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01-12-2007

Metabolic and Nutritional Status Changes After 10% WeightLoss in Severely Obese Patients Treated with Laparoscopic Surgery vs Integrated Medical Treatment

Authors: Federica del Genio, Lucia Alfonsi, Maurizio Marra, Carmine Finelli, Gianmattia del Genio, Gianluca Rossetti, Alberto del Genio, Franco Contaldo, Fabrizio Pasanisi

Published in: Obesity Surgery | Issue 12/2007

Abstract

Background

Bariatric surgery is considered the most effective treatment for reducing excess body weight and maintaining weight loss (WL) in severely obese patients. There are limited data evaluating metabolic and body composition changes after different treatments in type III obese (body mass index [BMI] > 40 kg/m²).

Methods

Twenty patients (9 males, 11 females; 37.6 ± 8 years; BMI = 50.1 ± 8 kg/m²) treated with dietary therapy and lifestyle correction (group 1) have been compared with 20 matched patients (41.8 ± 6 years; BMI = 50.4 ± 6 kg/m²) treated with laparoscopic gastric bypass (LGBP; group 2). Patients have been evaluated before treatment and after >10% WL obtained on average 6 weeks after LGBP and 30 weeks after integrated medical treatment. Metabolic syndrome (MS) was evaluated using the Adult Treatment Panel III/America Heart Association (ATP III/AHA) criteria. Resting metabolic rate (RMR) and respiratory quotient (RQ) was assessed with indirect calorimetry; body composition with bioimpedance analysis.

Results

At entry, RMR/fat-free mass (FFM) was 34.2 ± 7 kcal/24 h·kg in group 1 and 35.1 ± 8 kcal/24 h·kg in group 2 and did not decrease in both groups after 10% WL (31.8 ± 6 vs 34.0 ± 6). Percent FFM and fat mass (FM) was 50.7 ± 7% and 49.3 ± 7% in group 1 and 52.1 ± 6% and 47.9 ± 6% in group 2, respectively (p = n.s.). After WL, body composition significantly changed only in group 1 (% FFM increased to 55.9 ± 6 and % FM decreased to 44.1 ± 6; p = 0.002).

Conclusion

After >10% WL, MS prevalence decreases precociously in surgically treated patients; some improvements in body composition are observed in nonsurgically treated patients only. Further investigations are needed to evaluate long-term effects of bariatric surgery on body composition and RMR after stable WL.

Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med 2003;163:2146–8.PubMedCrossRef

Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917–23.PubMedCrossRef

Colicchio P, Tarantino G, del Genio F, et al. Nonalcoholic fatty liver disease in young adult severely obese non-diabetic patients in South Italy. Ann Nutr Metab 2005;49:289–95.PubMedCrossRef

Bracale R, Pasanisi F, Labruna G, et al. Metabolic syndrome and ADRB3 gene polymorphism in severely obese patients from South Italy. Eur J Clin Nutr 2007;14:1–7.

Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346(16):1221–31.PubMedCrossRef

Avenell A, Brown TJ, McGee MA, et al. What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behavior therapy or combinations of these interventions. J Hum Nutr Diet 2004;17:293–316.PubMedCrossRef

O’Brien P, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. Ann Intern Med 2006;144:625–33.PubMed

Saris WH. Fit, fat and fat free: the metabolic aspects of weight control. Int J Obes 1998;22(2):S15–21.

Vansant G, Van Gaal L, Van Acker K, et al. Short and long term effects of a very low calorie diet on resting metabolic rate and body composition. Int J Obes 1989;13(2):87–9.PubMed

10.

Kreitzman SN, Coxon AY, Johnson PG, et al. Dependence of weight loss during very-low-calorie diets on total energy expenditure rather than on resting metabolic rate, which is associated with fat-free mass. Am J Clin Nutr 1992;56(1):258S–61S.PubMed

11.

Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg 2006;16:1602–8.PubMedCrossRef

12.

National Institutes of Health. Third report of the National Cholesterol Education Program Expert Panel (Adult Treatment Panel III). Bethesda, MD: NIH Publication 2001, 01-3670.

13.

Bedogni G, Bellentani S, Miglioli L, et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006;6:33.PubMedCrossRef

14.

Anonymous. Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference, March 25–27, 1991, Bethesda, MD. Am J Clin Nutr 1992;55 Suppl 2:487S–619S.

15.

Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351(26):2683–93.PubMedCrossRef

16.

O’Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg 2006;16:1032–40.PubMedCrossRef

17.

Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004;14(9):1157–64.PubMedCrossRef

18.

