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Predictors of fat-free mass loss 1 year after laparoscopic sleeve gastrectomy

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Abstract

Purpose

Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric surgery interventions because of its safety and efficacy. Nevertheless, concerns have been raised on its detrimental effect on patient nutritional state that can ultimately lead to the loss of fat-free mass (FFM). There is interest in identifying predictors for the early identification of patients at risk of this highly unwanted adverse because they could benefit of nutritional preventive interventions. Therefore, we investigated whether anthropometric parameters, body composition or resting energy expenditure (REE) measured before surgery could predict FFM loss 1 year after LSG.

Methods

Study design was retrospective observational. We retrieved data on body weight, BMI, body composition and REE before and 1 year after LSG from the medical files of 36 patients operated on by LSG at our institutions. Simple regression, the Oldham’s method and multilevel analysis were used to identify predictors of FFM loss.

Results

Averaged percentage FFM loss 1 year after LSG was 17.0 ± 7.7% with significant differences between sexes (20.8 ± 6.6 in males and 12.2 ± 6.1% in females, p < 0.001). FFM loss was strongly predicted by pre-surgery FFM and this effect persisted also after correcting for the contribution of sex.

Conclusions

High FFM values before surgery predict a more severe FFM loss after LSG. This factor could also account for the higher FFM loss in men than in women. Our finding could help in the early identification of patient requiring a nutritional support after LSG.

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References

  1. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H (2015) Obesity Management Task Force of the European Association for the Study of Obesity. European Guidelines for Obesity Management in Adults. Obes Facts 8:402–424

    Article  Google Scholar 

  2. De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S (2016) Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 26:1659–1696

    Article  Google Scholar 

  3. Sjöström L (2013) Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med 273:219–234

    Article  Google Scholar 

  4. Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev 8:CD003641

    Google Scholar 

  5. O’Neill KN, Finucane FM, le Roux CW, Fitzgerald AP, Kearney PM (2016) Unmet need for bariatric surgery. Surg Obes Relat Dis 13:1052–1056

    Article  Google Scholar 

  6. Böckelman C, Hahl T, Victorzon M (2017) Mortality following bariatric surgery compared to other common operations in Finland during a 5-year period (2009–2013). A Nationwide Registry Study. Obes Surg 27:2444–2451

    Article  Google Scholar 

  7. Cunningham JJ (1991) Body composition as a determinant of energy expenditure: a synthetic review and a proposed general prediction equation. Am J Clin Nutr 54:963–969

    Article  CAS  Google Scholar 

  8. Faria SL, Kelly E, Faria OP (2009) Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg 19:856–859

    Article  Google Scholar 

  9. Webster JD, Hesp R, Garrow JS (1984) The composition of excess weight in obese women estimated by body density, total body water and total body potassium. Hum Nutr Clin Nutr 38:299–306

    CAS  PubMed  Google Scholar 

  10. Guida B, Belfiore A, Angrisani L, Micanti F, Mauriello C, Trio R, Pecoraro P, Falconi C (2005) Laparoscopic gastric banding and body composition in morbid obesity. Nutr Metab Cardiovasc Dis 15:198–203

    Article  Google Scholar 

  11. Belfiore A, Cataldi M, Minichini L, Aiello ML, Trio R, Rossetti G, Guida B (2015) Short-term changes in body composition and response to micronutrient supplementation after laparoscopic sleeve gastrectomy. Obes Surg 25:2344–2351

    Article  CAS  Google Scholar 

  12. Fruhbeck G, Diez Caballero A, Gil MJ (2004) Fundus functionality and ghrelin concentrations after bariatric surgery. N Engl J Med 350:308–309

    Article  Google Scholar 

  13. Sherf Dagan S, Tovim TB, Keidar A, Raziel A, Shibolet O, Zelber-Sagi S (2017) Inadequate protein intake after laparoscopic sleeve gastrectomy surgery is associated with a greater fat free mass loss. Surg Obes Relat Dis 13:101–109

    Article  Google Scholar 

  14. Galloro G, Magno L, Musella M, Manta R, Zullo A, Forestieri P (2014) A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: a case series. Surg Obes Relat Dis 10:607–611

    Article  Google Scholar 

  15. Musella M, Milone M, Bianco P, Maietta P, Galloro G (2016) Acute leaks following laparoscopic sleeve gastrectomy: early surgical repair according to a management algorithm. J Laparoendosc Adv Surg Tech A 26:85–91

    Article  Google Scholar 

  16. Hayes K, Eid G (2016) Laparoscopic sleeve gastrectomy: surgical technique and perioperative care. Surg Clin North Am 96:763–771

    Article  Google Scholar 

  17. Guida B, Cataldi M, Maresca ID, Germanò R, Trio R, Nastasi AM, Federico S, Memoli A, Apicella L, Memoli B, Sabbatini M (2013) Dietary intake as a link between obesity, systemic inflammation, and the assumption of multiple cardiovascular and antidiabetic drugs in renal transplant recipients. Biomed Res Int 2013:363728

    Article  Google Scholar 

  18. Guida B, De Nicola L, Trio R, Pecoraro P, Iodice C, Memoli B (2000) Comparison of vector and conventional bioelectrical impedance analysis in the optimal dry weight prescription in hemodialysis. Am J Nephrol 20:311–318

