Skip to main content
SpringerLink
Log in

Sex-Specific Changes in Body Composition Following Metabolic and Bariatric Surgery Are Associated with the Remission of Metabolic Syndrome

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

Abstract

Purpose

Metabolic and bariatric surgery (MBS) is the most effective treatment for metabolic syndrome (MetS). However, the mechanism of MetS remission after MBS remains unclear. We aimed to explore the relationship between sex differences, body composition, and the remission of MetS after MBS.

Materials and Methods

Cross-sectional study of 80 patients with obesity and MetS who underwent MBS with case-control design. The International Diabetes Federation criteria were used to define MetS. Body composition was measured using dual-energy X-ray absorptiometry before and 1 year after the operation. In addition to calculating changes in MetS and its prevalence, we performed a multiple logistic regression to determine predictors of MetS remission.

Results

There were significant differences in body composition between males and females after MBS. Both males and females had significant improvements in the overall prevalence of MetS, decreasing from 100 to 21.74% (P <0.001) and from 100 to 35.29% (P <0.001), respectively. A higher percentage of visceral adipose tissue (VAT) reduction tends to be associated with a higher chance of MetS remission in men. In females, the MetS nonremission subgroup had a higher %Trunk lean body mass (LBM), and %Android LBM reduction than the remission subgroup, but the multiple logistic regression analysis result was not statistically significant.

Conclusion

After MBS, reduced VAT might be related to MetS reversibility in males, while reduced LBM may result in MetS nonremission in females.

Graphical Abstract

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
Fig. 2

Similar content being viewed by others

Data Availability

The datas used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016(387):1377–96.

  2. Mitchell JD. Personalizing risk assessment in diabetes mellitus and metabolic syndrome. J Am Coll Cardiol Img. 2021;14:230–2.

    Article  Google Scholar 

  3. Hanipah ZN, Schauer PR. Bariatric surgery as a long-term treatment for type 2 diabetes/metabolic syndrome. Annu Rev Med. 2020;71:1–15.

    Article  CAS  PubMed  Google Scholar 

  4. Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39:893–901.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Madsbad S, Dirksen C, Holst JJ. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery. Lancet Diabetes Endocrinol. 2014;2:152–64.

    Article  CAS  PubMed  Google Scholar 

  6. Cho YM. A gut feeling to cure diabetes: potential mechanisms of diabetes remission after bariatric surgery. Diabetes Metab J. 2014;38:406–15.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Alomar AO, Shaheen MF, Almaneea AS, et al. The effect of bariatric surgery on metabolic syndrome: a three-center experience in Saudi Arabia. Obes Surg. 2021;31:3630–6.

    Article  PubMed  Google Scholar 

  8. Yu H, Zhang L, Bao Y, et al. Metabolic syndrome after Roux-en-Y gastric bypass surgery in Chinese obese patients with type 2 diabetes. Obes Surg. 2016;26:2190–7.

    Article  PubMed  Google Scholar 

  9. Silva LB, Oliveira B, Correia F. Evolution of body composition of obese patients undergoing bariatric surgery. Clinical Nutrition ESPEN. 2019;31:95–9.

    Article  PubMed  Google Scholar 

  10. Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93:359–404.

    Article  CAS  PubMed  Google Scholar 

  11. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2010;11:11–8.

    Article  PubMed  Google Scholar 

  12. Després JP, Allard C, Tremblay A, et al. Evidence for a regional component of body fatness in the association with serum lipids in men and women. Metabolism. 1985;34:967–73.

    Article  PubMed  Google Scholar 

  13. Sharma AM, Engeli S, Pischon T. New developments in mechanisms of obesity-induced hypertension: role of adipose tissue. Curr Hypertens Rep. 2001;3:152–6.

    Article  CAS  PubMed  Google Scholar 

  14. Rocchini AP. Obesity hypertension. Am J Hypertens. 2002;15:50s–2s.

    Article  PubMed  Google Scholar 

  15. Qian J, Scheer F. Sex-dependent link between circadian misalignment and adiposity. Nat Rev Endocrinol. 2020;16:13–5.

    Article  PubMed  Google Scholar 

  16. Reue K. Sex differences in obesity: X chromosome dosage as a risk factor for increased food intake, adiposity and co-morbidities. Physiol Behav. 2017;176:174–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143:CIR0000000000000973.

