Improved metabolism and body composition beyond normal levels following gastric bypass surgery: a longitudinal study. (25th September 2018)

• Record Type: Journal Article
• Authors: Andersson, D. P.; Dahlman, I.; Eriksson Hogling, D.; Bäckdahl, J.; Toft, E.; Qvisth, V.; Näslund, E.; Thorell, A.; Rydén, M.; Arner, P.
• Is Part Of: Journal of internal medicine. Volume 285:Number 1(2019)
• Page Start: 92
• Page End: 101
• Publication Date: 2018-09-25
• Subjects: adipose tissue -- body composition -- cardiovascular disease risk factors -- insulin resistance -- obesity -- weight loss; Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.12824
• Languages: English
• ISSNs: 0954-6820

Abstract

Abstract: Background: The cardiometabolic risk profile improves following bariatric surgery. However, the degree of improvement in relation to weight‐stable control subjects is unknown. Objectives: To study the differences in cardiometabolic risk profile between formerly obese patients following Roux‐en‐Y gastric bypass (RYGB) surgery and control subjects. Methods: Subjects undergoing RYGB and reaching a BMI <30 kg m −2 2 years postsurgery were matched with control subjects regarding age, sex and BMI. The following examinations were performed: insulin sensitivity measured by hyperinsulinaemic–euglycaemic clamp, insulin clearance, homeostatic model assessment of insulin resistance (HOMA‐IR), lipid profile, inflammatory marker levels, dual‐energy X‐ray absorptiometry and subcutaneous adipose tissue cellularity (fat cell size and number). Results: Sixty‐nine subjects undergoing RYGB were matched to a control subject. Insulin sensitivity measured by hyperinsulinaemic–euglycaemic clamp, blood pressure, inflammatory status and glucose, triglyceride and HDL cholesterol levels were comparable to values of control subjects. However, HOMA‐IR (1.0 ± 0.5 vs. 1.3 ± 0.7, P = 0.005), insulin clearance (0.38 ± 0.08 vs. 0.34 ± 0.08 μL m −2 min −1, P < 0.0001) and circulating levels of insulin (31 ± 15 vs. 37 ± 17 pmol L −1, P = 0.008), total cholesterol (4.1 ± 0.7 vs. 4.8 ± 0.9 mmol L −1, P < 0.0001) and LDL cholesterol (2.1 ± 0.6 vs. 2.9 ± 0.8 mmol L −1, P < 0.0001) were improved beyond the levels in matched control subjects. Furthermore, formerly obese subjects had higher lean and lower fat mass as well as a more benign type of adipose cellularity (hyperplasia with many small fat cells) compared to control subjects. Conclusions: Subjects who underwent RYGB and reached a postobese state demonstrated a beneficial body composition, slightly increased insulin sensitivity as indirectly measured by HOMA‐IR and higher insulin clearance, lower atherogenic lipid/lipoprotein levels and benign adipocyte morphology compared with control subjects who had never been obese. In line with previous results, our findings may in part explain why RYGB confers long‐term protection against metabolic complications.