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Improved metabolism and body composition beyond normal levels following gastric bypass surgery: a longitudinal study
Author(s) -
Andersson D. P.,
Dahlman I.,
Eriksson Hogling D.,
Bäckdahl J.,
Toft E.,
Qvisth V.,
Näslund E.,
Thorell A.,
Rydén M.,
Arner P.
Publication year - 2019
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12824
Subject(s) - medicine , insulin resistance , endocrinology , insulin , triglyceride , adipose tissue , gastric bypass surgery , homeostatic model assessment , obesity , glucose clamp technique , cholesterol , metabolic syndrome , homeostasis , weight loss , pancreatic hormone , gastric bypass
Background The cardiometabolic risk profile improves following bariatric surgery. However, the degree of improvement in relation to weight‐stable control subjects is unknown. Objectives To study the differences in cardiometabolic risk profile between formerly obese patients following Roux‐en‐Y gastric bypass ( RYGB ) surgery and control subjects. Methods Subjects undergoing RYGB and reaching a BMI <30 kg m −2 2 years postsurgery were matched with control subjects regarding age, sex and BMI . The following examinations were performed: insulin sensitivity measured by hyperinsulinaemic–euglycaemic clamp, insulin clearance, homeostatic model assessment of insulin resistance ( HOMA ‐ IR ), lipid profile, inflammatory marker levels, dual‐energy X‐ray absorptiometry and subcutaneous adipose tissue cellularity (fat cell size and number). Results Sixty‐nine subjects undergoing RYGB were matched to a control subject. Insulin sensitivity measured by hyperinsulinaemic–euglycaemic clamp, blood pressure, inflammatory status and glucose, triglyceride and HDL cholesterol levels were comparable to values of control subjects. However, HOMA ‐ IR (1.0 ± 0.5 vs. 1.3 ± 0.7, P = 0.005), insulin clearance (0.38 ± 0.08 vs. 0.34 ± 0.08 μL m −2 min −1 , P < 0.0001) and circulating levels of insulin (31 ± 15 vs. 37 ± 17 pmol L −1 , P = 0.008), total cholesterol (4.1 ± 0.7 vs. 4.8 ± 0.9 mmol L −1 , P < 0.0001) and LDL cholesterol (2.1 ± 0.6 vs. 2.9 ± 0.8 mmol L −1 , P < 0.0001) were improved beyond the levels in matched control subjects. Furthermore, formerly obese subjects had higher lean and lower fat mass as well as a more benign type of adipose cellularity (hyperplasia with many small fat cells) compared to control subjects. Conclusions Subjects who underwent RYGB and reached a postobese state demonstrated a beneficial body composition, slightly increased insulin sensitivity as indirectly measured by HOMA ‐ IR and higher insulin clearance, lower atherogenic lipid/lipoprotein levels and benign adipocyte morphology compared with control subjects who had never been obese. In line with previous results, our findings may in part explain why RYGB confers long‐term protection against metabolic complications.