1
|
Bezerra A, Boppre G, Freitas L, Battista F, Duregon F, Faggian S, Busetto L, Ermolao A, Fonseca H. Body Composition Changes in Adolescents Who Underwent Bariatric Surgery: A Systematic Review and Meta-analysis. Curr Obes Rep 2024; 13:107-120. [PMID: 38172484 PMCID: PMC10933211 DOI: 10.1007/s13679-023-00549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review and meta-analysis is to characterize the changes in body composition of children and adolescents who underwent bariatric surgery and identify possible negative effects of performing this procedure during pediatric ages. RECENT FINDINGS Bariatric surgery in children and adolescents is an emerging strategy to promote higher and faster body weight and fat mass losses. However, possible negative effects usually observed in surgical patients' muscle-skeletal system raise a major concern perform this intervention during growth. Despite these possible issues, most experimental studies and reviews analyze bariatric surgery's effectiveness only by assessing anthropometric outcomes such as body weight and BMI, disregarding the short- and long-term impact of bariatric surgery on all body composition outcomes. Bariatric surgery is effective to reduce fat mass in adolescents, as well as body weight, waist circumference, and BMI. Significant reduction in lean mass and fat-free mass is also observed. Bone mass seems not to be impaired. All outcomes reduction were observed only in the first 12 months after surgery. Sensitivity analysis suggests possible sex and type of surgery-related differences, favoring a higher fat mass, body weight, and BMI losses in boys and in patients who underwent RYGB.
Collapse
Affiliation(s)
- Andréa Bezerra
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Human Motricity Research Center, University Adventista, Chillean, Chile
| | - Laura Freitas
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy.
| | - Federica Duregon
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Sara Faggian
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| |
Collapse
|
2
|
Tencerova M, Duque G, Beekman KM, Corsi A, Geurts J, Bisschop PH, Paccou J. The Impact of Interventional Weight Loss on Bone Marrow Adipose Tissue in People Living with Obesity and Its Connection to Bone Metabolism. Nutrients 2023; 15:4601. [PMID: 37960254 PMCID: PMC10650495 DOI: 10.3390/nu15214601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
This review focuses on providing physicians with insights into the complex relationship between bone marrow adipose tissue (BMAT) and bone health, in the context of weight loss through caloric restriction or metabolic and bariatric surgery (MBS), in people living with obesity (PwO). We summarize the complex relationship between BMAT and bone health, provide an overview of noninvasive imaging techniques to quantify human BMAT, and discuss clinical studies measuring BMAT in PwO before and after weight loss. The relationship between BMAT and bone is subject to variations based on factors such as age, sex, menopausal status, skeletal sites, nutritional status, and metabolic conditions. The Bone Marrow Adiposity Society (BMAS) recommends standardizing imaging protocols to increase comparability across studies and sites, they have identified both water-fat imaging (WFI) and spectroscopy (1H-MRS) as accepted standards for in vivo quantification of BMAT. Clinical studies measuring BMAT in PwO are limited and have shown contradictory results. However, BMAT tends to be higher in patients with the highest visceral adiposity, and inverse associations between BMAT and bone mineral density (BMD) have been consistently found in PwO. Furthermore, BMAT levels tend to decrease after caloric restriction-induced weight loss. Although weight loss was associated with overall fat loss, a reduction in BMAT did not always follow the changes in fat volume in other tissues. The effects of MBS on BMAT are not consistent among the studies, which is at least partly related to the differences in the study population, skeletal site, and duration of the follow-up. Overall, gastric bypass appears to decrease BMAT, particularly in patients with diabetes and postmenopausal women, whereas sleeve gastrectomy appears to increase BMAT. More research is necessary to evaluate changes in BMAT and its connection to bone metabolism, either in PwO or in cases of weight loss through caloric restriction or MBS, to better understand the role of BMAT in this context and determine the local or systemic factors involved.
