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Harrison SA, Browne SK, Suschak JJ, Tomah S, Gutierrez JA, Yang J, Roberts MS, Harris MS. Effect of pemvidutide, a GLP-1/glucagon dual receptor agonist, on MASLD: A randomized, double-blind, placebo-controlled study. J Hepatol 2024:S0168-8278(24)02362-6. [PMID: 39002641 DOI: 10.1016/j.jhep.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND & AIMS This was a randomized, double-blind, placebo-controlled study to assess the effects of pemvidutide, a glucagon-like peptide-1 (GLP-1)/glucagon dual receptor agonist, on liver fat content (LFC) in subjects with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS Subjects with a BMI ≥28.0 kg/m2 and LFC ≥10% by magnetic resonance imaging-proton density fat fraction were randomized 1:1:1:1 to pemvidutide at 1.2 mg, 1.8 mg, or 2.4 mg, or placebo administered subcutaneously once weekly for 12 weeks. Participants were stratified according to a diagnosis of type 2 diabetes mellitus (T2DM). The primary efficacy endpoint was relative reduction (%) from baseline in LFC after 12 weeks of treatment. RESULTS 94 subjects were randomized and dosed. Median baseline BMI and LFC across the study population were 36.2 kg/m2 and 20.6%; 29% of subjects had T2DM. At Week 12, relative reductions in LFC from baseline were (1.2 mg) 46.6% [95% CI -63.7 to -29.6], (1.8 mg) 68.5% [95% CI -84.4 to -52.5], and (2.4 mg) 57.1% [95% CI -76.1 to -38.1] versus 4.4% [95% CI -20.2 to 11.3] in placebo subjects (p <0.001 vs. placebo, all treatment groups), with 94.4% and 72.2% of subjects achieving 30% and 50% reductions in LFC and 55.6% achieving normalization (≤5% LFC) at the 1.8 mg dose. Maximal responses for weight loss (-4.3%; p <0.001), alanine aminotransferase (-13.8 IU/L; p = 0.029), and corrected cT1 (-75.9 ms; p = 0.002) were all observed at the 1.8 mg dose. Pemvidutide was well-tolerated at all doses with no severe or serious adverse events. CONCLUSIONS In subjects with MASLD, weekly pemvidutide treatment yielded significant reductions in LFC, markers of hepatic inflammation, and body weight compared to placebo. IMPACT AND IMPLICATIONS MASLD, and MASH, are strongly associated with overweight and obesity and it is believed that the excess liver fat associated with obesity is an important driver of these diseases. Glucagon-like peptide-1 receptor (GLP-1R) agonists elicit weight loss through centrally and peripherally mediated effects on appetite. Unlike GLP-1R agonists, glucagon receptor (GCGR) agonists act directly on the liver to stimulate fatty acid oxidation and inhibit lipogenesis, potentially providing a more potent mechanism for liver fat content (LFC) reduction than weight loss alone. This study demonstrated the ability of once-weekly treatment with pemvidutide, a dual GLP-1R/GCGR agonist, to significantly reduce LFC, hepatic inflammatory activity, and body weight, suggesting that pemvidutide may be an effective treatment for both MASH and obesity. CLINICAL TRIAL NUMBER NCT05006885.
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Affiliation(s)
- Stephen A Harrison
- Department of Hepatology, University of Oxford, Oxford, UK; Pinnacle Clinical Research, San Antonio, TX, United States
| | | | | | | | - Julio A Gutierrez
- Altimmune, Inc, Gaithersburg, MD, USA; Center for Organ Transplant, Scripps, La Jolla, Ca, USA
| | - Jay Yang
- Altimmune, Inc, Gaithersburg, MD, USA
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Henry JA, Abdesselam I, Deal O, Lewis AJ, Rayner J, Bernard M, Dutour A, Gaborit B, Kober F, Soghomonian A, Sgromo B, Byrne J, Bege T, Borlaug BA, Neubauer S, Rider OJ. The effect of bariatric surgery type on cardiac reverse remodelling. Int J Obes (Lond) 2024; 48:808-814. [PMID: 38297029 PMCID: PMC11129945 DOI: 10.1038/s41366-024-01474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Bariatric surgery is effective in reversing adverse cardiac remodelling in obesity. However, it is unclear whether the three commonly performed operations; Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Band (LAGB) are equal in their ability to reverse remodelling. METHODS Fifty-eight patients underwent CMR to assess left ventricular mass (LVM), LV mass:volume ratio (LVMVR) and LV eccentricity index (LVei) before and after bariatric surgery (26 RYGB, 22 LSG and 10 LAGB), including 46 with short-term (median 251-273 days) and 43 with longer-term (median 983-1027 days) follow-up. Abdominal visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) were also assessed. RESULTS All three procedures resulted in significant decreases in excess body weight (48-70%). Percentage change in VAT and EAT was significantly greater following RYGB and LSG compared to LAGB at both timepoints (VAT:RYGB -47% and -57%, LSG -47% and -54%, LAGB -31% and -25%; EAT:RYGB -13% and -14%, LSG -16% and -19%, LAGB -5% and -5%). Patients undergoing LAGB, whilst having reduced LVM (-1% and -4%), had a smaller decrease at both short (RYGB: -8%, p < 0.005; LSG: -11%, p < 0.0001) and long (RYGB: -12%, p = 0.009; LSG: -13%, p < 0.0001) term timepoints. There was a significant decrease in LVMVR at the long-term timepoint following both RYGB (-7%, p = 0.006) and LSG (-7%, p = 0.021), but not LAGB (-2%, p = 0.912). LVei appeared to decrease at the long-term timepoint in those undergoing RYGB (-3%, p = 0.063) and LSG (-4%, p = 0.015), but not in those undergoing LAGB (1%, p = 0.857). In all patients, the change in LVM correlated with change in VAT (r = 0.338, p = 0.0134), while the change in LVei correlated with change in EAT (r = 0.437, p = 0.001). CONCLUSIONS RYGB and LSG appear to result in greater decreases in visceral adiposity, and greater reverse LV remodelling with larger reductions in LVM, concentric remodelling and pericardial restraint than LAGB.
