Study on the relationship between the short-term changes of body fat and improvement of insulin resistance in obesity after laparoscopic Roux-en-Y gastric bypass surgery

doi:10.3877/cma.j.issn.2095-9605.2019.02.002

Abstract

Abstract:

Objective

To investigate the short-term effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery on body composition and glycolipid metabolism in obese subjects, and to analyze the correlation between body fat changes and insulin resistance improvement.

Methods

20 Chinese adults with obesity receiving LRYGB at Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital with Nanjing Medical University were included to this study between Aug 2017 and Oct 2018. The body composition and glycolipid metabolism indexes were analyzed before and 3 months after surgery. Homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated.

Results

Weight, fasting glucose, fasting insulin (FINS), HbA1c and total triglycerides (TG) decreased significantly 3 months after surgery (P<0.05). HOMA-IR decreased from (7.70±4.17) to (2.63±1.52). The abdominal obesity indexes, including waist circumference, waist-hip ratio and visceral fat area were remarkably decreased (P<0.05). The body fat decreased from (47.89±13.01) kg to (30.40±10.89) kg, and the body fat percentage decreased from (43.11±1.27) % to (34.89±1.77) %. After 3 months postoperatively, the reduction of body fat was an independent factor affecting the improvement of HOMA-IR and FINS (HOMA-IR, r=0.58, P=0.007; FINS, r=0.69, P=0.001), while the improvement of HbA1c was independently and positively correlated with the reduction of waist-hip ratio (r=0.48, P=0.031). Meanwhile, the decrease of visceral fat area was independently and positively correlated with the change of TG (r=0.53, P=0.016).

Conclusions

Apart from reduction in weight, waist circumference and waist-hip ratio, the levels of body fat, body fat percentage and visceral fat area also decreased significantly in obesity in the short term after LRYGB. Moreover, the variation of body fat was an independent factor affecting the improvement of HOMA-IR after surgery, and the short-term change of waist-hip ratio was strongly associated with reduced HbA1c. In the early stage after the LRYGB procedure, by regulating the distribution of body fat, it may lead to a decrease in insulin resistance and an improvement in the benefit of glycolipid metabolism.

Key words: Laparoscopic Roux-en-Y gastric bypass, Obesity, Type 2 diabetes mellitus, Body fat distribution, Insulin resistance

Ying Li, Jue Jia, Zhenzhen Fu, Ruirong Pan, Ningli Yang, Wei Guan, Hui Liang, Hongwen Zhou. Study on the relationship between the short-term changes of body fat and improvement of insulin resistance in obesity after laparoscopic Roux-en-Y gastric bypass surgery[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2019, 05(02): 70-78.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2019.02.002

