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Effects of Bariatric Surgery on Sarcopenic Obesity Outcomes: A One-Year Prospective Study in Middle-Aged Women

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Abstract

Introduction

Sarcopenic obesity (SO) is characterised by the confluence of muscle deterioration and high adiposity. When non-surgical interventions prove insufficient, bariatric surgery (BS) becomes the primary approach. This study aimed to address BS effects on SO outcomes 1 year post-surgery among middle-aged women, also considering physical exercise’s impact.

Methods

Prospective single-centre study of 140 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy between November 2019 and December 2022. Participants were categorised into tertiles according to SO’s diagnosis and severity (group 1—patients with the most severe SO; group 2—intermediate; group 3—the least severe or without SO), calculated considering the consensus issued by ESPEN and EASO in 2022. Evaluations of clinical and biochemical parameters were conducted before and 12 months after BS, and the variation was used for comparative purposes. Body composition was assessed using bone density scans. Linear regression analysis accounted for both surgery type and baseline body mass index (BMI).

Results

Before BS, SO prevalence in the overall sample was 89.3%, decreasing to 2.9% after BS. Group 1 had more body fat mass (56.9 vs 54.8 vs 50.7 kg, p < 0.001), total, trunk and leg fat at baseline and a significantly lower total skeletal muscle mass (47.2 vs 49.4 vs 51.8 kg, p < 0.001). One year post-BS, group 1 presented more weight loss (− 39.8 ± 11.4 kg, p = 0.031), BMI reduction (− 15.9 ± 4.6 kg/m2, p = 0.005) and lost more fat mass (− 32.6 vs − 30.5 vs − 27.9 kg, p = 0.005), but not total skeletal muscle mass (− 5.8 vs − 5.9 vs − 6.8 kg, p = 0.130). Remission rates for comorbidities were substantial among all groups, but more marked among patients within group 1 (type 2 diabetes mellitus 75%, hypertension 47.1% and dyslipidemia 52.8%). Engagement in physical exercise of any kind has increased post-BS (33.1% vs 79.1%).

Conclusion

Despite concerns about malabsorptive mechanisms potentially worsening muscle loss, patients with the most severe SO undergoing BS lost more fat mass while experiencing the smallest reduction in total skeletal muscle mass. Remission rates for comorbidities following BS were notable among all groups.

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Author notes

  1. Pietra Rodrigues and Fernando Mendonça are both co-first authors and they contributed equally to this work.

Authors and Affiliations

  1. Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal

    Pietra S. Rodrigues, Carla Luís & Ilda Rodrigues

  2. Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal

    Fernando M. Mendonça, João S. Neves, Telma Moreno, Diana Festas, Jorge Pedro & Ana Varela

  3. CRIO group (Centro de Responsabilidade Integrada de Obesidade), São João Hospital and University Centre, 4200-319, Porto, Portugal

    Fernando M. Mendonça, Diana Festas, Jorge Pedro, Ana Varela, Eduardo L. Costa & Paula Freitas

  4. Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

    João S. Neves

  5. i3S (Instituto de Investigação e Inovação em Saúde), Universidade do Porto, 4200-135, Porto, Portugal

    Carla Luís & Paula Freitas

  6. Nuclear Medicine Department, São João Hospital and University Centre, 4200-319, Porto, Portugal

    Ana Fernandes

  7. CINTESIS.UFP@RISE (Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde), Universidade Fernando Pessoa, 4249-004, Porto, Portugal

    Ana Fernandes

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  1. Pietra S. Rodrigues
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Correspondence to Fernando M. Mendonça.

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Ethics Approval

All procedures performed in this study 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.

Informed Consent

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

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Key Points

• Bariatric surgery emerges as both a risk factor and a management approach in sarcopenic obesity.

• Patients with severe sarcopenic obesity lost more fat mass and less muscle mass after bariatric surgery.

• Bariatric surgery reduces sarcopenic obesity’s prevalence and improves comorbidities.

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Rodrigues, P.S., Mendonça, F.M., Neves, J.S. et al. Effects of Bariatric Surgery on Sarcopenic Obesity Outcomes: A One-Year Prospective Study in Middle-Aged Women. OBES SURG 34, 1674–1683 (2024). https://doi.org/10.1007/s11695-024-07164-x

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