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Affiliation(s)
- J A Henry
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - I Abdesselam
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - O Deal
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - A J Lewis
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - M Bernard
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - A Dutour
- Aix-Marseille University, APHM, INSERM, INRAE, C2VN, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, France
| | - B Gaborit
- Aix-Marseille University, APHM, INSERM, INRAE, C2VN, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, France
| | - F Kober
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - A Soghomonian
- Aix-Marseille University, APHM, INSERM, INRAE, C2VN, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, France
| | - B Sgromo
- Department of Upper GI Surgery, Churchill Hospital, Oxford, UK
| | - J Byrne
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T Bege
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, APHM, Marseille, France
| | - B A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Changes in Lean Tissue Mass, Fat Mass, Biological Parameters and Resting Energy Expenditure over 24 Months Following Sleeve Gastrectomy. Nutrients 2023; 15:nu15051201. [PMID: 36904198 PMCID: PMC10004853 DOI: 10.3390/nu15051201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Sleeve gastrectomy (SG) induces weight loss but its effects on body composition (BC) are less well known. The aims of this longitudinal study were to analyse the BC changes from the acute phase up to weight stabilization following SG. Variations in the biological parameters related to glucose, lipids, inflammation, and resting energy expenditure (REE) were concomitantly analysed. Fat mass (FM), lean tissue mass (LTM), and visceral adipose tissue (VAT) were determined by dual-energy X-ray absorptiometry in 83 obese patients (75.9% women) before SG and 1, 12 and 24 months later. After 1 month, LTM and FM losses were comparable, whereas at 12 months the loss of FM exceeded that of LTM. Over this period, VAT also decreased significantly, biological parameters became normalized, and REE was reduced. For most of the BC, biological and metabolic parameters, no substantial variation was demonstrated beyond 12 months. In summary, SG induced a modification in BC changes during the first 12 months following SG. Although the significant LTM loss was not associated with an increase in sarcopenia prevalence, the preservation of LTM might have limited the reduction in REE, which is a longer-term weight-regain criterion.
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Ali MM, Hafez A, Abdelgalil MS, Hasan MT, El-Ghannam MM, Ghogar OM, Elrashedy AA, Abd-ElGawad M. Impact of Cotadutide drug on patients with type 2 diabetes mellitus: a systematic review and meta-analysis. BMC Endocr Disord 2022; 22:113. [PMID: 35488292 PMCID: PMC9055739 DOI: 10.1186/s12902-022-01031-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The food and drug administration approved many drugs to treat diabetes mellitus, but those drugs do not have a noticeable effect on weight management. Recently, glucagon-like peptide 1 agonist known as Cotadutide serve as a potent drug in treating type 2 diabetes by reducing blood glucose levels and body weight indices. This study aimed to explore the safety and efficacy of Cotadutide as a treatment for type 2 diabetes individuals. METHODS A comprehensive literature search was done on different databases, including PubMed, Scopus, Web of Science, and Cochrane Library to capture all relevant articles using an established search strategy. The inclusion criteria were randomized controlled trials that assessed the safety and efficacy of Cotadutide versus placebo or any anti-diabetes drugs in patients with type 2 diabetes mellitus and a BMI between 22 kg/m2 and 40 kg/m2. We conducted the analysis using Revman software version 5.4. RESULTS We found 663 relevant articles. From which nine studies were included and subjected to qualitative analysis and eight for quantitative analysis. The pooled effect showed that Cotadutide was better than placebo in reducing body weight (kg) (Mean difference (MD) = 3.31, p < 0.00001), glycated hemoglobin (HbA1c) (MD = 0.68, p > 0.00001), glucose area under the plasma concentration curve (AUC [0-4 h]) (MD = 30.15, p < 0.00001), and fasting plasma glucose over time (mg/dl) (MD = 31.31, p < 0.00001). CONCLUSION Cotadutide is safe and effective in reducing plasma glucose levels, HbA1c and body weight in individuals with type 2 diabetes. TRIAL REGISTRATION The study protocol was registered on PROSPERO (CRD: CRD42021257670 ).
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Affiliation(s)
| | - Ahmed Hafez
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Xiang AH, Martinez MP, Trigo E, Utzschneider KM, Cree-Green M, Arslanian SA, Ehrmann DA, Caprio S, Mohamed PHIH, Hwang DH, Katkhouda N, Nayak KS, Buchanan TA. Liver Fat Reduction After Gastric Banding and Associations with Changes in Insulin Sensitivity and β-Cell Function. Obesity (Silver Spring) 2021; 29:1155-1163. [PMID: 34038037 PMCID: PMC8222142 DOI: 10.1002/oby.23174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between changes in liver fat and changes in insulin sensitivity and β-cell function 2 years after gastric banding surgery. METHODS Data included 23 adults with the surgery who had prediabetes or type 2 diabetes for less than 1 year and BMI 30 to 40 kg/m2 at baseline. Body adiposity measures including liver fat content (LFC), insulin sensitivity (M/I), and β-cell responses (acute, steady-state, and arginine-stimulated maximum C-peptide) were assessed at baseline and 2 years after surgery. Regression models were used to assess associations adjusted for age and sex. RESULTS Two years after surgery, all measures of body adiposity, LFC, fasting and 2-hour glucose, and hemoglobin A1c significantly decreased; M/I significantly increased; and β-cell responses adjusted for M/I did not change significantly. Among adiposity measures, reduction in LFC had the strongest association with M/I increase (r = -0.61, P = 0.003). Among β-cell measures, change in LFC was associated with change in acute C-peptide response to arginine at maximal glycemic potentiation adjusted for M/I (r = 0.66, P = 0.007). Significant reductions in glycemic measures and increase in M/I were observed in individuals with LFC loss >2.5%. CONCLUSIONS Reduction in LFC after gastric banding surgery appears to be an important factor associated with long-term improvements in insulin sensitivity and glycemic profiles in adults with obesity and prediabetes or early type 2 diabetes.
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Affiliation(s)
- Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mayra P Martinez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Enrique Trigo
- Division of Endocrinology and Diabetes, Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kristina M Utzschneider
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and the University of Washington, Seattle, Washington, USA
| | - Melanie Cree-Green
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Silva A Arslanian
- School of Medicine, UPMC Children's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David A Ehrmann
- Section of Endocrinology, Diabetes and Metabolism, the University of Chicago, Chicago, Illinois, USA
| | - Sonia Caprio
- Department of Pediatric/Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Passant H I H Mohamed
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Darryl H Hwang
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Namir Katkhouda
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Krishna S Nayak
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Quantification of Liver, Subcutaneous, and Visceral Adipose Tissues by MRI Before and After Bariatric Surgery. Obes Surg 2020; 29:2795-2805. [PMID: 31089967 PMCID: PMC6713693 DOI: 10.1007/s11695-019-03897-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background Morbid obesity is a worldwide epidemic and is increasingly treated by bariatric surgery. Fatty liver is a common finding; almost half of all patients with non-alcoholic steatohepatitis develop steatohepatitis. Bariatric surgery improves steatohepatitis documented by liver biopsy and single voxel magnetic resonance imaging (MRI) techniques. Objective To investigate changes before and after bariatric surgery using whole organ MRI quantification of liver, visceral, and subcutaneous fat. Setting University of Basel Hospital and St. Clara Research Ltd, Basel, Switzerland. Methods Sixteen morbidly obese patients were evaluated by abdominal MRI-scanning before and 3, 6, 12, and 24 months after bariatric surgery to measure percentage liver fat (%-LF), total liver volume (TLV) and visceral and subcutaneous adipose tissues (VAT and SAT). Fasting plasma samples were taken for measurement of glucose, insulin, blood lipids, and liver biomarkers. In a control group of 12 healthy lean volunteers, the liver biomarker was also measured. Results The reproducibility of fat quantification by use of MRI was excellent. LF decreased significantly faster than VAT and SAT (%-LF vs. VAT p < 0.001 and %-LF vs. SAT p < 0.001). At certain time points, %-LF, VAT, and SAT were associated with changes in blood lipids and insulin. Conclusions MRI quantification offers excellently reproducible results in measurement of liver fat and visceral and subcutaneous adipose tissues. Liver fat decreased significantly faster than visceral or subcutaneous adipose tissue. Decrease in %-LF and VAT is associated with decrease in total cholesterol, LDL, and plasma insulin. Electronic supplementary material The online version of this article (10.1007/s11695-019-03897-2) contains supplementary material, which is available to authorized users.