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2019/V05/I02/70

Figures/Tables 6

References 48

[1]	GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years[J]. N Engl J Med, 2017, 377(1): 13-27.
[2]	Mi YJ, Zhang B, Wang HJ, et al. Prevalence and Secular Trends in Obesity Among Chinese Adults, 1991-2011[J]. Am J Prev Med, 2015, 49(5): 661-669.
[3]	Yu YH, Vasselli JR, Zhang Y, et al. Metabolic vs. hedonic obesity: a conceptual distinction and its clinical implications [J]. Obesity Reviews, 2015, 16(3): 234-247.
[4]	Kanaya AM, Herrington D, Vittinghoff E, et al. Understanding the high prevalence of diabetes in U.S. south Asians compared with four racial/ethnic groups: the MASALA and MESA studies [J]. Diabetes Care, 2014, 37(6): 1621-1628.
[5]	Xueli Cai, Lili Xia, Yuesong Pan, et al. Differential role of insulin resistance and β-cell function in the development of prediabetes and diabetes in middle-aged and elderly Chinese population[J]. Diabetol Metab Syndr, 2019, 11(1): 24.
[6]	Liu J, Wu YY, Huang XM, et al. Ageing and type 2 diabetes in an elderly Chinese population: the role of insulin resistance and beta cell dysfunction[J]. Eur Rev Med Pharmacol Sci, 2014, 18(12): 1790-1797.
[7]	Wu H, Ballantyne CM. Inflammation versus host defense in obesity[J]. Cell Metab, 2014, 20(5): 708-709.
[8]	Wu H, Ballantyne CM. Skeletal muscle inflammation and insulin resistance in obesity[J]. J Clin Invest, 2017, 127(1): 43-54.
[9]	Sasaki R, Yano Y, Yasuma T, et al. Association of Waist Circumference and Body Fat Weight with Insulin Resistance in Male Subjects with Normal Body Mass Index and Normal Glucose Tolerance[J]. Intern Med, 2016, 55(11): 1425-1432.
[10]	Premanath M, Basavanagowdappa H, Mahesh M, et al. Correlation of abdominal adiposity with components of metabolic syndrome, anthropometric parameters and Insulin resistance, in obese and non obese, diabetics and non diabetics: A cross sectional observational study. (Mysore Visceral Adiposity in Diabetes Study)[J]. Indian J Endocrinol Metab, 2014, 18(5): 676-682.
[11]	Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity[J]. Circulation, 2009, 120 (16): 1640-1645.
[12]	Ramachandran A, Ma RC, Snehalatha C. Diabetes in Asia[J]. Lancet, 2010, 375(9712): 408-418.
[13]	Guerrero-García JJ, Carrera-Quintanar L, López-Roa RI, et al. Multiple Sclerosis and Obesity: Possible Roles of Adipokines[J]. Mediators Inflamm, 2016, 2016:1-24.
[14]	El Husseny MW, Mamdouh M, Shaban S, et al. Adipokines: Potential Therapeutic Targets for Vascular Dysfunction in Type II Diabetes Mellitus and Obesity[J]. J Diabetes Res, 2017, 2017: 1-11.
[15]	Haiming Cao. Adipocytokines in Obesity and Metabolic Disease[J]. J Endocrinol, 2014, 220(2): T47-T59.
[16]	Goossens GH. The Metabolic Phenotype in Obesity: Fat Mass, Body Fat Distribution, and Adipose Tissue Function[J]. Obes Facts, 2017, 10(3): 207-215.
[17]	Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes[J]. N Engl J Med, 2012, 366(17): 1577-1585.
[18]	Thöni V, Pfister A, Melmer A, et al. Dynamics of Bile Acid Profiles, GLP-1, and FGF19 After Laparoscopic Gastric Banding[J]. J Clin Endocrinol Metab, 2017, 102(8): 2974-2984.
[19]	Hans PK, Guan W, Lin S, et al. Long-term outcome of laparoscopic sleeve gastrectomy from a single center in mainland China[J]. Asian J Surg, 2018, 41(3): 285-290.
[20]	Lee BC, Lee J. Cellular and molecular players in adipose tissue inflammation in the development of obesity-induced insulin resistance[J]. Biochim Biophys Acta, 2014, 1842(3): 446-462.
[21]	Jianping Ye. Mechanisms of insulin resistance in obesity[J]. Front Med, 2013, 7(1): 14-24.
[22]	Michael P. Czech. Insulin action and resistance in obesity and type 2 diabetes[J]. Nat Med. 2017, 23(7): 804-814.
[23]	Ma RC, Chan JC. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States[J]. Ann N Y Acad Sci, 2013, 1281(1): 64-91.
[24]	Charmaine S. Tam, Wenting Xie, William D. Johnson, et al. Defining Insulin Resistance From Hyperinsulinemic-Euglycemic Clamps[J]. Diabetes Care, 2012, 35(7): 1605-1610.
[25]	Kim JK. Hyperinsulinemic-euglycemic clamp to assess insulin sensitivity in vivo[J]. Methods Mol Biol, 2009, 560:221-238.
[26]	Kurniawan LB, Bahrun U, Hatta M,et al. Body Mass, Total Body Fat Percentage, and Visceral Fat Level Predict Insulin Resistance Better Than Waist Circumference and Body Mass Index in Healthy Young Male Adults in Indonesia[J]. J Clin Med, 2018, 7(5): 96.
