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Obesity Surgery
Published in: Obesity Surgery 8/2016

01-08-2016 | Original Contributions

Is There a Role for Visceral Adiposity in Inducing Type 2 Diabetes Remission in Severely Obese Patients Following Biliopancreatic Diversion with Duodenal Switch Surgery?

Authors: Audrey Auclair, Julie Martin, Marjorie Bastien, Nadine Bonneville, Laurent Biertho, Simon Marceau, Frédéric-Simon Hould, Simon Biron, Stéfane Lebel, Odette Lescelleur, Jean-Pierre Després, Paul Poirier

Published in: Obesity Surgery | Issue 8/2016

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Abstract

Background

Severe obesity is often characterized by ectopic fat deposition, which is related to development of type 2 diabetes (T2D). Thus, resolution of T2D may not be linearly associated with weight loss. The importance of ectopic fat reduction after bariatric surgery and T2D resolution is uncertain.

Objective

The aim of this pilot study is to compare body composition and body fat distribution in severely obese patients with or without T2D after biliopancreatic diversion with duodenal switch (BPD-DS) surgery in relation to diabetes resolution.

Methods

Sixty-two severely obese patients were evaluated at baseline, 6, and 12 months. Of these, 40 patients underwent BPD-DS surgery. Anthropometric measurements and abdominal and mid-thigh computed tomography scans were performed at each visit.

Results

Before BPD-DS surgery, obese patients with T2D had higher weight as well as greater ectopic fat deposition in the abdomen and mid-thigh level than obese patients without T2D (p < 0.05). Resolution of T2D was 65 and 90 % at 6 and 12 months, respectively. No difference in body composition changes at 6 and 12 months could be found between patients without T2D, patients with T2D resolution, and patients who remained T2D. Resolution of T2D was associated with a greater absolute loss of visceral adipose tissue (VAT) in comparison to patients without T2D (−1175 ± 570 cm3 vs. −729 ± 394 cm3 at 6 months and −1647 ± 816 cm3 vs. −1103 ± 422 cm3 at 12 months; all p ≤ 0.05).

