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Argyrakopoulou G, Fountouli N, Dalamaga M, Kokkinos A. Revisiting Resting Metabolic Rate: What is the Relation to Weight Fluctuations? Curr Obes Rep 2023; 12:502-513. [PMID: 37755607 DOI: 10.1007/s13679-023-00528-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Despite the great progress in obesity-tackling strategies, a negative energy equilibrium between energy expenditure and energy intake remains the cornerstone in obesity management. The present review article aims to shed light on the complicated interrelations of resting metabolic rate to weight fluctuations. RECENT FINDINGS Energy expenditure depends on body composition and is highly affected by weight changes, exerting a significant role in subsequent weight regain and underlining the metabolic resistance that people with obesity face when dealing with weight maintenance. The main tissue involved in energy expenditure is fat-free mass, as opposed to fat mass, which exerts a substantially lower impact. Although people with obesity display higher energy expenditures than their lean counterparts, these decrease substantially in the setting of weight loss. Metabolic adaptation is the difference between measured and predicted RMR after weight loss, either via lifestyle modification or after obesity surgery. Plausible explanations for this include differences in body composition, with loss of fat-free mass playing a significant role. This becomes especially apparent in the setting of rapid and massive weight loss, as in the case of bariatric surgery. A better understanding of energy expenditure pathophysiology may aid in further enhancing weight loss and promoting weight maintenance in people with obesity.
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Affiliation(s)
| | - Nefeli Fountouli
- Diabetes and Obesity Unit, Athens Medical Center, 15125, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Chen W, Yin H, Xiao J, Liu W, Qu Q, Gong F, He X. The effect of aging on glucose metabolism improvement after Roux-en-Y gastric bypass in type 2 diabetes rats. Nutr Diabetes 2022; 12:51. [PMID: 36564376 PMCID: PMC9789110 DOI: 10.1038/s41387-022-00229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effect of aging on glucose metabolism improvement after Roux-en-Y gastric bypass (RYGB) in rat models with type 2 diabetes mellitus (T2DM). METHODS Twenty aged Goto-Kakizaki rats were randomly assigned into RYGB-A group and sham RYGB (SR-A) group, and 10 adult Goto-Kakizaki rats also accept RYGB procedures (RYGB-Y). Glucose metabolism, resting energy expenditure (REE), glucagon-like peptide-1 (GLP-1) and total bile acid level were measured. RESULTS RYGB could significantly improve glucose metabolism in aged diabetic rats. The fasting blood glucose level in the RYGB-A group decreased from 15.8 ± 1.1 mmol/l before surgery to 12.3 ± 1.5 mmol/l 16 weeks after surgery (P < 0.01), and the AUCOGTT value decreased from 2603.9 ± 155.4 (mmol/l) min to 2299.9 ± 252.8 (mmol/l) min (P = 0.08). The decrease range of fasting blood glucose in the RYGB-A group was less than that in the RYGB-Y group (20.5% ± 6.5% vs. 40.6% ± 10.6%, P < 0.01), so is the decrease range of AUCOGTT value (11.6% ± 14.8% vs. 38.5% ± 8.3%, P < 0.01). Moreover, at the 16th postoperative week, the increase range of REE of the RYGB-A group was lower than that of the RYGB-Y group (15.3% ± 11.1% vs. 29.1% ± 12.1%, P = 0.04). The increased range of bile acid of the RYGB-A group was less than that of the RYGB-Y group (80.2 ± 59.3 % vs.212.3 ± 139.0 %, P < 0.01). The GLP-1 level of the RYGB-A group was less than that of the RYGB-Y group (12.8 ± 3.9 pmol/L vs. 18.7 ± 5.6 pmol/L, P = 0.02). There was no significant difference between the RYGB-A group and the RYGB-Y group in the level of the triiodothyronine level. CONCLUSIONS RYGB could induce a glucose metabolism improvement in aged diabetic rats, and aging might moderate the effect of RYGB.
