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Observed changes in brown, white, hepatic and pancreatic fat after bariatric surgery: Evaluation with MRI

  • Magnetic Resonance
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Abstract

Objectives

To study the change in brown and white adipose tissue (BAT and WAT), as well as fat content in the liver and pancreas, in patients with morbid obesity before and after bariatric surgery.

Methods

Twelve patients with morbid obesity (F=8, M=4, age: 45.4 years (38.4–51.2), BMI: 35.2 kg/m2 (32.5–38.6)) underwent pre-op MRI at baseline and two post-op scans at 6-month and 12-month intervals after bariatric surgery. Co-registered water, fat, fat-fraction and T2* image series were acquired. Supraclavicular BAT and abdominal WAT were measured using in-house algorithms. Intrahepatic triglyceride (IHTG) was measured using MR spectroscopy and pancreatic fat was measured using a region-of-interest approach. Fat contents were compared between baseline and the first and second 6-month intervals using non-parametric analysis of Friedman’s test and Wilcoxon’s signed-rank test. Level of significance was selected at p=0.017 (0.05/3). Threshold of non-alcoholic fatty liver disease was set at 5.56%.

Results

Results indicated that BMI (p=0.005), IHTG (p=0.005), and subcutaneous (p=0.005) and visceral adipose tissues (p=0.005) were significantly reduced 6 months after surgery. Pancreatic fat (p=0.009) was significantly reduced at 12 months. Most reduction became stable between the 6-month and 12-month interval. No significant difference was observed in BAT volume, fat-fraction and T2* values.

Conclusion

The results of this study suggest that bariatric surgery effectively reduced weight, mainly as a result of the reduction of abdominal WAT. Liver and pancreatic fat were deceased below the threshold possibly due to the reduction of free fatty acid. BAT volume, fat-fraction and T2* showed no significant changes, probably because surgery itself might not have altered the metabolic profile of the patients.

Key Points

• No significant changes were observed in fat-fraction, T2* and volume of brown adipose tissue after bariatric surgery.

• Non-alcoholic fatty liver disease was resolved after surgery.

• Abdominal white fat and liver fat were significantly reduced 6 months after surgery and become stable between 6 and 12 months while pancreatic fat was significantly reduced between 0 and 12 months.

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Abbreviations

BAT:

Brown adipose tissue

BMI:

Body mass index

ICC:

Intraclass correlation coefficient

IHTG:

Intrahepatic triglyceride

IQR:

Interquartile range

LGCP:

Laparoscopic greater curvature plication

LSG:

Laparoscopic sleeve gastrectomy

NAFLD:

Nonalcoholic fatty liver disease

RYGB:

Roux-en-Y gastric bypass

SAT:

Subcutaneous adipose tissues

UCP1:

Uncoupling protein 1

VAT:

Visceral adipose tissues

WAT:

White adipose tissue

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Acknowledgements

The authors would like to thank Candice Lam and Sabrina Ler for their kind support and assistance with subject recruitment.

Funding

This study has received funding by the Research Grant Council of Hong Kong. The work described in this paper was partially supported by grants from the Research Grants Council (Project No.: 14206716 and SEG_CUHK02) of the Hong Kong Special Administrative Region

Author information

Authors and Affiliations

  1. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong SAR

    Steve C. N. Hui, Qiyong Ai, David K. W. Yeung & Winnie C. W. Chu

  2. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong SAR

    Simon K. H. Wong & Enders K. W. Ng

  3. Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong SAR

    David K. W. Yeung

Authors
  1. Steve C. N. Hui
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  2. Simon K. H. Wong
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  3. Qiyong Ai
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  5. Enders K. W. Ng
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  6. Winnie C. W. Chu
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Corresponding author

Correspondence to Winnie C. W. Chu.

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Guarantor

The scientific guarantor of this publication is Winnie CW Chu.

Conflict of interest

The authors of this paper declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• longitudinal study

• performed at one institution

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Hui, S.C.N., Wong, S.K.H., Ai, Q. et al. Observed changes in brown, white, hepatic and pancreatic fat after bariatric surgery: Evaluation with MRI. Eur Radiol 29, 849–856 (2019). https://doi.org/10.1007/s00330-018-5611-z

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  • DOI: https://doi.org/10.1007/s00330-018-5611-z

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