Rate and Determinants of Excessive Fat-Free Mass Loss After Bariatric Surgery

Malou A H Nuijten,Valerie M Monpellier,Ignace M C Janssen,Maria T E Hopman,Thijs M H Eijsvogels,Eric J Hazebroek

doi:10.1007/s11695-020-04654-6

Abstract

PurposeFat-free mass (FFM) loss is a concerning aspect of bariatric surgery, but little is known about its time-course and factors related with excessive FFM loss. This study examined (i) the progress of FFM loss up to 3 years post-bariatric surgery and (ii) the prevalence and determinants of excessive FFM loss.Materials and MethodsA total of 3596 patients (20% males, 43.5 ± 11.1 years old, BMI = 44.2 ± 5.5 kg/m2) underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. Bioelectrical impedance analysis was performed preoperatively and 3, 6, 9, 12, 18, 24 and 36 months post-surgery. Changes in body composition were assessed by mixed model analysis. Prevalence of excessive FFM loss (based on three different cutoff values: ≥ 25%, ≥ 30% and ≥ 35% FFM loss/weight loss (= %FFML/WL)) was estimated and its determinants were assessed by linear regression analysis.ResultsHighest rates of FFM loss were found at 3 and 6 months post-surgery, reflecting 57% and 73% of peak FFM loss, respectively. Prevalence of excessive FFM loss ranged from 14 to 46% at 36 months post-surgery, with an older age (β = 0.14, 95%CI = 0.10–0.18, P < .001), being male (β = 3.99, 95%CI = 2.86–5.12, P < .001), higher BMI (β = 0.13, 95%CI = 0.05–0.20, P = .002) and SG (β = 2.56, 95%CI = 1.36–3.76, P < .001) as determinants for a greater %FFML/WL.ConclusionPatients lost most FFM within 3 to 6 months post-surgery. Prevalence of excessive FFM loss was high, emphasizing the need for more vigorous approaches to counteract FFM loss. Furthermore, future studies should assess habitual physical activity and dietary intake shortly after surgery in relation to FFM loss.

Highlights

Bariatric surgery is considered the most effective strategy in patients with morbid obesity to achieve long-lasting weight loss, improve quality of life and reduce comorbidities [1, 2].Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Arnhem, The Netherlandsbariatric surgery is associated with nutritional deficiencies and excessive loss of fat-free mass (FFM) [3, 4]
I.e. lowest weight, BMI and fat percentage, was reached at 18 months post-surgery with a corresponding 33.1% TWL and 79.4% EWL. After this 18-month time point, some weight regain of approximately 4.3 kg occurred up to 36 months post-surgery, which mainly consisted of a significant increase in fat mass (+ 4.0 kg) whereas FFM stabilized after 18 months post-surgery
The present study examined the progress of FFM loss up to 36 months after bariatric surgery and determined the prevalence and determinants of excessive FFM loss

Summary

Introduction

Excessive FFM loss is detrimental for patients because this may lead to difficulties in daily life activities, lower quality of life, weight regain, fat accumulation and higher risk of developing sarcopenia and osteoporosis [5,6,7,8]. These consequences are especially of concern in post-bariatric patients since they may counteract the long-term success of surgery in terms of weight loss, quality of life and reduction of comorbidities

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