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Erschienen in: Obesity Surgery 12/2019

15.07.2019 | Original Contributions

Weight Loss and Changes in Adipose Tissue and Skeletal Muscle Volume after Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study with 12-Month Follow-Up

verfasst von: Hannes Götz Kenngott, Felix Nickel, Philipp Anthony Wise, Felix Wagner, Adrian Theophil Billeter, Johanna Nattenmüller, Diana Nabers, Klaus Maier-Hein, Hans-Ulrich Kauczor, Lars Fischer, Beat Peter Müller-Stich

Erschienen in: Obesity Surgery | Ausgabe 12/2019

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Abstract

Background

This study aimed to evaluate changes in body tissue composition with obesity surgery regarding visceral fat, subcutaneous fat, and skeletal muscle.

Design

Prospective non-randomized single-center cohort study

Methods

Whole-body magnetic resonance imaging (MRI) measured volumes of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle (SM) in 31 patients with laparoscopic sleeve gastrectomy (LSG, 20) or Roux-en-Y gastric bypass (RYGB, 11) preoperatively, at three- and 12-months follow-up.

Results

Body mass index (BMI) went down from 45.2 ± 6.5 preoperatively to 37.2 ± 5.6 (p < 0.001) at three months and 32.2 ± 5.3 kg/m2 (p < 0.001) at 12 months. SAT went down from 55.0 ± 14.0 L (liter) to 42.2 ± 13.3 L (p < 0.001) at three months and 31.7 ± 10.5 L (p < 0.001) at 12 months (− 42.3%). VAT went down from 6.5 ± 2.3 to 4.5 ± 1.7 (p < 0.001) at three months and 3.1 ± 1.7 L (p < 0.001) at 12 months (− 52.3%). SM went down from 22.7 ± 4.8 to 20.4 ± 3.6 (p = 0.008) at three months and remained 20.2 ± 4.6 L at 12 months (p = 0.17 relative three-month; p = 0.04 relative preop, − 11.1%). Relative loss was higher for VAT than that for SAT (52.3 ± 18.2% vs. 42.3 ± 13.8%; p = 0.03). At 12 months, there was no difference between LSG and RYGB for relative changes in BMI or body tissue composition.

