Obesity Surgery

, Volume 24, Issue 10, pp 1709–1716 | Cite as

Baseline Abdominal Lipid Partitioning Is Associated with the Metabolic Response to Bariatric Surgery

  • Andrei Keidar
  • Liat Appelbaum
  • Chaya Schweiger
  • Karen Hershkop
  • Idit Matot
  • Naama Constantini
  • Jacob Sosna
  • Ram Weiss
Original Contributions



The purpose of this study was to compare the effects of two bariatric procedures on abdominal lipid partitioning and metabolic response.


Fifty-one patients (RYGB 31(11 M/20 F); (SG) 20(8 M/12 F)) who met the criteria of metabolic syndrome before the operation were followed following Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Visceral and subcutaneous abdominal fat depots were assessed by CT before, 6 months, and 12 months following the operation.


Patients undergoing both procedures did not differ in baseline body mass index (BMI) (42.84 ± 4.65 vs. 41.70 ± 4.68 kg/m2) or abdominal lipid depots. BMI at 12 months post-op was similar (29.44 ± 3.35 vs 30.86 ± 4.31 kg/m2 for RYGB and SG, respectively). Both procedures led to a significant reduction in visceral and subcutaneous fat at 6 months (p < 0.001 for both). The visceral-to-subcutaneous fat ratio was comparable at 6 months vs. baseline yet was lower at 12 months vs. baseline for both procedures (p < 0.01). In patients who lost the diagnosis of metabolic syndrome, baseline visceral/subcutaneous fat was the only predictor of recovery (p < 0.005). No difference was detected between procedures in dynamics of abdominal fat depots or remission of cardiovascular risk factors.


RYGB and SG induce a similar effect on abdominal fat mobilization. The metabolic effects in individual patients are mostly determined by their baseline abdominal lipid partitioning.