    Article  CAS  Google Scholar 

  19. Cunningham JJ (1990) Calculation of energy expenditure from indirect calorimetry: assessment of the Weir equation. Nutrition 6:222–223

    CAS  PubMed  Google Scholar 

  20. Compher C, Frankenfield D, Keim N, Roth-Yousey L (2006) Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Am Diet Assoc 106:881–903

    Article  Google Scholar 

  21. R Core Team (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. https://www.R-project.org/

  22. Leibel RL, Rosenbaum M, Hirsch J (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332:621–628

    Article  CAS  Google Scholar 

  23. Ravussin E, Bogardus C (1989) Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization. Am J Clin Nutr 49(5 Suppl):968–975

    Article  CAS  Google Scholar 

  24. Tu YK, Gilthorpe MS (2007) Revisiting the relation between change and initial value: a review and evaluation. Stat Med 26:443–457

    Article  Google Scholar 

  25. Blance A, Tu YK, Gilthorpe MS (2005) A multilevel modelling solution to mathematical coupling. Stat Methods Med Res 14:553–565

    Article  Google Scholar 

  26. Bates D, Maechler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Software 67(1):1–48

    Article  Google Scholar 

  27. Zurlo F, Larson K, Bogardus C, Ravussin E (1990) Skeletal muscle metabolism is a major determinant of resting energy expenditure. J Clin Investig 86:1423–1427

    Article  CAS  Google Scholar 

  28. van Wessel T, de Haan A, van der Laarse WJ, Jaspers RT (2010) The muscle fiber type–fiber size paradox: hypertrophy or oxidative metabolism? Eur J Appl Physiol 110:665–694

    Article  Google Scholar 

  29. Schiaffino S, Reggiani C (2011) Fiber types in mammalian skeletal muscles. Physiol Rev 91:1447–1531

    Article  CAS  Google Scholar 

  30. Wang ZM, Heshka S, Gallagher D, Boozer CN, Kotler DP, Heymsfield SB (2000) Resting energy expenditure–fat-free mass relationship: new insights provided by body composition modeling. Am J Physiol Endocrinol Metab 279:E539–E545

    Article  CAS  Google Scholar 

  31. Ciciliot S, Rossi AC, Dyar KA, Blaauw B, Schiaffino S (2013) Muscle type and fiber type specificity in muscle wasting. Int J Biochem Cell Biol 45:2191–2199

    Article  CAS  Google Scholar 

  32. Haizlip KM, Harrison BC, Leinwand LA (2015) Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology (Bethesda) 30:30–39

    CAS  PubMed Central  Google Scholar 

  33. Lundsgaard AM, Kiens B (2014) Gender differences in skeletal muscle substrate metabolism—molecular mechanisms and insulin sensitivity. Front Endocrinol (Lausanne) 5:195

    Google Scholar 

  34. Roepstorff C, Thiele M, Hillig T, Pilegaard H, Richter EA, Wojtaszewski JF, Kiens B (2006) Higher skeletal muscle alpha2AMPK activation and lower energy charge and fat oxidation in men than in women during submaximal exercise. J Physiol 574:125–138

    Article  CAS  Google Scholar 

  35. Hoyenga KB, Hoyenga KT (1982) Gender and energy balance: sex differences in adaptations for feast and famine. Physiol Behav 28:545–563

    Article  CAS  Google Scholar 

  36. Das SK, Roberts SB, McCrory MA, Hsu LK, Shikora SA, Kehayias JJ, Dallal GE, Saltzman E (2003) Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr 78:22–30

    Article  CAS  Google Scholar 

  37. Carey DG, Pliego GJ, Raymond RL (2006) Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg 16:1602–1608

    Article  Google Scholar 

  38. Maïmoun L, Lefebvre P, Jaussent A, Fouillade C, Mariano-Goulart D, Nocca D (2017) Body composition changes in the first month after sleeve gastrectomy based on gender and anatomic site. Surg Obes Relat Dis 13:780–787

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy

    B. Guida, M. L. Aiello, S. Parolisi & A. Belfiore

  2. Federico II University Hospital, Naples, Italy

    B. Guida, M. Cataldi, M. Musella, D. Capone & A. Belfiore

  3. Division of Pharmacology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy

    M. Cataldi

  4. Department of Medicine, University of Padova, Padua, Italy

    L. Busetto

  5. Division of Surgery, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy

    M. Musella

  6. Division of Statistics, Department of Political Science, Federico II University of Naples, Naples, Italy

    V. Policastro & G. Ragozini

Authors
  1. B. Guida
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  2. M. Cataldi
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  3. L. Busetto
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  4. M. L. Aiello
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  10. A. Belfiore
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Correspondence to B. Guida.

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Guida, B., Cataldi, M., Busetto, L. et al. Predictors of fat-free mass loss 1 year after laparoscopic sleeve gastrectomy. J Endocrinol Invest 41, 1307–1315 (2018). https://doi.org/10.1007/s40618-018-0868-2

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  • DOI: https://doi.org/10.1007/s40618-018-0868-2

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