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Maïmoun L, Lefebvre P, Aouinti S, Picot MC, Mariano-Goulart D, Nocca D. Acute and longer-term body composition changes after bariatric surgery. Surg Obes Relat Dis 2019; 15:1965-1973. [PMID: 31519485 DOI: 10.1016/j.soard.2019.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bariatric surgery induces weight loss but its acute and longer-term effects on body composition (BC) are largely unknown. OBJECTIVES To determine the BC changes in obese French patients after sleeve gastrectomy (SG) at 1 and 12 months. SETTING Obesity Reference Center, University Hospital of Montpellier, France. METHODS Whole and localized BC (lean tissue mass [LTM] and fat mass [FM]) and abdominal adiposity, including total adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue, were determined by dual-energy X-ray absorptiometry in 30 obese patients (25 women, 83.3%) just before SG and 1 and 12 months later. RESULTS The mean weight loss was -9.7 ± 2.6 kg at 1 month and -32.1 ± 10.3 kg at 12 months. This weight loss was due to an equivalent decrease in LTM and FM in the acute phase, while FM loss appeared to be the main cause in the chronic phase. For each component (LTM and FM), the loss was relatively homogeneous across sites. Compared with the presurgical values, android and gynoid tissue and total adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue changed significantly over the 12-month period. No basal clinical parameter was predictive of the variation in LTM, whereas age and the whole-body LTM/FM ratio were associated with the decrease in FM. CONCLUSION This study demonstrates that SG induces a clear modification in BC, characterized by a decrease in LTM in the acute phase and sustained FM loss in the first year. These results suggest that the early phase should be targeted for strategies to reduce LTM loss, which is a longer-term weight-regain criterion. Further studies to investigate the potential advantages of visceral adipose tissue compared with whole-body FM for improving post-SG co-morbidities should be performed.
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Affiliation(s)
- Laurent Maïmoun
- Service de Médecine Nucléaire, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France; PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France, Médicale, CHU de Montpellier, Montpellier, France.
| | - Patrick Lefebvre
- Departement d'Endocrinologie, Diabetes, Nutrition, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France
| | - Safa Aouinti
- Unité de Recherche Clinique, Biostatistiques et Epidémiologie, Département de l'Information
| | - Marie-Christine Picot
- Unité de Recherche Clinique, Biostatistiques et Epidémiologie, Département de l'Information
| | - Denis Mariano-Goulart
- Service de Médecine Nucléaire, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France; PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France, Médicale, CHU de Montpellier, Montpellier, France
| | - David Nocca
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHU de Montpellier, Montpellier, France
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Al-Sofiani ME, Ganji SS, Kalyani RR. Body composition changes in diabetes and aging. J Diabetes Complications 2019; 33:451-459. [PMID: 31003924 PMCID: PMC6690191 DOI: 10.1016/j.jdiacomp.2019.03.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022]
Abstract
Aging is associated with changes in body composition, including both fat gain and muscle loss beginning in middle age, and is associated with increased risk of type 2 diabetes. Moreover, changes in fat distribution take place in adults as they age and may contribute to the increased risk of type 2 diabetes. Recent literature has shown differences in the age-related changes in body composition by diabetes status suggesting that some of these changes might not only be a risk factor of the development of diabetes but could also be a consequence of the disease. In this article, we review the current evidence on body composition changes that take place in adults after the diagnosis of type 2 diabetes and compare them to those observed in adults without diabetes as they age. We also review the effect of various lifestyle, pharmacological, and surgical treatments that lower blood glucose on body composition in adults with type 2 diabetes.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, MD, United States of America; Division of Endocrinology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Suneeta S Ganji
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, MD, United States of America.
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Comparative Effects of Medical Versus Surgical Weight Loss on Body Composition: a Pilot Randomized Trial. Obes Surg 2019; 29:2503-2510. [PMID: 30997619 DOI: 10.1007/s11695-019-03879-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL. METHODS In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30-39.9 kg/m2, we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10%WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons. RESULTS Twelve female participants (75% African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL - 5.2%, AGB - 10.3%, p = 0.021) and VAT (MWL + 10.9%, AGB - 28.0%, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9%, RYGB - 20.2%, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB - 12.38%, RYGB - 7.29%, p = 0.15). CONCLUSIONS At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL. CLINICAL TRIAL REGISTRATION NCTDK089557 - ClinicalTrials.gov.
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Deibert P, Lazaro A, Schaffner D, Berg A, Koenig D, Kreisel W, Baumstark MW, Steinmann D, Buechert M, Lange T. Comprehensive lifestyle intervention vs soy protein-based meal regimen in non-alcoholic steatohepatitis. World J Gastroenterol 2019; 25:1116-1131. [PMID: 30862999 PMCID: PMC6406181 DOI: 10.3748/wjg.v25.i9.1116] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-alcoholic steatohepatitis (NASH) has become one of the leading causes of liver disease in the western world. In obese patients weight reduction is recommended. Up to now there are no specific guidelines for weight loss in order to reduce hepatic fat content.
AIM To investigate the effects of a 24-wk guided lifestyle intervention program compared to a meal replacement regimen based on soy protein.
METHODS Twenty-six subjects with NASH participated in a randomized single-center study. They were randomly assigned to either meal replacement group (MR-G) with soy-yogurt-honey preparation or to guided lifestyle change group (LC-G) with endurance activity and nutrition counselling. Serum alanine transaminase (ALT), aspartate transaminase (AST), lipid parameters, and adipokines were measured. Liver fat content and lipid composition were determined by magnetic resonance imaging and magnetic resonance spectroscopy. Body fat mass and lean body mass were assessed using Bod Pod® device. Pre- and post-intervention monitoring of parameters was performed. Statistical analyses were conducted with SPSS software, results were expressed as median (interquartile range).
RESULTS Twenty-two subjects (MR-G, n = 11 and LC-G, n = 11) completed the study (9 women, 13 men; age 52.1 (15.0) years, body mass index (BMI) 32.3 (3.3) kg/m²). In both groups a significant weight loss was achieved (MR-G: -6.4 (3.6) kg, P < 0.01; LC-G: -9.1 (10.4) kg, P < 0.01). BMI dropped in both groups (MR-G: -2.3 (1.5) kg/m2, P = 0.003; LC-G: -3.0 (3.4) kg/m2, P = 0.006). Internal fat and hepatic lipid content were markedly reduced in both groups in comparable amount. There was a strong correlation between reduction in liver fat and decrease in ALT. Likewise, both groups showed an improvement in glycemic control and lipid profile. Changes in adipokines, particularly in adiponectin and leptin were closely related to intrahepatic lipid changes.
