Abstract
PurposeBariatric surgery (BS) induces a significant and sustained weight loss in patients with severe obesity (SO). Nevertheless, apart from significantly reducing body fat, fat-free mass (FFM) might also be lost. At present, there is little and controversial data in the literature regarding the impact of BS on FFM. In recent years, bioimpedance (BIA) has emerged as a reliable test to assess body composition easily to use in the daily clinical practice. On the bases, the aim of the present study is to evaluate the impact of BS on the FFM, evaluated by means of BIA.Material and MethodsThis is a prospective, observational study, including consecutive patients with SO that underwent BS between February 2018 and February 2019 at our center. At baseline, 1, 6, 12, and 24 months after the BS, all the patients underwent complete medical history, physical and anthropometric evaluation, and body composition assessment by means of BIA (using Bodystat QuadScan4000®).ResultsEighty-five patients with SO were recruited, 72.9% females, aged 45.54 ± 9.98 years, pre-BS BMI 43.87 ± 6.52 kg/m2. FFM significantly decreased continuously after BS at all timepoints. The loss of FFM 24 months post-BS accounted for approximately 21.71 ± 13.9% of the total weight loss, and was independent of BS technique or protein metabolism. Pre-BS HOMA-IR and FFM were independent predictors of FFM at 24 months.ConclusionsSignificant and early loss of FFM in patients with SO that undergo BS was seen, not related to protein metabolism parameters or the BS technique used, suggesting an independent mechanism.Graphical abstract
Highlights
The prevalence of obesity has increased worldwide over the last 50 years, reaching pandemic levels, in particular severe obesity (SO)
We showed in the present study that Bariatric surgery (BS) induces a significant and early loss of fat-free mass (FFM) after the BS, independent of protein metabolism, without significant differences between the BS techniques (RYGB and Sleeve gastrectomy (SG))
Our group showed that BS induces a significant reduction in basal metabolism rate starting 1 month after the BS in patients with extreme obesity that was associated with weight regain at 5-year follow-up [26]
Summary
The prevalence of obesity has increased worldwide over the last 50 years, reaching pandemic levels, in particular severe obesity (SO). Obesity Surgery challenge, and it is associated with a significant economic burden on the health systems of developed countries, mainly due to the associated comorbidities, in particular type 2 diabetes (T2D) [1,2,3]. Sarcopenic obesity (OS) is the combination of low muscle mass and strength with increased fat mass, and it has been associated with adverse health outcomes [6]. A recent meta-analysis found that the presence of OS was associated with a higher risk (OR 1.38, 95% CI [1.27–1.50]) of T2D than with each condition separately (obesity or sarcopenia) [7]. The complete underlying mechanism is still unclear, but it seems that there is a bi-directional relationship, having as main factors chronic inflammation and insulin resistance (IR)
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