13
Obesity Surgery (2023) 33:789–806
regardless of gender and menopausal status [107]. There-
fore, sufficient attention should be paid to the fracture risk
after bariatric surgery and enough calcium and vitamin D
needed to be administered. Subgroup analysis showed that
OAGB, RYGB, and BPD procedures brought about a more
significant increase in adiponectin than GB procedure. A
possible reason for this is that GB is just a restrictive sur-
gery, while OAGB, RYGB, and BPD are mixed procedures
which can combine intake limitation and malabsorption
and will provide better weight loss.
Ghrelin is a hormone produced mainly by P/D1 cells
in the gastric fundus. It was widely believed that bariatric
surgery could reduce ghrelin level. The whole pooled result
of ghrelin in our study also confirmed this (SMD =  − 0.50,
P = 0.009). What should be noteworthy in our subgroup
Obesity Surgery (2023) 33:789–806 801
Fig. 4  Forest plots showing change in ghrelin
analyses is that ghrelin levels reduced significantly in
patients who received LSG (SMD =  − 1.35, P < 0.00001),
increased in BPD (P = 0.0007), and remained unchanged
in RYGB and GB. The reduced ghrelin level after SG can
be attributed to having the gastric fundus resected. Few
included studies on BPD and GB may also have an impact
on the pooled data. Further studies considering the effect
of surgical procedures are needed.
CRP and Hs-CRP are both common inflammatory mark-
ers. As a chronic inflammatory status, obesity is associated
with elevated CRP and Hs-CRP levels. Our pooled data
indicated that CRP and Hs-CRP levels would reduce after
bariatric surgery. Regarding the comparison among vari-
ous surgeries, we found no significant differences in mean
change before and after surgery between different surgical
procedures. This was not inconsistent with Lautenbach’s
study, which found that CRP level were significantly higher
in patients undergoing SG compared to RYGB at some
postoperative time points [26]. With respect to the impact
of follow-up, our pooled data revealed no significant dif-
ference in CRP change in postoperative follow-up. But a
longer follow-up is needed because a study showed that
the decline in CRP and Hs-CRP could be at the U-shaped
curve, with the lowest level at postoperative 2 years fol-
lowed by a gradual increase [26]. TNF-α is another marker
that reflects an inflammatory state. Data from previous
studies reported unaltered TNF-α after bariatric surgery
[29, 108]. This meta-analysis concluded that bariatric sur-
gery was associated with significant decreased TNF-α.
IL-6 is a proinflammatory cytokine with many functions
and participates actively in the immune response. Patients
with obesity always encounter high chronic subclinical
inflammation. Therefore, increased serum IL-6 level was
found in our pooled result compared to the postoperative
level. Additionally, we found no significant relationship
between IL-6 change and surgical procedures and regions,
13

802
Fig. 5  Forest plots showing change in CRP
but the literature indicated that IL-6 had some association
with obesity-related diseases. For example, a positive cor-
relation between IL-6 and CT90 (the percentage of total
sleep time in which the oxygen saturation remains below
90%) was found before bariatric surgery [42], suggesting
that the status of obstructive sleep apnea in patients with
obesity can impact both inflammatory and metabolic lev-
els. Behinds, IL-6 change after bariatric surgery is earlier
and more obvious in patients with diabetes than without
diabetes, which may be explained by the fact that diabetes
is also an inflammatory disease and correcting adiposity
alone is probably not enough to improve the inflammatory
state [53].
Some other vital adipokines and gastrointestinal hor-
mones have also been included in this analysis. PYY is
secreted from the distal gut cells, which can suppress appe-
tite by reducing gastric emptying and slowing down the gut
flow. Our study found elevated PYY level after bariatric
surgery. Due to the fact that GLP-1 has significant anti-type
2 diabetes effects, GLP-1 analogs have been evaluated for
13
Obesity Surgery (2023) 33:789–806
their potential as weight-loss drugs, such as Seiglutide.
Increased GLP-1 level found in our study also supported
the effect of GLP-1 on weight reduction. IL-1β is a proin-
flammatory factor, and the pooled result of postoperative
IL-1β level decreased when compared with preoperative
data (SMD =  − 9.02, P < 0.00001).
Some limitations of this meta-analysis should be pointed
out. The first limitation is between-study heterogeneity; type
of bariatric surgery, study region, and follow-up duration
are different between studies and may result in reporting
biases. Nevertheless, the random-effects model was used
when appropriate to provide the most conservative results.
In addition, sensitivity analysis and subgroup analysis were
conducted and showed that the pooled data were relatively
robust. Another limitation is that available data about BPD
and OAGB procedures are limited. All in all, more studies
taking the type of bariatric surgery and patient characteris-
tics into account are needed, so as to determine the impact of
specific bariatric surgery on adipokines and gastrointestinal
hormones in particular populations.
Obesity Surgery (2023) 33:789–806 803
Fig. 6  Forest plots showing change in IL-6
Conclusion
Based on the currently available evidence, bariatric surgery
was associated with significant decrease in leptin, ghrelin,
CRP, IL-6, Hs-CRP, TNF-α, and IL-1β, as well as increase
in adiponectin, GLP-1, and PYY levels.
Funding  The work was supported by the Fundamental Research Funds
for the Central Universities (21622304) and the Basic and Applied
Basic Research Project of Guangzhou Basic Research Program
(SL2023A04J01245).
Data Availability  The analyzed datasets generated during the study are
available from the corresponding author on reasonable request.
Declarations  after bariatric surgery and correlates with markers of bone
Ethical Approval  This article does not contain any studies with human
participants or animals performed by any of the authors.
Consent to Participate  Informed consent does not apply.
Conflict of Interest  The authors declare no competing interests.
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Authors and Affiliations
Jiayun Huang1 · Yanya Chen1,2 · Xuan Wang1 · Cunchuan Wang3 · Jingge Yang3 · Bingsheng Guan3
1 3
School of Nursing, Jinan University, Guangzhou 510632,
China
2
Department of Infectious Diseases and Public Health, Jockey
Club College of Veterinary Medicine and Life Sciences, City
University of Hong Kong, Hong Kong 999077, China
13
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Department of Gastrointestinal Surgery, First Affiliated
Hospital of Jinan University, Guangzhou 510632, China