Bariatric surgery Visceral fat Subcutaneous fat Metabolic syndrome 


  1. 1.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  2. 2.
    Sjöström L, Narbro K, Sjöström CD, et al. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2, CD003641.PubMedGoogle Scholar
  4. 4.
    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.PubMedCrossRefGoogle Scholar
  6. 6.
    Weiss R. Fat distribution and storage: how much, where, and how? Eur J Endocrinol. 2007;157 Suppl 1:S39–45.PubMedCrossRefGoogle Scholar
  7. 7.
    Weiss R, Taksali SE, Dufour S, et al. The “obese insulin-sensitive” adolescent: importance of adiponectin and lipid partitioning. J Clin Endocrinol Metab. 2005;90(6):3731–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008;168(15):1617–24.PubMedCrossRefGoogle Scholar
  9. 9.
    Després JP. What is “metabolically healthy obesity”?: from epidemiology to pathophysiological insights. J Clin Endocrinol Metab. 2012;97(7):2283–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Arsenault BJ, Lachance D, Lemieux I, et al. Visceral adipose tissue accumulation, cardiorespiratory fitness, and features of the metabolic syndrome. Arch Intern Med. 2007;167(14):1518–25.PubMedCrossRefGoogle Scholar
  11. 11.
    Kotronen A, Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2008;28(1):27–38.PubMedCrossRefGoogle Scholar
  12. 12.
    Krssak M, Falk Petersen K, Dresner A, et al. Intramyocellular lipid concentrations are correlated with insulin sensitivity in humans: a 1H NMR spectroscopy study. Diabetologia. 1999;42(1):113–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Weiss R, Appelbaum L, Schweiger C, et al. Short-term dynamics and metabolic impact of abdominal fat depots after bariatric surgery. Diabetes Care. 2009;32(10):1910–5.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Grundy SM, Cleeman JI, Daniels SR et al. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement [published corrections appear in Circulation. 2005;112:e297 and Circulation. 2005;112:e298]. Circulation. 2005; 112: 2735–2752.Google Scholar
  15. 15.
    NIH Consensus Development Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956–61.CrossRefGoogle Scholar
  16. 16.
    Chowdhury B, Sjöström L, Alpsten M, et al. A multicompartment body composition technique based on computerized tomography. Int J Obes Relat Metab Disord. 1994;18:219–34.PubMedGoogle Scholar
  17. 17.
    Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Inabnet 3rd WB, Winegar DA, Sherif B, et al. Early outcomes of bariatric surgery in patients with metabolic syndrome: an analysis of the bariatric outcomes longitudinal database. J Am Coll Surg. 2012;214(4):550–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444(7121):881–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738.PubMedCrossRefGoogle Scholar
  21. 21.
    Mårin P, Andersson B, Ottosson M, et al. Kvist H, et al,:The morphology and metabolism of intraabdominal adipose tissue in men. Metabolism. 1992;41:1242–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93(1):359–404.PubMedCrossRefGoogle Scholar
  23. 23.
    Chaston TB, Dixon JB. Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes (Lond). 2008;32(4):619–28.CrossRefGoogle Scholar
  24. 24.
    Kim MK, Lee HC, Kwon H-S, et al. Visceral obesity is a negative predictor of remission of diabetes 1 year after bariatric surgery. Obesity. 2011;19:1835–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Taksali SE, Caprio S, Dziura J, et al. High visceral and low abdominal subcutaneous fat stores in the obese adolescent: a determinant of an adverse metabolic phenotype. Diabetes. 2008;57(2):367–71.PubMedCrossRefGoogle Scholar
  26. 26.
    Bacha F, Saad R, Gungor N, et al. Obesity, regional fat distribution, and syndrome X in obese black versus white adolescents: race differential in diabetogenic and atherogenic risk factors. J Clin Endocrinol Metab. 2003;88(6):2534–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Phillips ML, Lewis MC, Chew V, et al. The early effects of weight loss surgery on regional adiposity. Obes Surg. 2005;15(10):1449–55.PubMedCrossRefGoogle Scholar
  28. 28.
    Heath ML, Kow L, Slavotinek JP, et al. Abdominal adiposity and liver fat content 3 and 12 months after gastric banding surgery. Metabolism. 2009;58(6):753–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Gaborit B, Jacquier A, Kober F, et al. Effects of bariatric surgery on cardiac ectopic fat: lesser decrease in epicardial fat compared to visceral fat loss and no change in myocardial triglyceride content. J Am Coll Cardiol. 2012;60(15):1381–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Johansson L, Roos M, Kullberg J, et al. Lipid mobilization following Roux-en-Y gastric bypass examined by magnetic resonance imaging and spectroscopy. Obes Surg. 2008;18(10):1297–304.PubMedCrossRefGoogle Scholar
  31. 31.
    Jiménez A, Casamitjana R, Flores L, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256(6):1023–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Dixon JB, Chuang LM, Chong K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Després JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Andrei Keidar
    • 3
    • 6
  • Liat Appelbaum
    • 2
  • Chaya Schweiger
    • 3
  • Karen Hershkop
    • 1
  • Idit Matot
    • 4
  • Naama Constantini
    • 5
  • Jacob Sosna
    • 2
  • Ram Weiss
    • 1
  1. 1.Department of Human Metabolism and NutritionHebrew University School of MedicineJerusalemIsrael
  2. 2.Radiology DepartmentHadassah Ein Kerem Medical CenterJerusalemIsrael
  3. 3.Bariatric Surgery Service, Department of SurgeryRabin HospitalPetach TiqkvaIsrael
  4. 4.Department of Anesthesiology and Critical Care MedicineSourasky Medical Center affiliated with the Tel Aviv UniversityTel AvivIsrael
  5. 5.Department of Orthopedic SurgeryThe Hadassah-Hebrew University Medical CenterJerusalemIsrael
  6. 6.General Surgery DepartmentHadassah Ein Kerem Medical CenterJerusalemIsrael

Personalised recommendations