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

Johansson, Lars; Roos, Magnus; Kullberg, Joel; Weis, Ján; Åhlström, Håkan; Sundbom, Magnus; Engström, Britt Edén; Karlsson, F. Anders

doi:10.1007/s11695-008-9484-0

Cited by 44 publications

(28 citation statements)

References 42 publications

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“…Visceral type of fat is mobilized most rapidly after bariatric surgery, 28 a fact that might explain the rapid normalization in resistance vessel reactivity in this study despite that the subjects were still markedly overweight. It has also been reported by Park and Shim 17 that the improvement in the pulse-wave response after weight loss was proportional to the amount of loss in visceral fat, further emphasizing the important role of visceral adiposity in the determination of vasoreactivity.…”

Section: Discussionmentioning

confidence: 64%

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Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery

et al. 2009

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Background: Obesity is associated with increased risk of cardiovascular disease. We investigated vasoreactivity in conduit and resistance arteries in morbidly obese subjects, and the effect of weight loss after gastric bypass surgery. Methods: A total of 19 obese subjects (body mass index (BMI): 43.8 ± 3.1 kg m À2 , 75% female, mean age 41 years) were investigated before surgery and after 1 and 12 months of surgery. Nineteen non-obese controls matched for age and gender were examined. Vasoreactivity was evaluated by ultrasound to measure flow-mediated dilation (FMD, evaluating a conduit vessel) and pulse-wave analysis with terbutaline provocation (change in reflectance index (RI), evaluating resistance vessels). Results: Before surgery, the obese showed a low change in RI (18 ± 12 vs 37 ± 15% in controls, P ¼ 0.0001), but not significantly regarding FMD (7.9 ± 6.4 vs 8.9 ± 5.4% in controls). Surgery resulted in a weight loss of 9% at 1 month and 30% at 1 year. Change in RI markedly improved to 36 ± 12% at 1 month (P ¼ 0.0001 vs baseline) and further to 44 ± 11% at 1 year (P ¼ 0.014 vs 1 month). FMD did not change significantly. Heart rate and brachial artery diameter were reduced, with no significant change in blood pressure. The improvement in resistance vessel vasodilation, estimated as change in RI, was not correlated to changes in weight or measures of glucose and lipid metabolism. Conclusions: Obese patients showed impaired vasoreactivity in resistance arteries that was normalized already 1 month after gastric bypass surgery. The basis for this remarkable outcome, not significantly related to changes in body weight and metabolic variables, remains to be clarified.

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Section: Discussionmentioning

confidence: 64%

“…Metabolic variables were determined with assays in routine use as described by Johansson et al 28 The homeostasis model assessment (HOMA) index was determined by multiplying fasting plasma glucose (mmol l…”

Section: Blood Analysesmentioning

confidence: 99%

Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery

et al. 2009

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“…Although it is well known that insulin sensitivity improves within days after gastric bypass surgery, this initial improvement is likely related to caloric restriction (8). In fact, there is evidence that FFAs increase immediately after surgery, presumably because of increased lipolysis as reductions in adipose tissue occur (12). Long-term insulin sensitivity improvements are less well understood but appear to be more than expected for the amount of weight lost (3), and preferential loss of fat may be a key factor (7).…”

Section: E748 Insulin Sensitivity After Gastric Bypass Surgerymentioning

confidence: 99%

Gastric bypass surgery is associated with near-normal insulin suppression of lipolysis in nondiabetic individuals

Curry

Roberts²,

Basu

et al. 2011

American Journal of Physiology-Endocrinology and Metabolism

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We hypothesized that individuals who have undergone gastric bypass have greater insulin sensitivity that obese subjects but less compared with lean. We measured free fatty acid (FFA) and glucose kinetics during a two-step, hyperinsulinemic euglycemic clamp in nondiabetic subjects who were 38 Ϯ 5 mo post-gastric bypass surgery (GB; n ϭ 15), in lean subjects (L; n ϭ 15), and in obese subjects (O; n ϭ 16). Fasting FFAa were not significantly different between the three study groups but during both doses of insulin were significantly higher in O than in either GB or L. The effective insulin concentration resulting in half-maximal suppression of FFA was similar in L and GB and significantly less in both groups compared with O. Glucose infusion rates during low-dose insulin were not significantly different in GB compared with either L or O. During high-dose insulin, glucose infusion rates were significantly greater in GB than in O but less than in L. Endogenous glucose production in GB was significantly lower than O only during low dose of insulin. We conclude that gastric bypass is associated with improvements in adipose tissue insulin sensitivity to levels similar to lean, healthy persons and also with improvements in the response of glucose metabolism to insulin. These changes may be due to preferential reduction in visceral fat and decreased FFA availability. However, some differences in insulin sensitivity in GB remain compared with L. Residual insulin resistance may be related to excess total body fat or abnormal lipolysis and requires further study. insulin sensitivity; glucose; body composition; obesity OBESITY IS FREQUENTLY ACCOMPANIED by insulin resistance (5). Elevated circulating free fatty acid (FFA) concentrations, due to increased adipose tissue lipolysis, are thought to mediate insulin resistance in both obesity and type 2 diabetes (4). Weight loss via a hypocaloric diet has been shown to reduce lipolysis in obese individuals (14). However, although gastric bypass surgery has been shown to improve insulin action on glucose metabolism, relatively little is known about the effect of gastric bypass surgery on the insulin sensitivity of adipose tissue.We measured FFA kinetics during a two-step hyperinsulinemic euglycemic clamp in nondiabetic individuals who had undergone gastric bypass surgery and in nondiabetic lean and obese subjects. We hypothesized that gastric bypass subjects have greater insulin sensitivity with respect to lipolysis compared with obese subjects but less than lean subjects. We also hypothesized that gastric bypass subjects would have greater insulin sensitivity with respect to glucose kinetics than obese subjects but less than lean subjects and that there would be a relationship between adipose tissue insulin sensitivity and the sensitivity of glucose metabolism to insulin.Research design and methods. The Mayo Institutional Review Board approved the study, and subjects gave informed consent. The Mayo Clinical Research Unit (CRU) was used for this study. Three groups of nondiabetic sub...

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“…Prospective studies using computerized tomography, magnetic resonance imaging and spectroscopy, and dual energy x-ray absortiometry demonstrate a preferential loss of visceral and central adiposity. [10][11][12] Despite this impressive therapeutic response, most post- surgical patients remain overweight or obese. 15 We believe that this residual excess weight may have contributed to our negative findings.…”

Section: Discussionmentioning

confidence: 99%

“…Following surgery, weight is preferentially lost from visceral and central subcutaneous fat deposits. [10][11][12] Since improved reproductive performance is one of the many health benefits conferred upon women by this surgery, we hypothesized that this weight loss pattern could provide improved acoustic windows for 2 nd trimester obstetric sonographic examinations. 13 In other words, while women with and without gastric bypass may be of similar BMI, the resulting adipose distribution in the gastric bypass group may be more conducive to improved sonographic examination quality.…”

mentioning

confidence: 99%

The impact of Roux‐en‐Y gastric bypass surgery for morbid obesity on second trimester obstetric ultrasound completion rates

Wax

Cartin

Pinette

et al. 2010

J of Clinical Ultrasound

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

Cited by 44 publications

References 42 publications

Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery

Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery

Gastric bypass surgery is associated with near-normal insulin suppression of lipolysis in nondiabetic individuals

The impact of Roux‐en‐Y gastric bypass surgery for morbid obesity on second trimester obstetric ultrasound completion rates

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