CONCLUSION Comprehensive lifestyle intervention and meal replacement regimen have comparable effects on body and liver fat, as well as decrease in markers of hepatic inflammation among NASH patients.
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Affiliation(s)
- Peter Deibert
- Faculty of Medicine, Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center, University of Freiburg, Freiburg D-79106, Germany
| | - Adhara Lazaro
- Faculty of Medicine, Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center, University of Freiburg, Freiburg D-79106, Germany
| | - Denise Schaffner
- Faculty of Medicine, Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center, University of Freiburg, Freiburg D-79106, Germany
| | - Aloys Berg
- Department of Nutrition, Institute for Sports and Sports Science, University of Freiburg, Freiburg D-79106, Germany
| | - Daniel Koenig
- Department of Nutrition, Institute for Sports and Sports Science, University of Freiburg, Freiburg D-79106, Germany
| | - Wolfgang Kreisel
- Faculty of Medicine, Department of Medicine, Division of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center, University of Freiburg, Freiburg D-79106, Germany
| | - Manfred W Baumstark
- Faculty of Medicine, Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center, University of Freiburg, Freiburg D-79106, Germany
| | - Daniel Steinmann
- University Hospital of Freiburg, Occupational Medicine, Freiburg 79110, Germany
| | - Martin Buechert
- Faculty of Medicine, Department of Radiology - Medical Physics, Medical Center, University of Freiburg, Freiburg D-79106, Germany
| | - Thomas Lange
- Faculty of Medicine, Department of Radiology - Medical Physics, Medical Center, University of Freiburg, Freiburg D-79106, Germany
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Lehmann S, Linder N, Retschlag U, Schaudinn A, Stange R, Garnov N, Dietrich A, Oberbach A, Kahn T, Busse H. MRI assessment of changes in adipose tissue parameters after bariatric surgery. PLoS One 2018; 13:e0206735. [PMID: 30388152 PMCID: PMC6214540 DOI: 10.1371/journal.pone.0206735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/18/2018] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery and other therapeutic options for obese patients are often evaluated by the loss of weight, reduction of comorbidities or improved quality of life. However, little is currently known about potential therapy-related changes in the adipose tissue of obese patients. The aim of this study was therefore to quantify fat fraction (FF) and T1 relaxation time by magnetic resonance imaging (MRI) after Roux-en-Y gastric bypass surgery and compare the resulting values with the preoperative ones. Corresponding MRI data were available from 23 patients (16 females and 7 males) that had undergone MRI before (M0) and one month after (M1) bariatric surgery. Patients were 22–59 years old (mean age 44.3 years) and their BMI ranged from 35.7–54.6 kg/m2 (mean BMI 44.6 kg/m2) at M0. Total visceral AT volumes (VVAT-T, in L) were measured by semi-automatic segmentation of axial MRI images acquired between diaphragm and femoral heads. MRI FF and T1 relaxation times were measured in well-defined regions of visceral (VAT) and subcutaneous (SAT) adipose tissue using two custom-made analysis tools. Average BMI values were 45.4 kg/m2 at time point M0 and 42.4 kg/m2 at M1. Corresponding VVAT-T values were 5.94 L and 5.33 L. Intraindividual differences in both BMI and VVAT-T were highly significant (p<0.001). Average relaxation times T1VAT were 303.7 ms at M0 and 316.9 ms at M1 (p<0.001). Corresponding T1SAT times were 283.2 ms and 280.7 ms (p = 0.137). Similarly, FFVAT differences (M0: 85.7%, M1: 83.4%) were significant (p <0.01) whereas FFSAT differences (M0: 86.1, M1: 85.9%) were not significant (p = 0.517). In conclusion, bariatric surgery is apparently not only related to a significant reduction in common parameters of adipose tissue distribution, here BMI and total visceral fat volume, but also significant changes in T1 relaxation time and fat fraction of visceral adipose tissue. Such quantitative MRI measures may potentially serve as independent biomarkers for longitudinal and cross-sectional measurements in obese patients.
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Affiliation(s)
- Stefanie Lehmann
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Nicolas Linder
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Ulf Retschlag
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Roland Stange
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Nikita Garnov
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Arne Dietrich
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Section of Bariatric Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
- * E-mail:
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Coimbra S, Reis F, Ferreira C, Nunes S, Viana S, Catarino A, Rocha-Pereira P, Belo L, Monteiro L, Catarino C, Santos-Silva A. Weight loss achieved by bariatric surgery modifies high-density lipoprotein subfractions and low-density lipoprotein oxidation towards atheroprotection. Clin Biochem 2018; 63:46-53. [PMID: 30342017 DOI: 10.1016/j.clinbiochem.2018.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Weight loss achieved by laparoscopic adjustable gastric banding (LAGB) induces an increase in high-density lipoprotein cholesterol (HDLc) but a small effect on low-density lipoprotein (LDL), although changes in their quality (size and composition) are uncertain. Our aim was to study the impact of weight loss, achieved 13-months after LAGB, on inflammation and dyslipidemia, focusing on HDL and LDL subfractions, and oxidized LDL (oxLDL). DESIGN & METHODS We evaluated standard lipid profile, HDL and LDL subfractions, oxLDL, interleukin (IL)-6 and C-reactive protein (CRP), in twenty obese patients, before (T0) and 13-months after LAGB (T1), and in seventeen healthy controls. RESULTS At T1, patients showed lower body weight (12% median weight loss) and anthropometric indices; reduction in TG, atherogenic indices, oxLDL, oxLDL/LDL ratio, CRP and IL-6, and enhancement in HDLc; an increase in large HDL and intermediate HDL subfractions, and a decrease in small HDL subfraction; LDL subfractions were not modified. Percentual change (%Δ) of oxLDL, from T0 to T1, correlated significantly and positively with %Δ of small HDL subfraction and with %Δ of body mass index. CONCLUSIONS Weight loss induced atheroprotective changes on inflammation, and lipid profile, enhancing larger HDL, the more atheroprotective subfraction, reducing the less protective subclass, small HDL, and reducing oxLDL and oxLDL/LDL ratio. Quality of lipoproteins appears useful cardiovascular risk biomarkers, deserving further studies.
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Affiliation(s)
- Susana Coimbra
- UCIBIO\REQUIMTE, Porto; CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra-Paredes, Portugal.
| | - Flávio Reis
- iCBR, Instituto de Investigação Clínica e Biomédica de Coimbra, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Cátia Ferreira
- Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal
| | - Sara Nunes
- iCBR, Instituto de Investigação Clínica e Biomédica de Coimbra, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Sofia Viana
- iCBR, Instituto de Investigação Clínica e Biomédica de Coimbra, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Instituto Politécnico de Coimbra, Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal
| | - Alice Catarino
- Hospital da Prelada-Dr. Domingos Braga da Cruz, Porto, Portugal
| | - Petronila Rocha-Pereira
- UCIBIO\REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal; Centro de Investigação em Ciências Saúde (CICS), Universidade da Beira Interior, Covilhã, Portugal
| | - Luís Belo
- UCIBIO\REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal
| | - Luís Monteiro
- Hospital da Prelada-Dr. Domingos Braga da Cruz, Porto, Portugal
| | - Cristina Catarino
- UCIBIO\REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal
| | - Alice Santos-Silva
- UCIBIO\REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal.
