Improvement of Pancreatic Steatosis and Indices of Insulin Resistance After Metabolic Surgery

Ahmed Abdallah Salman; Mohamed Abdalla Salman; Mostafa Said; Mohammad El Sherbiny; Hesham Elkassar; Mohamed Badr Hassan; Ahmed Marwan; Mohamed Abdelkader Morad; Omar Ashoush; Safa Labib; Mohamed H Aon; Abeer Awad; Mohamed Sayed; Ahmed E Taha; Ahmed Moustafa; Hossam El-Din Shaaban; Amir Khater; Ahmed Elewa; Adel M Khalaf; Ahmed A Mostafa; Mohamed Matter; Ahmed Youssef

doi:10.3389/fmed.2022.894465

Improvement of Pancreatic Steatosis and Indices of Insulin Resistance After Metabolic Surgery

Front Med (Lausanne). 2022 Jun 6:9:894465. doi: 10.3389/fmed.2022.894465. eCollection 2022.

Authors

Ahmed Abdallah Salman¹, Mohamed Abdalla Salman², Mostafa Said¹, Mohammad El Sherbiny¹, Hesham Elkassar¹, Mohamed Badr Hassan¹, Ahmed Marwan³, Mohamed Abdelkader Morad¹, Omar Ashoush¹, Safa Labib¹, Mohamed H Aon¹, Abeer Awad¹, Mohamed Sayed¹, Ahmed E Taha⁴, Ahmed Moustafa⁴, Hossam El-Din Shaaban⁵, Amir Khater⁵, Ahmed Elewa⁶, Adel M Khalaf⁷, Ahmed A Mostafa⁷, Mohamed Matter⁸, Ahmed Youssef¹

Affiliations

¹ Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
² General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
³ Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
⁴ Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁵ Tropical and Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
⁶ General Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
⁷ Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
⁸ Radiodiagnosis Department, Faculty of Medicine, Alazhar University, Cairo, Egypt.

Abstract

Purpose: Obesity is associated with fat accumulation in ectopic sites such as the pancreas, the so-called pancreatic steatosis (PS). Bariatric surgery has been shown to be associated with reducing pancreatic fat. This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) on pancreatic volume and its fat content and glucose homeostasis.

Methods: The study enrolled 54 patients subjected to LSG. Metabolic variables and pancreatic exocrine function were assessed immediately before surgery and 12 months after. MRI of the abdomen was performed to measure pancreatic fat content and its total volume and visceral adipose tissue (VAT).

Results: Surgery resulted in a significant reduction in body weight and BMI. HbA1c, fasting insulin, C-peptide levels, HOMA-IR, and Hs-CRP levels decreased significantly. Surgery resulted in significant improvement in lipid profile except for HDL-cholesterol and liver function tests. Total VAT volume decreased significantly. Total pancreas volume decreased by a mean of 9.0 cm³ (95% CI: 6.6-11.3). The median change of pancreatic fat was -26.1% (range: -55.6 to 58.3%). Pancreatic lipase decreased significantly (P < 0.001). There was a positive correlation between the percentage of total weight loss and decrease in pancreatic fat volume (r = 0.295, P = 0.030).

Conclusion: Weight loss after LSG is associated with a reduction of total VAT volume, total pancreatic volume, and pancreatic fat content. These changes are associated with improved glucose homeostasis, reduced systemic inflammation, and decreased pancreatic lipase secretion.

Keywords: insulin; metabolic surgery; pancreas; resistance; steatosis.