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Effect of Sarcopenic Obesity on Weight Loss Outcomes and Quality of Life after Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study

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Abstract

Background

Sarcopenic obesity may affect the health outcome of people with obesity after laparoscopic sleeve gastrectomy (LSG). To assess the impact of sarcopenic obesity (SO) on weight loss outcomes and improvement of quality of life after LSG.

Materials and Methods

This observational study included patients who underwent LSG with SO (99 patients) or without SO (146 patients) from a single center. The primary endpoint was weight loss and disease-specific quality of life in patients with or without SO after the operation. Fat-free mass (FFM) and fat mass (FM) were calculated based on the L3-level images of preoperative CT scans. SO was diagnosed if FM/FFM ≥ 0.80.

Results

Operative time and postoperative hospital stay days were longer in the SO group (p < 0.001). After LSG, weight, BMI, and EBMI were significantly lower in the NSO group than in the SO group (all P < 0.05), while %EWL and the number of patients with %EWL ≥ 100% were significantly lower in the SO group (both p < 0.05). The total BAROS scores of patients in the NSO group were higher than those in the SO group (p < 0.05). Additionally, the MA II questionnaire assessment showed a lower percentage of “very good” and “good” outcomes in the SO group (p < 0.05).

Conclusions

Patients with SO take a slower rate, longer time to reach the ideal weight, and lower quality of life self-ratings than NSO patients after LSG. Thus, preoperative evaluation and tailoring rehabilitation guidance for people with SO should be accounted.

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Data Availability

Lin JX and Huang CM had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.

Abbreviations

LSG :

Laparoscopic sleeve gastrectomy

NSO :

No sarcopenic obesity

SO :

Sarcopenic obesity

FM :

Fat mass

FFM :

Fat-free mass

FM/FFM :

Fat mass to fat-free mass ratio

SMA :

Skeletal muscle area

%EWL :

Percentage of excess weight loss

%TWL :

Percentage of total weight loss

%WL :

Percentage of weight loss

BAROS :

Bariatric analysis and reporting outcome system

RBC :

Red blood cell

Hb :

Hemoglobin

VitB12 :

Vitamin B12

25-VitD :

25-Hydroxyvitamin D

Vit A :

Vitamin A

VitE :

Vitamin E

ALB :

Albumin

TG :

Triglyceride

CHOL :

Cholesterol

HDL-C :

High-density lipoprotein cholesterol

LDL-C :

Low-density lipoprotein cholesterol

BUN :

Blood urea nitrogen

CR :

Creatinine

UA :

Uric acid

ALT :

Alanine aminotransferase

AST :

Aspartate aminotransferase

AST/ALT :

Ratio of aspartate aminotransferase to alanine aminotransferase

VAT :

Visceral adipose tissue

SAT :

Subcutaneous adipose tissue

IMAT :

Intermuscular adipose tissue

SMI :

Skeletal muscle index

VAI :

Visceral adipose index

SAI :

Subcutaneous adipose index

HU :

Hounsfield unit

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Acknowledgements

We would like to acknowledge the bariatric and metabolic patients whose data were used for this study, without whom the work would not be possible. We extend our sincere appreciation to Prof. Feng-Qiong Liu of Fujian Medical University whose invaluable expertise in statistical analysis greatly contributed to the robustness and reliability of the findings presented in this study. Thanks to Dr. Zhi-Hong Huang of the Public Technology Service Center, Fujian Medical University.

Funding

This study was supported by the Financial Support for the Construction of “Dual High Medical Services in Fujian Province” (Min Wei Yi Zheng [2021] no. 76). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Author notes

  1. Zhi-Xin Shang-Guan, Guang-Tan Lin, and Zhi-Yu Liu contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, Fujian Province, China

    Zhi-Xin Shang-Guan, Guang-Tan Lin, Zhi-Yu Liu, Qing Zhong, Qiang Huang, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Hua-Long Zheng, Chao-Hui Zheng, Jian-Xian Lin & Chang-Ming Huang

  2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Guang-Tan Lin, Qing Zhong, Qiang Huang, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Hua-Long Zheng, Chao-Hui Zheng, Jian-Xian Lin & Chang-Ming Huang

  3. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Guang-Tan Lin, Qing Zhong, Qiang Huang, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Hua-Long Zheng, Chao-Hui Zheng, Jian-Xian Lin & Chang-Ming Huang

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  1. Zhi-Xin Shang-Guan
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Contributions

Drs. Shang-Guan ZX, Lin GT, and Liu ZY contributed equally to this work and should be considered co-first authors. Drs Lin JX and Huang CM had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Shang-Guan ZX, Lin GT, Liu ZY, Zheng CH, Huang CM, and Lin JX. Acquisition, analysis, and interpretation of data: Shang-Guan ZX, Lin GT, Liu ZY, Zhong Q, Li P, Xie JW, Lu J, Wang JB, Chen QY, Cao LL, Lin M, Zheng HL, Zheng CH, Huang CM, and Lin JX. Drafting of the manuscript: Shang-Guan ZX, Lin GT, Liu ZY, Huang CM, and Lin JX. Critical revision of the manuscript for important intellectual content: Shang-Guan ZX, Lin GT, Liu ZY, Zhong Q, Li P, Xie JW, Lu J, Wang JB, Chen QY, Cao LL, Lin M, Zheng HL, Zheng CH, Huang CM, and Lin JX. Statistical analysis: Shang-Guan ZX, Lin GT, Liu ZY, Huang CM, and Lin JX. Obtained funding: Shang-Guan ZX, Lin GT, Liu ZY, Huang CM, and Lin JX. Administrative, technical, and material support: Zhong Q, Li P, Xie JW, Lu J, Wang JB, Chen QY, Cao LL, Lin M, Zheng HL, and Zheng CH. Supervision: Zhong Q, Li P, Xie JW, Lu J, Wang JB, and Chen QY.

Corresponding author

Correspondence to Chang-Ming Huang.

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Ethical Approval

This study passed and was approved by the Fujian Medical University Union Hospital institutional review board (IRB number 2023KY068). Due to the retrospective and observational design, the IRB waived the need for informed consent for this study. For this type of study formal consent is not required.

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Participants were informed of the study’s purpose, procedures, potential risks and benefits, and their right to withdraw from the study at any time without penalty. The data collected were kept confidential and used solely for research purposes. For any identifiable human images or other personal information included in this manuscript, the corresponding author has secured written informed consent from the individuals. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Key Points

• SO group exhibited longer operative time and postoperative hospital stay. The NSO group showed significantly lower weight, BMI, and EBMI compared to the SO group.

• SO affects health outcomes after LSG, and assessment of its impact on weight loss and quality of life is crucial.

• People with SO after LSG face slow weight loss, prolonged ideal weight attainment, and reduced quality of life, emphasizing the need for preoperative assessment and personalized rehabilitation.

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Shang-Guan, ZX., Lin, GT., Liu, ZY. et al. Effect of Sarcopenic Obesity on Weight Loss Outcomes and Quality of Life after Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study. OBES SURG 34, 1479–1490 (2024). https://doi.org/10.1007/s11695-024-07146-z

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