Visceral fat loss evaluated by total body magnetic resonance imaging in obese women operated with laparascopic adjustable silicone gastric banding

Abstract

OBJECTIVE: To investigate the changes of visceral fat, as compared with total and subcutaneous adipose tissue (AT) in obese patients operated with laparascopic adjustable silicone gastric banding (LAP-BAND). SUBJECTS: Six premenopausal morbid obese (body mass index range: 41.4 ± 44.2 kgam 2 ) women, aged 38 ± 42 y, operated with LAP-BAND, evaluated before, 8 weeks after, and 24 weeks after surgery. MEASUREMENTS: Fat distribution was analysed by total body multi-slices MRI. Total AT, gluteo-femoral subcutaneous AT, abdominal subcutaneous AT, and abdominal visceral AT volumes were measured. FM was calculated from MRI-determined total AT volume and AT density. RESULTS: A weight loss of 9.9AE AE3.8 kg was observed in the ®rst 8 weeks after LAP-BAND (0 ± 8 weeks), and a further weight loss of 7.1AE AE4.9 kg in the subsequent 16 weeks (8 ± 24 weeks). Total AT showed a statistically signi®cant reduction of 6.2AE AE4.0 l in 0 ± 8 weeks and a further signi®cant reduction of 7.7AE AE3.9 l in 8 ± 24 weeks (P`0.01 from baseline). A similar trend was observed for both abdominal and gluteo-femoral subcutaneous AT. Visceral AT showed a statistically signi®cant reduction of 1.0AE AE0.9 l in the 0 ± 8 weeks (P`0.05) and a further non-signi®cant reduction of 0.6AE AE0.7 l in 8 ± 24 weeks (P`0.05 from baseline). In 0 ± 8 weeks, the relative reduction of visceral AT was higher than the relative reduction of both total AT and gluteo-femoral subcutaneous AT. A highly signi®cant correlation was observed between the reduction of total AT and the reduction of both abdominal and gluteo-femoral subcutaneous AT. By contrast, in 0 ± 8 weeks, the reduction of total AT and the reduction of visceral AT were not correlated. In a subsequent analysis, both observations collected in the ®rst 8 weeks after LAP-BAND and observations collected in the last 16 weeks are simultaneously considered, leading to a total of 12 time periods (two time periods for each individual patient). In order to identify factors associated with preferential visceral fat reduction, we calculated for each of the 12 time periods the difference between the percentage changes of visceral AT and the percentage changes of total AT. The relationship between this difference and several other variables were investigated by simple correlation analysis. The only variables found to be associated were the initial visceral AT volume, the absolute level of weight loss (kg) per week of observation, and the relative level of weight loss (%) per week of observation. CONCLUSION: In the phase of rapid weight loss following LAP-BAND, a preferential mobilization of visceral fat, as compared with total and subcutaneous AT, can occur. However, this preferential visceral fat reduction occurs only in those patients presenting higher levels of visceral fat deposition at baseline and higher levels of weight loss.

Reduction of visceral adipose tissue during weight loss

“…In women, the most consistent predictor of changes in VAT seems to be changes in body weight. This latter observation is in agreement with another recent study that demonstrated that body weight change was the only significant correlate of changes in VAT in a small sample of morbid obese women after laparascopic surgery (Busetto et al, 2000). These results should however be interpreted with caution since some studies have also shown that significant changes in VAT can occur with very small changes in body weight when exercise is part of the intervention (Mourier et al, 1997;Schwartz et al, 1991;Thomas et al, 2000;Thong et al, 2000;Treuth et al, 1995).…”

Quantitative comparison and evaluation of software packages for assessment of abdominal adipose tissue distribution by magnetic resonance imaging

“…TAT was calculated by adding SAT and VAT (TAT ¼ SAT þ VAT); therefore, some small intramuscular deposits of adipose tissue were not accounted for. Similar to other published reports, 5,7,18,22,25,29,[33][34][35][36][37][40][41][42][43][44][45]47,[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] VAT and SAT were not further subdivided.…”

Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review

“…It is clear from these regression analyses, and in studies with multiple time points 59,64,65 that preferential loss of visceral fat is greatest during initial modest weight loss (Figures 1b, 3 and 4). Furthermore, extrapolation of the regression lines in Figures 3 and 4 leads to speculation that measurements of abdominal fat loss made after about 20% weight loss may start to show preferential loss of SAT or retention of VAT.…”

“…The limited data we currently have from surgical weight loss studies are inconsistent and serial measures following long term sustained weight loss are recommended. [62][63][64][65] The metabolic disturbances associated with visceral obesity are reflected in numerous clinical observations. In the 'Portal hypothesis' it is suggested that the proximity of VAT lipolysis, hormone and cytokine production upstream from the liver exacerbates hepatic insulin resistance and increases glucose output.…”