Collapse
Affiliation(s)
- Michaela Tencerova
- Molecular Physiology of Bone, Institute of Physiology of the Czech Academy of Sciences, 14220 Prague, Czech Republic;
| | - Gustavo Duque
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Kerensa M. Beekman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Jeroen Geurts
- Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Peter H. Bisschop
- Department of Endocrinology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Julien Paccou
- Department of Rheumatology, MABLab ULR 4490, CHU Lille, University Lille, 59000 Lille, France
| |
Collapse
|
3
|
Huber FA, Singhal V, Tuli S, Stanford FC, Carmine B, Bouxsein ML, Misra M, Bredella MA. Biomechanical CT to Assess Bone After Sleeve Gastrectomy in Adolescents With Obesity: A Prospective Longitudinal Study. J Bone Miner Res 2023; 38:933-942. [PMID: 37073493 PMCID: PMC10363214 DOI: 10.1002/jbmr.4784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
Sleeve gastrectomy (SG) is effective in treating cardiometabolic complications of obesity but is associated with bone loss. Our aim was to determine the effect of SG on the lumbar spine by biomechanical CT analysis in adolescents/young adults with obesity. We hypothesized that SG would lead to a decrease in strength and bone mineral density (BMD) compared with nonsurgical controls. In a 12-month prospective nonrandomized study, adolescents/young adults with obesity underwent SG (n = 29, 18.0 ± 2.1 years, 23 female) or were followed without surgery (controls, n = 30, 17.95 ± 3.0 years, 22 female). At baseline and 12 months, participants underwent quantitative computed tomography (QCT) of L1 and L2 for biomechanical assessment and MRI of the abdomen and mid-thigh for body composition assessment. Twelve-month changes between groups and within groups were assessed. Analyses were controlled for baseline and 12-month changes in body mass index (BMI) by multivariable analyses. Regression analysis was performed to evaluate the effect of body composition on bone parameters. Our institutional review board (IRB) approved the study, and informed consent/assent was obtained. Participants in the SG group had a higher baseline BMI than controls (p = 0.01) and lost an average of 34.3 ± 13.6 kg 12 months after surgery, whereas weight was unchanged in controls (p < 0.001). There were significant reductions in abdominal adipose tissue and thigh muscle area in the SG group compared with controls (p < 0.001). Bone strength, bending stiffness, and average and trabecular volumetric BMD decreased in the SG group compared with controls (p < 0.001). After controlling for change in BMI, a 12-month reduction in cortical BMD was significant in the SG group compared with controls (p = 0.02). Reductions in strength and trabecular BMD were associated with reductions in BMI, visceral adipose tissue, and muscle (p ≤ 0.03). In conclusion, SG in adolescents decreased strength and volumetric BMD of the lumbar spine compared with nonsurgical controls. These changes were associated with decreases in visceral fat and muscle mass. © 2023 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Florian A. Huber
- Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- MGH Weight Center, Boston, Massachusetts
| | - Shubhangi Tuli
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Fatima C. Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- MGH Weight Center, Boston, Massachusetts
| | - Brian Carmine
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Mary L. Bouxsein
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Becetti I, Singhal V, Nimmala S, Lee H, Lawson EA, Bredella MA, Misra M. Serum Oxytocin Levels Decrease 12 Months Following Sleeve Gastrectomy and Are Associated with Decreases in Lean Mass. Int J Mol Sci 2023; 24:10144. [PMID: 37373292 DOI: 10.3390/ijms241210144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Oxytocin (OXT), an anorexigenic hormone, is also bone anabolic. Further, OXT administration results in increases in lean mass (LM) in adults with sarcopenic obesity. We examine, for the first time, associations of OXT with body composition and bone endpoints in 25 youth 13-25 years old with severe obesity who underwent sleeve gastrectomy (SG) and 27 non-surgical controls (NS). Forty participants were female. Subjects underwent fasting blood tests for serum OXT and DXA for areal bone mineral density (aBMD) and body composition. At baseline, SG vs. NS had higher median body mass index (BMI) but did not differ for age or OXT levels. Over 12 months, SG vs. NS had greater reductions in BMI, LM, and fat mass (FM). OXT decreased in SG vs. NS 12 months post-SG. While baseline OXT predicted a 12-month BMI change in SG, decreases in OXT levels 12 months post-SG were not associated with decreases in weight or BMI. In SG, decreases in OXT were positively associated with decreases in LM but not with decreases in FM or aBMD. Loss of LM, a strong predictor of BMD, after bariatric surgery may reduce functional and muscular capacity. OXT pathways may be targeted to prevent LM loss following SG.