Conclusion

Postoperatively, there was higher net loss of SAT but higher relative loss of VAT with weight loss. SM was lost only during the first three months. MRI provides accurate evaluation of surgeries’ effect on individual patients’ tissue composition. This can benefit risk assessment for related cardiovascular and metabolic health but cost-related factors will likely reserve the used methods for research.
Literatur
1.
Zurück zum Zitat Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13(3):329–30.PubMed Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13(3):329–30.PubMed
2.
Zurück zum Zitat Finkelstein EA, Khavjou O, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563–70.PubMed Finkelstein EA, Khavjou O, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563–70.PubMed
3.
4.
Zurück zum Zitat Kissler HJ, Settmacher U. Bariatric surgery to treat obesity. Semin Nephrol. 2013;33(1):75–89.PubMed Kissler HJ, Settmacher U. Bariatric surgery to treat obesity. Semin Nephrol. 2013;33(1):75–89.PubMed
5.
Zurück zum Zitat Billeter AT, de la Garza Herrera JR, Scheurlen KM, et al. Management of endocrine disease: which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol. 2018;179(2):R77–93.PubMed Billeter AT, de la Garza Herrera JR, Scheurlen KM, et al. Management of endocrine disease: which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol. 2018;179(2):R77–93.PubMed
7.
Zurück zum Zitat Nickel F, Schmidt L, Bruckner T, et al. Gastrointestinal quality of life improves significantly after sleeve gastrectomy and Roux-en-Y gastric bypass-a prospective cross-sectional study within a 2-year follow-up. Obes Surg. 2017;27(5):1292–7.PubMed Nickel F, Schmidt L, Bruckner T, et al. Gastrointestinal quality of life improves significantly after sleeve gastrectomy and Roux-en-Y gastric bypass-a prospective cross-sectional study within a 2-year follow-up. Obes Surg. 2017;27(5):1292–7.PubMed
8.
Zurück zum Zitat Nickel F, Schmidt L, Bruckner T, et al. Influence of bariatric surgery on quality of life, body image, and general self-efficacy within 6 and 24 months-a prospective cohort study. Surg Obes Relat Dis. 2017;13(2):313–9.PubMed Nickel F, Schmidt L, Bruckner T, et al. Influence of bariatric surgery on quality of life, body image, and general self-efficacy within 6 and 24 months-a prospective cohort study. Surg Obes Relat Dis. 2017;13(2):313–9.PubMed
9.
Zurück zum Zitat Nickel F, Tapking C, Benner L, et al. Bariatric surgery as an efficient treatment for non-alcoholic fatty liver disease in a prospective study with 1-year follow-up: BariScan study. Obes Surg. 2018;28(5):1342–50.PubMed Nickel F, Tapking C, Benner L, et al. Bariatric surgery as an efficient treatment for non-alcoholic fatty liver disease in a prospective study with 1-year follow-up: BariScan study. Obes Surg. 2018;28(5):1342–50.PubMed
10.
Zurück zum Zitat Pourhassan M, Gluer CC, Pick P, et al. Impact of weight loss-associated changes in detailed body composition as assessed by whole-body MRI on plasma insulin levels and homeostatis model assessment index. Eur J Clin Nutr. 2017;71(2):212–8.PubMed Pourhassan M, Gluer CC, Pick P, et al. Impact of weight loss-associated changes in detailed body composition as assessed by whole-body MRI on plasma insulin levels and homeostatis model assessment index. Eur J Clin Nutr. 2017;71(2):212–8.PubMed
11.
Zurück zum Zitat Baskota A, Li S, Dhakal N, et al. Bariatric surgery for type 2 diabetes mellitus in patients with BMI <30 kg/m2: a systematic review and meta-analysis. PLoS One. 2015;10(7):e0132335PubMedPubMedCentral Baskota A, Li S, Dhakal N, et al. Bariatric surgery for type 2 diabetes mellitus in patients with BMI <30 kg/m2: a systematic review and meta-analysis. PLoS One. 2015;10(7):e0132335PubMedPubMedCentral
12.
Zurück zum Zitat Lee CJ, Cheskin LJ. Bariatric surgery improved HbA1c at 5 y more than intensive medical care alone in obese patients with T2DM. Ann Intern Med. 2017;166(10):JC57PubMed Lee CJ, Cheskin LJ. Bariatric surgery improved HbA1c at 5 y more than intensive medical care alone in obese patients with T2DM. Ann Intern Med. 2017;166(10):JC57PubMed
13.
Zurück zum Zitat Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21(6):697–738.PubMed Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21(6):697–738.PubMed
14.
