Biliopancreatic Diversion and Weight Loss

Body Composition and Energy Expenditure after Weight Loss Following Bariatric Surgery

Giuseppe Benedetti, MD, Geltrude Mingrone, MD, PhD, FACN, Stefania Marcoccia, MD, Maria Benedetti, MD, Annalisa Giancaterini, MD, Aldo Virgilio Greco, VM, Marco Castagneto, MD, FACS, and Giovanni Gasbarrini, MD

Cattedra di Medicina Interna II (G.B., G.M., S.M., M.B., A.G., A.V.G., G.G.) Cattedra di Chirurgia Sostitutiva e dei Trapianti d’Organo (M.C.) CNR Centro di Fisiopatologia dello Shock, Università Cattolica del Sacro Cuore, Rome, Italy

Objective: To assess the effectiveness of biliopancreatic diversion (BPD) in the treatment of morbid obesity, and to evaluate how the procedure affects body weight.

Subjects: Fourteen morbidly obese subjects studied before and 30 months after BPD, and fifteen healthy volunteers, matched for age, sex and height (controls).

Methods: Comparison of following parameters were made in the study groups before surgery and 30 months after BPD and with those of the controls group: fat mass, fat-free mass, non-protein substrate oxidation, basal metabolic rate, plasma glucose, insulin and free fatty acid concentrations.

Results: Obese subjects lost 60.38±10.71 kg of weight during 18 months following surgery and then remained stable for another 12 months, when this study was performed. Weight loss was substantially due to a loss of fat mass (FM: 60.13± 13.01 kg before and 19.02±8.61 kg after BPD; p<0.001). FM were not statistically different between post-obese subjects and controls; however, post-obese patients retained significantly more fat free mass (FFM) than controls. Subsequently, basal metabolic rates of post-obese subjects were higher than those of the control group (p<0.05). Fasting non-protein respiratory quotient (npRQ) was significantly lower before BPD than 30 months after the surgery (0.798±0.04 vs. 0.90± 0.048, p<0.001), suggesting that, while obese, patients oxidized more lipids than carbohydrates. Moreover, fasting and two-hour plasma glucose and insulin concentrations decreased significantly after BPD, to values comparable to those of the control group.

Conclusion: Weight loss in obese patients after BPD is mainly due to lipid malabsorbtion, but increased energy expenditure associated with retaining a high FFM in physically active post-obese subjects, may also play a role, enabling them to maintain long-term reduced body weights.

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