[27]	Hui Liang, Wei Guan, Yanling Yang, et al. Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI<28 kg/m2: a multi-institutional study[J]. The Journal of Biomedical Research, 2015, 29(2): 112-117.
[28]	Medina DA, Pedreros JP, Turiel D, et al. Distinct patterns in the gut microbiota after surgical or medical therapy in obese patients [J]. PeerJ, 2017, 5(S3): e3443.
[29]	Cefalu WT, Rubino F, Cummings DE. Metabolic Surgery for Type 2 Diabetes: Changing the Landscape of Diabetes Care[J]. Diabetes Care, 2016, 39(6): 857-860
[30]	Tian J, Huang S, Sun S, et al. Bile acid signaling and bariatric surgery[J]. Liver Res, 2017, 1(4): 208-213.
[31]	Blüher S, Molz E, Wiegand S, et al. Body mass index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development[J]. J Clin Endocrinol Metab, 2013, 98(8): 3384-3393.
[32]	Ling JC, Mohamed MN, Jalaludin MY, et al. Determinants of High Fasting Insulin and Insulin Resistance Among Overweight/Obese Adolescents[J]. Sci Rep, 2016, 6: 36270.
[33]	Tuomi K, Logomarsino JV. Bacterial Lipopolysaccharide, Lipopolysaccharide-Binding Protein, and Other Inflammatory Markers in Obesity and After Bariatric Surgery[J]. Metab Syndr Relat Disord, 2016, 14(6): 279-288.
[34]	Garrido-Sanchez L, Murri M, Rivas-Becerra J, et al. Bypass of the duodenum improves insulin resistance much more rapidly than sleeve gastrectomy[J]. Surg Obes Relat Dis, 2012, 8(2):145-150.
[35]	Bennis MT, Schneider A, Victoria B, et al. The role of transplanted visceral fat from the long-lived growth hormone receptor knockout mice on insulin signaling[J]. GeroScience, 2017, 39(1): 51-59.
[36]	Rattarasarn C. Dysregulated lipid storage and its relationship with insulin resistance and cardiovascular risk factors in non-obese Asian patients with type 2 diabetes [J]. Adipocyte, 2018, 7(2): 71-80.
[37]	Han SJ, Boyko EJ, Fujimoto WY, et al. Low Plasma Adiponectin Concentrations Predict Increases in Visceral Adiposity and Insulin Resistance[J]. J Clin Endocrinol Metab, 2017, 102(12): 4626-4633.
[38]	Achike FI, To NH, Wang H, et al. Obesity, metabolic syndrome, adipocytes and vascular function: A holistic viewpoint. Clin Exp Pharmacol Physiol, 2011, 38(1): 1-10.
[39]	Alkahtani SA. A cross-sectional study on sarcopenia using different methods: reference values for healthy Saudi young men[J]. BMC Musculoskelet Disord, 2017, 18(1): 119.
[40]	Roekenes J, Strømmen M, Kulseng B, et al. The Impact of Feet Callosities, Arm Posture, and Usage of Electrolyte Wipes on Body Composition by Bioelectrical Impedance Analysis in Morbidly Obese Adults[J]. Obes Facts, 2015, 8(6): 364-372.
[41]	Zhao L, Zhu L, Su Z, et al.The role of visceral adipose tissue on improvement in insulin sensitivity following Roux-en-Y gastric bypass: a study in Chinese diabetic patients with mild and central obesity[J]. Gastroenterol Rep (Oxf), 2018, 6(4): 298-303.
[42]	Frikke-Schmidt H, O'Rourke RW, Lumeng CN, et al. Does bariatric surgery improve adipose tissue function? [J]. Obes Rev, 2016, 17(9): 795-809.
[43]	Se-Hong Kim, Ju-hye Chung, Sang-Wook Song, et al. Relationship between deep subcutaneous abdominal adipose tissue and metabolic syndrome: a case control study[J]. Diabetol Metab Syndr, 2016, 8(1): 10.
[44]	Nirmala Tilija Pun, Pil-Hoon Park. Role of p62 in the suppression of inflammatory cytokine production by adiponectin in macrophages: Involvement of autophagy and p21/Nrf2 axis[J]. Sci Rep, 2017, 7(1): 393.
[45]	Derek K. Hagman, Ilona Larson, Jessica N. Kuzma, et al. The Short-term and Long-term Effects of Bariatric/Metabolic Surgery on Subcutaneous Adipose Tissue Inflammation in Humans[J]. Metabolism, 2017, 70(5): 12-22.
[46]	Clement K, Langin D. Regulation of inflammation-related genes in human adipose tissue [J]. J Intern Med, 2007, 262(4): 422-430.
[47]	Toro-Ramos T, Goodpaster BH, Janumala I, et al. Continued loss in visceral and intermuscular adipose tissue in weight-stable women following bariatric surgery[J]. Obesity, 2015, 23(1): 62-69.
[48]	Favre L, Marino L, Roth A, et al. The Reduction of Visceral Adipose Tissue after Roux-en-Y Gastric Bypass Is more Pronounced in Patients with Impaired Glucose Metabolism[J]. Obes Surg, 2018, 28(12): 4006-4013.

