减肥手术对局部肥胖的早期影响。

The early effects of weight loss surgery on regional adiposity.

作者信息

Phillips Madeleine L, Lewis Mark C, Chew Veronica, Kow Lilian, Slavotinek John P, Daniels Lynne, Valentine Robin, Toouli Jim, Thompson Campbell H

机构信息

Department of Medicine, Flinders Medical Centre, Flinders University of South Australia, Bedford Park, South Australia.

出版信息

Obes Surg. 2005 Nov-Dec;15(10):1449-55. doi: 10.1381/096089205774859353.

DOI:10.1381/096089205774859353

PMID:16354526

Abstract

BACKGROUND

Weight loss beyond 6 months following laparoscopic adjustable gastric banding (LAGB) is associated with a preferential mobilization of visceral adipose tissue and an improvement in insulin sensitivity in insulin resistant subjects. Because the rate of weight loss is greatest in the first 3 months after LAGB, we investigated the impact of LAGB on changes in regional lipid deposition and insulin sensitivity over this period.

METHODS

10 female obese non-diabetic subjects underwent magnetic resonance (MR) imaging and spectroscopy before and 12 weeks after LAGB (using the Swedish band), for the quantification of abdominal subcutaneous and visceral adipose tissue areas and intrahepatic lipid. Fasting blood free fatty acids were analyzed. Insulin sensitivity was monitored by fasting insulin and homeostasis model assessment (HOMA).

RESULTS

Median weight loss 12 weeks after gastric banding was 9.5 kg [interquartile range (IQR): -16.5 to -6]. There were significant reductions in median abdominal subcutaneous (-20% [IQR: -24 to -13]) and visceral (-15% [IQR: -49 to -8]) adipose tissue depots as well as plasma free fatty acids (-34% [IQR: -79 to -8]). The amount of weight lost was directly proportional to the initial BMI (r=0.778; P=0.008). Visceral fat loss was proportional to initial visceral adiposity (r=0.80, P=0.01). There was no significant improvement in insulin sensitivity.

CONCLUSION

Significant fat loss occurs 3 months after LAGB. The absence of a concurrent improvement in insulin sensitivity may reflect the relatively small reduction in visceral adipose tissue at this stage. Improvement in insulin sensitivity beyond 3 months after LAGB may be due to the continued loss of visceral adipose tissue.

摘要

背景

腹腔镜可调节胃束带术（LAGB）后6个月以上的体重减轻与内脏脂肪组织的优先动员以及胰岛素抵抗受试者胰岛素敏感性的改善有关。由于LAGB后前3个月体重减轻速率最快，我们研究了LAGB在此期间对局部脂质沉积变化和胰岛素敏感性的影响。

方法

10名肥胖非糖尿病女性受试者在接受LAGB（使用瑞典胃束带）前及术后12周接受磁共振（MR）成像和波谱分析，以定量腹部皮下和内脏脂肪组织面积以及肝内脂质。分析空腹血游离脂肪酸。通过空腹胰岛素和稳态模型评估（HOMA）监测胰岛素敏感性。

结果

胃束带术后12周体重减轻中位数为9.5kg[四分位间距（IQR）：-16.5至-6]。腹部皮下脂肪组织中位数（-20%[IQR：-24至-13]）和内脏脂肪组织中位数（-15%[IQR：-49至-8]）以及血浆游离脂肪酸（-34%[IQR：-79至-8]）均显著减少。体重减轻量与初始体重指数直接相关（r=0.778；P=0.008）。内脏脂肪减少与初始内脏脂肪量成比例（r=0.80，P=0.01）。胰岛素敏感性无显著改善。