Metabolic Impact of Body Fat Percentage Independent of Body Mass Index in Women with Obesity Remission After Gastric Bypass

Daniel Eriksson Hogling,Jesper Bäckdahl,Anders Thorell,Mikael Rydén,Daniel P Andersson

doi:10.1007/s11695-019-04304-6

Daniel Eriksson Hogling, Jesper Bäckdahl + Show 3 more

Open Access

https://doi.org/10.1007/s11695-019-04304-6

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Abstract

Background/ObjectiveBody mass index (BMI) is central when evaluating treatment effect after gastric bypass. The metabolic impact of BMI-independent differences in body fat percentage (BF%) after gastric bypass is not fully understood. We compared metabolic and adipose tissue characteristics in women with high versus low BF% independent of BMI after obesity remission following gastric bypass.Subjects/MethodsA cohort of 215 women was included at baseline. A total of 166 women were re-examined 2 years after gastric bypass, whereof 130 had obesity remission (BMI < 30 kg/m2). Anthropometric parameters, blood pressure, and lipids were measured. Total and regional body fat mass was determined by dual-energy X-ray absorptiometry. Insulin sensitivity was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and hyperinsulinemic euglycemic clamp (M value). Adipocyte size and number were determined.ResultsOf the 130 women with obesity remission, 64 had BF% ≥ 35 and 65 < 35. Independent of BMI, high BF% were associated with higher HOMA-IR (P = 0.021), lower M value (P = 0.0046), higher triglycerides (P = 0.013), higher visceral/total and android/gynoid fat mass ratios (P = 0.0032 and 0.0003 respectively), and larger subcutaneous fat cell volume (P < 0.0001) 2 years after gastric bypass. No differences in anthropometric measures, glucose, blood pressure, or fat cell number were observed.ConclusionsIndependent of BMI, patients with higher BF% displayed lower insulin sensitivity, higher triglyceride levels, central fat distribution, and larger subcutaneous adipocytes 2 years after gastric bypass. Thus, determination of BF% provides additional information of metabolic characteristics at follow-up of non-obese patients after gastric bypass.

Highlights

Body mass index (BMI) is the standard anthropometric measure for the categorization of overweight and obesity [1]
We investigated if BMIindependent differences in BF% are associated with differences in metabolic function, anthropometric measures, or adipose tissue characteristics in patients reaching a non-obese state after Roux-en-Y gastric bypass (RYGB)
We demonstrate that high BF% in women with obesity remission after RYGB is associated with reduced insulin sensitivity, higher TG concentration, and a more unfavorable body fat distribution, independent of BMI

Summary

Introduction

Body mass index (BMI) is the standard anthropometric measure for the categorization of overweight and obesity [1]. High body fat percentage (BF%), often defined as ≥ 35% in women, is reported in up to 50% of the population with a BMI within the non-obese range [2,3,4,5] and is linked to worse metabolic parameters [3, 6] including disturbed glucose metabolism [7] and future risk of type 2 diabetes [8] Bariatric surgery, such as Roux-en-Y gastric bypass (RYGB), remains the most effective treatment of obesity [9,10,11]. Postoperative BMI is central in the evaluation of treatment effect, and is the most frequently

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