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Affiliation(s)
- Weijie Chen
- grid.413106.10000 0000 9889 6335Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing, 100730 PR China
| | - Haixin Yin
- grid.413106.10000 0000 9889 6335Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing, 100730 PR China
| | - Jianchun Xiao
- grid.413106.10000 0000 9889 6335Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing, 100730 PR China
| | - Wei Liu
- grid.413106.10000 0000 9889 6335Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing, 100730 PR China
| | - Qiang Qu
- grid.413106.10000 0000 9889 6335Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing, 100730 PR China
| | - Fengying Gong
- grid.413106.10000 0000 9889 6335Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing, 100730 PR China
| | - Xiaodong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing, 100730, PR China.
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Molero J, Olbeyra R, Flores L, Jiménez A, de Hollanda A, Andreu A, Ibarzabal A, Moizé V, Cañizares S, Balibrea JM, Obach A, Vidal J. Prevalence of low skeletal muscle mass following bariatric surgery. Clin Nutr ESPEN 2022; 49:436-441. [PMID: 35623849 DOI: 10.1016/j.clnesp.2022.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Evidence on the occurrence of low skeletal muscle mass (low-SMM) following bariatric surgery (BS) as well as on the impact of low-SMM antedating BS on post-surgical body composition (BC) are scant. In this context, we aimed to prospectively evaluate the prevalence of low-SMM prior to and up to 5 years after BS, and to evaluate pre-surgical low-SMM as an independent risk factor for the presence of low-SMM after BS. METHODS Retrospective analysis of prospectively collected database. BC was assessed by bioelectrical impedance analysis (BIA). A BIA-based formula was used to calculate skeletal muscle mass (SMM). Class I and class II low-SMM were defined respectively as a SMM index (SMMI = SMM/height2) value between -1 and -2, or > -2 standard deviations from the gender-specific regression line of the BMI versus the SMMI relationship in our reference group. RESULTS A total 952 subjects were included, with BC being available for 877 (92%) subjects at 12 months and for 576 subjects (60%) at 60 months after BS. Prior to surgery, and at 12-, or at 60-months after surgery, class I and class II low-SMM was ascertained respectively in 15.6% and 4.6%, 5.3% and 1.4%, and 16.6% and 6.3% of the study participants. Logistic regression analysis showed that the occurrence of low-SMM at 12- and 60-months follow-up, was independently predicted not only by age at the time of surgery [respectively, HR: 1.052 (95% CI 1.020-1.084), p = 0.001; and 1.042 (95% CI 1.019-1.066); p < 0.001] but also by the presence of low-SMM prior to surgery [respectively, HR: 10.717 (95% CI 5.771-19.904), p < 0.001; and 5.718 (95% CI 3.572-9.153); p < 0.001]. CONCLUSIONS Our data suggest that a low-SMM phenotype occurs not only in obesity surgery candidates but also after BS, and that low-SMM prior to surgery is an important risk factor for low-SMM throughout post-surgical follow-up.
