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Observational Study
. 2018 Dec;28(12):4006-4013.
doi: 10.1007/s11695-018-3455-x.

The Reduction of Visceral Adipose Tissue after Roux-en-Y Gastric Bypass Is more Pronounced in Patients with Impaired Glucose Metabolism

Lucie Favre  1 , Laura Marino  2 , Aline Roth  2 , James Acierno Jr  2 , Didier Hans  3 , Nicolas Demartines  4 , Nelly Pitteloud  2 , Michel Suter  4   5 , Tinh-Hai Collet  2
Affiliations
Observational Study

The Reduction of Visceral Adipose Tissue after Roux-en-Y Gastric Bypass Is more Pronounced in Patients with Impaired Glucose Metabolism

Lucie Favre et al. Obes Surg. 2018 Dec.

Abstract

Purpose: Visceral adipose tissue (VAT) is associated with cardiometabolic risk factors and insulin resistance. The physiological mechanisms underlying the benefits of Roux-en-Y gastric bypass surgery (RYGB) on glucose metabolism remain incompletely understood. The impact of RYGB on VAT was assessed among three groups of patients stratified by their glucose tolerance before surgery.

Methods: Forty-four obese women were categorized into normoglycemia (n = 21), impaired glucose tolerance (IGT, n = 18) and diabetes (n = 5) before surgery. Body composition measured by dual-energy X-ray absorptiometry (DXA) was performed before surgery, 6 months and 12 months after.

Results: The three groups had comparable mean age (mean 38.6 ± SD 9.9) and BMI at baseline (41.9 ± 4.3 kg/m2). After 12 months, total weight loss (mean 35.1% ± 7.5) and excess weight loss (91.1% ± 25.1) were similar between groups. Pre-surgery mean VAT was significantly higher in diabetes (mean 2495 ± 616 g) than in normoglycemia (1750 ± 617 g, p = 0.02). The percentage of VAT to total body fat was significantly higher in diabetes (mean 4.4% ± 0.9) compared to normoglycemia (2.9% ± 0.8, p = 0.003). Twelve months after surgery, VAT loss was significantly greater among patients with diabetes (mean 1927 ± 413 g) compared to normoglycemia (1202 ± 450, p = 0.009).

Conclusions: RYGB leads to important VAT loss, and this loss is greater in patients with diabetes prior to surgery. As VAT is associated with insulin resistance, this reduction may account for the profound impact of this surgery on glucose metabolism.

Keywords: Bariatric surgery; Dual-energy X-ray absorptiometry (DXA); Roux-en-Y gastric bypass; Type 2 diabetes; Visceral adipose tissue.

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Conflict of interest statement

Conflict of Interest Statement

L.F., L.M., A.R., J.A., D.H., N.D., N.P., M.S., T.H.C. declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. The study was approved by the local institutional review board.

Figures

Fig. 1
Fig. 1
Weight loss and VAT evolution after surgery. Abbreviations: BMI, body mass index; DXA, dual-energy X-ray absorptiometry; %EWL, % excess weight loss; IGT, impaired glucose tolerance; %TWL, % total weight loss; VAT, visceral adipose tissue. Legend: Weight loss after Roux-en-Y gastric bypass surgery across the three groups (color legend shown in panel A) expressed as BMI (panel A), %EWL, and %TWL (panel B). Evolution of VAT mass as measured by DXA over time after surgery in each group (panels C-E) and comparison between groups (panel F). The 6-month DXA was missed by 6 patients with normoglycemia and their individual course is not shown in Panel D. The error bars represent SD
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