Collapse
Affiliation(s)
- Imen Becetti
- Division of Pediatric Endocrinology, Mass General for Children and Harvard Medical School, Boston, MA 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Vibha Singhal
- Division of Pediatric Endocrinology, Mass General for Children and Harvard Medical School, Boston, MA 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Pediatric Program, MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Interventions, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Mass General for Children and Harvard Medical School, Boston, MA 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| |
Collapse
|
5
|
Huber FA, Singhal V, Tuli S, Becetti I, López López AP, Bouxsein ML, Misra M, Bredella MA. Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with Obesity Assessed with Quantitative CT and MR Spectroscopy. Radiology 2023; 307:e223256. [PMID: 37310246 PMCID: PMC10315522 DOI: 10.1148/radiol.223256] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 06/14/2023]
Abstract
Background Sleeve gastrectomy (SG) is effective in the treatment of cardiometabolic complications of obesity but is associated with bone loss. Purpose To determine the long-term effects of SG on vertebral bone strength, density, and bone marrow adipose tissue (BMAT) in adolescents and young adults with obesity. Materials and Methods This 2-year prospective nonrandomized longitudinal study enrolled adolescents and young adults with obesity who underwent either SG (SG group) or dietary and exercise counseling without surgery (control group) at an academic medical center from 2015 to 2020. Participants underwent quantitative CT of the lumbar spine (L1 and L2 levels) to assess bone density and strength, proton MR spectroscopy to assess BMAT (L1 and L2 levels), and MRI of the abdomen and thigh to assess body composition. Student t and Wilcoxon signed-rank tests were used to compare 24-month changes between and within groups. Regression analysis was performed to evaluate associations between body composition, vertebral bone density, strength, and BMAT. Results A total of 25 participants underwent SG (mean age, 18 years ± 2 [SD], 20 female), and 29 underwent dietary and exercise counseling without surgery (mean age, 18 years ± 3, 21 female). Body mass index (BMI) decreased by a mean of 11.9 kg/m2 ± 5.21 [SD] after 24 months in the SG group (P < .001), while it increased in the control group (mean increase, 1.49 kg/m2 ± 3.10; P = .02). Mean bone strength of the lumbar spine decreased after surgery compared with that in control subjects (mean decrease, -728 N ± 691 vs -7.24 N ± 775; P < .001). BMAT of the lumbar spine increased after SG (mean lipid-to-water ratio increase, 0.10 ± 0.13; P = .001). Changes in vertebral density and strength correlated positively with changes in BMI and body composition (R = 0.34 to R = 0.65, P = .02 to P < .001) and inversely with vertebral BMAT (R = -0.33 to R = -0.47, P = .03 to P = .001). Conclusion SG in adolescents and young adults reduced vertebral bone strength and density and increased BMAT compared with those in control participants. Clinical trial registration no. NCT02557438 © RSNA, 2023 See also the editorial by Link and Schafer in this issue.