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Affiliation(s)
- Judith Molero
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Romina Olbeyra
- Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Lilliam Flores
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Amanda Jiménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de La Obesidad y Nutrición (CIBEROBN), Spain
| | - Ana de Hollanda
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de La Obesidad y Nutrición (CIBEROBN), Spain
| | - Alba Andreu
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de La Obesidad y Nutrición (CIBEROBN), Spain
| | - Ainitze Ibarzabal
- Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Violeta Moizé
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Sílvia Cañizares
- Department of Clinical Psychology and Psychobiology, Section of Clinical Health Psychology, Clinical Institute of Neurosciences, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - José María Balibrea
- Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Amadeu Obach
- Department of Clinical Psychology and Psychobiology, Section of Clinical Health Psychology, Clinical Institute of Neurosciences, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Vidal
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut D'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
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Rebello CJ, Greenway FL, Zhang D, Johnson WD, Patterson E, Raum W. Sympathomimetic increases resting energy expenditure following bariatric surgery: A randomized controlled clinical trial. Obesity (Silver Spring) 2022; 30:874-883. [PMID: 35244344 PMCID: PMC10167942 DOI: 10.1002/oby.23384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to test the hypothesis that ephedrine + caffeine (EC) reduces the fall in resting energy expenditure (REE) following bariatric surgery. METHODS This 32-week, randomized, double-blinded, placebo-controlled trial included 142 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery. Participants were randomized to either EC or placebo for 27 weeks, beginning 5 weeks post surgery. The primary end points were change in REE (measured), percentage of predicted REE ([measured REE/Harris-Benedict equation-predicted REE] × 100), and body composition. Secondary outcomes included change in percentage of weight. Adverse events (AEs) were recorded. RESULTS The reduction in REE was smaller in the EC versus the placebo group, but it was not significant. Percentage of predicted REE was increased in the EC versus the placebo group (difference, mean [SE]: 5.82 [2.29], p = 0.013). Percentage of weight (difference: -3.83 [1.39], p = 0.007) was reduced in the EC versus the placebo group. Percentage of predicted REE was increased and body weight decreased in the EC-treated participants who underwent SG compared with those who underwent SG and were treated with placebo (difference in percentage of predicted REE = 8.06 [2.83], p = 0.006; difference in weight percentage = -4.37 [1.92], p = 0.025). Percentage of fat-free mass was increased in the SG participants treated with EC versus placebo (difference: 1.31 [0.63], p = 0.042). The most common AEs were anxiety, dizziness, insomnia, and tremors. Most AEs were not different from placebo by Week 32. CONCLUSIONS EC enhances weight loss and reduces the fall in REE following bariatric surgery. Adrenergic symptoms mostly resolve over time.
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Affiliation(s)
- Candida J Rebello
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Frank L Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Dachuan Zhang
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - William D Johnson
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | | | - William Raum
- Oregon Weight Loss Surgery, LLC, Portland, Oregon, USA
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Pakzad M, Miratashi Yazdi SA, Talebpour M, Elyasinia F, Abolhasani M, Zabihi-Mahmoudabadi H, Najjari K, Geranpayeh L. Short-Term Changes on Body Composition After Sleeve Gastrectomy and One Anastomosis Gastric Bypass. J Laparoendosc Adv Surg Tech A 2022; 32:884-889. [PMID: 35443804 DOI: 10.1089/lap.2021.0792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: Changes in body composition after different bariatric surgeries have been studied extensively, but most of them have emphasized on Roux-en-Y gastric bypass. Only a few studies have assessed the effects of sleeve gastrectomy (SG). Also, the effect of one anastomosis gastric bypass (OAGB) on body composition is not fully apprehended. Furthermore, there is no agreement on how much fat-free mass (FFM) loss is tolerable in weight loss interventions. Therefore, we decided to assess the reduction in fat mass (FM) and FFM at 1, 3, 6, and 12 months after two types of bariatric surgery in a single center. Methods: In the current retrospective cross-sectional study, the patients' hospital records were analyzed. We included patients who had SG or OAGB and a complete 1-year follow-up record. We recorded demographic data as well as weight, body mass index (BMI), FM, and FFM before and at 1, 3, 6, and 12 months after surgery in a predesigned checklist. Results: We analyzed 311 patients (43 males and 268 females) in the SG (N = 192, 61.7%) and OAGB (N = 119, 38.3%) groups. Both the SG and OAGB groups demonstrated a statistically significant reduction in weight, BMI, FM, and FFM indices at 12 months after the intervention (P < .001). Moreover, no statistically significant difference was observed between the SG and OAGB groups regarding the mean of all body composition indices at 3, 6, and 12 months after the intervention. Conclusion: We found that SG and OAGB effectively decreased weight and body composition indices, comprising FM and FFM, with no significant difference between each other.
