Abstract
Background: Ectopic fat deposition in obesity is associated with organ dysfunction; however, little is known about fat deposition within the lymphatic system and associated lymphatic dysfunction. Methods: One hundred fifty-five women who underwent routine screening mammography before and after a Roux-en-y gastric bypass or a sleeve gastrectomy were retrospectively reviewed and after excluding women without visible nodes both before and after bariatric surgery, 84 patients were included in the final analysis. Axillary lymph node size, patient weight in kilograms, body mass index, and a diagnosis of hypertension, type 2 diabetes, and dyslipidemia were evaluated before and after surgery. Binary linear regression models and Fischer’s exact test were used to evaluate the relationship between the size of fat-infiltrated axillary lymph nodes, patient age, change in patient weight, and diagnosis of hypertension, type 2 diabetes, and dyslipidemia. Results: Fat-infiltrated axillary lymph nodes demonstrated a statistically significant decrease in size after bariatric surgery with a mean decrease of 4.23 mm (95% CI: 3.23 to 5.2, p < 0.001). The resolution of dyslipidemia was associated with a decrease in lymph node size independent of weight loss (p = 0.006). Conclusions: Mammographically visualized fat-infiltrated axillary lymph nodes demonstrated a statistically significant decrease in size after bariatric surgery. The decrease in lymph node size was significantly associated with the resolution of dyslipidemia, independent of weight loss, age, and type of surgery.
Highlights
The incidence of obesity is steadily increasing with current data estimating that over 30% of adults worldwide are obese [1]
Our study showed that fat-expanded axillary lymph nodes may decrease in size after weight loss, and that a decrease in fatty lymph node size was associated with the resolution of dyslipidemia independent of patient age and weight loss (p = 0.006)
Serum LDL value is the focal point of treatment and drives the clinical decision to initiate statin therapy; optimizing LDL levels is the main goal of current guidelines, including the American Heart Association and the American College of Cardiology [19]
Summary
The incidence of obesity is steadily increasing with current data estimating that over 30% of adults worldwide are obese [1]. This heterogeneity may explain why approximately 10–30% of people with obesity, defined by BMI, do not manifest cardio-metabolic disease This phenotype of “metabolically healthy obesity” is associated with lower ectopic fat within and around organs. This is consistent with evidence demonstrating that the distribution of excess fat throughout the body is more closely correlated with cardiometabolic disease and adverse health outcomes than BMI [2,3]. Patient weight in kilograms, body mass index, and a diagnosis of hypertension, type 2 diabetes, and dyslipidemia were evaluated before and after surgery. The decrease in lymph node size was significantly associated with the resolution of dyslipidemia, independent of weight loss, age, and type of surgery
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