Zurück zum Zitat Öhman MK, Wright AP, Wickenheiser KJ, et al. Visceral adipose tissue and atherosclerosis. Curr Vasc Pharmacol. 2009;7(2):169–79.PubMed Öhman MK, Wright AP, Wickenheiser KJ, et al. Visceral adipose tissue and atherosclerosis. Curr Vasc Pharmacol. 2009;7(2):169–79.PubMed
15.
Zurück zum Zitat Duren DL, Sherwood RJ, Czerwinski SA, et al. Body composition methods: comparisons and interpretation. J Diabetes Sci Technol. 2008;2(6):1139–46.PubMedPubMedCentral Duren DL, Sherwood RJ, Czerwinski SA, et al. Body composition methods: comparisons and interpretation. J Diabetes Sci Technol. 2008;2(6):1139–46.PubMedPubMedCentral
16.
Zurück zum Zitat Lee SJ, Kuk JL. Changes in fat and skeletal muscle with exercise training in obese adolescents: comparison of whole-body MRI and dual energy X-ray absorptiometry. Obesity (Silver Spring). 2013;21(10):2063–71. Lee SJ, Kuk JL. Changes in fat and skeletal muscle with exercise training in obese adolescents: comparison of whole-body MRI and dual energy X-ray absorptiometry. Obesity (Silver Spring). 2013;21(10):2063–71.
17.
Zurück zum Zitat Vogt LJ, Steveling A, Meffert PJ, et al. Magnetic resonance imaging of changes in abdominal compartments in obese diabetics during a low-calorie weight-loss program. PLoS One. 2016;11(4):e0153595PubMedPubMedCentral Vogt LJ, Steveling A, Meffert PJ, et al. Magnetic resonance imaging of changes in abdominal compartments in obese diabetics during a low-calorie weight-loss program. PLoS One. 2016;11(4):e0153595PubMedPubMedCentral
18.
Zurück zum Zitat Lemos T, Gallagher D. Current body composition measurement techniques. Current Opin Endocrinol Diabetes Obes. 2017;24(5):310–4. Lemos T, Gallagher D. Current body composition measurement techniques. Current Opin Endocrinol Diabetes Obes. 2017;24(5):310–4.
19.
Zurück zum Zitat Evers SS, Lewis AG, Tong C, Shao Y, Alvarez R, Ridelman E, et al. The unconventional role for gastric volume in the response to bariatric surgery for both weight loss and glucose lowering. Annals of Surgery. 9000; Publish Ahead of Print. Evers SS, Lewis AG, Tong C, Shao Y, Alvarez R, Ridelman E, et al. The unconventional role for gastric volume in the response to bariatric surgery for both weight loss and glucose lowering. Annals of Surgery. 9000; Publish Ahead of Print.
20.
Zurück zum Zitat Wald D, Teucher B, Dinkel J, et al. Automatic quantification of subcutaneous and visceral adipose tissue from whole-body magnetic resonance images suitable for large cohort studies. J Magn Reson Imaging. 2012;36(6):1421–34.PubMed Wald D, Teucher B, Dinkel J, et al. Automatic quantification of subcutaneous and visceral adipose tissue from whole-body magnetic resonance images suitable for large cohort studies. J Magn Reson Imaging. 2012;36(6):1421–34.PubMed
21.
Zurück zum Zitat Preis SR, Massaro JM, Robins SJ, et al. Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham heart study. Obesity (Silver Spring). 2010;18(11):2191–8. Preis SR, Massaro JM, Robins SJ, et al. Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham heart study. Obesity (Silver Spring). 2010;18(11):2191–8.
22.
Zurück zum Zitat Zhao L, Zhu L, Su Z, et al. The role of visceral adipose tissue on improvement in insulin sensitivity following Roux-en-Y gastric bypass: a study in Chinese diabetic patients with mild and central obesity. Gastroenterol Rep (Oxf). 2018;6(4):298–303. Zhao L, Zhu L, Su Z, et al. The role of visceral adipose tissue on improvement in insulin sensitivity following Roux-en-Y gastric bypass: a study in Chinese diabetic patients with mild and central obesity. Gastroenterol Rep (Oxf). 2018;6(4):298–303.
23.
Zurück zum Zitat Trembling PM, Apostolidou S, Gentry-Maharaj A, et al. Risk of chronic liver disease in post-menopausal women due to body mass index, alcohol and their interaction: a prospective nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). BMC Public Health. 2017;17(1):603.PubMedPubMedCentral Trembling PM, Apostolidou S, Gentry-Maharaj A, et al. Risk of chronic liver disease in post-menopausal women due to body mass index, alcohol and their interaction: a prospective nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). BMC Public Health. 2017;17(1):603.PubMedPubMedCentral
24.
