Skip to main content
SpringerLink
Log in

Modifications of Resting Energy Expenditure After Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Objectives

Resting energy expenditure (REE) declines more than what is expected according to body composition changes after caloric restriction. This metabolic adaptation is considered one of the factors favoring weight regain. The aim of this study is to evaluate the changes of REE and calculate the degree of metabolic adaptation occurring after laparoscopic sleeve gastrectomy (LSG).

Methods

REE (by indirect calorimetry) and body composition (fat-free mass or FFM, fat mass or FM by bioelectrical impedance analysis) were determined before and after 12 months in 154 patients with obesity treated with laparoscopic sleeve gastrectomy (LSG).

Results

Weight loss was 29.8 ± 10.6%, with corresponding relative reductions in FM (44.5 ± 22.8%), FFM (13.7 ± 9.9%), and REE (27.3 ± 12.9%). A predictive equation for REE was computed by using the baseline FFM and FM values to account for body composition changes. A predicted post-weight loss REE was calculated by using this equation and entering post-weight loss body composition values. Observed post-surgery REE was significantly lower than predicted one (1410 ± 312 vs 1611 ± 340 kcal/day, P < 0.001) and metabolic adaptation, calculated as the difference between observed and predicted post-weight loss REE, was − 199 ± 238 kcal/day. The post-surgery level of metabolic adaptation was inversely related to postoperative percent weight loss (r = − 0.170; P < 0.05) and FM loss (r = − 0.245; P < 0.01).

Conclusions

A significant reduction of resting energy expenditure and a significant degree of metabolic adaptation both occur after sleeve gastrectomy. A greater metabolic adaptation could be partly responsible for a lower weight loss after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ogden CL, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;219:1–8.

    Google Scholar 

  2. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet. 2011;377:557–67.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.

    Google Scholar 

  5. Bond DS, Phelan S, Leahey TM, et al. Weight-loss maintenance in successful weight losers: surgical vs non-surgical methods. Int J Obes. 2009;33:173–80.

    Article  CAS  Google Scholar 

  6. Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes. 2015;39(8):1188–96.

    Article  CAS  Google Scholar 

  7. Müller MJ, Bosy-Westphal A. Adaptive thermogenesis with weight loss in humans. Obesity (Silver Spring) 2013; 21: 218–228.

  8. Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995;332:621–8.

    Article  PubMed  CAS  Google Scholar 

  9. Müller MJ, Enderle J, Pourhassan M, et al. Metabolic adaptation to caloric restriction and subsequent refeeding: the Minnesota Starvation Experiment revisited. Am J Clin Nutr. 2015;102:807–19.

    Article  PubMed  CAS  Google Scholar 

  10. Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23:1922–33.

    Article  PubMed  Google Scholar 

  11. Sepúlveda M, Alamo M, Saba J, et al. Long-term weight loss in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2017;13:1676–81.

    Article  PubMed  Google Scholar 

  12. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.

    Article  PubMed  Google Scholar 

  13. Stylopoulos N, Hoppin AG, Kaplan LM. Roux-en-Y gastric bypass enhances energy expenditure and extends lifespan in diet-induced obese rats. Obesity (Silver Spring). 2009;17:1839–47.

    Article  Google Scholar 

  14. Hao Z, Mumphrey MB, Townsend RL, et al. Body composition, food intake, and energy expenditure in a murine model of Roux-en-Y gastric bypass surgery. Obes Surg. 2016;26:2173–82.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hankir MK, Bronisch F, Hintschich C, et al. Differential effects of Roux-en-Y gastric bypass surgery on brown and beige adipose tissue thermogenesis. Metabolism. 2015;64:1240–9.

    Article  PubMed  CAS  Google Scholar 

  16. Faria SL, Faria OP, Buffington C, et al. Energy expenditure before and after Roux-en-Y gastric bypass. Obes Surg. 2012;22:1450–5.

    Article  PubMed  Google Scholar 

  17. Rabl C, Rao MN, Schwarz JM, et al. Thermogenic changes after gastric bypass, adjustable gastric banding or diet alone. Surgery. 2014;156:806–12.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Werling M, Olbers T, Fändriks L, et al. Increased postprandial energy expenditure may explain superior long term weight loss after Roux-en-Y gastric bypass compared to vertical banded gastroplasty. PLoS One. 2013;8:e60280.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Knuth ND, Johannsen DL, Tamboli RA, et al. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring). 2014;22:2563–9.

