Evaluation of body composition changes after bariatric surgery according to gender and anatomical region

Abstract

Purpose: Bariatric surgery induces acute weight loss, but there is insufficient information about its effect on postoperative early changes in body composition (BC). In this study, BC changes in the first month after Mini gastric bypass (MGB) and Sleeve gastrectomy (SG) were examined according to gender and anatomical region.

Materials and methods: Body composition changes in 100 morbidly obese patients (70 women, 30 men) after MGB and SG were measured using Bioelectrical Impedance Analysis (BIA) technology.

Results: After MGB, both men and women had a reduction in both their body fat (p=0.071) and lean tissue mass (p=0.781). In addition, muscle mass loss was not statistically significant in all groups after MGB. However, after SG, significant fat tissue loss occurred in women (p=0.014), whereas in men, there was a significant decrease in lean tissue mass (p=0.029) and upper limb muscle mass (p=0.001).

Conclusion: Our study clearly shows that bariatric surgery induces acute weight loss and that both whole-body fat and lean tissue mass are affected, and muscle loss in some anatomical regions is higher than fat loss. It has been found that changes in body composition in the early period after bariatric surgery may include differences according to gender and surgical procedure. Since muscle mass loss can have harmful consequences in the long term, nutritional strategies should be determined as soon as possible after bariatric surgery.

Keywords

• mini gastric bypass
• sleeve gastrectomy
• body composition
• fat mass
• lean tissue mass

Bariatrik cerrahi sonrası akut dönem vücut kompozisyon değişimlerinin cinsiyet ve anatomik bölgeye göre değerlendirilmesi

Öz

Amaç: Bariatrik cerrahi (BC) akut kilo kaybına neden olur, ancak vücut kompozisyonundaki postoperatif erken dönem değişiklikler üzerindeki etkisi hakkında yeterli bilgi yoktur. Bu çalışmada, Mini gastrik bypas (MGB) ve Sleeve gastrektomi (SG) sonrası ilk aydaki vücut kompozisyon değişiklikleri cinsiyet ve anatomik bölgeye göre incelenmiştir.

Gereç ve yöntem: MGB ve SG öncesi ve postoperatif 1 ay sonra 100 morbid obez hastada (70 kadın, 30 erkek) vücut kompozisyonu (üst ekstremite, alt ekstremite, gövde kas ve yağ oranları) ayrıca tüm vücut yağ doku ve yağsız doku kütlesi Biyoelektrik Empedans Analizi (BIA) teknolojisi kullanılarak ölçüldü.

Bulgular: MGB sonrası kadın ve erkeklerde hem tüm vücut yağ kütlesinde (p=0,071) hem de yağsız doku kütlesinde (p=0,781) azalma gerçekleşmiştir. Ayrıca MGB sonrası tüm gruplarda kas kütle kaybı istatistiksel olarak anlamlı değildir. Ancak SG sonrası kadınlarda anlamlı yağ doku kaybı oluşurken (p=0,014) erkeklerde yağsız doku kütlesinde (p=0,029) ve üst ekstremite kas kütlesinde (p=0,001) anlamlı azalma tespit edilmiştir.

Sonuç: Çalışmamız bariatrik cerrahinin akut kilo kaybına neden olduğunu ve hem tüm vücut yağ kütlesi hem de yağsız doku kütlesinin etkilendiğini ve bazı anatomik bölgelerde kas kaybının yağ kaybından daha yüksek olduğunu açıkça göstermektedir. Bariatrik cerrahi sonrası akut dönemde vücut kompozisyonundaki değişimlerin cinsiyet ve yapılan cerrahi prosedüre göre farklılıklar içerebileceği bulunmuştur. Kas kütle kaybının uzun vadede zararlı sonuçları olabileceğinden, bariatrik cerrahi sonrası beslenme stratejilerinin mümkün olan en kısa sürede belirlenmesi gerekmektedir. 

Anahtar Kelimeler

• Mini Gastrik Bypas
• sleeve gastrektomi
• vücut kompozisyonu
• yağ doku kütlesi
• yağsız doku kütlesi

Kaynakça

1. 1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014;384(9945):766-781. doi:10.1016/S0140-6736(14)60460-8.
2. 2. Hales CM. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. 2020;(360):8.
3. 3. Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22(12):2554-2563. doi:10.1007/s00464-008-0074-y.
4. 4. Kehagias I, Karamanakos SN, Argentou M, Kalfarentzos F. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650-1656. doi:10.1007/s11695-011-0479-x.
5. 5. Sjöström L, Narbro K, Sjöström CD, et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. New England Journal of Medicine. 2007;357(8):741-752. doi:10.1056/NEJMoa066254.
6. 6. Buchwald H, Ikramuddin S, Dorman RB, Schone JL, Dixon JB. Management of the metabolic/bariatric surgery patient. Am J Med. 2011;124(12):1099-1105. doi:10.1016/j.amjmed.2011.05.035.
7. 7. Nocca D, Krawczykowsky D, Bomans B, et al. A Prospective Multicenter Study of 163 Sleeve Gastrectomies: Results at 1 and 2 Years. OBES SURG. 2008;18(5):560-565. doi:10.1007/s11695-007-9288-7.
8. 8. Overs SE, Freeman RA, Zarshenas N, Walton KL, Jorgensen JO. Food tolerance and gastrointestinal quality of life following three bariatric procedures: adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Obes Surg. 2012;22(4):536-543. doi:10.1007/s11695-011-0573-0.

