Abstract
Weight loss in metabolically healthy obese (MHO) subjects may result in deterioration of cardio-metabolic risk profile. We analyzed the effects of weight loss induced by laparoscopic adjustable gastric banding (LAGB) on cardio-metabolic risk factors in MHO and insulin resistant obese (IRO) individuals. This study included 190 morbidly obese non-diabetic subjects. Obese individuals were stratified on the basis of their insulin sensitivity index (ISI), estimated from an OGTT, into MHO (ISI index in the upper quartile) and IRO (ISI in the three lower quartiles). Anthropometric and cardio-metabolic variables were measured at baseline and 6-months after LAGB. Six months after LAGB, anthropometric measures were significantly reduced in both MHO and IRO. Percent changes in body weight, BMI, and waist circumference did not differ between the two groups. Fasting glucose and insulin levels, triglycerides, AST, and ALT were significantly reduced, and HDL cholesterol significantly increased, in both MHO and IRO subjects with no differences in percent changes from baseline. Insulin sensitivity increased in both MHO and IRO group. Insulin secretion was significantly reduced in the IRO group only. However, the disposition index significantly increased in both MHO and IRO individuals with no differences in percent changes from baseline between the two groups. The change in insulin sensitivity correlated with the change in BMI (r = −0.43; P<0.0001). In conclusion, our findings reinforce the recommendation that weight loss in response to LAGB intervention should be considered an appropriate treatment option for morbidly obese individuals regardless of their metabolic status, i.e. MHO vs. IRO subjects.
Highlights
Increasing evidence suggests that a subset of relatively insulin sensitive obese subjects, referred to as metabolically healthy obese (MHO) individuals, has a favorable cardio-metabolic risk profile and a lower risk for type 2 diabetes and cardio-vascular disease, as compared with insulin resistant obese (IRO) subjects [1,2]
Increasing evidence suggests that obesity is a heterogeneous disorder with a subset of obese subjects, known as metabolically healthy obese (MHO), that appears to be protected against obesity-related cardio-metabolic abnormalities [1,2,3,4,5,6,7,8,9,10,11]
Recent studies have raised the question of whether MHO subjects may gain any additional cardio-metabolic benefit from weight loss; three studies have reported no change in cardio-metabolic risk profile or a paradoxical deterioration in insulin sensitivity in MHO subjects despite significant weight loss [12,13,14], whereas one study has shown an improvement in cardio-metabolic risk factors among MHO individuals after lifestyle intervention [15]
Summary
Increasing evidence suggests that a subset of relatively insulin sensitive obese subjects, referred to as metabolically healthy obese (MHO) individuals, has a favorable cardio-metabolic risk profile and a lower risk for type 2 diabetes and cardio-vascular disease, as compared with insulin resistant obese (IRO) subjects [1,2]. Studies assessing the effects of lifestyle interventions, including diet and/or exercise, in MHO individuals have led to divergent results [12,13,14,15]. Three studies have reported an improvement in the cardiometabolic risk profile in IRO, but not in MHO, subjects, despite similar weight loss [12,13,14], whereas one study has shown an improvement in cardio-metabolic risk factors of MHO individuals after a weight loss intervention [15]. Because bariatric surgery-induced weight loss is associated with an improvement of the cardio-metabolic risk profile in morbidly obese subjects [16,17], we sought to investigate the effects of LAGB-induced weight loss on cardio-metabolic risk factors among MHO and IRO individuals
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