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. 2021 Mar;19(2):83-92.
doi: 10.1089/met.2020.0008. Epub 2020 Nov 2.

Associations of Visceral, Subcutaneous, Epicardial, and Liver Fat with Metabolic Disorders up to 14 Years After Weight Loss Surgery

Affiliations

Associations of Visceral, Subcutaneous, Epicardial, and Liver Fat with Metabolic Disorders up to 14 Years After Weight Loss Surgery

Steven C Hunt et al. Metab Syndr Relat Disord. 2021 Mar.

Abstract

Background: Bariatric surgery leads to long-term remission and reduced incidence of diabetes, hypertension, and dyslipidemia. Short-term studies suggest reduction in specific fat depots may be more predictive of health improvement than reduced body mass index (BMI). Visceral, subcutaneous, epicardial, and liver fat, measured 11 years after bariatric surgery, were associated with long-term remission and incidence of diabetes, dyslipidemia, and hypertension. Methods: Fat depots an average of 11 (maximum 14) years after surgery were quantified by noncontrast computed tomography in subjects who did (N = 261; 86% gastric bypass) or did not (N = 243) have bariatric surgery. Multiple regression related fat depots to disease endpoints with and without adjustment for change in BMI and surgical status. Results: Visceral fat was 42% lower, subcutaneous fat 20% lower, epicardial fat 30% lower, and liver-to-spleen density ratio 9% higher at follow-up in the bariatric surgery group compared with the nonsurgery group (all P < 0.01). Higher visceral fat at follow-up exam was significantly associated with reduced remission and increased incidence of diabetes, hypertension, and dyslipidemia. Subcutaneous fat was not associated with disease. The liver-to-spleen ratio was associated with the remission and incidence of hypertriglyceridemia and not with other fat depots. Epicardial fat was related to incidence of elevated low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol. Conclusions: Whether or not a patient shows greater long-term diabetes, dyslipidemia, or hypertension remission or incidence after bariatric surgery appears dependent on the amount of fat within specific fat depots measured at follow-up. Furthermore, associations of the three disease endpoints with different fat depots suggest varied fat depot pathology.

Keywords: bariatric surgery; dyslipidemia; fat distribution; hypertension; type 2 diabetes.

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Conflict of interest statement

The authors declared the funding listed as the only potential conflict of interest. No other competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Examples of abdominal slices from noncontrast CT scans of representative subjects. On the left are images from a nonsurgery subject who has large amounts of both subcutaneous and visceral fat (top) and a surgery subject who has moderate subcutaneous fat with much less visceral fat (bottom). On the right are examples of fat quantification. The top image shows definition of visceral fat based on HU of −45 to −195 (orange color). The bottom image shows both subcutaneous and visceral fat (pink). The difference between the two is the subcutaneous fat. The area of fat tissue is multiplied by the slice thickness to obtain a volume. CT, computed tomography; HU, Hounsfield units.
FIG. 2.
FIG. 2.
Examples of epicardial fat in a nonsurgery subject (left) and a subject who underwent bariatric surgery (right). Arrows indicate epicardial and pericardial borders (epicardial fat is between the epicardium and the pericardium). A nonsurgery subject has much larger epicardial fat volume than the surgery subject. Quantification performed as in Fig. 1.

References

    1. Flegal KM, Graubard BI, Williamson DF, et al. . Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007;298:2028–2037 - PubMed
    1. Britton KA, Massaro JM, Murabito JM, et al. . Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol 2013;62:921–925 - PMC - PubMed
    1. Neeland IJ, Turer AT, Ayers CR, et al. . Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. JAMA 2012;308:1150–1159 - PMC - PubMed
    1. Sahakyan KR, Somers VK, Rodriguez-Escudero JP, et al. . Normal-weight central obesity: Implications for total and cardiovascular mortality. Ann Intern Med 2015;163:827–835 - PMC - PubMed
    1. Pou KM, Massaro JM, Hoffmann U, et al. . Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: The Framingham Heart Study. Circulation 2007;116:1234–1241 - PubMed

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