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. 2008 Nov;121(11):966-73.
doi: 10.1016/j.amjmed.2008.06.033.

Dramatic reversal of derangements in muscle metabolism and left ventricular function after bariatric surgery

Joshua G Leichman  1 , Erik B Wilson, Terry Scarborough, David Aguilar, Charles C Miller 3rd, Sherman Yu, Mohamed F Algahim, Manuel Reyes, Frank G Moody, Heinrich Taegtmeyer
Affiliations

Dramatic reversal of derangements in muscle metabolism and left ventricular function after bariatric surgery

Joshua G Leichman et al. Am J Med. 2008 Nov.

Abstract

Objective: The study objective was to define muscle metabolic and cardiovascular changes after surgical intervention in clinically severe obese patients.

Methods: Obesity is a state of metabolic dysregulation that can lead to maladaptive changes in heart and skeletal muscle, including insulin resistance and heart failure. In a prospective longitudinal study, 43 consecutive patients underwent metabolic profiling, skeletal muscle biopsies, and resting echocardiograms at baseline and 3 and 9 months after bariatric surgery.

Results: Body mass index decreased (mean changes, 95% confidence interval [CI]): 7.7 kg/m(2) (95% CI, 6.70-8.89) at 3 months and 5.6 kg/m(2) (95% CI, 4.45-6.80; P<.0001) at 9 months after surgery, with restoration of insulin sensitivity and decreases in plasma leptin at the same time points. Concurrent with these changes were dramatic decreases in skeletal muscle transcript levels of stearoyl coenzyme-A desaturase and pyruvate dehydrogenase kinase-4 at 3 and 9 months (P<.0001, for both) and a significant decrease in peroxisome proliferation activated receptor-alpha-regulated genes at 9 months. Left ventricular relaxation impairment, assessed by tissue Doppler imaging, normalized 9 months after surgery.

Conclusion: Weight loss results in the reversal of systemic and muscle metabolic derangements and is accompanied by a normalization of left ventricular diastolic function.

Trial registration: ClinicalTrials.gov NCT00178633.

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Conflict of interest statement

Authors Verifications: None of the authors of this work have any financial conflicts of interest to disclose. All authors had access to the data and a role in writing the manuscript.

Figures

Figure 1
Figure 1
Oil-red-O stain of muscle biopsies. Samples were obtained at baseline, 3 and 9 months after surgery. The slides are representative of four sections for each patient at each of the time points (baseline, 3 and 9 months). Baseline vs 3 months 4.2 AU (−2.4–10.9), p<0.2. Three months vs 9 months 8.7 AU (2.4–15.1), p<0.009. See text for further details.
Figure 2
Figure 2
Transcript Levels of Metabolically Relevant Enzymes. 2A. mRNA levels of pyruvate dehydrogenase kinase 4 (PDK4). *p<0.0001 time point vs baseline; **p<0.001, 3 months vs 9 months. 2B. mRNA levels of Stearoyl CoA Desaturase (SCD1). *p<0.0001, time point vs baseline. 2C. mRNA levels of PPAR-α Regulated Genes. *p<0.05, baseline vs 9 months; **p<0.05, 3 months vs 9 months. PPAR-α -- Perioxisome Proliferator Activating Receptor- alpha; CPT1, -- Carnintine Phosphotidyl Transferase 1; MCAD -- Medium Chain Acetyl-CoA Dehydrogenase. See text for further details.
See this image and copyright information in PMC

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