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Prospective Longitudinal Trends in Body Composition and Clinical Outcomes 3 Years Following Sleeve Gastrectomy

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Abstract

Background and Aims

Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG).

Methods

A prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery.

Results

Sixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss “failure” (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up.

Conclusions

Weight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.

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Abbreviations

BIA:

Bioelectrical impedance analysis

BMI:

Body mass index

CRP:

C-reactive protein

DEXA:

Dual X-ray absorptiometry

EWL:

Excess weight loss

FFM:

Fat free mass

FM:

Fat mass

HbA1C:

Hemoglobin A1c

HRI:

Hepato-renal index

HDL-C:

High-density lipoprotein cholesterol

HOMA:

Homeostasis model assessment

IBW:

Ideal body weight

IR:

Insulin resistance

LDL-C:

Low-density lipoprotein cholesterol

NAFLD:

Nonalcoholic fatty liver disease

RCT:

Randomized clinical trial

RYGB:

Roux-en-Y gastric bypass

RMR:

Resting metabolic rate

SG:

Sleeve gastrectomy

TC:

Total cholesterol

WC:

Waist circumference

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Funding

This study was supported (in part) by grant no. 3-10470 from the Chief Scientist Office of the Ministry of Health, Israel. The funding source did not have a role in the design, conduct, and analysis of the study or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel

    Shiri Sherf-Dagan, Shira Zelber-Sagi, Nir Bar, Muriel Webb & Oren Shibolet

  2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Shiri Sherf-Dagan, Nir Bar, David Goitein & Oren Shibolet

  3. Department of Nutrition, Assuta Medical Center, 20 Habarzel St., 69710, Tel Aviv, Israel

    Shiri Sherf-Dagan

  4. School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

    Shira Zelber-Sagi

  5. Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel

    Assaf Buch

  6. School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel

    Assaf Buch

  7. Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel

    Nasser Sakran, Asnat Raziel & David Goitein

  8. Department of Surgery A, Emek Medical Center, Afula, Israel

    Nasser Sakran

  9. Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Nasser Sakran

  10. Department of Surgery C, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    David Goitein

  11. Department of General Surgery, Assuta Ashdod Public Hospital, The Ben-Gurion University, Be’er Sheva, Israel

    Andrei Keidar

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  1. Shiri Sherf-Dagan
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Contributions

The authors’ responsibilities were as follows—SSD, OS, SZS, NS, DG, AR, and AD designed the research; SSD, AB, NB, and MW performed the research; SSD and SZS analyzed the data; SSD, SZS, and OS wrote the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

Corresponding author

Correspondence to Shiri Sherf-Dagan.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were approved by the institutional review board and in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The RCT study was pre-registered in the NIH registration website (TRIAL no. NCT01922830).

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Informed consent was obtained from all individual participants included in the study.

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Sherf-Dagan, S., Zelber-Sagi, S., Buch, A. et al. Prospective Longitudinal Trends in Body Composition and Clinical Outcomes 3 Years Following Sleeve Gastrectomy. OBES SURG 29, 3833–3841 (2019). https://doi.org/10.1007/s11695-019-04057-2

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