Differential Effects of Bariatric Surgery Versus Exercise on Excessive Visceral Fat Deposits

Abstract

The aim of the present study was to compare differential impacts of bariatric surgery and exercise-induced weight loss on excessive abdominal and cardiac fat deposition.Excessive fat accumulation around the heart may play an important role in the pathogenesis of cardiovascular disease. Recent evidences have suggested that bariatric surgery results in relatively less decrease in epicardial fat compared with abdominal visceral fat and paracardial fat.Sixty-four consecutive overweight or obese subjects were enrolled in the study. Clinical characteristics and metabolic profiles were recorded. The volumes of abdominal visceral adipose tissue (AVAT), abdominal subcutaneous adipose tissue (ASAT), epicardial (EAT), and paracardial adipose tissue (PAT) were measured by computed tomography in the bariatric surgery group (N = 25) and the exercise group (N = 39) at baseline and 3 months after intervention. Subjects in both the surgery and exercise groups showed significant reduction in body mass index (15.97%, 7.47%), AVAT (40.52%, 15.24%), ASAT (31.40, 17.34%), PAT (34.40%, 12.05%), and PAT + EAT (22.31%, 17.72%) (all P < 0.001) after intervention compared with baseline. In both the groups, the decrease in EAT was small compared with the other compartments (P < 0.01 in both groups). Compared with the exercise group, the surgery group had greater loss in abdominal and cardiac visceral adipose tissue (AVAT, ASAT, PAT, EAT+PAT) (P < 0.001), but lesser loss in EAT (P = 0.037).Compared with the exercise group, bariatric surgery results in significantly greater percentage loss of excessive fat deposits except for EAT. EAT, but not PAT, was relatively preserved despite weight reduction in both the groups. The physiological impact of persistent EAT deserves further investigation.

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

“…The treatment of obesity or type 2 diabetes can influence the mass or biology of epicardial adipose tissue. However, epicardial fat is relatively resistant to weight loss regimens; 79 thus, the modest weight loss typically seen with dietary interventions has little effect on epicardial fat deposits, 80 and calorie restriction that leads to a small decrease in weight has minimal effects on AF, diastolic filling abnormalities and HF. 53,81,82 In contrast, marked weight loss (by intensive calorie restriction or bariatric surgery) can decrease both the mass and inflammation of epicardial fat, [83][84][85][86][87][88] and has reduced the burden of AF and restored sinus rhythm in patients with established AF in both observational studies and randomized trials.…”

Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes

“…Interestingly, after 6–12 months of laparoscopic Roux-en-Y gastric bypass, obese subjects exhibited a substantial decrease in EAT accompanied with VAT, BMI, waist circumference, and cardiovascular risk factors (i.e., total cholesterol, TAG and fasting blood sugar) [71]. Although EAT loss was lower and more limited than VAT, obese patients exhibited higher secretion of adiponectin and leptin, and lessen WAT -related pro-inflammatory adipokines [72, 73]. Intriguingly, the underlying mechanisms of weight loss after bariatric interventions could be more dependent on alteration in gut hormone production [74], neural signalling [75], and glucose/lipid metabolism [76], than those mechanisms related with nutrient absorption.…”

The Potential Role of Objective Activity Monitoring in Off-Site Follow-Ups Post-Bariatric Surgery

“…The most effective treatment for individuals living with obesity and associated co-morbidities is bariatric surgery [1]. Results from combined restrictive and mal-absorptive procedures such as roux-en-y gastric bypass (RYGB) demonstrate excellent immediate weight loss with reductions in body fat mass and visceral adipose tissue (VAT) [1,2].…”

“…Results from combined restrictive and mal-absorptive procedures such as roux-en-y gastric bypass (RYGB) demonstrate excellent immediate weight loss with reductions in body fat mass and visceral adipose tissue (VAT) [1,2]. Reductions in fat mass and VAT play an important role in decreasing the risk of cardiovascular disease and type-2-diabetes [1].…”

“…Results from combined restrictive and mal-absorptive procedures such as roux-en-y gastric bypass (RYGB) demonstrate excellent immediate weight loss with reductions in body fat mass and visceral adipose tissue (VAT) [1,2]. Reductions in fat mass and VAT play an important role in decreasing the risk of cardiovascular disease and type-2-diabetes [1]. However, bariatric surgery alone may not mitigate the aforementioned comorbidities associated with obesity over the long-term as varying amounts of weight regain are commonly observed postsurgery [3].…”