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Doctor of Medical Sciences Proves OAGB Surgery Effective in Reducing Body Weight and Inflammation in Obesity Models
Located in the Postgraduate Hall, 3rd Floor of the Postgraduate Building, Udayana University, the Doctoral Program in Medical Sciences, Faculty of Medicine, Udayana University held an open Doctoral Promotion examination with the candidate for promovenda, dr. Tjokorda Istri Anom Saturti, SpPD., FINASIM., MARS., with the dissertation title, "The Effect of One Anastomosis Gastric Bypass Surgery on Ghrelin Levels, Body Weight, White Fat Cell Size, Tumor Necrosis Factor Alpha, Interleukin-18, and Interleukin-10 in Male Wistar Rats (Rattus Norvegicus L.) Obesity Model." (3/24/2025)
Obesity is a global health problem that continues to increase due to energy imbalance and the role of digestive hormones, leptin, ghrelin, and chronic inflammation. Obesity therapy approaches include lifestyle change therapy, pharmacological, and surgical intervention in cases of morbid obesity, where one of the most recent types of surgery is One Anastomosis Gastric Bypass (OAGB). OAGB has been studied and proven effective in reducing body weight in the management of obesity, but its physiological and molecular mechanisms are still not fully understood in terms of inflammation, adipose tissue changes, and hormones. Therefore, this study aims to evaluate the effects of OAGB on ghrelin levels, body weight, white fat cell size, TNF-α levels, and IL-18, and IL-10 levels in obese male Wistar rats (Rattus novergicus L.). This study used an experimental design with a randomized post-test only control group design. The subjects of the study were 33 male Wistar rats (Rattus norvegicus L.) randomly divided into three groups: non-obese control group without surgery (P0), obese group without surgery (P1), and obese group undergoing One Anastomosis Gastric Bypass (OAGB) procedure (P2). Rats in the obese group were induced using a high-fat diet and sucrose water. The analysis used parametric tests with One-Way ANOVA to compare ghrelin levels, body weight, white fat cell size, and TNF-α, IL-18, and IL-10 levels and continued with Post-Hoc Test. Path analysis regression with Structural Equation Model (SEM) was performed to test the influence between research parameters.
One-Way ANOVA and Post-Hoc tests showed that the parameters of ghrelin levels, body weight, white fat cell size, and IL-18 were significantly lower in P2 when compared to P1 (p < 0.05). IL-10 levels in group P2 were observed to be higher compared to group P1 (p< 0.05). Compared to the untreated control group (P0), ghrelin, body weight, and white fat cell size showed significantly lower levels and sizes (p< 0.05) while IL-10 levels were observed to be significantly higher in P2 (p = 0.001). However, IL-18 levels were not significantly different between groups P0 and P2. There was no significant difference between TNF-α levels in all study groups. Path analysis regression using structural equation model (SEM) showed that body weight was significantly correlated with white fat cell size (estimate = 0.68; p = 0.001) and TNF-α levels (estimate = 2.67; p = 0.03), while the relationship with IL-10 and IL-18 was not significant. Ghrelin had no significant effect on white fat cell size or cytokine levels. However, there was a strong relationship between body weight and ghrelin (r² = 0.519; p = 0.009), indicating that weight gain is closely related to ghrelin levels.
OAGB surgery in obese Wistar rats can reduce ghrelin levels, body weight, fat cell size, and IL-18 levels and increase IL-10 levels. However, OAGB had no significant impact on TNF-α levels. This shows the effectiveness of OAGB in reducing body weight and its histological effects on white fat tissue, hormonal, and inflammation.
This examination was led by the Dean of the Faculty of Medicine, Udayana University, Prof. Dr. dr. Komang Januartha Putra Pinatih, M.Kes., with the examination team:
1. Prof. Dr. dr. Ketut Suastika, Sp.PD-KEMD (Promoter)
2. Dr. dr. Made Ratna Saraswati, Sp.PD, KEMD., FINASIM (Copromotor I)
3. Dr. dr. Ni Putu Sriwidyani, Sp.PA., Subsp.S.M.(K) (Co-promoter II)
4. Prof. Dr. dr. I Gde Raka Widiana, Sp.PD-KGH
5. Prof. Dr. dr. I Wayan Weta, MS., Sp.GK
6. Prof. Dr. dr. I Made Sudarmaja, M.Kes
7. Prof. Dr. dr. R.A. Tuty Kuswardhani, Sp.PD., K-Ger, M.Kes, M.H
8. Dr. dr. Wira Gotera, Sp.PD-KEMD-FINASIM
9. Dr. dr. I Ketut Mariadi, Sp.PD-KGEH, FACG, FINASIM
With academic invitation:
1. Dr. dr. Ida Ayu Ika Wahyuniari, M.Kes
2. Dr. dr. I Wayan Losen Adnyana, Sp.PD-KHOM, FINASIM
3.Dr. Dr. Kadek Mulyantari, Sp.PK, Subsp.BDKT(K)
4.Dr. Dr. Luh Oliva Saraswati Suastika, Sp.JP Eko.(K), FIHA
5.Dr. Dr. Ni Made Renny Anggreni Rena, Sp.PD., KHOM., FINASIM
In this exam, Dr. dr. Tjokorda Istri Anom Saturti, SpPD., FINASIM., MARS was declared to have passed as the 453rd Doctoral Graduate of the Doctoral Program in Medical Sciences, Faculty of Medicine, Udayana University with the predicate CUMLAUDE.
UDAYANA UNIVERSITY