    Article  Google Scholar 

  18. CZ JL, Wang Y, et al. Guidelines for surgical treatment of obesity and type 2 diabetes mellitus in China. Chin J Pract Surg. 2014;34:6.

    Google Scholar 

  19. Agha R, Abdall-Razak A, Crossley E, et al. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg. 2019;72:156–65.

    Article  PubMed  Google Scholar 

  20. Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25:587–606.

    Article  PubMed  Google Scholar 

  21. Alberti G, Zimmet P, Shaw J, et al. The IDF consensus worldwide definition of the metabolic syndrome. The Lancet. 2005;366:1059–62.

    Article  Google Scholar 

  22. Wilding J. Weight loss is the major player in bariatric surgery benefits. Nat Med. 2020;26:1678–9.

    Article  CAS  PubMed  Google Scholar 

  23. To VT, Hüttl TP, Lang R, et al. Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery. Exp Clin Endocrinol Diabetes. 2012;120:547–52.

    Article  CAS  PubMed  Google Scholar 

  24. Busetto L, Pisent C, Rinaldi D, et al. Variation in lipid levels in morbidly obese patients operated with the LAP-BAND adjustable gastric banding system: effects of different levels of weight loss. Obes Surg. 2000;10:569–77.

    Article  CAS  PubMed  Google Scholar 

  25. Guerreiro V, Neves JS, Salazar D, et al. Long-term weight loss and metabolic syndrome remission after bariatric surgery: the effect of sex, age, metabolic parameters and surgical technique - a 4-year follow-up study. Obes Facts. 2019;12:639–52.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. Bmj. 2013;347:f5934.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Maïmoun L, Lefebvre P, Aouinti S, et al. Acute and longer-term body composition changes after bariatric surgery. Surg Obes Relat Dis. 2019;15:1965–73.

    Article  PubMed  Google Scholar 

  28. Haghighat N, Kazemi A, Asbaghi O, et al. Long-term effect of bariatric surgery on body composition in patients with morbid obesity: a systematic review and meta-analysis. Clin Nutr. 2021;40:1755–66.

    Article  PubMed  Google Scholar 

  29. Davidson LE, Yu W, Goodpaster B, et al. Fat weight increases while fat-free mass decreases in women 5 years after gastric bypass surgery. Obes Rev. 2016;17:60.

    Google Scholar 

  30. Domínguez Alvarado GA, Otero Rosales MC, Cala Duran JC, et al. The effect of bariatric surgery on metabolic syndrome: a retrospective cohort study in Colombia. Health science reports. 2023;6:e1090.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Menguer RK, Weston AC, Schmid H. Evaluation of metabolic syndrome in morbidly obese patients submitted to laparoscopic bariatric surgery: comparison of the results between Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2017;27:1719–23.

    Article  PubMed  Google Scholar 

  32. Mahawar KK, Graham Y, Carr WR, et al. Revisional Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review of comparative outcomes with respective primary procedures. Obes Surg. 2015;25:1271–80.

    Article  PubMed  Google Scholar 

  33. Coblijn UK, Verveld CJ, van Wagensveld BA, et al. Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band--a systematic review. Obes Surg. 2013;23:1899–914.

    Article  PubMed  Google Scholar 

  34. Knopp KB, Stakleff KS, Thomas TM, et al. Gender influence on weight and body composition following sleeve gastrectomy: outcomes suggest potential bariatric surgery body composition goals. Bariatric Surgical Practice and Patient Care. 2020;15:205–10.

  35. Blouin K, Boivin A, Tchernof A. Androgens and body fat distribution. J Steroid Biochem Mol Biol. 2008;108:272–80.

    Article  CAS  PubMed  Google Scholar 

  36. Blouin K, Després JP, Couillard C, et al. Contribution of age and declining androgen levels to features of the metabolic syndrome in men. Metabolism. 2005;54:1034–40.

