Modifications of Resting Energy Expenditure After Sleeve Gastrectomy

Bettini, Silvia; Bordigato, Emanuel; Fabris, Roberto; Serra, Roberto; Prà, Chiara Dal; Belligoli, Anna; Sanna, Marta; Compagnin, Chiara; Foletto, Mirto; Prevedello, Luca; Fioretto, Paola; Vettor, Roberto

doi:10.1007/s11695-018-3190-3

Cited by 36 publications

(20 citation statements)

References 35 publications

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“…We firstly considered all variables correlated with REE in 209 PWO and then we performed a multiple regression model, excluding some interrelated variables. Our results confirm that FFM, which reflects the metabolically active tissue, is the major determinant of REE (1, 21). However, FM and HOMA were also found to be independent predictors of REE.…”

Section: Discussionsupporting

confidence: 84%

Resting Energy Expenditure, Insulin Resistance and UCP1 Expression in Human Subcutaneous and Visceral Adipose Tissue of Patients With Obesity

et al. 2019

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Determinants of resting energy expenditure (REE) in humans are still under investigation, especially the association with insulin resistance. Brown adipose tissue (AT) regulates energy expenditure through the activity of the uncoupling protein 1 (UCP1). White AT browning is the process by which some adipocytes within AT depots acquire properties of brown adipocytes (“brite” adipocytes) and it correlates with metabolic improvement. We analyzed determinants of REE in patients with obesity and assessed UCP1 expression as a “brite” marker in abdominal subcutaneous AT (SAT) and visceral omental AT (VAT). Clinical data, REE, free fat mass (FFM), and fat mass (FM) were determined in 209 patients with obesity. UCP1 , PPARG coactivator 1 alpha ( PPARGC1A ), transcription factor A, mitochondrial ( TFAM ), T-box transcription factor 1 ( TBX1 ), and solute carrier family 27 member 1 ( SLC27A1 ) expression was assayed in SAT and VAT samples, obtained during sleeve gastrectomy from 62 patients with obesity. REE and body composition data were also available for a subgroup of 35 of whom. In 209 patients with obesity a multiple regression model was computed with REE as the dependent variable and sex, waist, FFM, FM, homeostasis model assessment-insulin resistance (HOMA), interleukin-6 and High Density Lipoprotein-cholesterol as the independent variables. Only FFM, FM and HOMA were independently correlated with REE ( r = 0.787, AdjRsqr = 0.602). In each patient VAT displayed a higher UCP1, PPARGC1A, TFAM, TBX1 , and SLC27A1 expression than SAT and UCP1 expression in VAT ( UCP1 -VAT) correlated with Body Mass Index (BMI) ( r = 0.287, p < 0.05). Introducing UCP1 -VAT in the multivariate model, we showed that FFM, HOMA, interleukin-6, High Density Lipoprotein-cholesterol, and UCP1 -VAT were independent factors correlated with REE ( r = 0.736, AdjRsqr = 0.612). We confirmed that REE correlates with FFM, FM and HOMA in a large cohort of patients. Our results clearly showed that UCP1 -VAT expression was significantly increased in severe human obesity (BMI > 50 kg/m 2 ) and that it behaved as an independent predictor of REE. Lastly, we suggest that an increased REE and browning in metabolically complicated severe obesity could represent an effort to counteract further weight gain.

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Section: Discussionsupporting

confidence: 84%

Resting Energy Expenditure, Insulin Resistance and UCP1 Expression in Human Subcutaneous and Visceral Adipose Tissue of Patients With Obesity

et al. 2019

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“…Changes in metabolic rate following bariatric surgery have been hypothesized to contribute to weight regain. Lowered resting metabolic rates (RMR) have been found in post-bariatric surgery patients who regained weight compared to those with sustained weight loss [33][34][35] . These changes may in part be explained by postoperative reduction in fat free mass (FFM).…”