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Ambery P, Parker VE, Stumvoll M, Posch MG, Heise T, Plum-Moerschel L, Tsai LF, Robertson D, Jain M, Petrone M, Rondinone C, Hirshberg B, Jermutus L. MEDI0382, a GLP-1 and glucagon receptor dual agonist, in obese or overweight patients with type 2 diabetes: a randomised, controlled, double-blind, ascending dose and phase 2a study. Lancet 2018; 391:2607-2618. [PMID: 29945727 DOI: 10.1016/s0140-6736(18)30726-8] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Weight loss is often key in the management of obese or overweight patients with type 2 diabetes, yet few treatments for diabetes achieve clinically meaningful weight loss. We aimed to assess the efficacy, tolerability, and safety of treatment with MEDI0382, a balanced glucagon-like peptide-1 and glucagon receptor dual agonist developed to provide glycaemic control and weight loss, in patients with type 2 diabetes. METHODS This randomised, placebo-controlled, double-blind, combined multiple-ascending dose (MAD) and phase 2a study was done at 11 study sites (hospitals and contract research organisations) in Germany. We enrolled patients aged 18-65 years with controlled type 2 diabetes (glycated haemoglobin A1c [HbA1c] levels of 6·5-8·5% at screening) and a body-mass index between 27 kg/m2 and 40 kg/m2. An interactive web-response system was used to randomly assign patients to receive MEDI0382 or placebo. Patients were randomly assigned 2:1 in cohorts A-C and 3:1 in cohorts D and E in the MAD portion of the study, and 1:1 in the phase 2a portion. Randomisation was done by a contracted third-party operator who was not involved in the clinical operations of the study. The pharmacists, participants, and study site personnel involved in treating and assessing participants were masked to treatment allocation. Patients received once-daily subcutaneous injections of the study drug at doses of no more than 300 μg for 22 days or less in the MAD portion of the study, and a dose of no more than 200 μg for 41 days or less in the phase 2a portion. The two primary endpoints of the phase 2a portion were the change from baseline to day 41 in glucose area under the curve at 0-4 h (AUC0-4 h) after a mixed-meal tolerance test (MMTT), assessed in all participants who received at least one dose of study drug and whose measurements were taken at baseline and day 41, and change from baseline in bodyweight, assessed in the intention-to-treat (ITT) population. Safety analyses were done in all participants who received any study drug analysed according to the treatment they received. This study is registered with ClinicalTrials.gov, number NCT02548585. FINDINGS Patients were recruited between Dec 9, 2015, and Feb 24, 2017. 61 patients were randomly assigned to the MAD part of the study (42 to MEDI0382 and 19 to placebo). 51 patients were randomly assigned to the phase 2a part, of whom 25 were randomly assigned to MEDI0382 and 26 to placebo. In the phase 2a study, three patients in the MEDI0382 group and one in the placebo group discontinued, all as a result of adverse events. 22 (88%) patients in the MEDI0382 group and 25 (96%) in the placebo group received at least one dose and had measurements taken at baseline and day 41. Glucose AUC0-4 h post MMTT decreased significantly with MEDI0382 versus placebo (least squares [LS] mean -32·78% [90% CI -36·98 to -28·57] vs -10·16% [-14·10 to -6·21], and the mean difference was -22·62% [-28·40 to -16·85]; p<0·0001). In the ITT population, reduction in bodyweight was significantly greater with MEDI0382 than with placebo (LS mean -3·84 kg [90% CI -4·55 to -3·12] vs -1·70 kg [-2·40 to -1·01] and mean difference of 2·14 kg [-3·13 to -1·31]; p=0·0008). The proportion of patients who had a treatment-emergent adverse event (TEAE) was similar between treatment groups (22 [88%] of 25 in the MEDI0382 group vs 23 [88%] of 26 in the placebo group); gastrointestinal disorders (18 [72%] vs 13 [40%]) and decreased appetite (five [20%] vs none) occurred more frequently with MEDI0382 than placebo. No participants in the MEDI0382 group had a grade 3 or worse TEAE (vs two [8%] in the placebo group). INTERPRETATION MEDI0382 has the potential to deliver clinically meaningful reductions in blood glucose and bodyweight in obese or overweight individuals with type 2 diabetes. FUNDING MedImmune.
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Affiliation(s)
- Philip Ambery
- Cardiovascular, Renal, and Metabolism, MedImmune, Cambridge, UK.
| | | | | | | | | | | | | | | | - Meena Jain
- Cardiovascular, Renal, and Metabolism, MedImmune, Cambridge, UK
| | | | | | | | - Lutz Jermutus
- Cardiovascular, Renal, and Metabolism, MedImmune, Cambridge, UK
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Merlotti C, Ceriani V, Morabito A, Pontiroli AE. Subcutaneous fat loss is greater than visceral fat loss with diet and exercise, weight-loss promoting drugs and bariatric surgery: a critical review and meta-analysis. Int J Obes (Lond) 2017; 41:672-682. [DOI: 10.1038/ijo.2017.31] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/30/2016] [Accepted: 01/20/2017] [Indexed: 02/07/2023]
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15
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Effects of Bariatric Surgery on Non-alcoholic Fatty Liver Disease: Magnetic Resonance Imaging Is an Effective, Non-invasive Method to Evaluate Changes in the Liver Fat Fraction. Obes Surg 2017; 27:1755-1762. [DOI: 10.1007/s11695-016-2531-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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16
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Mizrahi I, Beglaibter N, Simanovsky N, Lioubashevsky N, Mazeh H, Ghanem M, Chapchay K, Eid A, Grinbaum R. Ultrasound evaluation of visceral and subcutaneous fat reduction in morbidly obese subjects undergoing laparoscopic gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass: a prospective comparison study. Obes Surg 2015; 25:959-66. [PMID: 25394586 DOI: 10.1007/s11695-014-1495-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Visceral fat (VF) plays a major role in the development of metabolic syndrome associated with obesity. The aim of our study is to compare VF and subcutaneous fat (SCF) reduction measured by ultrasonography (US) after laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-En-Y gastric bypass (LRYGB). METHODS Thirty-nine morbidly obese patients were prospectively evaluated by US before surgery and 3, 6, and 12 months following surgery to determine VF and SCF thickness. RESULTS Three statistically comparable groups of morbidly obese patients underwent LRYGB (n = 13), LSG (n = 15), and LAGB (n = 11). The three groups did not differ in initial age, gender, body mass index (BMI), VF, or SCF. Final excess weight loss (EWL%) was highest after LSG and LRYGB followed by LAGB (81 ± 5.8 vs. 69.5 ± 4.5 vs. 43.4 ± 5.2, p < 0.001). LSG and LRYGB were significantly more efficient in VF reduction (ΔVF) compared with LAGB (7.1 ± 0.5 vs. 5.6 ± 0.6 vs. 3.6 ± 0.8, p = 0.004). SCF reduction (ΔSCF) was also highest after LSG followed by LRYGB and LAGB (3 ± 0.2 vs. 2.2 ± 0.4 vs. 1.9 ± 0.4, p = 0.08). The change in fat distribution, determined as Δ(VF/SCF), showed a preferential VF reduction in the LSG and LRYGB patients compared with patients that underwent LAGB (0.59 ± 0.1 vs. 0.52 ± 0.2 vs. 0.19 ± 0.2, p = 0.42). In a subgroup analysis comparing only LSG to LRYGB, no statistically significant difference was seen in EWL%, ΔVF, ΔSCF, or in fat distribution Δ(VF/SCF). CONCLUSION LSG and LRYGB show better preferential and overall VF reduction than LAGB. US may serve as a simple tool of evaluating postoperative fat distribution.
