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Lipid Mobilization Following Roux-en-Y Gastric Bypass Examined by Magnetic Resonance Imaging and Spectroscopy

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Abstract

Background

Recent developments of magnetic resonance imaging (MRI) and spectroscopy have made it possible to quantify lipid deposited in different tissues. To what extent an improvement of glucose tolerance shortly after Roux-en-Y gastric bypass surgery (RYGBP) is reflected in lipid levels in liver and skeletal muscle, markers of insulin resistance, has not been clarified.

Methods

Whole-body MRI and MR spectroscopy (MRS) of liver and muscle and measurements of biochemical markers of glucose and lipid metabolism were performed at baseline and 1, 6, and 12 months following surgery in seven morbidly obese women. Volumes of adipose tissue depots and liver and muscle lipids were assessed from the MRI/MRS data.

Results

At 1 month postoperatively, body mass index and visceral and subcutaneous adipose tissues were reduced by 9%, 26%, and 10%, respectively, whereas no reductions in intrahepatocellular or skeletal intramyocellular lipid concentrations were found. Free fatty acid and beta-hydroxybutyrate levels were elevated two- and sixfold, respectively; glucose and insulin levels were lowered, indicating increased insulin sensitivity. Further weight loss up to 1 year was associated with reductions in all investigated lipid depots investigated, with the exception of the intramyocellular compartment.

Conclusion

RYGBP causes rapid lipid mobilization from visceral and subcutaneous adipose depots and enhanced free fatty acid flux to the liver. An exceptional disconnection between liver fat and insulin sensitivity occurs in the early dynamic phase after surgery. However, in the late phase, the energy restriction imposed by the surgical procedure also reduces the liver lipids, but not the intramyocellular lipids.

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Acknowledgements

We thank Margareta Ericson for expert technical assistance and Elisabeth Olsson for excellent care and samplings. This study was supported by Uppsala University, the Novo Nordisk Fund, and Ernfors Fund.

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Authors and Affiliations

  1. Department of Radiology, Uppsala University Hospital, Uppsala, Sweden

    L. Johansson, J. Kullberg, J. Weis & H. Ahlström

  2. Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden

    M. Roos, B. Edén Engström & F. A. Karlsson

  3. Department of Surgery, Uppsala University Hospital, Uppsala, Sweden

    M. Sundbom

  4. Section of Endocrinology and Diabetes, Department of Medical Sciences, University Hospital, 751 85, Uppsala, Sweden

    F. A. Karlsson

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  1. L. Johansson
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  2. M. Roos
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  3. J. Kullberg
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  4. J. Weis
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  5. H. Ahlström
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  6. M. Sundbom
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  7. B. Edén Engström
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  8. F. A. Karlsson
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Correspondence to F. A. Karlsson.

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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 18, 1297–1304 (2008). https://doi.org/10.1007/s11695-008-9484-0

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  • DOI: https://doi.org/10.1007/s11695-008-9484-0

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