指标	术前
性别(男/女)	12/8 (60%，40%)
年龄(岁)	37.30±10.36
体重(kg)	110.56±21.85
BMI(kg/m2)	38.25±5.89
合并症	?
高血压病	9 (45%)
高脂血症	12 (60%)
T2DM	16 (80%)
IR	19 (95%)
HbA1c(%)	8.15 ±1.10

指标	术前
性别(男/女)	12/8 (60%，40%)
年龄(岁)	37.30±10.36
体重(kg)	110.56±21.85
BMI(kg/m2)	38.25±5.89
合并症	?
高血压病	9 (45%)
高脂血症	12 (60%)
T2DM	16 (80%)
IR	19 (95%)
HbA1c(%)	8.15 ±1.10

指标	体重（kg）	BMI（kg/m2）	SBP（mmHg）	DBP（mmHg）	BF（kg）	PBF（%）	VFA（cm2）	WC（cm）	HC（cm）	WHR	BMR（kcal）
术前	110.56±21.85	38.25±5.89	142.85±22.63	88.65±15.89	47.89±13.01	43.11±1.27	210.20±40.45	120.68±12.68	120.60±13.00	1.02±0.06	1721±255.19
术后3月	86.96±16.28	30.10±4.16	123.35±12.87	76.50±6.86	30.40±10.89	34.89±1.77	135.02±53.53	103.07±13.46	107.75±9.55	0.95±0.06	1585.25±217.12
P值	<0.001^a	<0.001^a	0.007^a	0.004^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a

指标	体重（kg）	BMI（kg/m2）	SBP（mmHg）	DBP（mmHg）	BF（kg）	PBF（%）	VFA（cm2）	WC（cm）	HC（cm）	WHR	BMR（kcal）
术前	110.56±21.85	38.25±5.89	142.85±22.63	88.65±15.89	47.89±13.01	43.11±1.27	210.20±40.45	120.68±12.68	120.60±13.00	1.02±0.06	1721±255.19
术后3月	86.96±16.28	30.10±4.16	123.35±12.87	76.50±6.86	30.40±10.89	34.89±1.77	135.02±53.53	103.07±13.46	107.75±9.55	0.95±0.06	1585.25±217.12
P值	<0.001^a	<0.001^a	0.007^a	0.004^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a	<0.001^a

指标	FPG（mmol/L）	FINS（pmol/L）	FCP（pmol/L）	HbA1c（%）	HOMA-IR	ISI
术前	5.67（5.07，7.07）	156.40（107.28，253.40）	1236.00（952.70，1866.75）	7.70（7.40，8.68）	7.70±4.17	0.15(0.10，0.24)
术后3月	5.29（4.82，5.68）	71.50（36.95，97.98）	810.30（505.95，1188.75）	5.10（4.83，5.98）	2.63±1.52	0.28(0.44，0.73)
P值	0.005^b	<0.001^b	<0.001^b	<0.001^b	<0.001^a	<0.001^b

Please choose a citation manager

Content to export