9. 9. Dogan K, Gadiot RPM, Aarts EO, et al. Effectiveness and Safety of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding in Morbidly Obese Patients: a Multicenter, Retrospective, Matched Cohort Study. Obes Surg. 2015;25(7):1110-1118. doi:10.1007/s11695-014-1503-8.
10. 10. Georgiadou D, Sergentanis TN, Nixon A, Diamantis T, Tsigris C, Psaltopoulou T. Efficacy and safety of laparoscopic mini gastric bypass. A systematic review. Surg Obes Relat Dis. 2014;10(5):984-991. doi:10.1016/j.soard.2014.02.009.
11. 11. Noria SF, Grantcharov T. Biological effects of bariatric surgery on obesity-related comorbidities. Can J Surg. 2013;56(1):47-57. doi:10.1503/cjs.036111.
12. 12. Mahawar KK, Carr WRJ, Balupuri S, Small PK. Controversy surrounding “mini” gastric bypass. Obes Surg. 2014;24(2):324-333. doi:10.1007/s11695-013-1090-0.
13. 13. Mahawar KK, Jennings N, Brown J, Gupta A, Balupuri S, Small PK. “Mini” gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890-1898. doi:10.1007/s11695-013-1026-8.
14. 14. Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA. 2002;288(14):1758-1761. doi:10.1001/jama.288.14.1758.
15. 15. Suter M, Giusti V. [Surgical options for obesity: results and complications]. Rev Med Suisse. 2005;1(12):832-836.
16. 16. Schiavo L, Scalera G, Pilone V, et al. A Comparative Study Examining the Impact of a Protein-Enriched Vs Normal Protein Postoperative Diet on Body Composition and Resting Metabolic Rate in Obese Patients after Sleeve Gastrectomy. Obes Surg. 2017;27(4):881-888. doi:10.1007/s11695-016-2382-y.
17. 17. K A, D T, M N, L A, G Z, E L. The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: the results of 3 years of follow-up. Surg Endosc. 2015;30(2):699-705. doi:10.1007/s00464-015-4262-2.
18. 18. Aquino L, Pereira S, Silva J, Sobrinho C, Ramalho A. Bariatric Surgery: Impact on Body Composition After Roux-en-Y Gastric Bypass. Obesity surgery. 2011;22:195-200. doi:10.1007/s11695-011-0500-4.
19. 19. Maïmoun L, Lefebvre P, Jaussent A, Fouillade C, Mariano-Goulart D, Nocca D. Body composition changes in the first month after sleeve gastrectomy based on gender and anatomic site. Surg Obes Relat Dis. 2017;13(5):780-787. doi:10.1016/j.soard.2017.01.017.
20. 20. Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants. Lancet. 2011;378(9785):31-40. doi:10.1016/S0140-6736(11)60679-X.
21. 21. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011-2012. NCHS Data Brief. 2013;(131):1-8.
22. 22. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2):187-193. doi:10.1001/jama.289.2.187.
23. 23. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007;370(9603):1929-1938. doi:10.1016/S0140-6736(07)61696-1.
24. 24. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724-1737. doi:10.1001/jama.292.14.1724.
25. 25. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014;370(21):2002-2013. doi:10.1056/NEJMoa1401329.
26. 26. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547-559. doi:10.7326/0003-4819-142-7-200504050-00013.
27. 27. Lee W-J, Chong K, Ser K-H, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143-148. doi:10.1001/archsurg.2010.326.
28. 28. Li J, Lai D, Wu D. Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis. Obes Surg. 2016;26(2):429-442. doi:10.1007/s11695-015-1996-9.
29. 29. Albeladi B, Bourbao-Tournois C, Huten N. Short- and midterm results between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy for the treatment of morbid obesity. J Obes. 2013;2013:934653. doi:10.1155/2013/934653.
30. 30. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741-749. doi:10.1097/01.sla.0000224726.61448.1b.
31. 31. Musella M, Milone M. Still “controversies” about the mini gastric bypass? Obes Surg. 2014;24(4):643-644. doi:10.1007/s11695-014-1193-2.
32. 32. Mostafa EA, Wahab EMA, Sayed YGA, Gafar MH. Laparoscopic sleeve gastrectomy versus laparoscopic mini‑gastric bypass in management of morbid obesity and its comorbidities. :6.
33. 33. Després J-P, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444(7121):881-887. doi:10.1038/nature05488.
34. 34. Friedrich AE, Damms-Machado A, Meile T, et al. Laparoscopic sleeve gastrectomy compared to a multidisciplinary weight loss program for obesity--effects on body composition and protein status. Obes Surg. 2013;23(12):1957-1965. doi:10.1007/s11695-013-1036-6.
35. 35. Belfiore A, Cataldi M, Minichini L, et al. Short-Term Changes in Body Composition and Response to Micronutrient Supplementation After Laparoscopic Sleeve Gastrectomy. Obes Surg. 2015;25(12):2344-2351. doi:10.1007/s11695-015-1700-0.
36. 36. Moizé V, Andreu A, Rodríguez L, et al. Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr. 2013;32(4):550-555. doi:10.1016/j.clnu.2012.11.007.
37. 37. Schollenberger AE, Karschin J, Meile T, Küper MA, Königsrainer A, Bischoff SC. Impact of protein supplementation after bariatric surgery: A randomized controlled double-blind pilot study. Nutrition. 2016;32(2):186-192. doi:10.1016/j.nut.2015.08.005.