Gender Influence on Weight and Body Composition Following Sleeve Gastrectomy: Outcomes Suggest Potential Bariatric Surgery Body Composition Goals

Nutrition to Enhance Metabolic-Bariatric Surgery Outcomes

BACKGROUND

Gender-specific post-surgical goals for 12-month percent body fat (%BF) based on World Health Organization (WHO) obesity thresholds and for lean mass-sparing were published as preliminary body composition (BC) guidelines to address a knowledge gap in metabolic-bariatric surgery (MBS). Other studies' %BF outcomes inconsistently fell below obesity thresholds; none described nutrition practices. To help practitioners positively influence patients' BC and weight changes, this study describes the team-supported process of conducting serial body composition analysis (sBCA) concomitantly with the evidence-based nutrition practices applied to generate the preliminary guidelines.

METHODS

Guidelines were generated using the cumulative outcomes of separate, original research board-approved Roux-en-Y Gastric Bypass and Sleeve Gastrectomy studies. One dietitian assessed BC using the same bioimpedance machine, educated patients, and collected data from patients aged 18 and older in a 532-bed nonprofit acute-care institution in Northeast Ohio, USA, from May, 2007, through November, 2016. Essential to pre- and postoperative education was the "Nutrition Goal Checklist," an evidence-based synopsis of imperative practices. Body composition was assessed on initial visit, presurgically, and postoperative months 3, 6, and 12, generating individual patient handouts of progressive weight and BC changes with coordinating %BF graphs. Serial assessment enabled intervention toward meeting BC goals.

RESULTS

For genders in both surgeries, the described process influenced highly significant fat mass reduction, transitioning %BF below obesity thresholds. Lean mass-sparing outcomes supported the suggested preliminary guidelines.

CONCLUSIONS

Utilizing sBCA with evidence-based nutrition practices consistently generated outcomes to formulate preliminary BC guidelines following MBS. Further research is needed to solidify formal guidelines.

Sex-Specific Changes in Body Composition Following Metabolic and Bariatric Surgery Are Associated with the Remission of Metabolic Syndrome

PURPOSE

Metabolic and bariatric surgery (MBS) is the most effective treatment for metabolic syndrome (MetS). However, the mechanism of MetS remission after MBS remains unclear. We aimed to explore the relationship between sex differences, body composition, and the remission of MetS after MBS.

MATERIALS AND METHODS

Cross-sectional study of 80 patients with obesity and MetS who underwent MBS with case-control design. The International Diabetes Federation criteria were used to define MetS. Body composition was measured using dual-energy X-ray absorptiometry before and 1 year after the operation. In addition to calculating changes in MetS and its prevalence, we performed a multiple logistic regression to determine predictors of MetS remission.

RESULTS

There were significant differences in body composition between males and females after MBS. Both males and females had significant improvements in the overall prevalence of MetS, decreasing from 100 to 21.74% (P <0.001) and from 100 to 35.29% (P <0.001), respectively. A higher percentage of visceral adipose tissue (VAT) reduction tends to be associated with a higher chance of MetS remission in men. In females, the MetS nonremission subgroup had a higher %Trunk lean body mass (LBM), and %Android LBM reduction than the remission subgroup, but the multiple logistic regression analysis result was not statistically significant.

CONCLUSION

After MBS, reduced VAT might be related to MetS reversibility in males, while reduced LBM may result in MetS nonremission in females.

Risedronate use may blunt appendicular lean mass loss secondary to sleeve gastrectomy: Results from a pilot randomized controlled trial

Background

Despite robust weight loss and cardiometabolic benefit, lean mass loss following sleeve gastrectomy (SG) confers health risk. Bisphosphonates are a potential therapeutic agent for lean mass maintenance. Thus, our objective was to explore the effect of six months of risedronate (vs placebo) on change in dual energy x-ray absorptiometry (DXA) and computed tomography (CT) derived lean mass metrics in the year following SG.

Methods

24 SG patients were randomized to six months of 150 mg oral risedronate or placebo capsules (NCT03411902). Body composition was assessed at baseline and six months with optional 12-month follow-up using whole-body DXA and CT at the lumbar spine and mid-thigh. Group treatment effects and 95% CIs were generated from a mixed model using contrast statements at six and 12 months, adjusted for baseline values.

Results

Of 24 participants enrolled [55.7±6.7 years (mean±SD), 79% Caucasian, 83% women, body mass index (BMI) 44.7±6.3kg/m2], 21 returned for six-month testing, and 14 returned for 12-month testing. Six-month weight loss was -16.3 kg (-20.0, -12.5) and -20.9 kg (-23.7, -18.1) in the risedronate and placebo groups, respectively (p=.057). Primary analysis at six-months revealed a non-significant sparing of appendicular lean mass in the risedronate group compared to placebo [-1.2 kg (-2.3, -0.1) vs -2.1 kg (-3.0, -1.2)]; p=.20. By 12-months, the risedronate group displayed no change in appendicular lean mass from baseline [-0.5 kg (-1.5, 0.6)]; however, the placebo group experienced significantly augmented loss [-2.9 kg (-3.6, -2.1)].

Conclusion

Pilot data indicate risedronate treatment may mitigate appendicular lean mass loss following SG. Further study is warranted.