Is There a Role for Visceral Adiposity in Inducing Type 2 Diabetes Remission in Severely Obese Patients Following Biliopancreatic Diversion with Duodenal Switch Surgery?
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Severe obesity is often characterized by ectopic fat deposition, which is related to development of type 2 diabetes (T2D). Thus, resolution of T2D may not be linearly associated with weight loss. The importance of ectopic fat reduction after bariatric surgery and T2D resolution is uncertain.
The aim of this pilot study is to compare body composition and body fat distribution in severely obese patients with or without T2D after biliopancreatic diversion with duodenal switch (BPD-DS) surgery in relation to diabetes resolution.
Sixty-two severely obese patients were evaluated at baseline, 6, and 12 months. Of these, 40 patients underwent BPD-DS surgery. Anthropometric measurements and abdominal and mid-thigh computed tomography scans were performed at each visit.
Before BPD-DS surgery, obese patients with T2D had higher weight as well as greater ectopic fat deposition in the abdomen and mid-thigh level than obese patients without T2D (p < 0.05). Resolution of T2D was 65 and 90 % at 6 and 12 months, respectively. No difference in body composition changes at 6 and 12 months could be found between patients without T2D, patients with T2D resolution, and patients who remained T2D. Resolution of T2D was associated with a greater absolute loss of visceral adipose tissue (VAT) in comparison to patients without T2D (−1175 ± 570 cm3 vs. −729 ± 394 cm3 at 6 months and −1647 ± 816 cm3 vs. −1103 ± 422 cm3 at 12 months; all p ≤ 0.05).
Ectopic fat mobilization, particularly the absolute loss of VAT, may play a major role in T2D resolution following BPD-DS surgery, regardless of the amount of weight loss.
KeywordsSevere obesity Biliopancreatic diversion with duodenal switch surgery Type 2 diabetes Ectopic fat Computed tomography scan
This work was supported by the Institut universitaire de cardiologie et de pneumologie de Québec foundation support granted to Dr Paul Poirier. Audrey Auclair, Marjorie Bastien, and Nadine Bonneville are recipients of a studentship from the Fonds de Recherche du Québec—Santé (FRQS). Laurent Biertho is co-chair of a Research Chair in Bariatric and Metabolic Surgery. Jean-Pierre Després is the Scientific Director of the International Chair on Cardiometabolic Risk. Paul Poirier is a senior clinical scientist from the FRQS. We thank Veronic Tremblay for technical assistance for CT images analysis and Serge Simard for statistical analysis support.
Compliance with Ethical Standards
This work was funded by a grant from the “Institut universitiare de cardiologie et de pneumologie de Québec” Foundation.
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.
Informed consent was obtained from all individual participant included in the study.
Conflict of Interest
The authors declare that they have no conflict of interest.
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