Collapse
Affiliation(s)
- Florian A. Huber
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Vibha Singhal
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Shubhangi Tuli
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Imen Becetti
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Ana Paola López López
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Mary L. Bouxsein
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Madhusmita Misra
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Miriam A. Bredella
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| |
Collapse
|
6
|
Liu L, Rosen CJ. New Insights into Calorie Restriction Induced Bone Loss. Endocrinol Metab (Seoul) 2023; 38:203-213. [PMID: 37150516 PMCID: PMC10164494 DOI: 10.3803/enm.2023.1673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Caloric restriction (CR) is now a popular lifestyle choice due to its ability in experimental animals to improve lifespan, reduce body weight, and lessen oxidative stress. However, more and more emerging evidence suggests this treatment requires careful consideration because of its detrimental effects on the skeletal system. Experimental and clinical studies show that CR can suppress bone growth and raise the risk of fracture, but the specific mechanisms are poorly understood. Reduced mechanical loading has long been thought to be the primary cause of weight loss-induced bone loss from calorie restriction. Despite fat loss in peripheral depots with calorie restriction, bone marrow adipose tissue (BMAT) increases, and this may play a significant role in this pathological process. Here, we update recent advances in our understanding of the effects of CR on the skeleton, the possible pathogenic role of BMAT in CR-induced bone loss, and some strategies to mitigate any potential side effects on the skeletal system.
Collapse
Affiliation(s)
- Linyi Liu
- MaineHealth Institute for Research, Scarborough, ME, USA
| | | |
Collapse
|
7
|
Bone marrow adipose tissue composition and glycemic improvements after gastric bypass surgery. Bone Rep 2022; 17:101596. [PMID: 35734226 PMCID: PMC9207612 DOI: 10.1016/j.bonr.2022.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022] Open
Abstract
Fracture risk is increased in type 2 diabetes, which may in part be due to altered bone marrow adiposity. Cross sectional studies have reported that people with type 2 diabetes have lower unsaturated BMAT lipid levels than people without diabetes, although there are limited data on longitudinal changes. We hypothesized that Roux-en-Y gastric bypass (RYGB), which dramatically improves glycemic status, would have differential effects on BMAT composition, with increases in the unsaturated lipid index in people with diabetes. Given reports that axial BMAT is responsive to metabolic stimuli while appendicular BMAT is stable, we hypothesized that BMAT changes would occur at the spine but not the tibia. We enrolled 30 obese women, stratified by diabetes status, and used magnetic resonance spectroscopy to measure BMAT at the spine in all participants, and the tibia in a subset (n = 19). At baseline, BMAT parameters were similar between those with and without diabetes, except tibial marrow fat content was lower in women with diabetes (97.4 % ± 1.0 % versus 98.2 % ± 0.4 %, p = 0.04). Six months after surgery, both groups experienced similar weight loss of 27 kg ± 7 kg. At the spine, there was a significant interaction between diabetes status and changes in both marrow fat content and the unsaturated lipid index (p = 0.02, p < 0.01 for differences, respectively). Women with diabetes had a trend towards a decline in marrow fat content (-4.3 % ± 8.2 %, p = 0.09) and increase in the unsaturated lipid index (+1.1 % ± 1.5 %, p = 0.02). In contrast, BMAT parameters did not significantly change in women without diabetes. In all women, changes in the unsaturated lipid index inversely correlated with hemoglobin A1c changes (r = -0.47, p = 0.02). At the tibia, there was little BMAT change by diabetes status. Our results suggest that vertebral BMAT composition is responsive to changes in glycemic control after RYGB.
Collapse
|
8
|
Ou X, Chen M, Xu L, Lin W, Huang H, Chen G, Wen J. Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis. Eur J Med Res 2022; 27:144. [PMID: 35934692 PMCID: PMC9358806 DOI: 10.1186/s40001-022-00774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
To assess changes in bone mineral density (BMD) following bariatric surgery (BS) in patients with different bone sites, postoperative periods and ages. Twenty-two studies were included. Femoral neck (FN) BMD decreased after surgery (MD, - 0.05 g/cm2, CI - 0.10 to - 0.01, P = 0.03). Postoperative BMD decreased more in the FN and lumbar spine (LS) of patients older than 40 (FNBMD, - 0.07 g/cm2, CI - 0.13 to - 0.00, P = 0.04; LSBMD, - 0.03 g/cm2, CI - 0.05 to - 0.00, P = 0.02) or patients with a postoperative time of greater than 12 months (FNBMD, - 0.06 g/cm2, CI - 0.12 to - 0.01, P = 0.03; LSMD, - 0.04 g/cm2, CI - 0.09 to 0.01, P = 0.12); therefore, post-BS bone loss should be monitored among patients in these groups. Longer follow-ups are needed to determine whether BMD changes or stabilizes.