Conclusion

Ectopic fat mobilization, particularly the absolute loss of VAT, may play a major role in T2D resolution following BPD-DS surgery, regardless of the amount of weight loss.
Literature
1.
2.
Despres JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301–13.CrossRefPubMed
3.
Poirier P, Cornier MA, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123(15):1683–701.CrossRefPubMed
4.
5.
Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. Jama. 2003;289(2):187–93.CrossRefPubMed
6.
Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. Jama. 2012;307(1):56–65.CrossRefPubMed
7.
Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.CrossRefPubMedPubMedCentral
8.
Piche ME, Auclair A, Harvey J, et al. How to choose and use bariatric surgery in 2015. Can J Cardiol. 2015;31(2):153–66.CrossRefPubMed
9.
Hall TC, Pellen MG, Sedman PC, et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg. 2010;20(9):1245–50.CrossRefPubMed
10.
Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.PubMedPubMedCentral
11.
Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3–60 month follow-up. Obes Surg. 2000;10(3):233–9.CrossRefPubMed
12.
Martin J, Bergeron S, Pibarot P, et al. Impact of bariatric surgery on N-terminal fragment of the prohormone brain natriuretic peptide and left ventricular diastolic function. Can J Cardiol. 2013;29(8):969–75.CrossRefPubMed
13.
Caron-Cantin SM, Martin J, Bastien M, et al. Acute and chronic effects of biliopancreatic diversion with duodenal switch surgery on plasma visfatin and apelin levels in patients with severe obesity. Obes Surg. 2013;23(11):1806–14.CrossRefPubMed
14.
Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2009;17(1):S1–70.CrossRefPubMed
15.
Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22(9):947–54.CrossRefPubMed
16.
Biertho L, Lebel S, Marceau S, et al. Laparoscopic sleeve gastrectomy: with or without duodenal switch? A consecutive series of 800 cases. Dig Surg. 2014;31(1):48–54.CrossRefPubMed
17.
Marceau P, Biron S, Hould FS, et al. Duodenal switch: long-term results. Obes Surg. 2007;17(11):1421–30.CrossRefPubMed
18.
American DA. Standards of medical care in diabetes—2006. Diabetes Care. 2006;29 Suppl 1:S4–42.
19.
20.
Ferland M, Despres JP, Tremblay A, et al. Assessment of adipose tissue distribution by computed axial tomography in obese women: association with body density and anthropometric measurements. Br J Nutr. 1989;61(2):139–48.CrossRefPubMed
21.
Kuk JL, Church TS, Blair SN, et al. Associations between changes in abdominal and thigh muscle quantity and quality. Med Sci Sports Exerc. 2008;40(7):1277–81.CrossRefPubMed
22.
Borel AL, Nazare JA, Smith J, et al. Visceral and not subcutaneous abdominal adiposity reduction drives the benefits of a 1-year lifestyle modification program. Obesity. 2012;20(6):1223–33.CrossRefPubMed
23.
Sjostrom L, Kvist H, Cederblad A, et al. Determination of total adipose tissue and body fat in women by computed tomography, 40K, and tritium. Am J Physiol. 1986;250(6 Pt 1):E736–45.PubMed
24.
Kelley DE, Slasky BS, Janosky J. Skeletal muscle density: effects of obesity and non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1991;54(3):509–15.PubMed
25.
Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2009;52(1):17–30.CrossRefPubMed
26.
Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17(9):961–9.CrossRefPubMed
27.
Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122(7):481–6.CrossRefPubMed
28.
Pontiroli AE, Frige F, Paganelli M, et al. In morbid obesity, metabolic abnormalities and adhesion molecules correlate with visceral fat, not with subcutaneous fat: effect of weight loss through surgery. Obes Surg. 2009;19(6):745–50.CrossRefPubMed
29.
Galanakis CG, Daskalakis M, Manios A, et al. Computed tomography-based assessment of abdominal adiposity changes and their impact on metabolic alterations following bariatric surgery. World J Surg. 2015;39(2):417–23.CrossRefPubMed
30.
Carroll JF, Franks SF, Smith AB, et al. Visceral adipose tissue loss and insulin resistance 6 months after laparoscopic gastric banding surgery: a preliminary study. Obes Surg. 2009;19(1):47–55.CrossRefPubMed
31.
Umemura A, Sasaki A, Nitta H, et al. Effects of changes in adipocyte hormones and visceral adipose tissue and the reduction of obesity-related comorbidities after laparoscopic sleeve gastrectomy in Japanese patients with severe obesity. Endocr J. 2014;61(4):381–91.CrossRefPubMed
32.
Toro-Ramos T, Goodpaster BH, Janumala I, et al. Continued loss in visceral and intermuscular adipose tissue in weight-stable women following bariatric surgery. Obesity. 2015;23(1):62–9.CrossRefPubMed
33.
Miller GD, Carr JJ, Fernandez AZ. Regional fat changes following weight reduction from laparoscopic Roux-en-Y gastric bypass surgery. Diabetes Obes Metab. 2011;13(2):189–92.CrossRefPubMed
34.
Bazzocchi A, Ponti F, Cariani S, et al. Visceral fat and body composition changes in a female population after RYGBP: a two-year follow-up by DXA. Obes Surg. 2015;25(3):443–51.CrossRefPubMed
35.
Johansson L, Roos M, Kullberg J, et al. Lipid mobilization following Roux-en-Y gastric bypass examined by magnetic resonance imaging and spectroscopy. Obes Surg. 2008;18(10):1297–304.CrossRefPubMed
36.
Busetto L, Tregnaghi A, Bussolotto M, et al. Visceral fat loss evaluated by total body magnetic resonance imaging in obese women operated with laparascopic adjustable silicone gastric banding. Int J Obes Relat Metab Disord. 2000;24(1):60–9.CrossRefPubMed
37.
Otto M, Farber J, Haneder S, et al. Postoperative changes in body composition–comparison of bioelectrical impedance analysis and magnetic resonance imaging in bariatric patients. Obes Surg. 2015;25(2):302–9.CrossRefPubMed
38.
Rao RS, Yanagisawa R, Kini S. Insulin resistance and bariatric surgery. Obes Rev. 2012;13(4):316–28.CrossRefPubMed
39.
Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.CrossRefPubMed
40.
Plourde CE, Grenier-Larouche T, Caron-Dorval D, et al. Biliopancreatic diversion with duodenal switch improves insulin sensitivity and secretion through caloric restriction. Obesity. 2014;22(8):1838–46.CrossRefPubMed
41.
Dobrosielski DA, Barone Gibbs B, Chaudhari S, et al. Effect of exercise on abdominal fat loss in men and women with and without type 2 diabetes. BMJ Open. 2013;3(11):e003897.CrossRefPubMedPubMedCentral
42.
Renard E. Bariatric surgery in patients with late-stage type 2 diabetes: expected beneficial effects on risk ratio and outcomes. Diabetes Metab. 2009;35(6 Pt 2):564–8.CrossRefPubMed
Metadata
Title
Is There a Role for Visceral Adiposity in Inducing Type 2 Diabetes Remission in Severely Obese Patients Following Biliopancreatic Diversion with Duodenal Switch Surgery?
Authors
Audrey Auclair
Julie Martin
Marjorie Bastien
Nadine Bonneville
Laurent Biertho
Simon Marceau
Frédéric-Simon Hould
Simon Biron
Stéfane Lebel
Odette Lescelleur
Jean-Pierre Després
Paul Poirier
Publication date
01-08-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1973-3

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