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Affiliation(s)
- Mohsen Pakzad
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Talebpour
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fezzeh Elyasinia
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Faculty of Medicine, Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Khosrow Najjari
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Loabat Geranpayeh
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Santini S, Vionnet N, Pasquier J, Suter M, Hans D, Gonzalez-Rodriguez E, Pitteloud N, Favre L. Long-term body composition improvement in post-menopausal women following bariatric surgery: a cross-sectional and case-control study. Eur J Endocrinol 2022; 186:255-263. [PMID: 34879003 PMCID: PMC8789027 DOI: 10.1530/eje-21-0895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/08/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Bariatric surgery (BS) induces loss of body fat mass (FM) with an inexorable loss of lean mass (LM). Menopause leads to deleterious changes in body composition (BC) related to estrogen deficiency including LM loss and increase in total and visceral adipose tissue (VAT). This study aims to describe the long-term weight evolution of post-menopausal women after Roux-en-Y gastric bypass (RYGB) and to compare the BC between BS patients vs post-menopausal non-operated women. DESIGN Cross-sectional study of 60 post-menopausal women who underwent RYGB ≥2 years prior to the study with nested case-control design. METHODS Post-menopausal BS women were matched for age and BMI with controls. Both groups underwent DXA scan, lipids and glucose metabolism markers assessment. RESULTS Median follow-up was 7.5 (2-18) years. Percentage of total weight loss (TWL%) was 28.5 ± 10%. After RYGB, LM percentage of body weight (LM%) was positively associated with TWL% and negatively associated with nadir weight. Forty-one post-BS women were age- and BMI-matched with controls. Post-BS patients showed higher LM% (57.7% (±8%) vs 52.5% (±5%), P = 0.001), reduced FM% (39.4% (±8.4%) vs 45.9% (±5.4%), P < 0.01) and lower VAT (750.6 g (±496) vs 1295.3 g (±688), P < 0.01) with no difference in absolute LM compared to controls. While post-BS women showed a better lipid profile compared to controls, no difference was found in glucose markers. CONCLUSIONS Post-menopausal women after RYGB have a lower FM and VAT, preserved LM and a better lipid profile compared to controls. Weight loss after RYGB seems to have a persistent positive impact on metabolic health.
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Affiliation(s)
- Sara Santini
- Division of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathalie Vionnet
- Division of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
- Faculty of Biology and medicine, University of Lausanne, Lausanne, Switzerland
| | - Didier Hans
- Faculty of Biology and medicine, University of Lausanne, Lausanne, Switzerland
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Elena Gonzalez-Rodriguez
- Faculty of Biology and medicine, University of Lausanne, Lausanne, Switzerland
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Nelly Pitteloud
- Division of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and medicine, University of Lausanne, Lausanne, Switzerland
| | - Lucie Favre
- Division of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and medicine, University of Lausanne, Lausanne, Switzerland
- Correspondence should be addressed to L Favre;
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The Effect of Protein Consumption on Fat-Free Mass, Fat Mass, and Weight Loss 1 Year After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:4741-4748. [PMID: 34426908 DOI: 10.1007/s11695-021-05565-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) both limit protein and calorie intake and result in loss of fat-free mass (FFM), fat mass (FM), and weight. This study examined protein consumption and body composition changes after bariatric surgery. METHODS A prospective study of patients undergoing SG and RYGB between January 1 and December 31, 2016, with 1-year follow-up. Dietary, body composition, and physical activity data were collected at 3, 6, and 12 months post-operatively by bioelectric impedance and food records. Clinical laboratory data were obtained pre- and post-surgery. RESULTS One hundred and five patients (62 [59%] SG and 43 [41%] RYGB) were included in this study. Mean age was 31.8 ± 7.22 years. TWL% after 1 year in SG was 27.11% (p < 0.001) and that in RYGB was 30.41% (p < 0.0001). Reported protein consumptions after RYGB increased from 41.59 ± 22.86 g/day at 3 months (p = 0.004) to 57.90 ± 19.24 g/day at 12 months compared to 52.36 ± 25.04 g and 53.54 ± 29.75 g in SG. Similarly, energy intake after RYGB at 3 and 12 months increased from 895.9 ± 422.61 to 1188.15 ± 463.86 kcal/day compared to 1007.67 ± 422.62 to 1068 ± 575.89 kcal/day after SG (p = 0.009). There was a significant loss of fat-free mass and muscle mass in SG patients at 3 and 12 months from 61.58 ± 3.61 kg and 58.47 ± 3.09 kg to 54.18 ± 11.05 (p < 0.001) and 51.55 ± 10.62 (p = 0.004) but not in RYGB patients. Physical activity levels were similar in SG and RYGB patients. CONCLUSION There was a significant preservation of muscle mass after RYGB. Protein intake in majority of the patients was below 60 g/day during the first year after SG and RYGB.