Zurück zum Zitat Yu AH, Duan-Mu YY, Zhang Y, et al. Correlation between non-alcoholic fatty liver disease and visceral adipose tissue in non-obese Chinese adults: a CT evaluation. Korean J Radiol. 2018;19(5):923–9.PubMedPubMedCentral Yu AH, Duan-Mu YY, Zhang Y, et al. Correlation between non-alcoholic fatty liver disease and visceral adipose tissue in non-obese Chinese adults: a CT evaluation. Korean J Radiol. 2018;19(5):923–9.PubMedPubMedCentral
25.
Zurück zum Zitat Akil L, Ahmad HA. Relationships between obesity and cardiovascular diseases in four southern states and Colorado. J Health Care Poor Underserved. 2011;22(4 Suppl):61–72.PubMedPubMedCentral Akil L, Ahmad HA. Relationships between obesity and cardiovascular diseases in four southern states and Colorado. J Health Care Poor Underserved. 2011;22(4 Suppl):61–72.PubMedPubMedCentral
26.
Zurück zum Zitat Kim JH, Choi KH, Kang KW, Kim JT, Choi SM, Lee SH, et al. Impact of visceral adipose tissue on clinical outcomes after acute ischemic stroke. Stroke. 2019;50(2):448-454.PubMed Kim JH, Choi KH, Kang KW, Kim JT, Choi SM, Lee SH, et al. Impact of visceral adipose tissue on clinical outcomes after acute ischemic stroke. Stroke. 2019;50(2):448-454.PubMed
27.
Zurück zum Zitat Kirwan JP, Aminian A, Kashyap SR, et al. Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care. 2016;39(6):941–8.PubMedPubMedCentral Kirwan JP, Aminian A, Kashyap SR, et al. Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care. 2016;39(6):941–8.PubMedPubMedCentral
28.
Zurück zum Zitat Dixon SC, Nagle CM, Thrift AP, et al. Adult body mass index and risk of ovarian cancer by subtype: a Mendelian randomization study. Int J Epidemiol. 2016;45(3):884–95.PubMedPubMedCentral Dixon SC, Nagle CM, Thrift AP, et al. Adult body mass index and risk of ovarian cancer by subtype: a Mendelian randomization study. Int J Epidemiol. 2016;45(3):884–95.PubMedPubMedCentral
29.
Zurück zum Zitat Poorolajal J, Jenabi E, Masoumi SZ. Body mass index effects on risk of ovarian cancer: a meta- analysis. Asian Pac J Cancer Prev. 2014;15(18):7665–71.PubMed Poorolajal J, Jenabi E, Masoumi SZ. Body mass index effects on risk of ovarian cancer: a meta- analysis. Asian Pac J Cancer Prev. 2014;15(18):7665–71.PubMed
30.
Zurück zum Zitat Secord AA, Hasselblad V, Von Gruenigen VE, et al. Body mass index and mortality in endometrial cancer: a systematic review and meta-analysis. Gynecol Oncol. 2016;140(1):184–90.PubMed Secord AA, Hasselblad V, Von Gruenigen VE, et al. Body mass index and mortality in endometrial cancer: a systematic review and meta-analysis. Gynecol Oncol. 2016;140(1):184–90.PubMed
31.
Zurück zum Zitat Kwon H, Chang Y, Cho A, Ahn J, Park SE, Park CY, et al. Metabolic obesity phenotypes and thyroid cancer risk: a cohort study. Thyroid. 2019;29(3):349-358.PubMed Kwon H, Chang Y, Cho A, Ahn J, Park SE, Park CY, et al. Metabolic obesity phenotypes and thyroid cancer risk: a cohort study. Thyroid. 2019;29(3):349-358.PubMed
32.
Zurück zum Zitat Pothuraju R, Rachagani S, Junker WM, et al. Pancreatic cancer associated with obesity and diabetes: an alternative approach for its targeting. J Exp Clin Cancer Res. 2018;37(1):319.PubMedPubMedCentral Pothuraju R, Rachagani S, Junker WM, et al. Pancreatic cancer associated with obesity and diabetes: an alternative approach for its targeting. J Exp Clin Cancer Res. 2018;37(1):319.PubMedPubMedCentral
33.
Zurück zum Zitat Weihrauch-Bluher S, Schwarz P, Klusmann JH. Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood. Metabolism. 2018;92:147-152PubMed Weihrauch-Bluher S, Schwarz P, Klusmann JH. Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood. Metabolism. 2018;92:147-152PubMed
34.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMed Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMed
35.
Zurück zum Zitat Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56 e5.PubMed Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56 e5.PubMed
36.
Zurück zum Zitat Xu H, Zhang P, Han X, et al. Sex effect on obesity indices and metabolic outcomes in patients with obese obstructive sleep apnea and type 2 diabetes after laparoscopic Roux-en-Y gastric bypass surgery: a preliminary study. Obes Surg. 2016;26(11):2629–39.PubMed Xu H, Zhang P, Han X, et al. Sex effect on obesity indices and metabolic outcomes in patients with obese obstructive sleep apnea and type 2 diabetes after laparoscopic Roux-en-Y gastric bypass surgery: a preliminary study. Obes Surg. 2016;26(11):2629–39.PubMed
37.
