D P Andersson1, H Wahrenberg1, E Toft2, V Qvisth2, P Löfgren1, K Hertel1, B-M Leijonhufvud1, A Thorell3, E Näslund4, P Arner1. 1. Department of Medicine, Karolinska Institutet, Karolinska University Hospital Clinic for Endocrinology and Metabolism, Stockholm, Sweden. 2. Department of Medicine, Ersta Hospital, Stockholm, Sweden. 3. Department of Surgery, Ersta Hospital, Stockholm, Sweden. 4. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Abstract
OBJECTIVE: To validate the use of waist circumference to assess reversal of insulin resistance after weight loss induced by bariatric surgery. DESIGN: In cross-sectional studies, threshold values for insulin resistance were determined with homeostasis model assessment of insulin resistance (HOMA-IR) (algorithm based on fasting plasma glucose and insulin) in 1018 lean subjects and by hyperinsulinemic euglycemic clamp (clamp) in 26 lean women. In a cohort study on 211 patients scheduled for bariatric surgery, HOMA-IR and waist circumference were measured before and 1.5-3 years after weight reduction. In a subgroup of 53 women, insulin sensitivity was also measured using clamp. RESULTS: The threshold for insulin resistance (90th percentile) was 2.21 (mg dl(-1) fasting glucose × mU l(-1) fasting insulin divided by 405) for HOMA-IR and 6.118 (mg glucose per kg body weight per minute) for clamp. Two methods to assess reversal of insulin resistance by measuring waist circumference were used. A single cutoff value to <100 cm for waist circumference was associated with reversal of insulin resistance with an odds ratio (OR) of 49; 95% confidence interval (CI)=7-373 and P=0.0002. Also, a diagram based on initial and weight loss-induced changes in waist circumference in patients turning insulin sensitive predicted reversal of insulin resistance following bariatric surgery with a very high OR (32; 95% CI=4-245; P=0.0008). Results with the clamp cohort were similar as with HOMA-IR analyses. CONCLUSIONS: Reversal of insulin resistance could either be assessed by a diagram based on initial waist circumference and reduction of waist circumference, or by using 100 cm as a single cutoff for waist circumference after weight reduction induced by bariatric surgery.
OBJECTIVE: To validate the use of waist circumference to assess reversal of insulin resistance after weight loss induced by bariatric surgery. DESIGN: In cross-sectional studies, threshold values for insulin resistance were determined with homeostasis model assessment of insulin resistance (HOMA-IR) (algorithm based on fasting plasma glucose and insulin) in 1018 lean subjects and by hyperinsulinemic euglycemic clamp (clamp) in 26 lean women. In a cohort study on 211 patients scheduled for bariatric surgery, HOMA-IR and waist circumference were measured before and 1.5-3 years after weight reduction. In a subgroup of 53 women, insulin sensitivity was also measured using clamp. RESULTS: The threshold for insulin resistance (90th percentile) was 2.21 (mg dl(-1) fasting glucose × mU l(-1) fasting insulin divided by 405) for HOMA-IR and 6.118 (mg glucose per kg body weight per minute) for clamp. Two methods to assess reversal of insulin resistance by measuring waist circumference were used. A single cutoff value to <100 cm for waist circumference was associated with reversal of insulin resistance with an odds ratio (OR) of 49; 95% confidence interval (CI)=7-373 and P=0.0002. Also, a diagram based on initial and weight loss-induced changes in waist circumference in patients turning insulin sensitive predicted reversal of insulin resistance following bariatric surgery with a very high OR (32; 95% CI=4-245; P=0.0008). Results with the clamp cohort were similar as with HOMA-IR analyses. CONCLUSIONS: Reversal of insulin resistance could either be assessed by a diagram based on initial waist circumference and reduction of waist circumference, or by using 100 cm as a single cutoff for waist circumference after weight reduction induced by bariatric surgery.
Authors: Boyd A Swinburn; Gary Sacks; Kevin D Hall; Klim McPherson; Diane T Finegood; Marjory L Moodie; Steven L Gortmaker Journal: Lancet Date: 2011-08-27 Impact factor: 79.321
Authors: S G Wannamethee; O Papacosta; P H Whincup; C Carson; M C Thomas; D A Lawlor; S Ebrahim; N Sattar Journal: Diabetologia Date: 2010-02-10 Impact factor: 10.122
Authors: Beverley Balkau; John E Deanfield; Jean-Pierre Després; Jean-Pierre Bassand; Keith A A Fox; Sidney C Smith; Philip Barter; Chee-Eng Tan; Luc Van Gaal; Hans-Ulrich Wittchen; Christine Massien; Steven M Haffner Journal: Circulation Date: 2007-10-23 Impact factor: 29.690
Authors: Hong Jiao; Peter Arner; Johan Hoffstedt; David Brodin; Beatrice Dubern; Sébastien Czernichow; Ferdinand van't Hooft; Tomas Axelsson; Oluf Pedersen; Torben Hansen; Thorkild I A Sørensen; Johannes Hebebrand; Juha Kere; Karin Dahlman-Wright; Anders Hamsten; Karine Clement; Ingrid Dahlman Journal: BMC Med Genomics Date: 2011-06-28 Impact factor: 3.063
Authors: D Eriksson-Hogling; D P Andersson; J Bäckdahl; J Hoffstedt; S Rössner; A Thorell; E Arner; P Arner; M Rydén Journal: Int J Obes (Lond) Date: 2015-02-10 Impact factor: 5.095
Authors: J Samavat; E Facchiano; G Cantini; A Di Franco; G Alpigiano; G Poli; G Seghieri; M Lucchese; G Forti; M Luconi Journal: Int J Obes (Lond) Date: 2013-12-05 Impact factor: 5.095
Authors: Larissa Monteiro Costa Pereira; Felipe J Aidar; Dihogo Gama de Matos; Jader Pereira de Farias Neto; Raphael Fabrício de Souza; Antônio Carlos Sobral Sousa; Rebeca Rocha de Almeida; Marco Antonio Prado Nunes; Albená Nunes-Silva; Walderi Monteiro da Silva Júnior Journal: Int J Environ Res Public Health Date: 2019-06-04 Impact factor: 3.390
Authors: Juhua Luo; Michael Hendryx; JoAnn E Manson; Jane C Figueiredo; Erin S LeBlanc; Wendy Barrington; Thomas E Rohan; Barbara V Howard; Kerryn Reding; Gloria Yf Ho; David O Garcia; Rowan T Chlebowski Journal: JNCI Cancer Spectr Date: 2019-08-09
Authors: Ruth I Versteeg; Karin E Koopman; Jan Booij; Mariëtte T Ackermans; Unga A Unmehopa; Eric Fliers; Susanne E la Fleur; Mireille J Serlie Journal: Neuroendocrinology Date: 2016-09-14 Impact factor: 4.914
Authors: Rebeca Rocha de Almeida; Márcia Ferreira Cândido de Souza; Dihogo Gama de Matos; Larissa Monteiro Costa Pereira; Victor Batista Oliveira; Joselina Luzia Menezes Oliveira; José Augusto Soares Barreto-Filho; Marcos Antonio Almeida-Santos; Raphael Fabrício de Souza; Aristela de Freitas Zanona; Victor Machado Reis; Felipe J Aidar; Antônio Carlos Sobral Sousa Journal: Int J Environ Res Public Health Date: 2019-11-27 Impact factor: 3.390