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Alkharaiji M, Anyanwagu U, Donnelly R, Idris I. Effect of Bariatric Surgery on Diagnosed Chronic Kidney Disease and Cardiovascular Events in Patients with Insulin-treated Type 2 Diabetes: a Retrospective Cohort Study from a Large UK Primary Care Database. Obes Surg 2021; 30:1685-1695. [PMID: 32130651 PMCID: PMC7228901 DOI: 10.1007/s11695-019-04201-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims To compare the effect of bariatric surgery on renal, chronic kidney disease (CKD) and cardiovascular (CV) outcomes among obese patients with insulin-treated type 2 diabetes (T2D) with and without microalbuminuria (i.e., uACR > 3.0 mg/mmol). Methods A retrospective cohort study was conducted among 11,125 active patients with T2D from The Health Improvement Network (THIN) database. Propensity score matching (up to 1:6 ratio) was used to identify patients who underwent bariatric surgery (N = 131) with a non-bariatric cohort (N = 579). Follow-up was undertaken for 10 years (6487 person-years) to compare differences in risk of cardiovascular events and in renal outcomes. Results For the matched cohort at baseline: mean age 52 ± 13 years (60% female); weight 116 ± 25 kg, body mass index (BMI) 41 ± 9kg/m2, estimated glomerular filtration rate (eGFR); 70.4 ± 20 mL/min/1.73 m2, and median albumin-creatinine ratio (uACR) 2.0 mg/mmol (interquartile range (IQR): 0.9–5.2 mg/mmol). Bariatric surgery was associated with a 54% reduction in developing CKD compared to their matched non-bariatric cohort (adjusted hazard ratio [aHR]: 0.46; 95%CI: 0.24–0.85, P = 0.02). Among patients with microalbuminuria at baseline, bariatric surgery was protective against CKD (aHR: 0.42, 95%CI: 0.18–0.99, P = 0.050). eGFR was significantly increased from baseline favouring the bariatric group during 75% of the follow-up time (calculated mean difference between groups: 4.1 mL/min/1.73 m2; P < 0.05), especially at 5-year point (74.2 vs 67.8 mL/min/1.73 m2; P < 0.001). However, no significant change was observed with non-fatal CVD episodes (aHR: 0.36, 95%CI: 0.11–1.13, P = 0.079). Albumin levels were significantly reduced throughout the 2 years following the surgery (3.9 vs 4.1 g/dL, P < 0.001). uACR and total protein levels had little or no statistical association to the intervention. Conclusion Bariatric surgery may protect patients with diabetes with or without microalbuminuria against the risk of CKD and with a modest protective effect on non-fatal CVD risk. Bariatric surgery is also associated with improvements in overall renal outcomes such as eGFR.
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Affiliation(s)
- Mohammed Alkharaiji
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.,Faculty of Public Health, College of Health, The Saudi Electronic University, Riyadh, Saudi Arabia
| | - Uchenna Anyanwagu
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - Richard Donnelly
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - Iskandar Idris
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.