    Google Scholar 

  20. Butte NF, Brandt ML, Wong WW, et al. Energetic adaptations persist after bariatric surgery in severely obese adolescents. Obesity (Silver Spring) 2015; 23: 591–601.

  21. Tam CS, Rigas G, Heilbronn LK, et al. Energy adaptations persist 2 years after sleeve gastrectomy and gastric bypass. Obes Surg. 2016;26:459–63.

    Article  PubMed  Google Scholar 

  22. Yumuk V, Tsigos C, Fried M, et al. European guidelines for obesity management in adults. Obes Facts. 2015;8:402–24.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bernante P, Foletto M, Busetto L, et al. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg. 2006;16:1327–30.

    Article  PubMed  Google Scholar 

  24. Sbraccia P, Nisoli E, Vettor R (eds). Clinical management of overweight and obesity. Recommendations of the Italian Society of Obesity (SIO). Springer International Publishing: Switzerland, 2016, pp 13–35.

  25. Ferrannini E. The theoretical bases of indirect calorimetry: a review. Metabolism. 1988;37:287–301.

    Article  PubMed  CAS  Google Scholar 

  26. Branson RD, Johannigman JA. The measurement of energy expenditure. Nutr Clin Pract. 2004;19:622–36.

    Article  PubMed  Google Scholar 

  27. Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949;109:1–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.

    PubMed  CAS  Google Scholar 

  29. Matthews D, Hosker J, Rudenski A, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28:12–9.

    Article  Google Scholar 

  30. Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity (Silver Spring). 2016;24:1612–9.

    Article  Google Scholar 

  31. Bosy-Westphal A, Eichhorn C, Kutzner D, et al. The age-related decline in resting energy expenditure in humans is due to the loss of fat-free mass and to alterations in its metabolically active components. J Nutr. 2003;133:2356–62.

    Article  PubMed  CAS  Google Scholar 

  32. Rosenbaum M, Leibel R. The role of leptin in energy homeostasis in humans. J Endocrinol. 2015;223:T83–96.

    Article  CAS  Google Scholar 

  33. Rosenbaum M, Hirsch J, Gallagher DA, et al. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008;88:906–12.

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

The study was conducted with the institutional funds of the Comprehensive Care Obesity Centre, University of Padua, and without external sources of financial support.

Author information

Authors and Affiliations

  1. Comprehensive Care Obesity Centre, University of Padua, Padua, Italy

    Silvia Bettini, Emanuel Bordigato, Roberto Fabris, Roberto Serra, Chiara Dal Pra’, Anna Belligoli, Marta Sanna, Chiara Compagnin, Mirto Foletto, Luca Prevedello, Paola Fioretto, Roberto Vettor & Luca Busetto

  2. Department of Medicine, University of Padua, Internal Medicine 3, Via Giustiniani 2, 35128, Padua, Italy

    Silvia Bettini, Emanuel Bordigato, Roberto Fabris, Roberto Serra, Chiara Dal Pra’, Anna Belligoli, Marta Sanna, Chiara Compagnin, Paola Fioretto, Roberto Vettor & Luca Busetto

Authors
  1. Silvia Bettini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuel Bordigato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Fabris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Serra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiara Dal Pra’
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna Belligoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marta Sanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chiara Compagnin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mirto Foletto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Luca Prevedello
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paola Fioretto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Roberto Vettor
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Luca Busetto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SB and EB contributed equally to the preparation of this paper.

Corresponding author

Correspondence to Silvia Bettini.

Ethics declarations

Conflict of Interest

Dr. Serra reports receiving personal fees from Pizeta Pharma and Astra Zeneca for his services as a speaker and scientific advisor. Dr. Fioretto reports receiving personal fees from Astra Zeneca, Boehringer Ingelheim-Lilly, and Janssen for her services as a speaker and scientific advisor. Dr. Busetto reports receiving personal fees from IntraPace, Pizeta Pharma, and Novo Nordisk for his services as a scientific advisor. Dr. Bettini, Dr. Belligoli, Dr. Bordigato, Dr. Fabris, Dr. Dal Pra’, Dr. Compagnin, Dr. Foletto, Dr. Prevedello, Dr. Sanna, and Dr. Vettor declare no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bettini, S., Bordigato, E., Fabris, R. et al. Modifications of Resting Energy Expenditure After Sleeve Gastrectomy. OBES SURG 28, 2481–2486 (2018). https://doi.org/10.1007/s11695-018-3190-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3190-3

Keywords

Search

Navigation