Effect of laparoscopic sleeve gastrectomy on mobilization of site-specific body adipose depots: a prospective cohort study

Abstract

Background: Effect of bariatric surgery on mobilization of site-specific body adipose depots is not well investigated. Herein, the authors conducted a prospective cohort study to assess whether bariatric surgery can differentially affect specific fat storage pools and to further investigate correlations between site-specific fat mobilization and clinical outcomes. Materials and methods: In this single-centre prospective cohort study, 49 participants underwent laparoscopic sleeve gastrectomy (LSG) from 24 May 2022 to 20 October 2022 and underwent MRI to estimate subcutaneous fat area, visceral fat area (VFA), hepatic and pancreatic proton density fat fraction (PDFF) at baseline and 3 months after surgery. The protocol for this study was registered on clinicaltrials.gov. Results: Among 49 patients who met all inclusion criteria, the median [interquartile range (IQR)] age was 31.0 (23.0–37.0) years, the median (IQR) BMI was 38.1 (33.7–42.2) kg/m2 and 36.7% were male. Median (IQR) percentage hepatic PDFF loss was the greatest after bariatric surgery at 68.8% (47.3–79.7%), followed by percentage pancreatic PDFF loss at 51.2% (37.0–62.1%), percentage VFA loss at 36.0% (30.0–42.4%), and percentage subcutaneous fat area loss at 22.7% (17.2–32.4%) (P<0.001). By calculating Pearson correlation coefficient and partial correlation coefficient, the positive correlations were confirmed between change in VFA and change in glycated haemoglobin (r=0.394, P=0.028; partial r=0.428, P=0.042) and between change in hepatic PDFF and change in homoeostatic model assessment of insulin resistance (r=0.385, P=0.025; partial r=0.403, P=0.046). Conclusions: LSG preferentially mobilized hepatic fat, followed by pancreatic fat and visceral adipose tissue, while subcutaneous adipose tissue was mobilized to the least extent. Reduction in visceral adipose tissue and hepatic fat is independently associated with the improvement of glucose metabolism after LSG.