Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal.
Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal.
Obes Surg. 2024 May;34(5):1674-1683. doi: 10.1007/s11695-024-07164-x. Epub 2024 Mar 25.
Sarcopenic obesity (SO) is characterised by the confluence of muscle deterioration and high adiposity. When non-surgical interventions prove insufficient, bariatric surgery (BS) becomes the primary approach. This study aimed to address BS effects on SO outcomes 1 year post-surgery among middle-aged women, also considering physical exercise's impact.
Prospective single-centre study of 140 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy between November 2019 and December 2022. Participants were categorised into tertiles according to SO's diagnosis and severity (group 1-patients with the most severe SO; group 2-intermediate; group 3-the least severe or without SO), calculated considering the consensus issued by ESPEN and EASO in 2022. Evaluations of clinical and biochemical parameters were conducted before and 12 months after BS, and the variation was used for comparative purposes. Body composition was assessed using bone density scans. Linear regression analysis accounted for both surgery type and baseline body mass index (BMI).
Before BS, SO prevalence in the overall sample was 89.3%, decreasing to 2.9% after BS. Group 1 had more body fat mass (56.9 vs 54.8 vs 50.7 kg, p < 0.001), total, trunk and leg fat at baseline and a significantly lower total skeletal muscle mass (47.2 vs 49.4 vs 51.8 kg, p < 0.001). One year post-BS, group 1 presented more weight loss (- 39.8 ± 11.4 kg, p = 0.031), BMI reduction (- 15.9 ± 4.6 kg/m, p = 0.005) and lost more fat mass (- 32.6 vs - 30.5 vs - 27.9 kg, p = 0.005), but not total skeletal muscle mass (- 5.8 vs - 5.9 vs - 6.8 kg, p = 0.130). Remission rates for comorbidities were substantial among all groups, but more marked among patients within group 1 (type 2 diabetes mellitus 75%, hypertension 47.1% and dyslipidemia 52.8%). Engagement in physical exercise of any kind has increased post-BS (33.1% vs 79.1%).
Despite concerns about malabsorptive mechanisms potentially worsening muscle loss, patients with the most severe SO undergoing BS lost more fat mass while experiencing the smallest reduction in total skeletal muscle mass. Remission rates for comorbidities following BS were notable among all groups.
肌少症性肥胖（SO）的特点是肌肉恶化和高度肥胖的同时存在。当非手术干预证明无效时，减重手术（BS）成为主要方法。本研究旨在探讨 BS 对中年女性 SO 患者术后 1 年结局的影响，同时考虑到身体运动的影响。
这是一项前瞻性单中心研究，纳入了 2019 年 11 月至 2022 年 12 月期间接受 Roux-en-Y 胃旁路术或袖状胃切除术的 140 名患者。根据 2022 年 ESPEN 和 EASO 发布的共识，根据 SO 的诊断和严重程度（第 1 组为 SO 最严重的患者；第 2 组为中度；第 3 组为最不严重或没有 SO）将患者分为三组。在 BS 前后进行临床和生化参数评估，并使用变化进行比较。使用骨密度扫描评估身体成分。线性回归分析考虑了手术类型和基线体重指数（BMI）。
BS 前，整体样本中 SO 的患病率为 89.3%，BS 后降至 2.9%。第 1 组的体脂质量（56.9 比 54.8 比 50.7kg，p<0.001）、总脂肪、躯干脂肪和腿部脂肪在基线时更高，总骨骼肌质量明显更低（47.2 比 49.4 比 51.8kg，p<0.001）。BS 后 1 年，第 1 组体重减轻（-39.8±11.4kg，p=0.031）、BMI 降低（-15.9±4.6kg/m，p=0.005）和体脂质量减少（-32.6 比-30.5 比-27.9kg，p=0.005）更多，但总骨骼肌质量无明显变化（-5.8 比-5.9 比-6.8kg，p=0.130）。所有组的合并症缓解率都很高，但第 1 组患者的缓解率更高（2 型糖尿病 75%、高血压 47.1%和血脂异常 52.8%）。BS 后患者进行任何类型的身体运动的比例均有所增加（33.1%比 79.1%）。
尽管有关于吸收不良机制可能会加重肌肉损失的担忧，但接受 BS 的 SO 最严重的患者在经历总骨骼肌质量最小减少的情况下，体脂质量减少更多。BS 后所有组的合并症缓解率均显著。
