Persistent lipedema pain in patients after bariatric surgery: a case series of 13 patients

Cornely, Manuel E.; Hettenhausen, Christian; Hasenberg, Till; Cornely, Oliver A.; Ure, Christian; Schmidt, Jeremias

doi:10.1016/j.soard.2021.12.027

Cited by 19 publications

(21 citation statements)

References 18 publications

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“…Lipedema is mostly diagnosed in women and its onset and development are generally recorded in periods of hormonal, weight and shape shifts such as during puberty, pregnancy, childbirth and menopause ( 1 ). The main clinical component concomitant to the increase of SAT mass, but distinguishing lipedema from obesity is the reported pain (“ painful fat ”), which together with the increased tissue fibrosis is speculated to be a consequence of high inflammation in lipedema tissue ( 1 , 10 , 11 ). Moreover, the reduction of AT mass by various weight loss measures is less effective in lipedema patients compared to obesity, which severely affects patients’ quality of life and leads to psychological problems and an increased risk of suicide ( 3 , 4 , 8 , 10 , 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Is subcutaneous adipose tissue expansion in people living with lipedema healthier and reflected by circulating parameters?

Nankam

Cornely²,

Klöting

et al. 2022

Front. Endocrinol.

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Lipedema may be considered a model for healthy expandability of subcutaneous adipose tissue (SAT). This condition is characterized by the disproportional and symmetrical SAT accumulation in the lower-body parts and extremities, avoiding the abdominal area. There are no circulating biomarkers facilitating the diagnosis of lipedema. We tested the hypothesis that women living with lipedema present a distinct pattern of circulating parameters compared to age- and BMI-matched women. In 26 women (Age 48.3 ± 13.9 years, BMI 32.6 ± 5.8 kg/m2; lipedema group: n=13; control group: n=13), we assessed circulating parameters of glucose and lipid metabolism, inflammation, oxidative stress, sex hormones and a proteomics panel. We find that women with lipedema have better glucose metabolism regulation represented by lower HbA1c (5.55 ± 0.62%) compared to controls (6.73 ± 0.85%; p<0.001); and higher adiponectin levels (lipedema: 4.69 ± 1.99 mmol/l; control: 3.28 ± 1.00 mmol/l; p=0.038). Despite normal glycemic parameters, women with lipedema have significantly higher levels of total cholesterol (5.84 ± 0.70 mmol/L vs 4.55 ± 0.77 mmol/L in control; p<0.001), LDL-C (3.38 ± 0.68 mmol/L vs 2.38 ± 0.66 mmol/L in control; p=0.002), as well as higher circulating inflammation (top 6 based on p-values: TNFSF14, CASP8, EN-RAGE, EIF4EBP1, ADA, MCP-1) and oxidative stress markers (malondialdehyde, superoxide dismutase and catalase). Our findings suggest that the expected association between activation of inflammatory and oxidative stress pathways and impaired glucose metabolism are counterbalanced by protective factors in lipedema.

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Section: Introductionmentioning

confidence: 99%

Is subcutaneous adipose tissue expansion in people living with lipedema healthier and reflected by circulating parameters?

Nankam

Cornely²,

Klöting

et al. 2022

Front. Endocrinol.

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“…This adds further to the controversy surrounding lymphoedema and lipoedema by conceptualizing a primary or concurrent underlying lymphatic abnormality causing oedema in lipoedema. This is not always due to the patients' interpretation of internet or informal information but is directly espoused by some surgeons undertaking liposuction and some therapists treating lipoedema as a lymphatic condition 35 …”