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Affiliation(s)
- Ido Mizrahi
- Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, P.O.B. 24035, 91240, Jerusalem, Israel,
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Computed tomography-based assessment of abdominal adiposity changes and their impact on metabolic alterations following bariatric surgery. World J Surg 2015; 39:417-23. [PMID: 25331726 DOI: 10.1007/s00268-014-2826-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of surgically induced weight loss on the abdominal adipose tissue depots and the metabolic profile in morbidly obese (MO) patients. METHODS The study was performed with a semi-automated quantification of adipose tissue compartments on single-slice abdominal CT series before surgery, 6 and 12 months after bariatric surgery. Thirty-eight MO patients with mean age of 35.7 ± 10.1 years and mean body mass index (BMI) of 43.6 ± 6.5 kg/m(2) were studied (20 patients underwent gastric banding and 18 patients underwent sleeve gastrectomy). Anthropometric measurements, metabolic and inflammatory parameters were analyzed in each patient. RESULTS Markedly decreased levels of total abdominal adipose tissue, abdominal subcutaneous adipose tissue (AbSAT) and visceral adipose tissue (VAT) at 6 and 12 months were noted in comparison to the preoperative values. The total % reduction of VAT was significant higher in comparison to the total % reduction of AbSAT at 12 months after bariatric surgery (P < 0.01) with the mean ratio of AbSAT/VAT to increase from 4.1 ± 1.7 preoperatively to 6.2 ± 3.1 at 12 months postoperatively (P < 0.001). In addition, high-sensitivity C-reactive protein (hsCRP) decreased significantly with weight loss after bariatric surgery and the total abdominal lipid loss was related to the decrease in hsCRP. CONCLUSIONS Significant changes in abdominal lipid deposition occurred in MO patients 6 and 12 months after bariatric surgery. The changes were significantly, correlated with the magnitude of BMI loss. The fat redistribution may contribute to the improvements in metabolic abnormalities.
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18
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Toro-Ramos T, Goodpaster BH, Janumala I, Lin S, Strain GW, Thornton JC, Kang P, Courcoulas AP, Pomp A, Gallagher D. Continued loss in visceral and intermuscular adipose tissue in weight-stable women following bariatric surgery. Obesity (Silver Spring) 2015; 23:62-9. [PMID: 25384375 PMCID: PMC4308947 DOI: 10.1002/oby.20932] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/22/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess changes in total (TAT), subcutaneous (SAT), visceral (VAT), and intermuscular (IMAT) adipose tissue by whole-body MRI before surgery and at 12 months and 24 months post-surgery in a subset of participants of the Longitudinal Assessment of Bariatric Surgery-2. METHODS From 0 to 12 months, n = 20 females and 3 males; from 12 to 24 months, n = 42 females and 7 males. Paired t-tests and GLM repeated measures examined changes in TAT, SAT, VAT, and IMAT at 12 and 24 months, with sex and age as covariates. RESULTS Changes from 0 to 12 months included weight (-41.9 ± 12.1 kg; -36%), TAT (-33.5 ± 9.6 kg; -56%), SAT (-29.2 ± 8.2 kg; -55%), VAT (-3.3 ± 1.6 kg; -73%), and IMAT (-0.99 ± 0.68 kg; -50%), all P < 0.001. In females, from 12 to 24 months, despite relative weight stability (-1.8 ± 6.5 kg, -2%; P = 0.085), VAT (-0.5 ± 0.7 kg; -30%; P < 0.001) and IMAT (-0.2 ± 0.4 kg; -14%; P = 0.012) decreased further. In males, from 12 to 24 months, weight increased (5.1 ± 5.2 kg; 6%; P = 0.04) with no significant changes in TAT or sub-depots. CONCLUSIONS Bariatric surgery continues to induce favorable changes in body composition, i.e., persistent adipose tissue loss at 24 months in the absence of further significant weight loss.
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Affiliation(s)
- Tatiana Toro-Ramos
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
- Institute of Human Nutrition & Dept. of Medicine, College of Physicians and Surgeons, Columbia University Medical Center
| | - Bret H. Goodpaster
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Isaiah Janumala
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
| | - Susan Lin
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
- Center for Family and Community Medicine, Columbia University Medical Center
| | - Gladys W. Strain
- Laparoscopic and Bariatric Surgery Division, Weill Cornell Medical College, New York, New York
| | - John C. Thornton
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
| | - Patrick Kang
- Department of Radiology, St. Luke’s-Roosevelt Hospital, New York, New York
| | - Anita P. Courcoulas
- General Surgery-Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alfons Pomp
- Laparoscopic and Bariatric Surgery Division, Weill Cornell Medical College, New York, New York
| | - Dympna Gallagher
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
- Institute of Human Nutrition & Dept. of Medicine, College of Physicians and Surgeons, Columbia University Medical Center
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Fjeldborg K, Pedersen SB, Møller HJ, Rask P, Danielsen AV, Stødkilde-Jørgensen H, Richelsen B. Intrahepatic fat content correlates with soluble CD163 in relation to weight loss induced by Roux-en-Y gastric bypass. Obesity (Silver Spring) 2015; 23:154-61. [PMID: 25376508 DOI: 10.1002/oby.20942] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/18/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Soluble CD163 (sCD163) is a new marker of obesity-related metabolic complications. sCD163 and CD163 mRNA were investigated in relation to the fat distribution at baseline and 12 months after Roux-en-Y gastric bypass (RYGB). METHODS Thirty-one obese subjects (BMI: 42.3 ± 4.7 kg/m(2)) were enrolled. Subcutaneous (SAT) and visceral adipose tissue (VAT) volume were determined by MRI, intrahepatic lipid content (IHL) by MR-spectroscopy, and body composition by DXA. Fasting blood samples and adipose tissue samples were obtained, and ELISA and RT-PCR were performed. RESULTS RYGB-induced weight loss (36 ± 11 kg) was accompanied by a significant reduction in sCD163 (2.1 ± 0.8 mg/l vs. 1.7 ± 0.7 mg/l), SAT, VAT, and IHL (all, P < 0.001). At baseline, sCD163 was associated with VAT (r = 0.40, P < 0.05) but not with SAT or IHL. Moreover, CD163 mRNA was significantly upregulated in VAT compared with SAT at baseline (P < 0.05) and significantly downregulated in SAT after RYGB (P < 0.001). ΔsCD163 was significantly associated with ΔIHL after RYGB compared with baseline (r = 0.40, P < 0.05). CONCLUSIONS RYGB-induced weight loss results in a reduction of sCD163 and CD163 mRNA. The association between ΔsCD163 and ΔIHL may reflect a reduction in sCD163-producing Kupffer cells in the liver. Moreover, sCD163 may be a marker of "unhealthy" fat distribution in obese subjects.
