Changes in adipose tissue distribution and relation to cardiometabolic risk factors after Roux-en-Y gastric bypass in adolescents

Andrew J Beamish; Olivia H Dengel; Elise F Palzer; Eva Gronowitz; Aaron S Kelly; Donald R Dengel; Kyle D Rudser; Markus Brissman; Torsten Olbers; Jovanna Dahlgren; Carl-Erik Flodmark; Claude Marcus; Justin R Ryder

doi:10.1016/j.soard.2023.04.326

Changes in adipose tissue distribution and relation to cardiometabolic risk factors after Roux-en-Y gastric bypass in adolescents

Surg Obes Relat Dis. 2023 Oct;19(10):1154-1161. doi: 10.1016/j.soard.2023.04.326. Epub 2023 Apr 25.

Authors

Affiliations

¹ Department of Gastrosurgical Research and Education, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Swansea University Medical School, Swansea University, Swansea, United Kingdom; Research Department, Royal College of Surgeons of England, London, United Kingdom.
² College of Veterinary Medicine, University of Minnesota, Minneapolis, Minnesota.
³ School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota.
⁴ Department of Pediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
⁵ Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
⁶ Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; School of Kinesiology, University of Minnesota, Minneapolis, Minnesota.
⁷ School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota; Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
⁸ Department of Clinical Science, Intervention and Technology (CLINTEC), Glasgow, United Kingdom.
⁹ Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
¹⁰ Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden.
¹¹ Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern Feinberg School of Medicine, Chicago, Illinois. Electronic address: jryder@luriechildrens.org.

PMID: 37296018
DOI: 10.1016/j.soard.2023.04.326

Abstract

Background: Roux-en-Y gastric bypass (RYGB) among adolescents with obesity results in significant weight loss; however, depot-specific changes have been understudied.

Objective: We hypothesized that visceral adipose tissue (VAT) reduction in adolescents undergoing RYGB would be greater than other depots and associated with improvement in cardiometabolic risk factors.

Setting: Three specialized treatment centers in Sweden.

Methods: Fifty-nine adolescents underwent dual x-ray absorptiometry before surgery and at 1, 2, and 5 years after RYGB. Changes in body composition in multiple depots (total fat, lean body, gynoid fat, android fat, subcutaneous adipose tissue, and VAT) and cardiometabolic risk factors were assessed using multiple linear regression analysis and generalized estimating equations adjusting for age, sex, and baseline risk factor levels. Data are presented as percent change (95% CI) with regression models showing slopes and estimated P values.

Results: At 1 year post-RYGB, a significant reduction was observed across all body composition measures (P < .001) with the greatest reduction observed in VAT (-65.1% [-68.7, -61.8]). From year 1 to 5 years post-RYGB, a regain was observed in all depots except lean body mass (1.2% [.3, 2.7], P = .105). A sex-specific difference in overall trajectories was only observed in lean body mass with males consistently having higher mean levels. Change in VAT at 1 year correlated with change in triglycerides (slope: .21 mg/dL/kg, P = .034) and fasting plasma insulin (slope: 44 pmol/L/kg, P = .027).

Conclusions: Adiposity measures all decreased after RYGB but poorly predicted change in cardiometabolic risk. Despite significant reductions at 1 year, a steady regain was observed out to 5 years, with values still well below baseline. Further research should consider control group comparison and extended follow-up.

Keywords: Adiposity; Adolescent; Body composition; Gastric bypass; Metabolic and bariatric surgery.

MeSH terms

Adolescent
Body Fat Distribution
Cardiometabolic Risk Factors
Female
Gastric Bypass* / methods
Humans
Male
Obesity / surgery
Tissue Distribution