Azagara JS, Goergen M, Ansay J, et al. Laparoscopic gastric reduction surgery. Preliminary results of a randomized, prospective trial of laparoscopic vs open vertical banded gastroplasty. Surg Endosc 1999;13:555–8.CrossRef

19.

Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 2001;11:284–92.PubMedCrossRef

20.

Blackburn G. Effect of degree of weight loss on health benefits. Obes Res 1995;3(2):211S–6S.PubMed

21.

Goldstein DJ. Beneficial effects of modest weight loss. Int J Obes Relat Metab Disord 1992;16:397–415.PubMed

22.

Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992;56:320–8.PubMed

23.

Wing R, Jeffery RW. Effect of modest weight loss on changes in cardiovascular risk factors: are there differences between men and women or between weight loss and maintenance? Int J Obes Relat Metab Disord 1995;19:67–73.PubMed

24.

Anderson JW, Konz EC. Obesity and disease management: effects of weight loss on comorbid conditions. Obes Res 2001;9(4):326S–34S.PubMedCrossRef

25.

Douketis J, Macie C, Thabane L, et al. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes 2005;29:317–23.CrossRef

26.

Guidone C, Manco M, Valera-Mora E, et al. Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes 2006;55(7):2025–31.PubMedCrossRef

27.

Muscelli E, Mingrone G, Camastra S, et al. Differential effect of weight loss on insulin resistance in surgically treated obese patients. Am J Med 2005;118:51–7.PubMedCrossRef

28.

Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg 2004;240:236–42.PubMedCrossRef

29.

Guida B, Belfiore A, Angrisani L, et al. Laparoscopic gastric banding and body composition in morbid obesity. Nutr Metab Cardiovasc Dis 2005;15:198–203.PubMedCrossRef

30.

Spanier AH, Kurtz RS, Shibata HR, et al. Alterations in body composition following intestinal bypass for morbid obesity. Surgery 1976;80:171–7.PubMed

31.

Benedetti G, Mingrone G, Marcoccia S, et al. Body composition and energy expenditure after weight loss following bariatric surgery. J Am Coll Nutr 2000;19:270–4.PubMed

32.

Tacchino RM, Mancini A, Perrelli M, et al. Body composition and energy expenditure: relationship and changes in obese subjects before and after biliopancreatic diversion. Metabolism 2003;52:552–8.PubMedCrossRef

33.

Das SK, Roberts SB, McCrory MA, et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr 2003;78:22–30.PubMed

34.

Wadstrom C, Backman L, Forsberg AM, et al. Body composition and muscle constituents during weight loss: studies in obese patients following gastroplasty. Obes Surg 2000;10:203–13.PubMedCrossRef

35.

Carey DG, Pliego GJ, Raymond RL, et al. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate. Obes Surg 2006;16:469–77.PubMedCrossRef

36.

Leibel RL, Rosenbaum M, Hiesh J. Changes in energy expenditure resulting from altered body weight. N Engl J Med 1995;332:621–8.PubMedCrossRef

37.

McFarland RJ, Ang L, Parker W, et al. The dynamics of weight loss after gastric partition for gross obesity. Int J Obes 1989;13:81–8.PubMed

38.

de Boer JO, van Es AJH, Roovers LCA, et al. Adaptation of energy metabolism of overweight women to low-energy intake, studied with whole body calorimeters. Am J Clin Nutr 1986;44:585–95PubMed

39.

Astrup A, Gotzsche P, Van de Werken K, et al. Meta-analysis of resting metabolic rate in formerly obese subjects. Am J Clin Nutr 1999;69:1117–22.PubMed

40.

Welle S, Amatruda J, Forbes G. Resting metabolic rates of obese women after rapid weight loss. J Clin Endocrinol Metab 1984;59:41–4.PubMedCrossRef

41.

Wyatt H, Grunwald G, Seagle H, et al. Resting energy expenditure in reduced-obese subjects in the National Weight Control registry. Am J Clin Nutr 1999;69:1189–93.PubMed

Title: Metabolic and Nutritional Status Changes After 10% WeightLoss in Severely Obese Patients Treated with Laparoscopic Surgery vs Integrated Medical Treatment
Authors: Federica del Genio
Lucia Alfonsi
Maurizio Marra
Carmine Finelli
Gianmattia del Genio
Gianluca Rossetti
Alberto del Genio
Franco Contaldo
Fabrizio Pasanisi
Publication date: 01-12-2007
Publisher: Springer-Verlag
Published in: Obesity Surgery / Issue 12/2007
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-007-9286-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Metabolic and Nutritional Status Changes After 10% WeightLoss in Severely Obese Patients Treated with Laparoscopic Surgery vs Integrated Medical Treatment

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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