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Affiliation(s)
- Karen Fjeldborg
- Department of Medicine and Endocrinology MEA, Aarhus University Hospital, Aarhus, Denmark
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Pola A, Sadananthan SA, Gopalan V, Tan MLS, Keong TY, Zhou Z, Ishino S, Nakano Y, Watanabe M, Horiguchi T, Nishimoto T, Zhu B, Velan SS. Investigation of Fat Metabolism during Antiobesity Interventions by Magnetic Resonance Imaging and Spectroscopy. MAGNETIC RESONANCE INSIGHTS 2014; 7:33-40. [PMID: 25574137 PMCID: PMC4251539 DOI: 10.4137/mri.s19362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/17/2014] [Accepted: 10/28/2014] [Indexed: 12/20/2022]
Abstract
The focus of current treatments for obesity is to reduce the body weight or visceral fat, which requires longer duration to show effect. In this study, we investigated the short-term changes in fat metabolism in liver, abdomen, and skeletal muscle during antiobesity interventions including Sibutra mine treatment and diet restriction in obese rats using magnetic resonance imaging, magnetic resonance spectroscopy, and blood chemistry. Sibutramine is an antiobesity drug that results in weight loss by increasing satiety and energy expenditure. The Sibutramine-treated rats showed reduction of liver fat and intramyocellular lipids on day 3. The triglycerides (TG) decreased on day 1 and 3 compared to baseline (day 0). The early response/nonresponse in different fat depots will permit optimization of treatment for better clinical outcome rather than staying with a drug for longer periods.
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Affiliation(s)
- Arunima Pola
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
| | | | - Venkatesh Gopalan
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
| | | | - Terry Yew Keong
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
| | | | - Seigo Ishino
- Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | | | | | | | | | - Bin Zhu
- Takeda Singapore Pte. Ltd., Singapore
| | - S Sendhil Velan
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore
- Clinical Imaging Research Centre, NUS-A*STAR, Singapore
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Keidar A, Appelbaum L, Schweiger C, Hershkop K, Matot I, Constantini N, Sosna J, Weiss R. Baseline Abdominal Lipid Partitioning Is Associated with the Metabolic Response to Bariatric Surgery. Obes Surg 2014; 24:1709-16. [DOI: 10.1007/s11695-014-1249-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Blüher S, Raschpichler M, Hirsch W, Till H. A case report and review of the literature of laparoscopic sleeve gastrectomy in morbidly obese adolescents: beyond metabolic surgery and visceral fat reduction. Metabolism 2013; 62:761-7. [PMID: 23219586 DOI: 10.1016/j.metabol.2012.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 11/01/2012] [Accepted: 11/06/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Data on safety, effectiveness and amelioration of metabolic comorbidities are scarce for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). METHODS Data on a 17 year-old female who underwent LSG due to morbid obesity and quantification of visceral adipose tissue (VAT)/hepatic fat (HF) by MRI scan are presented. In addition, a review of the literature related to LSG in adolescent obesity is provided [search terms: laparoscopic sleeve gastrectomy, adolescence, obesity]. RESULTS Pre-existing comorbidities in our patient included insulin resistance, NASH (HF: 28%) and hyperuricemia. BMI dropped from 52.9 kg/m(2) to 40.4 and 35.0 kg/m(2) after 6 and 24 months, respectively, following LSG. VAT dropped by 49.2% and by 71.5% within 6 and 24 months, accompanied by a decrease of HF to 1.53% and to 0.85%, respectively. Improvements of metabolic parameters towards normal range, which were reached within 6 months following LSG, could be maintained for 2 years. The review of the literature revealed that 9 original papers on LSG in adolescent obesity are available to date, ranging from single case presentations to case series of 108 patients and including children and adolescents 8-18 years. CONCLUSIONS LSG is a safe and - in the short term - effective bariatric procedure for adolescent obesity (follow up 24 months). Long-term results with larger numbers of patients and involving additional features, such as quantification of VAT and HF as markers of metabolic risk and insulin resistance, are warranted to further understand the effectiveness and safety and to further explore the long-term benefits of this procedure in adolescence.
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Affiliation(s)
- Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Germany.
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Qi J, Fong Y, Saltz L, D'Angelica MI, Kemeny NE, Gonen M, Shia J, Shukla-Dave A, Jarnagin WM, Do RKG, Schwartz LH, Koutcher JA, Zakian KL. Serial measurement of hepatic lipids during chemotherapy in patients with colorectal cancer: a 1 H MRS study. NMR IN BIOMEDICINE 2013; 26:204-12. [PMID: 22961714 PMCID: PMC3519948 DOI: 10.1002/nbm.2837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 06/20/2012] [Accepted: 06/21/2012] [Indexed: 05/12/2023]
Abstract
Hepatic steatosis is a hallmark of chemotherapy-induced liver injury. We made serial (1) H MRS measurements of hepatic lipids in patients over the time course of a 24-week chemotherapeutic regimen to determine whether (1) H MRS could be used to monitor the progression of chemotherapy-induced steatosis. Thirty-four patients with stage III or IV colorectal cancer receiving 5-fluorouracil, folinic acid and oxaliplatin (n=21) or hepatic arterial infusion of floxuridine with systemic irinotecan (n=13) were studied prospectively. (1) H MRS studies were performed at baseline and after 6 and 24 weeks of treatment. A (1) H MR spectrum was acquired from the liver during a breath hold and the ratio of fat to fat+water (FFW) was calculated to give a measure of hepatic triglycerides (HTGCs). The methodology was histologically validated in 18 patients and the reproducibility was assessed in 16 normal volunteers. Twenty-seven patients completed baseline, 6-week and 24-week (1) H MRS examinations and one was censored. Thirteen of 26 patients (50%) showed an increase in FFW after completion of treatment. Six patients (23%) developed hepatic steatosis and two patients converted from steatosis to nonsteatotic liver. Patients whose 6-week hepatic lipid levels had increased significantly relative to baseline also had a high probability of lipid elevation relative to baseline at the completion of treatment. Serial (1) H MRS is effective for the monitoring of HTGC changes during chemotherapy and for the detection of chemotherapy-associated steatosis. Six of 26 patients developed steatosis during chemotherapy. Lipid changes were observable at 6 weeks.
