Elsevier

Surgery for Obesity and Related Diseases

Volume 2, Issue 6, November–December 2006, Pages 592-599
Surgery for Obesity and Related Diseases

Original article
Improvements in systemic metabolism, anthropometrics, and left ventricular geometry 3 months after bariatric surgery

https://doi.org/10.1016/j.soard.2006.09.005Get rights and content

Abstract

Background

Several lines of evidence have suggested a link between obesity and heart failure, including chronic inflammation, increased sympathetic tone, and insulin resistance. The goal of this study was to evaluate the changes in systemic metabolism, anthropometrics, and left ventricular (LV) contraction, as well as geometry, in clinically severe obese women after bariatric surgery.

Methods

Enrollment was offered consecutively to 22 women with clinically severe obesity. Participants underwent abdominal magnetic resonance imaging to quantify the visceral adipose tissue (VAT) area and tissue Doppler imaging echocardiography to measure the LV contractile function. Fasting blood chemistries were drawn to measure inflammatory markers and to calculate insulin sensitivity. All tests were performed before surgery and 3 months postoperatively.

Results

Three months after surgery, a significant increase in insulin sensitivity (mean change ± SEM 34.0 ± 10.4, P <.0001) was present. The VAT area had significantly decreased (−66.1 ± 17.8 cm2, P = .002) and was associated with decreases in body mass index, serum glucose concentrations, and high-sensitivity C-reactive protein levels (r = .61 and P = .005, r = .48 and P = .033, and r = .53 and P = .016, respectively). The LV mass decreased significantly (−3.8 ± 1.7 g/m2.7, P = .037), and this decrease was associated with a decrease in glucose concentration (r = .46, P = .041). The LV systolic and diastolic contractile function were normal at baseline, and no change occurred after surgery.

Conclusion

The early phase of weight loss after bariatric surgery produces favorable changes in LV geometry, and these are associated with normalization in the glucose metabolism.

Section snippets

Subject Selection

We offered participation to consecutive patients, of any race/ethnicity, from the University of Texas, Houston Bariatric Surgery Center, who met the candidacy requirements for bariatric surgery, as outlined previously [10]. In brief, they included a body mass index (BMI) >40 kg/m2 (or ≥35 kg/m2 with significant obesity-related co-morbidities), normal psychological evaluation findings, a history of multiple failed medically managed weight loss attempts, and an absence of any genetic or

Baseline Characteristics

The baseline clinical and demographic characteristics are shown in Table 1. The mean age ± SEM and BMI was 44 ± 2.1 years and 46.8 ± 1.4 kg/m2, respectively. The mean resting heart rate and blood pressure were normal. All patients met the criteria for abdominal obesity as determined from the waist circumference. The abdominal VAT area was 232 ± 18.5 cm2 at baseline, an area that has been demonstrated to predict for significant cardiovascular risk in women [23]. Even though only slightly greater

Discussion

In this prospective, longitudinal study after bariatric surgery, we have demonstrated improvements in systemic metabolism and profound decreases in weight and VAT during the first 3 postoperative months. Concurrent with these changes was a decrease in LV hypertrophy, but no change in LV contractile function, at 3 months postoperatively.

The causes of LV hypertrophy include obesity, activation of the sympathetic nervous system [26], and derangements in glucose and insulin metabolism [27]. We have

Conclusion

The results of this study have shown that the early phase of weight loss after bariatric surgery produces favorable changes in LV geometry that are associated with changes in glucose metabolism. The improvement in anthropometric measures and decreases in sympathetic tone, as a consequence of weight loss, may also play a role in decreased LV hypertrophy.

Acknowledgments

We thank E. Jane Meyers for her administrative support and Mark Punyanitya for his technical assistance with the MRI analysis; we also acknowledge Roxy Tate for her technical and editorial assistance.

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    Supported in part from the National Institutes of Health, National Heart, Lung, and Blood Institute (5RO1 HL073162-02) to H. Taegtmeyer; American Society of Bariatric Surgeons Research grant to E. B. Wilson; and University of Texas Houston General Clinical Research Center (grant M01RR002558)

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