Stanley Heshka1,2, Thaisa Lemos1, Nerys M Astbury1,3, Elizabeth Widen4, Lance Davidson5, Bret H Goodpaster6, James P DeLany6, Gladys W Strain7, Alfons Pomp7, Anita P Courcoulas8, Susan Lin9, Isaiah Janumala1, Wen Yu1, Patrick Kang10, John C Thornton11, Dympna Gallagher12,13,14. 1. Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA. 2. Institute of Human Nutrition, Columbia University, New York, NY, USA. 3. Nuffield Department of Primary Care Health Sciences and National Institutes of Health Research Biomedical Research Centre, University of Oxford, Oxford, UK. 4. Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA. 5. Department of Exercise Sciences, Brigham Young University, Provo, UT, USA. 6. Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA. 7. GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY, USA. 8. General Surgery, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 9. Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA. 10. New York Radiology Partners, New York, NY, USA. 11. Thornton Consulting, Mahopac, NY, USA. 12. Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA. dg108@columbia.edu. 13. Institute of Human Nutrition, Columbia University, New York, NY, USA. dg108@columbia.edu. 14. Body Composition Unit, Columbia University Medical Center, 21 Audubon Avenue, New York, NY, 10032, USA. dg108@columbia.edu.
Abstract
INTRODUCTION: Bariatric surgery-induced weight loss may reduce resting energy expenditure (REE) and fat-free mass (FFM) disproportionately thereby predisposing patients to weight regain and sarcopenia. METHODS: We compared REE and body composition of African-American and Caucasian Roux-en-Y gastric bypass (RYGB) patients after surgery with a group of non-operated controls (CON). REE by indirect calorimetry; skeletal muscle (SM), trunk organs, and brain volumes by MRI; and FFM by DXA were measured at post-surgery visits and compared with CON (N = 84) using linear regression models that adjusted for relevant covariates. Ns in RYGB were 50, 42, and 30 for anthropometry and 39, 27, 17 for MRI body composition at years 1, 2, and 5 after surgery, respectively. RESULTS: Regression models adjusted for age, weight, height, ethnicity, and sex showed REE differences (RYGB minus CON; mean ± s.e.): year 1 (43.2 ± 34 kcal/day, p = 0.20); year 2 (- 27.9 ± 37.3 kcal/day, p = 0.46); year 5 (114.6 ± 42.3 kcal/day, p = 0.008). Analysis of FFM components showed that RYGB had greater trunk organ mass (~ 0.4 kg) and less SM (~ 1.34 kg) than CON at each visit. REE models adjusted for FFM, SM, trunk organs, and brain mass showed no between-group differences in REE (- 15.9 ± 54.8 kcal/day, p = 0.8; - 46.9 ± 64.9 kcal/day, p = 0.47; 47.7 ± 83.0 kcal/day, p = 0.57, at years 1, 2, and 5, respectively). CONCLUSIONS: Post bariatric surgery patients maintain a larger mass of high-metabolic rate trunk organs than non-operated controls of similar anthropometrics. Interpreting REE changes after weight loss requires an accurate understanding of fat-free mass composition at both the organ and tissue levels. CLINICAL TRIAL REGISTRATION: Long-term Effects of Bariatric Surgery (LABS-2) NCT00465829.
INTRODUCTION: Bariatric surgery-induced weight loss may reduce resting energy expenditure (REE) and fat-free mass (FFM) disproportionately thereby predisposing patients to weight regain and sarcopenia. METHODS: We compared REE and body composition of African-American and Caucasian Roux-en-Y gastric bypass (RYGB) patients after surgery with a group of non-operated controls (CON). REE by indirect calorimetry; skeletal muscle (SM), trunk organs, and brain volumes by MRI; and FFM by DXA were measured at post-surgery visits and compared with CON (N = 84) using linear regression models that adjusted for relevant covariates. Ns in RYGB were 50, 42, and 30 for anthropometry and 39, 27, 17 for MRI body composition at years 1, 2, and 5 after surgery, respectively. RESULTS: Regression models adjusted for age, weight, height, ethnicity, and sex showed REE differences (RYGB minus CON; mean ± s.e.): year 1 (43.2 ± 34 kcal/day, p = 0.20); year 2 (- 27.9 ± 37.3 kcal/day, p = 0.46); year 5 (114.6 ± 42.3 kcal/day, p = 0.008). Analysis of FFM components showed that RYGB had greater trunk organ mass (~ 0.4 kg) and less SM (~ 1.34 kg) than CON at each visit. REE models adjusted for FFM, SM, trunk organs, and brain mass showed no between-group differences in REE (- 15.9 ± 54.8 kcal/day, p = 0.8; - 46.9 ± 64.9 kcal/day, p = 0.47; 47.7 ± 83.0 kcal/day, p = 0.57, at years 1, 2, and 5, respectively). CONCLUSIONS: Post bariatric surgery patients maintain a larger mass of high-metabolic rate trunk organs than non-operated controls of similar anthropometrics. Interpreting REE changes after weight loss requires an accurate understanding of fat-free mass composition at both the organ and tissue levels. CLINICAL TRIAL REGISTRATION: Long-term Effects of Bariatric Surgery (LABS-2) NCT00465829.
Entities:
Keywords:
Bariatric surgery; Body composition; Brain; Fat-free mass; Organs; Resting energy expenditure; Roux-en-Y gastric bypass; Skeletal muscle
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