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Abstract
INTRODUCTION Bariatric surgery-induced weight loss may reduce resting energy expenditure (REE) and fat-free mass (FFM) disproportionately thereby predisposing patients to weight regain and sarcopenia. METHODS We compared REE and body composition of African-American and Caucasian Roux-en-Y gastric bypass (RYGB) patients after surgery with a group of non-operated controls (CON). REE by indirect calorimetry; skeletal muscle (SM), trunk organs, and brain volumes by MRI; and FFM by DXA were measured at post-surgery visits and compared with CON (N = 84) using linear regression models that adjusted for relevant covariates. Ns in RYGB were 50, 42, and 30 for anthropometry and 39, 27, 17 for MRI body composition at years 1, 2, and 5 after surgery, respectively. RESULTS Regression models adjusted for age, weight, height, ethnicity, and sex showed REE differences (RYGB minus CON; mean ± s.e.): year 1 (43.2 ± 34 kcal/day, p = 0.20); year 2 (- 27.9 ± 37.3 kcal/day, p = 0.46); year 5 (114.6 ± 42.3 kcal/day, p = 0.008). Analysis of FFM components showed that RYGB had greater trunk organ mass (~ 0.4 kg) and less SM (~ 1.34 kg) than CON at each visit. REE models adjusted for FFM, SM, trunk organs, and brain mass showed no between-group differences in REE (- 15.9 ± 54.8 kcal/day, p = 0.8; - 46.9 ± 64.9 kcal/day, p = 0.47; 47.7 ± 83.0 kcal/day, p = 0.57, at years 1, 2, and 5, respectively). CONCLUSIONS Post bariatric surgery patients maintain a larger mass of high-metabolic rate trunk organs than non-operated controls of similar anthropometrics. Interpreting REE changes after weight loss requires an accurate understanding of fat-free mass composition at both the organ and tissue levels. CLINICAL TRIAL REGISTRATION Long-term Effects of Bariatric Surgery (LABS-2) NCT00465829.
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Changes of Resting Energy Expenditure in Type 2 Diabetes Rats After Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:2994-3000. [PMID: 32338325 DOI: 10.1007/s11695-020-04638-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sherf-Dagan S, Zelber-Sagi S, Buch A, Bar N, Webb M, Sakran N, Raziel A, Goitein D, Keidar A, Shibolet O. Prospective Longitudinal Trends in Body Composition and Clinical Outcomes 3 Years Following Sleeve Gastrectomy. Obes Surg 2019; 29:3833-3841. [PMID: 31301031 DOI: 10.1007/s11695-019-04057-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG). METHODS A prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery. RESULTS Sixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss "failure" (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up. CONCLUSIONS Weight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. .,Department of Nutrition, Assuta Medical Center, 20 Habarzel St., 69710, Tel Aviv, Israel.
| | - Shira Zelber-Sagi
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel.,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Assaf Buch
- Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Nir Bar
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Muriel Webb
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Nasser Sakran
- Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Asnat Raziel
- Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - David Goitein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.,Department of Surgery C, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Andrei Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, The Ben-Gurion University, Be'er Sheva, Israel
| | - Oren Shibolet
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Davidson LE, Yu W, Goodpaster BH, DeLany JP, Widen E, Lemos T, Strain GW, Pomp A, Courcoulas AP, Lin S, Janumala I, Thornton JC, Gallagher D. Fat-Free Mass and Skeletal Muscle Mass Five Years After Bariatric Surgery. Obesity (Silver Spring) 2018; 26:1130-1136. [PMID: 29845744 PMCID: PMC6014876 DOI: 10.1002/oby.22190] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated changes in fat-free mass (FFM) and skeletal muscle 5 years after surgery in participants from the Longitudinal Assessment of Bariatric Surgery-2 trial. METHODS A three-compartment model assessed FFM, and whole-body magnetic resonance imaging (MRI) quantified skeletal muscle mass prior to surgery (T0) and 1 year (T1), 2 years (T2), and 5 years (T5) postoperatively in 93 patients (85% female; 68% Caucasian; age 44.2 ± 11.6 years) who underwent gastric bypass (RYGB), sleeve gastrectomy, or adjustable gastric band. Repeated-measures mixed models were used to analyze the data. RESULTS Significant weight loss occurred across all surgical groups in females from T0 to T1. FFM loss from T0 to T1 was greater after RYGB (mean ± SE: -6.9 ± 0.6 kg) than adjustable gastric band (-3.5 ± 1.4 kg; P < 0.05). Females with RYGB continued to lose FFM (-3.3 ± 0.7 kg; P < 0.001) from T1 to T5. A subset of males and females with RYGB and MRI-measured skeletal muscle showed similar initial FFM loss while maintaining FFM and skeletal muscle from T1 to T5. CONCLUSIONS Between 1 and 5 years following common bariatric procedures, FFM and skeletal muscle are maintained or decrease minimally. The changes observed in FFM and muscle during the follow-up phase may be consistent with aging.
