Long‐Term Body Composition Changes in Women Following Roux‐en‐Y Gastric Bypass Surgery

Abstract

BACKGROUND Although most individuals experience successful weight loss following Roux-en-Y gastric bypass (RYGB), weight regain is a concern, the composition of which is not well-documented. Our aim was to evaluate changes in body composition and handgrip strength as a measure of functional status in participants from a previous 1-year post-RYGB longitudinal study who had undergone RYGB approximately 9-years prior. METHODS Five women from an original larger cohort were monitored pre-RYGB and 1.5-months, 6-months, 1-year, and 9-years post-RYGB. Body composition was assessed at all time points using dual energy x-ray absorptiometry (DXA) and multiple dilution. Handgrip strength was measured using a digital isokinetic hand dynamometer (Takei Scientific Instruments, Ltd., Japan). RESULTS Mean time to final follow-up was 8.7-years. Lean soft tissue (LST) loss over the ~9-year period was on average 11.9 ± 5.6 kg. Compared to 1-year post-RYGB, 9-year LST was 4.4 ± 3.0 kg lower (P=0.03). Fat free mass (FFM) decreased over the 9-year period by 12.6 ± 5.8 kg. Mean FM decreased from 75.4 ± 22.6 kg pre-RYGB to 35.5 ± 21.5 kg 1-year post-RYGB, but then trended towards an increase of 8.6 ± 7.0 kg between 1-year and 9-years post-RYGB (P=0.053). Loss of LST was correlated with loss of handgrip strength (r = 0.64, P=0.0005). CONCLUSION The continued loss of lean mass associated with decreased handgrip strength occurring with long-term trend towards FM regain post-RYGB is concerning. The loss of LST and functional strength carries particular implications for the aging bariatric population and should be investigated further.

Rate and Determinants of Excessive Fat-Free Mass Loss After Bariatric Surgery

“…We found that the highest rates of FFM loss were observed at 3 and 6 months post-surgery, and a plateau phase was reached at 18 months post-surgery. Our findings align with previous studies reporting substantial FFM loss at 6 months post-surgery with little change up to 12 months post-surgery [17,18].…”

“…14% of the patients exceeds the 35%FFML/WL threshold at 36 months post-surgery). Although no previous studies assessed prevalence of excessive FFM loss, substantial amounts of FFM loss with large variation between individuals have been reported in other studies [17][18][19]. These findings suggest that FFM loss is not sufficiently tackled by post-bariatric care.…”

The magnitude and progress of lean body mass, fat‐free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta‐analysis

“…The systematic search resulted in 302 eligible articles in PubMed, 507 articles in Embase, and 315 articles in Web of Science. After removal of duplicates and elimination based on the selection criteria, 59 studies were included in risk and bias assessment and quantitative analyses (Figure 2), with 37 studies assessing LBM, 11,16-51 20 studies assessing FFM 22,25,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] , and 3 studies assessing SMM. [71][72][73] The subanalysis on type of surgery was performed on 52 studies.…”

Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies

“…The population of participants had a mean age of 44 years, and no documented differences were observed in weight loss results or comorbidity resolution. Bariatric surgery leads to loss of fat mass 394 , alters gut hormones 395 and can exacerbate weight loss-induced sarcopenia 396–398 and osteoporosis 399–402 . Carefully designed studies are needed before promoting this intervention.…”