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Affiliation(s)
- Jing Qi
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Yuman Fong
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Leonard Saltz
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - Nancy E. Kemeny
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mithat Gonen
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Jinru Shia
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Abstract
The objective of this article is to systematically review the changes in insulin resistance after various types of bariatric surgical procedures. A Pubmed and EMBASE search for studies measuring insulin resistance before and after bariatric surgery was done and all original research articles from 1980 to present (2011) were included. Only the currently widely performed bariatric procedures were included. A meta-analysis of change in HOMA-IR was conducted, grouping studies with similar duration of follow-up. The percentage decrease in HOMA-IR at <=2 weeks, 1 month, 3 months, 6 months, 12 months and >16-18 months was found to be (mean ± standard error) -33.48 ± 5.78, -46.43 ± 6.99, -38.79 ± 9.64, -58.62 ± 7.38, -44.91 ± 7.98 and -67.04 ± 10.78%, respectively. RYGB (gastric bypass) and BPD (biliopancreatic diversion) produced a significant decrease in insulin resistance at 2 weeks after surgery, while LSG (sleeve gastrectomy) was strongly trending. LSG produced an earlier decrease in insulin resistance when compared to LAGB (gastric banding). RYGB, BPD and LSG produce an early decrease in insulin resistance through yet unknown mechanisms.
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Affiliation(s)
- R S Rao
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Diabetes and Bone Disease, Mount Sinai School of Medicine, 5 E. 98th St., New York, NY 10029, USA.
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Hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery: assessment with open-system 1H-MR spectroscopy. AJR Am J Roentgenol 2011; 196:W736-42. [PMID: 21606262 DOI: 10.2214/ajr.10.5215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to assess, with histopathologic control, the use of open-system 1-T (1)H MR spectroscopy for the evaluation of hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery. SUBJECTS AND METHODS Patients underwent (1)H MR spectroscopy (MRS) for the assessment of steatosis before and 3 months after surgery. Liver biopsy was performed during surgery. Hepatic steatosis was expressed as the ratio of fat peak area to cumulative water and fat peak areas. Histopathologic percentage of steatosis was graded as none (0-5%), mild (5-33%), moderate (33-66%), or severe (> 66%). The accuracy of (1)H-MRS and Spearman correlation coefficient were calculated. Differences between groups were assessed with the Wilcoxon signed rank and Mann-Whitney tests. RESULTS The study included 38 patients (median age, 45.5 years; median body mass index, 47.7). Before surgery, median steatosis measured with (1)H-MRS was 5.8%. The accuracy of (1)H-MRS was 89% (32/36), and the (1)H-MRS findings correlated with the histopathologic assessment of steatosis (r = 0.85, p < 0.001). With (1)H-MRS, no steatosis was discriminated from mild steatosis (p = 0.011), mild was discriminated from moderate steatosis (p < 0.001), and moderate was discriminated from severe steatosis (p = 0.021). Three months after surgery, steatosis had decreased to 3.1% (p < 0.001). The prevalence of hepatic steatosis measured with (1)H-MRS decreased from 53% to 32%. CONCLUSION In the care of morbidly obese patients undergoing assessment of hepatic steatosis and changes in steatosis after gastric bypass surgery, (1)H-MRS with an open 1-T MRI system is feasible. Measurements of hepatic fat with (1)H-MRS are accurate and correlate with clinical and histopathologic results.
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Reeder SB, Sirlin CB. Quantification of liver fat with magnetic resonance imaging. Magn Reson Imaging Clin N Am 2011; 18:337-57, ix. [PMID: 21094444 DOI: 10.1016/j.mric.2010.08.013] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intracellular fat accumulation is common feature of liver disease. Intracellular fat (steatosis) is the histologic hallmark of nonalcoholic fatty liver disease but also may occur with alcohol abuse, viral hepatitis, HIV and genetic lipodystrophies, and chemotherapy. This article reviews emerging MR imaging techniques that attempt to quantify liver fat. The content provides an overview of fatty liver disease and diseases where fat is an important disease feature. Also discussed is the current use and limitation of nontargeted biopsy in diffuse liver disease and why quantitative noninvasive biomarkers of liver fat would be beneficial.
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Affiliation(s)
- Scott B Reeder
- Liver Imaging Research Program, Department of Radiology, University of Wisconsin, E1/374 CSC, 600 Highland Avenue, Madison, WI 53792-3252, USA.
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Bose M, Machineni S, Oliván B, Teixeira J, McGinty JJ, Bawa B, Koshy N, Colarusso A, Laferrère B. Superior appetite hormone profile after equivalent weight loss by gastric bypass compared to gastric banding. Obesity (Silver Spring) 2010; 18:1085-91. [PMID: 20057364 PMCID: PMC2877144 DOI: 10.1038/oby.2009.473] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The goal of this study was to understand the mechanisms of greater weight loss by gastric bypass (GBP) compared to gastric banding (GB) surgery. Obese weight- and age-matched subjects were studied before (T0), after a 12 kg weight loss (T1) by GBP (n = 11) or GB (n = 9), and at 1 year after surgery (T2). peptide YY(3-36) (PYY(3-36)), ghrelin, glucagon-like peptide-1 (GLP-1), leptin, and amylin were measured after an oral glucose challenge. At T1, glucose-stimulated GLP-1 and PYY levels increased significantly after GBP but not GB. Ghrelin levels did not change significantly after either surgery. In spite of equivalent weight loss, leptin and amylin decreased after GBP, but not after GB. At T2, weight loss was greater after GBP than GB (P = 0.003). GLP-1, PYY, and amylin levels did not significantly change from T1 to T2; leptin levels continued to decrease after GBP, but not after GB at T2. Surprisingly, ghrelin area under the curve (AUC) increased 1 year after GBP (P = 0.03). These data show that, at equivalent weight loss, favorable GLP-1 and PYY changes occur after GBP, but not GB, and could explain the difference in weight loss at 1 year. Mechanisms other than weight loss may explain changes of leptin and amylin after GBP.
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Affiliation(s)
- Mousumi Bose
- New York Obesity Research Center, St Luke's Roosevelt Hospital Center, New York, New York, USA.
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Springer F, Machann J, Claussen CD, Schick F, Schwenzer NF. Liver fat content determined by magnetic resonance imaging and spectroscopy. World J Gastroenterol 2010; 16:1560-6. [PMID: 20355234 PMCID: PMC2848364 DOI: 10.3748/wjg.v16.i13.1560] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic steatosis as the most prevalent liver disorder can either be related to alcoholic liver disease (ALD) or non-alcoholic fatty liver disease (NAFLD). In both conditions, hepatocytes excessively accumulate fat-containing vacuoles within their cytoplasm, which is the key histological feature. In contrast to ALD, NAFLD is commonly associated with metabolic syndrome, obesity and insulin resistance. To determine increased liver fat content, liver biopsy is currently considered the gold standard. Besides the invasive technique, various other non-invasive techniques have been developed, such as ultrasound, computed tomography (CT), magnetic resonance spectroscopy (MRS) and magnetic resonance imaging (MRI) based methods. Among these techniques, ultrasound and CT provide only qualitative information about hepatic steatosis, whereas MRS- or MRI-based methods are able to determine even small amounts of fat accurately. These non-invasive magnetic resonance techniques have already proven their great potential, especially in longitudinal and cross-sectional studies regarding various metabolic conditions and medical treatment regimens. In this review, the most common, non-invasive MRS/MRI techniques for assessment of intrahepatic lipid content are described with their inherent advantages and limitations.
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