Section: Discussionmentioning

confidence: 99%

Differentiation of lipoedema from bilateral lower limb lymphoedema by imaging assessment of indocyanine green lymphography

et al. 2023

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Summary Lipoedema is characterized by disproportionate painful fat accumulation mostly in the lower limbs. The presence of lymphoedema in lipoedema remains controversial. This study aimed to assess the presence or absence of lymphoedema in the lower limbs of women with lipoedema using indocyanine green (ICG) lymphography. A cross‐sectional retrospective study was undertaken in women with a clinical diagnosis of lipoedema whose lower limbs were examined with ICG lymphography. MD Anderson Cancer Center (MDACC) ICG staging was used to determine lymphoedema presence and severity. Patient characteristics, ICG lymphography findings, Stemmer sign, body mass index, waist‐to‐hip ratio, limb volume and bioimpedance spectroscopy measures were recorded. Forty women with lipoedema underwent ICG lymphography for the lower limbs from January 2018 to July 2022. Thirty‐four women (85.0%) were determined by ICG lymphography as MDACC ICG Stage 0 representing normal lymphatics. Of the six women who demonstrated dermal backflow on ICG lymphography, all were determined as ICG Stage 1, four had localized traumatic dermal backflow area at their ankles, one had previously diagnosed with primary lymphoedema and one was classified as lipoedema stage 4. ICG lymphography findings suggested the absence of lymphoedema in a clear majority of women with lower limb lipoedema.

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“…These often unsuccessful interventions may even promote eating disorders, increase risk of depression, and other psychological disorders. The use of DXA in patients with suspected lipedema could allow appropriate early treatment and prevent late complications of the disease while also preventing affected patients from receiving inappropriate and even high-risk treatments such as bariatric surgery techniques [45].…”

Section: Discussionmentioning

confidence: 99%

Body Composition Assessment by Dual-Energy X-Ray Absorptiometry: A Useful Tool for the Diagnosis of Lipedema

et al. 2022

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Introduction: Lipedema is a poorly known condition. Diagnosis is based almost exclusively on clinical criteria, which may be subjective and not always reliable. This study aimed to investigate regional body composition (BC) by dual-energy X-ray absorptiometry (DXA) in patients with lipedema and healthy controls and to determine cut-off values of fat mass (FM) indices to provide an additional tool for the diagnosis and staging of this condition. Methods: This study is a single-center case-control study performed at Lausanne University Hospital, Switzerland. Women with clinically diagnosed lipedema underwent regional BC assessment by DXA. The control group without clinical lipedema was matched for age and body mass index (BMI) at a ratio of 1:2 and underwent similar examination. Regional FM (legs, arms, legs and arms, trunk, android and gynoid FM) was measured in (kg) and divided by FM index (FMI) (kg/m2) and total FM (kg). The trunk/legs and android/gynoid ratios were calculated. For all indices of FM distribution showing a significant difference between cases and controls, we defined the receiver operating characteristic (ROC) curves, calculating the area under the curve (AUC), sensitivity, specificity, and Youden’s index. Types and stages of lipedema were compared in terms of FM indices. Correlation analyses between all FM distribution indices and lipedema stages were performed. Results: We included 222 women (74 with lipedema and 148 controls). Overall, the mean age was 41 years (standard deviation [SD] 11), and mean BMI was 30.9 kg/m2 (SD 7.6). A statistically significant difference was observed for all DXA-derived indices of FM distribution between groups, except for arm FM indices. The ROC curve analysis of leg FM/total FM, as a potential indicator of lipedema, resulted in an AUC of 0.90 (95% confidence interval 0.86–0.94). According to Youden’s index, optimal cut-off value identifying lipedema was 0.384. Sensitivity and specificity were 0.95 and 0.73, respectively. We found no significant differences between lipedema types and stages in terms of FM indices, nor significant correlations between the latter and lipedema stages. Discussion/Conclusion: BC assessment by DXA, and particularly calculation of the leg FM/total FM index, is a simple tool that may help clinicians rule out lipedema in doubtful cases.

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Persistent lipedema pain in patients after bariatric surgery: a case series of 13 patients

Cited by 19 publications

References 18 publications

Is subcutaneous adipose tissue expansion in people living with lipedema healthier and reflected by circulating parameters?

Is subcutaneous adipose tissue expansion in people living with lipedema healthier and reflected by circulating parameters?

Differentiation of lipoedema from bilateral lower limb lymphoedema by imaging assessment of indocyanine green lymphography

Body Composition Assessment by Dual-Energy X-Ray Absorptiometry: A Useful Tool for the Diagnosis of Lipedema

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