Pancreas volume reduction and metabolic effects in Japanese patients with severe obesity following laparoscopic sleeve gastrectomy

Adaptive changes in pancreas post Roux‐en‐Y gastric bypass induced weight loss

“…Honka et al reported a 40% decrease in pancreatic lipid content after a 10‐unit decrease in BMI following RYGB or sleeve gastrectomy using a PET/CT‐based approach; similarly, no significant change was seen in pancreatic fat‐free volume . Umemura et al reported that pancreatic volume significantly decreased 6 months after sleeve gastrectomy, which correlated with improvements in pancreatic steatosis . According to our results, it can be stated that in an analogous manner to the increase in pancreatic volume in response to obesity, weight loss resulted in a greater decrement in fat compared to parenchyma.…”

“…3 Umemura et al reported that pancreatic volume significantly decreased 6 months after sleeve gastrectomy, which correlated with improvements in pancreatic steatosis. 24 According to our results, it can be stated that in an analogous manner to the increase in pancreatic volume in response to obesity, weight loss resulted in a greater decrement in fat compared to parenchyma. Moreover, even though there are no population data for pancreatic fat volumes in humans by the use of MR imaging, data indicate that pancreatic fat decreases to "normal" and that pancreatic steatosis is reversible only 6 months following RYGB.…”

“…A potential mechanism underlying our findings may include a tissue‐specific reduction in pancreatic fatty acid uptake after surgery, which might be explained by a reduced demand for energy and a change in fatty acid transport proteins . Interestingly, previous volumetric CT and MRI data suggest that the extent of weight reduction may be crucial in markedly affecting pancreatic fat content and that there is a positive relationship between decreased ectopic pancreatic fat and excess weight loss following bariatric surgery , . Other studies did not find any association with the degree of change in body weight, , assuming that pancreas fat volume could secondarily or additionally be affected by alterations in gastrointestinal hormone secretion, eg, GLP‐1 and gastric inhibitory polypeptide .…”

“…3 Interestingly, previous volumetric CT and MRI data suggest that the extent of weight reduction may be crucial in markedly affecting pancreatic fat content and that there is a positive relationship between decreased ectopic pancreatic fat and excess weight loss following bariatric surgery. 26,24 Other studies did not find any association with the degree of change in body weight, 3,27 assuming that pancreas fat volume could secondarily or additionally be affected by alterations in gastrointestinal hormone secretion, eg, GLP-1 and gastric inhibitory polypeptide. 3 In this context, a secondary objective of the present study was to address whether or not the estimated beta-cell mass decreases following RYGB, which is associated with increased GLP-1 levels.…”

“…Similarly, Lim et al found no correlation between indices of insulin secretion and pancreatic fat in 11 patients with type 2 diabetes after dietary energy restriction despite normalisation of beta‐cell function and hepatic insulin sensitivity . Likewise, Umemura et al observed that there was no correlation between decreased pancreatic volume and changes in the peak insulin level after sleeve gastrectomy, which suggests that there might be individual thresholds of lipotoxicity rather than a simple dose response relationship within the pancreas . Few studies have succeeded in predicting beta‐cell function in patients with pancreatic steatosis.…”