Premium
The plateau principle, a model of approach to steady state for weight and metabolic functions after bariatric surgery
Author(s) -
Hargrove James L.,
Heinz Grete,
Smith Jeffrey W.,
Frediani Jennifer,
Ziegler Thomas R.,
Lin Edward,
GletsuMiller Nana
Publication year - 2011
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.25.1_supplement.532.2
Roux‐en‐y gastric bypass surgery reduces energy intake and shifts the balance between synthesis and oxidation of tissue lipids. If tissue loss rate is proportional to the energy deficit, the transition may follow first‐order kinetics with a fractional rate parameter estimated as:k e ' = 1 t L n( M 0 ‐ M s s ) ( M t ‐ M s s )k ′ e is the fractional loss rate after surgery and M 0 , M t , and M ss are the quantities present at baseline, at a future time t , and at steady state, respectively. We have analyzed changes in body composition and insulin sensitivity according to a model of approach to steady state for 31 adult females with initial body mass indices ranging from 34 to 56 kg/m 2 for 2 years following gastric bypass. Changes in body mass, fat‐free mass, fat mass, visceral adipose tissue, waist girth, HOMA, and leptin could be modeled as an exponential approach to steady state. In general, visceral adipose tissue and anthropometric measures stabilized between 9–18 mo after surgery, whereas HOMA stabilized in 1–6 mo. Changes in insulin resistance, systolic blood pressure, and leptin were characterized by a faster rate than changes in body mass and waist girth. Kinetic analysis permits the clinician to forecast future changes in subjects who have recently undergone gastric bypass surgery. This analysis suggests why many benefits of weight loss occur long before weight has stabilized at a new level. (NIH #DK067167, #DK 075745, Gen. Clin. Res. Ctr #M01 RR00039, Atl. Clin. Transl. Sci. Inst. #UL1 RR025008 ).