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Affiliation(s)
- Lance E. Davidson
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Wen Yu
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Bret H. Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA
| | - James P. DeLany
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX
| | - Thaisa Lemos
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Gladys W. Strain
- GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Alfons Pomp
- GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Anita P. Courcoulas
- General Surgery, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University Medical Center, New York, New York, USA
| | - Isaiah Janumala
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | | | - Dympna Gallagher
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
- Institute of Human Nutrition, Columbia University, New York, New York, USA
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13
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Li W, Richard D. Effects of Bariatric Surgery on Energy Homeostasis. Can J Diabetes 2017; 41:426-431. [DOI: 10.1016/j.jcjd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/11/2017] [Accepted: 05/04/2017] [Indexed: 12/11/2022]
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14
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Schiavo L, Scalera G, Pilone V, De Sena G, Iannelli A, Barbarisi A. Fat mass, fat-free mass, and resting metabolic rate in weight-stable sleeve gastrectomy patients compared with weight-stable nonoperated patients. Surg Obes Relat Dis 2017; 13:1692-1699. [PMID: 28802792 DOI: 10.1016/j.soard.2017.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/22/2017] [Accepted: 06/27/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is evidence that body composition and resting metabolic rate (RMR) in weight-stable patients after Roux-en-Y gastric bypass and duodenal switch is similar to that of nonoperated individuals within the same body mass index (BMI) interval. Currently, data concerning fat mass (FM), fat-free mass (FFM), and RMR on weight-stable patients after sleeve gastrectomy (SG) are lacking. OBJECTIVES To assess FM, FFM, and RMR, in a selected and homogenous population of weight-stable SG patients (WSSG) and compare them with those obtained from healthy normal weight-stable nonoperated (WSNO) volunteers controls of similar sex, age, and BMI. SETTING University hospital, Italy. METHODS We assessed total weight, FM, and FFM by bioelectrical impedance assay, and RMR by indirect calorimetry, in 70 WSSG patients (47 females, 23 males) at a mean follow-up of 3.2 ± 2.1 years after SG and compared them with 70 healthy WSNO volunteers, as controls (47 females, 23 males). RESULTS There was no significant difference between WSSG and WSNO groups concerning total weight (males, 72 ± 2.66 versus 72.8 ± 1.99 kg, P = .0254; females 65.1 ± 2.53 versus 63.7 ± 2.87 kg, P = .0139), FM (males, 17.7 ± 1.53 versus 16.7 ± 1.57 kg, P = .0341; females 19.6 ± 0.50 versus 18.5 ± 2.85 kg, P = .0104), FFM (males, 54.3 ± 3.07 versus 56.1 ± 3.30 kg; P = .049; females 45.5 ± 2.29 versus 45.1 ± 1.13 kg, P = .287), and RMR (males, 1541 ± 121.3 versus 1463 ± 74.4 kcal/d; P = .0118; females 1214 ± 54.9 versus 1250 ± 90.1 kcal/d, P = .0215). CONCLUSION At a mean follow-up of 3.2 ± 2.1 years after SG, WSSG patients of both sexes have a FM, FFM, and RMR comparable to that of healthy WSNO individuals within the same age and BMI interval. These findings further support bariatric surgery-induced weight loss as a physiologic process and indicate that young patients, in the setting of an adequate preoperative and postoperative specific diet and moderate physical activity, do not suffer from excessive FFM depletion after SG in the mid-term.
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Affiliation(s)
- Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy; IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy.
| | - Giuseppe Scalera
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Gabriele De Sena
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy; IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, F-06202, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of obesity", F-06204, Nice, France; University of Nice Sophia-Antipolis, F-06107, Nice, France
| | - Alfonso Barbarisi
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy; IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
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