Abstract
PurposeVisceral adipose tissue (VAT) is associated with cardiometabolic risk factors and insulin resistance. The physiological mechanisms underlying the benefits of Roux-en-Y gastric bypass surgery (RYGB) on glucose metabolism remain incompletely understood. The impact of RYGB on VAT was assessed among three groups of patients stratified by their glucose tolerance before surgery.MethodsForty-four obese women were categorized into normoglycemia (n = 21), impaired glucose tolerance (IGT, n = 18) and diabetes (n = 5) before surgery. Body composition measured by dual-energy X-ray absorptiometry (DXA) was performed before surgery, 6 months and 12 months after.ResultsThe three groups had comparable mean age (mean 38.6 ± SD 9.9) and BMI at baseline (41.9 ± 4.3 kg/m2). After 12 months, total weight loss (mean 35.1% ± 7.5) and excess weight loss (91.1% ± 25.1) were similar between groups. Pre-surgery mean VAT was significantly higher in diabetes (mean 2495 ± 616 g) than in normoglycemia (1750 ± 617 g, p = 0.02). The percentage of VAT to total body fat was significantly higher in diabetes (mean 4.4% ± 0.9) compared to normoglycemia (2.9% ± 0.8, p = 0.003). Twelve months after surgery, VAT loss was significantly greater among patients with diabetes (mean 1927 ± 413 g) compared to normoglycemia (1202 ± 450, p = 0.009).ConclusionsRYGB leads to important VAT loss, and this loss is greater in patients with diabetes prior to surgery. As VAT is associated with insulin resistance, this reduction may account for the profound impact of this surgery on glucose metabolism.
Highlights
MethodsIn recent years, bariatric surgery has been shown to be the most effective strategy to achieve a significant and sustained long-term weight loss in severely obese patients [1]
Considering the profound influence of visceral adipose tissue (VAT) on glucose metabolism, we aimed to investigate the impact of weight loss after Roux-en-Y gastric bypass surgery (RYGB) on body composition and VAT, as measured by dual-energy Xray absorptiometry (DXA) among patients stratified by their glucose tolerance before surgery
The mechanisms underlying the profound impact of RYGB on glucose metabolism are not yet fully understood, and a reduction in VAT may account for a crucial role
Summary
MethodsIn recent years, bariatric surgery has been shown to be the most effective strategy to achieve a significant and sustained long-term weight loss in severely obese patients [1]. Obesity is associated with an increased risk of metabolic comorbidities including type 2 diabetes. Abdominal fat has long been associated with insulin resistance and increased cardiovascular risk [10, 11]. VAT surrounds the internal organs and is associated with higher cardiometabolic risk and insulin resistance [14] It is increased in patients with impaired glucose tolerance (IGT) or type 2 diabetes compared to patients with normal glucose tolerance [15]. The modest weight reduction of 4.5% over 12 months of follow-up was accompanied by a marked reduction of 12% in VAT In their recent article, Chooi et al described the effect of a 5% diet-induced weight loss on body composition in 11 metabolically unhealthy lean Asian individuals (mean baseline BMI 22.7 kg/m2) [19]. The weight loss achieved in 6 to 16 weeks resulted in a reduction of total fat mass by 9%, reduction of VAT by 11% and in an increase in peripheral insulin sensitivity
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