Zurück zum Zitat Dehghan M, Merchant AT. Is bioelectrical impedance accurate for use in large epidemiological studies? Nutr J. 2008;7:26.PubMedPubMedCentral Dehghan M, Merchant AT. Is bioelectrical impedance accurate for use in large epidemiological studies? Nutr J. 2008;7:26.PubMedPubMedCentral
38.
Zurück zum Zitat Bosy-Westphal A, Later W, Hitze B, et al. Accuracy of bioelectrical impedance consumer devices for measurement of body composition in comparison to whole body magnetic resonance imaging and dual X-ray absorptiometry. Obes Facts. 2008;1(6):319–24.PubMedPubMedCentral Bosy-Westphal A, Later W, Hitze B, et al. Accuracy of bioelectrical impedance consumer devices for measurement of body composition in comparison to whole body magnetic resonance imaging and dual X-ray absorptiometry. Obes Facts. 2008;1(6):319–24.PubMedPubMedCentral
39.
Zurück zum Zitat Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23(6):1430–53.PubMed Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23(6):1430–53.PubMed
40.
Zurück zum Zitat Kumar SV, Nagesh A, Leena M, et al. Incidence of metabolic syndrome and its characteristics of patients attending a diabetic outpatient clinic in a tertiary care hospital. J Nat Sci Biol Med. 2013;4(1):57–62.PubMedPubMedCentral Kumar SV, Nagesh A, Leena M, et al. Incidence of metabolic syndrome and its characteristics of patients attending a diabetic outpatient clinic in a tertiary care hospital. J Nat Sci Biol Med. 2013;4(1):57–62.PubMedPubMedCentral
41.
Zurück zum Zitat Nickel F, Schmidt L, Sander J, et al. Patient perspective in obesity surgery: goals for weight loss and improvement of body shape in a prospective cohort study. Obes Facts. 2018;11(6):466–74.PubMedPubMedCentral Nickel F, Schmidt L, Sander J, et al. Patient perspective in obesity surgery: goals for weight loss and improvement of body shape in a prospective cohort study. Obes Facts. 2018;11(6):466–74.PubMedPubMedCentral
42.
Zurück zum Zitat de Leva P. Adjustments to Zatsiorsky-Seluyanov’s segment inertia parameters. J Biomech. 1996;29(9):1223–30.PubMed de Leva P. Adjustments to Zatsiorsky-Seluyanov’s segment inertia parameters. J Biomech. 1996;29(9):1223–30.PubMed
43.
Zurück zum Zitat Yamauchi J, Kurihara T, Yoshikawa M, et al. Specific characterization of regional storage fat in upper and lower limbs of young healthy adults. SpringerPlus. 2015;4:402.PubMedPubMedCentral Yamauchi J, Kurihara T, Yoshikawa M, et al. Specific characterization of regional storage fat in upper and lower limbs of young healthy adults. SpringerPlus. 2015;4:402.PubMedPubMedCentral
44.
Zurück zum Zitat Schweitzer L. What is the best reference site for a single MRI slice to assess wholebody skeletal muscle and adipose tissue volumes in healthy adults? Am J Clin Nutr. 2015;102(1):58-65PubMed Schweitzer L. What is the best reference site for a single MRI slice to assess wholebody skeletal muscle and adipose tissue volumes in healthy adults? Am J Clin Nutr. 2015;102(1):58-65PubMed
45.
Zurück zum Zitat Irlbeck T, Massaro JM, Bamberg F, et al. Association between single-slice measurements of visceral and abdominal subcutaneous adipose tissue with volumetric measurements: the Framingham heart study. Int J Obes. 2010;34(4):781–7. Irlbeck T, Massaro JM, Bamberg F, et al. Association between single-slice measurements of visceral and abdominal subcutaneous adipose tissue with volumetric measurements: the Framingham heart study. Int J Obes. 2010;34(4):781–7.
46.
Zurück zum Zitat Shen W, Chen J, Gantz M, et al. A single mri slice does not accurately predict visceral and subcutaneous adipose tissue changes during weight loss. Obesity. 2012;20(12):2458–63.PubMed Shen W, Chen J, Gantz M, et al. A single mri slice does not accurately predict visceral and subcutaneous adipose tissue changes during weight loss. Obesity. 2012;20(12):2458–63.PubMed
Metadaten
Titel
Weight Loss and Changes in Adipose Tissue and Skeletal Muscle Volume after Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study with 12-Month Follow-Up
verfasst von
Hannes Götz Kenngott
Felix Nickel
Philipp Anthony Wise
Felix Wagner
Adrian Theophil Billeter
Johanna Nattenmüller
Diana Nabers
Klaus Maier-Hein
Hans-Ulrich Kauczor
Lars Fischer
Beat Peter Müller-Stich
Publikationsdatum
15.07.2019
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 12/2019
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04087-w

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