Collapse
Affiliation(s)
- Xiaodan Ou
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Mingguang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.,Department of Cardiac Intensive Care Unit, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Lizhen Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Wei Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Huibin Huang
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
| | - Gang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Junping Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
| |
Collapse
|
9
|
Shu JB, Kim TY. Bone marrow adiposity in diabetes and clinical interventions. Curr Opin Endocrinol Diabetes Obes 2022; 29:303-309. [PMID: 35776685 DOI: 10.1097/med.0000000000000741] [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] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This study aims to review bone marrow adipose tissue (BMAT) changes in people with diabetes, contributing factors, and interventions. RECENT FINDINGS In type 1 diabetes (T1D), BMAT levels are similar to healthy controls, although few studies have been performed. In type 2 diabetes (T2D), both BMAT content and composition appear altered, and recent bone histomorphometry data suggests increased BMAT is both through adipocyte hyperplasia and hypertrophy. Position emission tomography scanning suggests BMAT is a major source of basal glucose uptake. BMAT is responsive to metabolic interventions. SUMMARY BMAT is a unique fat depot that is influenced by metabolic factors and proposed to negatively affect the skeleton. BMAT alterations are more consistently seen in T2D compared to T1D. Interventions such as thiazolidinedione treatment may increase BMAT, whereas metformin treatment, weight loss, and exercise may decrease BMAT. Further understanding of the role of BMAT will provide insight into the pathogenesis of diabetic bone disease and could lead to targeted preventive and therapeutic strategies.
Collapse
Affiliation(s)
- Jessica B Shu
- University of California, San Francisco and the San Francisco VA Health Care System, San Francisco, California, USA
| | | |
Collapse
|
10
|
Pachón-Peña G, Bredella MA. Bone marrow adipose tissue in metabolic health. Trends Endocrinol Metab 2022; 33:401-408. [PMID: 35396163 PMCID: PMC9098665 DOI: 10.1016/j.tem.2022.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
Recent studies have highlighted the role of bone marrow adipose tissue (BMAT) as a regulator of skeletal homeostasis and energy metabolism. While long considered an inert filler, occupying empty spaces from bone loss and reduced hematopoiesis, BMAT is now considered a secretory and metabolic organ that responds to nutritional challenges and secretes cytokines, which indirectly impact energy and bone metabolism. The recent advances in our understanding of the function of BMAT have been enabled by novel noninvasive imaging techniques, which allow longitudinal assessment of BMAT in vivo following interventions. This review will focus on the latest advances in our understanding of BMAT and its role in metabolic health. Imaging techniques to quantify the content and composition of BMAT will be discussed.
