Visceral Obesity Is a Negative Predictor of Remission of Diabetes 1 Year After Bariatric Surgery

Abstract

Our aim was to identify preoperative anthropometric and clinical parameters that predict the remission of diabetes after Roux‐en‐Y gastric bypass (RYGB). Fifty severely obese Korean patients with type 2 diabetes underwent RYGB. Visceral and abdominal subcutaneous fat area (SFA) was assessed using computed tomography before and 6 and 12 months after RYGB. Remission was defined as a glycated hemoglobin (A1C) level <6.5% and a fasting glucose concentration <126 mg/dl for 1 year or more without the use of medication. The visceral‐to‐SFA ratio decreased from 0.60 ± 0.30 to 0.53 ± 0.29 (P = 0.001) after 6 months and decreased further to 0.42 ± 0.24 (P < 0.001) after 12 months. Thirty‐four of the 50 patients (68%) had remission of diabetes (remission group). Compared with patients in the nonremission group, patients in the remission group had a shorter duration of diabetes and lower preoperative A1C level, and were less likely to use insulin preoperatively. Preoperative BMI did not differ in two groups. However, the preoperative visceral‐to‐SFA ratio was greater in the nonremission group compared with the remission group (0.79 ± 0.29 vs. 0.53 ± 0.26, P = 0.003). Finally, the preoperative visceral‐to‐SFA ratio was an independent predictor of the remission of diabetes after RYGB in multiple stepwise logistic regression analysis. In conclusion, our data suggest that visceral adiposity negatively influence the likelihood of the patient experiencing the remission of diabetes after RYGB.

Visceral fat area as a new predictor of short-term diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with a body mass index less than 35 kg/m2

“…However, the relationship between preoperative body composition or fat distribution and the long-term effects of bariatric surgery on glycemic homeostasis remains unclear. A recent Korean study revealed that visceral fat is a negative predictor of remission in diabetes after bariatric surgery [24], which contradicts our results. In our study, patients with increased baseline visceral adiposity were more likely to achieve remission after RYGB.…”

Changes in Serum Levels of Bone Morphogenic Protein 4 and Inflammatory Cytokines after Bariatric Surgery in Severely Obese Korean Patients with Type 2 Diabetes

“…In our previous study, predominant visceral fat depots were a negative predictor of diabetes remission 1 year after bariatric surgery [9]. VFA remained higher in the nonremission group than in the remission group at 12 months after surgery.…”

“…Bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), causes significant rapid weight loss, including loss of a substantial amount of fat [8]. Our previous study showed a greater reduction of visceral fat than subcutaneous fat at 1 year after RYGB [9]. Changes in inflammatory cytokine levels after bariatric surgery have not been well characterized.…”

Mechanisms of improved glucose handling after metabolic surgery: the big 6

“…The independence of improvements in insulin sensitivity between tissues (hepatic vs. peripheral) is important in highlighting newer data. Traditionally thought to be associated with insulin resistance, increases in visceral adiposity are not necessarily associated with increases in insulin resistance 20 or outcomes following bariatric surgery 21 and there are conflicting reports in regards to correlations between visceral fat content and improvements in glucose homeostasis following surgery 22,23 . This further supports the idea that signaling in the liver (including pathways involved in insulin sensitivity) is an important player in diabetes remission.…”