Influence of restrictive surgical treatment on body composition in morbidly obese patients: a pilot study

Czech version

Authors: M. Bužga ¹; P. Holéczy ²; V. Zavadilová ¹; Z. Jirák ¹; V. Šmajstrla ³; R. Végh ¹; Z. Švagera ⁴
Authors‘ workplace: Ústav fyziologie, Lékařská fakulta, Ostravská univerzita v Ostravě, Přednosta: doc. RNDr. Pavol Švorc, CSc. ¹; Katedra chirurgických oborů, Lékařská fakulta, Ostravská univerzita v Ostravě, Přednosta: doc. MUDr. Jan Dostalík, CSc. ²; Osteodenzitometrická laboratoř, NZZ Bormed, Ostrava, Vedoucí lékař: MUDr. Vít Šmajstrla ³; Katedra biomedicínských oborů, Lékařská fakulta, Ostravská univerzita v Ostravě, Přednosta: doc. RNDr. Kristián Šafarčík, Ph. D. ⁴
Published in: Prakt. Lék. 2012; 92(5): 260-263
Category: Of different specialties

Overview

Introduction:
Obesity increases the risk of developing a range of diseases. The treatment of obese patients is very demanding and long-lasting and the weight loss achieved may not be permanent. One of the most efficient means of treatment of obesity and related metabolism diseases is major surgery.

Methodology:
In connection with a prospective pilot study that examined the influence of gastric sleeve resection on the body constitution, we examined 42 morbidly obese women by means of bioelectrical impedance analysis (BIA). All patients were carefully selected according to IFSO-Guidelines (persons with BMI ≥ 40 kg/m² or with BMI ≥ 35 kg/m² with associated comorbidities). The patient selection, surgical procedures (laparoscopic gastric tubulisation) and the 12-month observation period took place from April 2010 to January 2012.

Results:
The average weight in the group was 116,4 ± 17,6 kg, with the average BMI 42.4 ± 4.8 kg/m² and average waist girth 112,0 ± 10,3 cm. 12 months after surgery, the average weight loss was 30.8 kg. The average BMI of the group came down in average from 42.4 kg/m² (3^rd grade obesity) to 31.0 kg/m² (1^st grade obesity). The waist girth was reduced in average by 18.2 cm. During the 12-month period after surgery there was a statistically significant decrease in body weight, body fat and the amount of the body cell mass (BCM) in all of the women in the study. At the same time, the amount of total body water (TBW), intracellular water (ICW) and extracellular water (ECW) changed, yet only the ECW decrease was statistically significant. The waist and hips girth reduction is also marked.

Conclusion:
In the 12-month period following resection significant weight loss occurred, both in the total weight and in the body fat and body water weight. We can conclude that, from the point of view of weight loss and body constitution, our results clearly indicate a very positive effect of the surgical treatment of extreme obesity by means of a laparoscopic gastric tubulisation method.

Key words:
obesity treatment, bariatric surgery, laparoscopic gastric tubulisation, bioelectrical impedance analysis, body constitution

Sources

1. Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA, 1999, 282(16), p. 1530–1538.

2. Andreu A, Moizé V, Rodríguez L, et al. Protein intake, body composition, and protein status following bariatric surgery. Obes Surg, 2010, 20(11), p. 1509–1515.

3. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg, 2010, 20(5), p. 535–540.

4. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA, 2004, 292(14), p. 1724–1737.

5. Buchwald, H. Metabolic surgery: a brief history and perspective. Sur Obes Rel Dis 2010, 6(2), p. 221–222.

6. Carey, DG, Pliego, JG, Raymond, R. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one- year follow-up. Obes Surg, 2006, 16(12), p. 1602–1608.

7. de Aquino LA, Pereira SE, de Souza Silva J, et al. Bariatric surgery: impact on body composition after Roux-en-Y gastric bypass. Obes Surg, 2012, 22(2), p. 195–200.

8. Deurenberg, P. Limitations of the bioelectrical impedance method for the assessment of body fat in severe obesity. Am J Clin Nutr, 1996, 64(3), p. 449S–452S.

9. Fried M, Ribaric G, Buchwald JN, et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m2: an integrative review of early studies. Obes Surg, 2010, 20(6), p. 776–790.

10. Fried, M. Laparoskopické bariatrické operace. Endoskopie, 2009, 18(1), s. 19-21.

11. Hainer, V. a kol. Základy klinické obezitologie. 2 vyd. Praha: Grada, 2011. 422 s. ISBN 978-80-247-3252-7.

12. Jebb, SA, Siervo M, Murgatroyd PR, et al. Validity of the leg-to-leg bioimpedance to estimate changes in body fat during weight loss and regain in overweight women: a comparison with multi-compartment models. Int J Obes (Lond), 2007, 31(5), p. 756–762.

13. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part I: review of principles and methods. Clin Nutr, 2004, 23(5), p. 1226–1243.

14. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part II: utilization in clinical practice. Clin Nutr, 2004, 23(6), p. 1430–1453.

15. Matoulek, M, Svačina, Š, Lajka, J. Výskyt obezity a jejích komplikací v České republice. Vnitř. Lék, 2010, 56(10), s. 1019–1027.

16. Ogden J., Clementi C., Aylwin S., Patel A. Exploring the impact of obesity surgery on patients health status: a quantitative and qualitative study. Obes Surg, 2005, 15(2), p. 266–272.

17. Sjostrom CD, Lissner L, Wedel H, Sjostrom L. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res, 1999, 7(5), p. 477–484.

18. Tucker, ON, Szomstein, S, Rosenthal, RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg, 2008, 12(4), p. 662–667.

19. Větrovská, R, Lančňák, Z, Haluzíková, D. a kol. Srovnání různých metod pro stanovení množství tuku v těle u žen s nadváhou a obezitou. Vnitř. Lék. 2009, 55(5), s. 455–461.

20. WHO. Obesity: Preventing and managing the global epidemic. No. l.: Report on a WHO Consultation, 2000. ISBN-139789241208949.

21. Zavadilová, V, Bužga, M, Jirák, Z. Srovnání metod DXA a BIA u obézních žen indikovaných ke sleeve gastrektomii - pilotní studie. Prakt. Lék. 2011, 91(12), s. 723–726.