    Article  CAS  PubMed  Google Scholar 

  37. Gapstur SM, Gann PH, Kopp P, et al. Serum androgen concentrations in young men: a longitudinal analysis of associations with age, obesity, and race. The CARDIA male hormone study. Cancer Epidemiol Biomarkers Prev. 2002;11:1041–7.

    CAS  PubMed  Google Scholar 

  38. Laaksonen DE, Niskanen L, Punnonen K, et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004;27:1036–41.

    Article  CAS  PubMed  Google Scholar 

  39. Pasquali R, Casimirri F, Cantobelli S, et al. Effect of obesity and body fat distribution on sex hormones and insulin in men. Metabolism. 1991;40:101–4.

    Article  CAS  PubMed  Google Scholar 

  40. Liu J, Fox CS, Hickson DA, et al. Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson Heart Study. J Clin Endocrinol Metab. 2010;95:5419–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Neeland IJ, Yokoo T, Leinhard OD, et al. 21st century advances in multimodality imaging of obesity for care of the cardiovascular patient. J Am Coll Cardiol Img. 2021;14:482–94.

    Article  Google Scholar 

  42. Xia L, Hua J, Dray X, et al. Endoscopic visceral fat removal as therapy for obesity and metabolic syndrome: a sham-controlled pilot study (with video). Gastrointest Endosc. 2011;74:637–44.

    Article  PubMed  Google Scholar 

  43. Vaurs C, Diméglio C, Charras L, et al. Determinants of changes in muscle mass after bariatric surgery. Diabetes Metab. 2015;41:416–21.

    Article  CAS  PubMed  Google Scholar 

  44. Kaneko S, Iida RH, Suga T, et al. Changes in triacylglycerol-accumulated fiber type, fiber type composition, and biogenesis in the mitochondria of the soleus muscle in obese rats. Anat Rec. 2011;294:1904–12.

    Article  CAS  Google Scholar 

  45. Nuijten MAH, Eijsvogels TMH, Monpellier VM, et al. The magnitude and progress of lean body mass, fat-free mass, and skeletal muscle mass loss following bariatric surgery: a systematic review and meta-analysis. Obesity reviews. 2021;23:e13370.

  46. Park SH, Park JH, Park HY, et al. Additional role of sarcopenia to waist circumference in predicting the odds of metabolic syndrome. Clin Nutr. 2014;33:668–72.

    Article  PubMed  Google Scholar 

Download references

Funding

This research was supported by the Wisdom Accumulation and Talent Cultivation Project of the Third Xiangya Hospital of Central South University (YX202102).

Author information

Author notes

  1. Xianhao Yi and Weizheng Li are co-first authors that have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China

    Xianhao Yi, Weizheng Li, Guohui Wang, Pengzhou Li, Xulong Sun, Haibo Tang, Beibei Cui, Jiapu Ling, Ping Luo, Zhibing Fu, Hui Zhou, Liyong Zhu & Shaihong Zhu

  2. Department of Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China

    Xianhao Yi

Authors
  1. Xianhao Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weizheng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guohui Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pengzhou Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xulong Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Haibo Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beibei Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jiapu Ling
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ping Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zhibing Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hui Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Liyong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Shaihong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: LZ, SZ. Conduct/data collection: XY, WL, PL. Data extraction: XS, GW, HZ. Data analysis: XY, HT, JL, BC, PL, ZF. Writing manuscript: XY, WL. Critical revision: LZ, SZ. All authors have participated sufficiently in the study and approved the final version.

Corresponding authors

Correspondence to Liyong Zhu or Shaihong Zhu.

Ethics declarations

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.

Consent to Participate

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

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

1. Both males and females had significant improvements in MetS after MBS.

2. Reduced VAT might be related to MetS reversibility in males after MBS.

3. While reduced LBM may result in MetS nonremission in females.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yi, X., Li, W., Wang, G. et al. Sex-Specific Changes in Body Composition Following Metabolic and Bariatric Surgery Are Associated with the Remission of Metabolic Syndrome. OBES SURG 33, 2780–2788 (2023). https://doi.org/10.1007/s11695-023-06741-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-023-06741-w

Keywords

Search

Navigation