Collapse
Affiliation(s)
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| |
Collapse
|
11
|
Bredella MA, Buckless C, Fazeli PK, Rosen CJ, Torriani M, Klibanski A, Miller KK. Bone marrow adipose tissue composition following high-caloric feeding and fasting. Bone 2021; 152:116093. [PMID: 34186250 PMCID: PMC8323345 DOI: 10.1016/j.bone.2021.116093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bone marrow adipose tissue (BMAT) plays a role in systemic energy metabolism and responds to nutritional changes. Chronic starvation as well as visceral adiposity are associated with BMAT accumulation. Two types of BMAT have been described which differ in anatomic location (proximal-regulated-rBMAT vs distal-constitutive-cBMAT) and composition (higher unsaturated lipids of cBMAT compared to rBMAT). OBJECTIVE To determine the response of BMAT composition to short-term high-caloric feeding and fasting. We hypothesized that high-feeding and caloric restriction would be associated with differences in BMAT composition according to the skeletal site. MATERIALS AND METHODS We examined 23 healthy subjects (13 m, 10 f, mean age 33 ± 7 years, BMI 26 ± 1.5 kg/m2) who were admitted for a 10-day high-caloric stay (caloric intake with goal to achieve 7% weight gain) followed by discharge home for 13-18 days to resume normal diet (stabilization period), followed by a 10-day fasting stay (no caloric intake). Subjects underwent single voxel proton MR spectroscopy (1H-MRS) at 3T of the lumbar spine (L4) (rBMAT), the femoral diaphysis and distal tibial metaphysis (cBMAT) to determine BMAT composition (unsaturation index, UI and saturation index, SI). Within group comparisons were performed by the Wilcoxon signed rank test. RESULTS After the high-calorie visit, SI of L4 increased compared to baseline (0.62 ± 0.27 to 0.70 ± 0.28, p = 0.02), and there was a trend of an increase in femoral SI and UI (p ≥ 0.07), while there was no significant change in tibial BMAT (p ≥ 0.13). During the stabilization period, SI of L4 decreased (0.70 ± 0.28 to 0.57 ± 0.21, p < 0.0001) and SI of the femoral diaphysis decreased (5.37 ± 2.27 to 5.09 ± 2.43, p = 0.03), while there was no significant change in UI or tibial BMAT (p ≥ 0.14). During the fasting period, SI of L4 increased (0.57 ± 0.21 to 0.63 ± 0.30, p = 0.03), while there was no change in UI (p = 0.7). SI and UI of femoral diaphysis decreased (5.09 ± 2.43 to 4.68 ± 2.15, p = 0.03, and 0.62 ± 0.42 to 0.47 ± 0.37, p = 0.02, respectively) and UI of the tibial metaphysis decreased (1.48 ± 0.49 to 1.24 ± 0.57, p = 0.04). CONCLUSION 1H-MRS is able to quantify BMAT composition during short-term nutritional challenges, showing a significant increase in SI of rBMAT during high caloric feeding and a differential response to fasting with an increase in SI of rBMAT and a decrease in SI and UI of femoral cBMAT and decrease in UI of tibial cBMAT.
Collapse
Affiliation(s)
- Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America.
| | - Colleen Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Pouneh K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Clifford J Rosen
- Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| |
Collapse
|
12
|
Bredella MA, Karzar NH, Singhal V, Bose A, Animashaun A, Mitchell DM, Yu EW, Misra M. Impact of sleeve gastrectomy on bone outcomes in adolescents vs. adults with obesity. Bone 2021; 149:115975. [PMID: 33901724 PMCID: PMC8217278 DOI: 10.1016/j.bone.2021.115975] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/03/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgery (MBS) procedure in adolescents and adults. Only few studies have assessed bone outcomes following SG and it is unknown whether skeletal changes differ by age group. Recent studies have identified marrow adipose tissue (MAT) as a novel biomarker for bone quality with studies in adults showing high MAT in those with visceral adiposity and a reciprocal increase in MAT with bone loss. OBJECTIVE To determine the impact of SG on volumetric BMD (vBMD) and MAT in adolescents and adults with obesity. We hypothesized that SG would lead to a decrease in vBMD and increase in MAT but that these changes would be less pronounced in adolescents compared to adults. MATERIALS AND METHODS The study was IRB-approved and HIPAA-compliant. Written informed consent/assent was obtained. We examined 10 adolescents (mean age 17.8 ± 2.5 years, mean BMI 43.5 ± 5.6 kg/m2) and 10 sex, race, and BMI-matched adults (mean age 49.5 ± 13.6 years, mean BMI 43.7 ± 5.9 kg/m2), before and 