Acute and 1-month effect of small-volume suction lipectomy on insulin sensitivity and cardiovascular risk

Abstract

Objective: The most common surgical procedure for obesity is liposuction, the majority of which are small-volume procedures. The effect of large-volume liposuction on cardiovascular risk and insulin sensitivity has been variable. This study was performed to evaluate the effect of the more common, smaller-volume liposuction on insulin sensitivity, inflammatory mediators, and cardiovascular risk factors. Subjects and study design: In all, 15 overweight or obese premenopausal women underwent metabolic evaluation prior to, 1 day following and 1 month following suction lipectomy of the abdomen. Metabolic evaluation included assessment of free fatty acids, glucose, insulin, insulin sensitivity by frequently sampled i.v. glucose tolerance test, and adipokines (IL-6, angiotensin II, leptin, PAI-1, adiponectin, and TNF-a). Results: Free fatty acids did not change acutely although there was an almost 30% decrease in free fatty acids at 1 month. Fasting insulin levels decreased at one month from 8.371.1 to 5.671.3 mU/ml (P ¼ 0.006). Insulin sensitivity by i.v. glucose tolerance test did not change at 1 month (4.070.8 to 5.070.7, P ¼ 0.12) although with subgroup analysis insulin sensitivity improved in obese but not overweight participants. Several adipokines worsened acutely (IL-6 increased 15 fold and angiotensin II increased 67%), but there was no change in PAI-1, and other adipokines (adiponectin, leptin, and TNF-a) decreased. At the 1-month follow-up, all adipokines were similar to baseline. Conclusion: This study provides little evidence supporting increased or decreased cardiovascular risk although there is evidence supporting improved insulin sensitivity at one month, especially in obese women.

The effect of fat removal on glucose tolerance is depot specific in male and female mice

“…Metabolic products of visceral adipose tissue, including nonesterified free fatty acids and glycerol, reach the liver directly and thus could exert disproportionately greater effects on hepatic metabolism and hepatic insulin resistance (8). The portal drainage hypothesis is also consistent with the failure of human (subcutaneous) liposuction (11,25) and IWATx in the current mouse study to improve glucose tolerance under either chow or the HFD.…”

Women gain weight and fat mass despite lipectomy at abdominoplasty and breast reduction

“…In a review of 631 patients who underwent liposuction, it was reported that w80% were able to maintain a stable post-operative weight but no details of weight were given (1). Cardiovascular risk profile does not appear to improve after liposuction (2,3), although insulin sensitivity has been reported to improve (4) but not in all studies (2). In animal models, the removal of fat results in compensatory weight gain (5)(6)(7)(8)(9).…”

C-Reactive Protein Decrease After Postbariatric Abdominoplasty

“…Alleviation of systemic inflammation and insulin resistance has been reported by some researches, whereas in certain studies, the improvement of plasma lipids has been confirmed [4][5][6][7][8]. In contrast, no changes in insulin action and cardiovascular risk factors have been noticed by other studies [9,10]. Furthermore, a single long-term protocol has been identified, namely, up to 4 years, in a cohort of just seven obese women, again without any noteworthy trends [11].…”

“…Otherwise, a stable nutritional biochemical pattern was documented throughout the observation period (Table 2). Table 3 summarizes the findings from the literature concerning the impact of liposuction and abdominoplasty on metabolic variables [2][3][4][5][6][7][8][9][10][11][12].…”