Section: Discussionmentioning

confidence: 99%

Five-Year Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Osland

Alam

Khan

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Laparoscopic vertical sleeve gastrectomy (LVSG) has overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most frequently performed bariatric surgical procedure. To date little has been reported on the long-term outcomes of the LVSG procedure comparative to the traditionally favoured LRYGB. We undertook a systematic review and meta-analysis to review the five year outcomes of comparing LVSG and LRYGB.We undertook a systematic review and meta-analysis to compare five year weight loss outcomes of randomized controlled trials (RCTs) comparing LVSG to LRYGB.Methods: Searches of electronic databases (Pubmed, EMBASE, CINAHL, Cochrane) were undertaken for RCTs describing weight loss outcomes in adults at five years postoperatively.Where sufficient data was available to undertake meta-analysis, the Hartung-Knapp-Sidik-Jonkman (HKSJ) estimation method for random effects model was utilised. The review was registered with PROSPERO and reported following in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results:Five studies met the inclusion criteria totalling 1028 patients (LVSG=520, LRYGB=508). Moderate but comparable levels of bias were observed within studies.Statistically significant BMI loss ranged from -11.37kg/m 2 (range -6.3 to -15.7 kg/m 2 ) in the LVSG group and -12.6 kg/m 2 (range -9.5 to -15.4 kg/m 2 ) for LRYGB at five years (p<0.001).Systematic review suggested that LRYGB produced a greater weight loss expressed as percent excess weight and percent excess BMI loss than LVSG: this was not corroborated in the meta-analysis. Conclusions:Five year weight loss outcomes suggest both LRYGB and LVSG are effective in achieving significant weight loss at five years postoperatively, however differences in reporting parameters limit the ability to reliably compare the outcomes using statistical methods. Furthermore, results may be impacted by large dropout rates and per protocol 4 analysis of the two largest included studies. Further long-term studies are required to contradict or validate the results of this meta-analysis.

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“…The matter has been studied in two ways: by comparing post-surgery measured vs predicted values based on regression equations (or ratios), either derived from own sample before surgery or from published equations; or, by comparing post-surgery patients with matched non-surgery controls of similar anthropometrics (BMI, weight, age, sex) who represent the normal range of FFM and REE. Many studies using the former method find evidence for excessive REE reductions (19)(20)(21)(22)(23) although there are exceptions (6,8,9). In contrast, investigators using the second approach have not found evidence for excessive REE decline.…”

Section: Introductionmentioning

confidence: 99%

Resting Energy Expenditure and Organ-Tissue Body Composition 5 Years After Bariatric Surgery

et al. 2019

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Introduction: Bariatric surgery induced weight loss may reduce resting energy expenditure (REE) and fat-free mass (FFM) disproportionately thereby predisposing patients to weight regain and sarcopenia. Methods:We compared REE and body composition of African-American and Caucasian Rouxen-Y gastric bypass (RYGB) patients after surgery with a group of non-operated controls (CON). REE by indirect calorimetry; skeletal muscle (SM), trunk organs and brain volumes by MRI; and FFM by DXA, were measured at post-surgery visits and compared with CON (N=84) using linear regression models that adjusted for relevant covariates. Ns in RYGB were 50, 42, and 30 for anthropometry and 39, 27, 17 for MRI body composition at years 1, 2 and 5 after surgery, respectively.Results: Regression models adjusted for age, weight, height, ethnicity, and sex showed REE differences (RYGB minus CON; mean±s.e.): year 1 (43.2±34 kcal/d, p=0.20); year 2 (-27.9±37.3 kcal/d, p=0.46); year 5 (114.6 ±42.3 kcal/d, p=0.008). Analysis of FFM components showed that RYGB had greater trunk organ mass (~0.4 kg) and less SM (~1.34 kg) than CON at each visit. REE models adjusted for FFM, SM, trunk-organs, and brain mass showed no between group differences in REE (-15.9 ± 54.8 kcal/d, p=0.8; -46.9±64.9 kcal/d, p=0.47; 47.7±83.0 kcal/d, p=0.57, at years 1, 2 and 5, respectively). Conclusions:Post bariatric surgery patients maintain a larger mass of high-metabolic rate trunk organs than non-operated controls of similar anthropometrics. Interpreting REE changes after weight loss requires an accurate understanding of fat-free mass composition at both the organ and tissue level.

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Modifications of Resting Energy Expenditure After Sleeve Gastrectomy

Abstract: A significant reduction of resting energy expenditure and a significant degree of metabolic adaptation both occur after sleeve gastrectomy. A greater metabolic adaptation could be partly responsible for a lower weight loss after surgery.

Cited by 36 publications

References 35 publications

Resting Energy Expenditure, Insulin Resistance and UCP1 Expression in Human Subcutaneous and Visceral Adipose Tissue of Patients With Obesity

Resting Energy Expenditure, Insulin Resistance and UCP1 Expression in Human Subcutaneous and Visceral Adipose Tissue of Patients With Obesity

Five-Year Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Resting Energy Expenditure and Organ-Tissue Body Composition 5 Years After Bariatric Surgery

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