12 months after SG. At baseline and 12 months, subjects underwent quantitative CT of the lumbar spine (L1-L2) to assess trabecular vBMD, single voxel proton MR spectroscopy at 3 T (PRESS pulse sequence without water suppression) at L1-L2 to quantify MAT, and MRI of the abdomen to assess visceral (VAT) and subcutaneous adipose tissue (SAT). RESULTS At baseline, adolescents had lower MAT (p = 0.0002) and higher vBMD (p = 0.050) compared to adults. Adolescents and adults lost 27.9 ± 6.5 vs. 25.0 ± 11.2% of body weight (p < 0.0001 for within group change), while there was no significant difference between groups (p = 0.455). There was a significant reduction in vBMD in adults (-3.9 ± 3.9%, p = 0.005) and a trend for a reduction in adolescents (-3.7 ± 7.5%, p = 0.119), with no significant difference between groups (p = 0.944). Lumbar MAT content increased in both adults and adolescents (p ≤ 0.034), while the difference was not significant between groups (p = 0.281). In adolescents and adults, 12-month percent change in weight and BMI was positively associated with % change in MAT (p ≤ 0.042). 12-month percent change in MAT was positively associated with 12-month % change in SAT in adolescents and 12-month percent change in VAT in adults (p ≤ 0.045). CONCLUSION SG in adolescents and adults with severe obesity is associated with a reduction in lumbar vBMD and an increase in lumbar MAT, although the reduction in adolescents did not reach statistical significance, with no significant differences in these endpoints between groups. Our results suggest detrimental effects of bariatric surgery on bone for patients across the life span.
Collapse
Affiliation(s)
- Miriam A Bredella
- Department of Radiology, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
| | - Nazanin Hazhir Karzar
- Neuroendocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Vibha Singhal
- Neuroendocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Pediatric Endocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; MGH Weight Center, Boston, MA, United States of America
| | - Amita Bose
- Neuroendocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Abisayo Animashaun
- Neuroendocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Deborah M Mitchell
- Pediatric Endocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Madhusmita Misra
- Neuroendocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Pediatric Endocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
13
|
Abstract
PURPOSE The prevalence of childhood obesity has increased over past decades with a concomitant increase in metabolic and bariatric surgery (MBS). While MBS in adults is associated with bone loss, only a few studies have examined the effect of MBS on the growing skeleton in adolescents. METHODS This mini-review summarizes available data on the effects of the most commonly performed MBS (sleeve gastrectomy and gastric bypass) on bone in adolescents. A literature review was performed using PubMed for English-language articles. RESULTS Dual-energy x-ray absorptiometry (DXA) measures of areal bone mineral density (aBMD) and BMD Z scores decreased following all MBS. Volumetric BMD (vBMD) by quantitative computed tomography (QCT) decreased at the lumbar spine while cortical vBMD of the distal radius and tibia increased over a year following sleeve gastrectomy (total vBMD did not change). Reductions in narrow neck and intertrochanteric cross-sectional area and cortical thickness were observed over this duration, and hip strength estimates were deleteriously impacted. Marrow adipose tissue (MAT) of the lumbar spine increased while MAT of the peripheral skeleton decreased a year following sleeve gastrectomy. The amount of weight loss and reductions in lean and fat mass correlated with bone loss at all sites, and with changes in bone microarchitecture at peripheral sites. CONCLUSION MBS in adolescents is associated with aBMD reductions, and increases in MAT of the axial skeleton, while sleeve gastrectomy is associated with an increase in cortical vBMD and decrease in MAT of the peripheral skeleton. No reductions have been reported in peripheral strength estimates.
Collapse
Affiliation(s)
- Madhusmita Misra
- Division of Pediatric Endocrinology, Mass General Hospital for Children and Harvard Medical School, Boston, Massachusetts
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Madhusmita Misra, MD, MPH, 175 Cambridge Street, 5th Floor, Boston, MA 02114, USA. E-mail:
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|