Obesity Surgery

, Volume 29, Issue 7, pp 2037–2044 | Cite as

Four Weeks of Preoperative Omega-3 Fatty Acids Reduce Liver Volume: a Randomised Controlled Trial

  • Nathalie BakkerEmail author
  • Rick S. van den Helder
  • Remy W. F. Geenen
  • Michiel A. Hunfeld
  • Huib A. Cense
  • Ahmet Demirkiran
  • Alexander P. J. Houdijk
Original Contributions



Weight loss before bariatric surgery with a low-calorie diet (LCD) has several advantages, including reduction of liver volume and an improved access to the lesser sac. Disadvantages include performing surgery in a state of undernutrition, side effects, costs and patient compliance. Omega-3 fatty acids may serve as an alternative to reduce liver steatosis.

Materials and Methods

A randomised controlled open-label trial was done to compare the effects of a LCD with Modifast (800 kcal/day) during 2 weeks with 2 g of omega-3 fatty acids a day and a normal diet (2000 kcal/day) during 4 weeks. Total liver volume (TLV) and volume of the left liver lobe (LLL), visceral fat area (VFA) and muscle area (SMA) at the L3–L4 level were measured with MRI before and after preoperative treatment.


Sixty-two morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) were recruited. In both groups, there was a significant decrease in LLL, TLV and VFA. For LLL and TLV reduction, the LCD had a significantly larger effect (p < 0.05). Only in the LCD group was there a significant decrease in SMA with significantly more side effects and worse compliance.


Both the LCD and omega-3 diet reduced LLL, TLV and VFA. The LCD outperformed the omega-3 diet in LLL and TLV reduction, but induced significant loss of SMA and had worse compliance due to more side effects. Omega-3 fatty acids may provide a safe and more patient-friendly alternative for a LCD and further research is indicated.

Trial Registration

The study is registered at (NCT02206256).


Laparoscopic Roux-en-Y gastric bypass Liver volume Visceral fat Muscle mass Low calorie diet Omega-3 fatty acids 



We thank all of the patients for their participation in this study. We thank the staff of the Dutch Obesity Clinic for their help with recruiting patients. We thank the staff of the Radiology Department for their assistance with the MRI scans. We thank the staff of the Red Cross Hospital Laboratory, Outpatient Clinic and Operation Room for their help with the practical aspects of the study. We thank H.J. Doodeman for his assistance with the statistical plan and analyses.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval and Informed Consent

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 participants included in the study.

Supplementary material

11695_2019_3814_MOESM1_ESM.doc (36 kb)
ESM 1 (DOC 36 kb)


  1. 1.
    Powell MS, Fernandez Jr AZ. Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass. Surg Clin N Am. 2011;91:1203–24. viiiCrossRefGoogle Scholar
  2. 2.
    Prado CM, Cushen SJ, Orsso CE, et al. Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact. Proc Nutr Soc. 2016;75:188–98.CrossRefGoogle Scholar
  3. 3.
    Edholm D, Kullberg J, Karlsson FA, et al. Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis. 2015;11:602–6.CrossRefGoogle Scholar
  4. 4.
    Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84:304–11.CrossRefGoogle Scholar
  5. 5.
    Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701.CrossRefGoogle Scholar
  6. 6.
    Gonzalez-Perez J, Sanchez-Leenheer S, Delgado AR, et al. Clinical impact of a 6-week preoperative very low calorie diet on body weight and liver size in morbidly obese patients. Obes Surg. 2013;23:1624–31.CrossRefGoogle Scholar
  7. 7.
    Jump DB, Lytle KA, Depner CM, et al. Omega-3 polyunsaturated fatty acids as a treatment strategy for nonalcoholic fatty liver disease. Pharmacol Ther. 2017.Google Scholar
  8. 8.
    Iannelli A, Martini F, Schneck AS, et al. Preoperative 4-week supplementation with omega-3 polyunsaturated fatty acids reduces liver volume and facilitates bariatric surgery in morbidly obese patients. Obes Surg. 2013;23:1761–5.CrossRefGoogle Scholar
  9. 9.
    Jaser N, Mustonen H, Pietila J, et al. Preoperative transabdominal ultrasonography (US) prior to laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic sleeve gastrectomy (LSG) in the first 100 operations. Was it beneficial and reliable during the learning curve? Obes Surg. 2012;22:416–21.CrossRefGoogle Scholar
  10. 10.
    Kim B, Tsujimoto T, So R, et al. Changes in muscle strength after diet-induced weight reduction in adult men with obesity: a prospective study. Diabetes Metab Syndr Obes. 2017;10:187–94.CrossRefGoogle Scholar
  11. 11.
    Jeromson S, Gallagher IJ, Galloway SD, et al. Omega-3 fatty acids and skeletal muscle health. Mar Drugs. 2015;13:6977–7004.CrossRefGoogle Scholar
  12. 12.
    Smith GI, Atherton P, Reeds DN, et al. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr. 2011;93:402–12.CrossRefGoogle Scholar
  13. 13.
    Smith GI, Julliand S, Reeds DN, et al. Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr. 2015;102:115–22.CrossRefGoogle Scholar
  14. 14.
    Lalia AZ, Dasari S, Robinson MM, et al. Influence of omega-3 fatty acids on skeletal muscle protein metabolism and mitochondrial bioenergetics in older adults. Aging (AlbanyNY). 2017;9:1096–129.CrossRefGoogle Scholar
  15. 15.
    Sato T, Kameyama T, Ohori T, et al. Effects of eicosapentaenoic acid treatment on epicardial and abdominal visceral adipose tissue volumes in patients with coronary artery disease. J Atheroscler Thromb. 2014;21:1031–43.CrossRefGoogle Scholar
  16. 16.
    Despres JP. Is visceral obesity the cause of the metabolic syndrome? Ann Med. 2006;38:52–63.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryRed Cross Hospital BeverwijkBeverwijkNetherlands
  2. 2.Department of SurgeryNorthwest Clinics AlkmaarAlkmaarNetherlands
  3. 3.Department of SurgeryVU Medical Center AmsterdamAmsterdamNetherlands

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