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. 2021 Nov;11(11):4569-4582.
doi: 10.21037/qims-20-1380.

How much abdominal fat do obese patients lose short term after laparoscopic sleeve gastrectomy? A quantitative study evaluated with MRI

Jing Sun  1 , Han Lv  1 , Mengyi Li  2 , Lei Zhao  1 , Yawen Liu  3 , Na Zeng  4 , Xuan Wei  1 , Qian Chen  1 , Pengling Ren  1 , Yang Liu  2 , Peng Zhang  2 , Zhenghan Yang  1 , Zhongtao Zhang  2 , Zhenchang Wang  1
Affiliations

How much abdominal fat do obese patients lose short term after laparoscopic sleeve gastrectomy? A quantitative study evaluated with MRI

Jing Sun et al. Quant Imaging Med Surg. 2021 Nov.

Abstract

Background: This study aimed to elucidate the changes in the amount of abdominal adipose tissue after laparoscopic sleeve gastrectomy in obese Chinese patients over a relatively short follow-up period and to analyze the differences in the effects of surgery between genders.

Methods: Ninety-one patients were enrolled in the study, including 18 males and 73 females. These patients underwent laparoscopic sleeve gastrectomy between November 2017 and November 2019. Before and short term after surgery, the areas of subcutaneous/visceral adipose tissue and the liver proton density fat fraction were calculated with upper abdominal magnetic resonance (MR) examinations.

Results: Approximately 100 days after surgery, the median values of weight loss and body mass index reduction were 23.1 kg and 8.1 kg/m2, respectively. The patients achieved a greater absolute loss of subcutaneous adipose tissue index than of visceral adipose tissue index (3.2×10-3 vs. 1.6×10-3, P<0.001). The amount of weight loss, body mass index loss and absolute/relative reduction in visceral adipose tissue index were much greater in males than in females (31.7 vs. 21.7 kg, P<0.001; 9.8 vs. 7.9 kg/m2, P=0.016; 2.5×10-3 vs. 1.3×10-3, P=0.007; 28.2% vs. 20.9%, P=0.029). There was a correlation between decreased amounts in subcutaneous and visceral adipose tissue in sum and weight loss (r=0.282, P=0.032). The absolute/relative reduction in visceral adipose tissue index was also correlated with absolute/relative reduction in liver proton density fat fraction (r=0.283, P=0.013; r=0.372, P=0.001).

Conclusions: The reductions in body weight and visceral fat were more significant in male patients. The sum of absolute reduction in subcutaneous and visceral fat deposits was correlated with weight loss, in all patients enrolled. For severely obese patients, an upper abdominal MR examination could assess the body tissue composition and how it changes after bariatric surgery.

Keywords: Upper abdominal magnetic resonance imaging (upper abdominal MRI); abdominal adipose tissue; bariatric surgery; single magnetic resonance slice (single MR slice).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/qims-20-1380). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient selection for eligible subjects. SAT, subcutaneous adipose tissue; VAT, visceral adipose tissue; LRYGB, Laparoscopic Roux-en-Y gastric bypass; LOAGB, Laparoscopic one-anastomosis gastric bypass; L, lumbar.
Figure 2
Figure 2
Outline of SAT area at the L1–L2 intervertebral disc on the LAVA-Flex sequence. (A) SAT in a male patient at baseline; (B) SAT at 113 days after LSG. The SATI at L1–L2 decreased from 7.7×10−3 to 3.4×10−3. SAT, subcutaneous adipose tissue; SATI, subcutaneous adipose tissue index; LSG, laparoscopic sleeve gastrectomy; L, lumbar.
Figure 3
Figure 3
Outline of VAT area at the L1–L2 intervertebral disc on the LAVA-Flex sequence. (A) VAT in the same male patient at baseline; (B) VAT at 113 days after LSG. The VATI at L1–L2 decreased from 7.7×10−3 to 4.9×10−3. VAT, visceral adipose tissue; VATI, visceral adipose tissue index; LSG, laparoscopic sleeve gastrectomy; L, lumbar.
Figure 4
Figure 4
The acquisition of liver PDFF value on the PDFF map. (A) Liver PDFF in the same male patient at baseline; (B) liver PDFF at 113 days after LSG. The liver PDFF decreased from 11.4% to 3.3%. PDFF, proton density fat fraction; LSG, laparoscopic sleeve gastrectomy.
Figure 5
Figure 5
Pairwise comparison of relative loss among three different types of adipose tissue. The relative reduction in liver PDFF was higher than that of SATI (P<0.001) and VATI (P<0.001). There was no difference between the relative change in SATI and VATI (P=0.706, after Bonferroni correction). PDFF, proton density fat fraction; SATI, subcutaneous adipose tissue index; VATI, visceral adipose tissue index.
Figure 6
Figure 6
Linear plots showing the correlation among reductions in different types of abdominal fat. (A) The correlation between the absolute reduction in VATI and absolute reduction in liver PDFF was statistically significant (r=0.283, P=0.013). (B) The correlation between the relative reduction in VATI and relative reduction in liver PDFF was statistically significant (r=0.372, P=0.001). (C) The correlation between the relative reduction in SATI and relative reduction in VATI was statistically significant (r=0.245, P=0.049). PDFF, proton density fat fraction; SATI, subcutaneous adipose tissue index; VATI, visceral adipose tissue index.
Figure 7
Figure 7
Linear plots showing the correlation between abdominal fat reduction and changes in weight-related parameters. (A) The absolute loss in VATI was correlated with weight loss (r=0.282, P=0.011). (B) The relative loss in VATI was correlated with EWL (r=0.274, P=0.013). (C) The relative loss in VATI was correlated with TWL (r=0.252, P=0.022). (D) The absolute reduction in SATI + VATI was correlated with weight loss (r=0.282, P=0.032). SATI, subcutaneous adipose tissue index; VATI, visceral adipose tissue index; EWL, excess weight loss; TWL, total weight loss.
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