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Preserved Fat-Free Mass after Gastric Bypass and Duodenal Switch
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. (Clinical Nutrition and Metabolism)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. (Clinical Nutrition and Metabolism)ORCID iD: 0000-0002-8620-4586
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2017 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 7, p. 1735-1740Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Concerns for the possibility of an excessive loss of fat-free mass (FFM) and resting metabolic rate (RMR) after bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) and duodenal switch (BPD/DS), have been raised.

OBJECTIVES: This study aims to examine body composition and RMR in patients after RYGB and BPD/DS and in non-operated controls.

METHODS: Body composition and RMR were studied with Bod Pod and indirect calorimetry in weight-stable RYGB (n = 15) and BPD/DS patients (n = 12) and compared with non-operated controls (n = 17). All patients were 30-55 years old and weight stable with BMI 28-35 kg/m(2).

RESULTS: FFM% was 58% (RYGB), 61% (BPD/DS), and 58% (controls). Body composition did not differ after RYGB and BPD/DS compared to controls, despite 27 and 40% total body weight loss, respectively. No difference in RMR or RMR/FFM was observed (1539, 1617, and 1490 kcal/24 h; and 28.9, 28.4, and 28.8 kcal/24 h/kg).

CONCLUSION: Weight-stable patients with BMI 28-35 kg/m(2) after RYGB and BPD/DS have a body composition and RMR similar to that of non-operated individuals within the same BMI interval.

Place, publisher, year, edition, pages
2017. Vol. 27, no 7, p. 1735-1740
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-310894DOI: 10.1007/s11695-016-2476-6ISI: 000404529600016PubMedID: 27885535OAI: oai:DiVA.org:uu-310894DiVA, id: diva2:1058111
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2019-02-25Bibliographically approved
In thesis
1. Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch
Open this publication in new window or tab >>Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is associated with increased morbidity and mortality. A BMI >40 kg/mshortens life expectancy by about 10 years. The obesity related comorbidities diabetes, hypertension, dyslipidemia and sleep apnea contributes to the increased risk of cardiovascular events. There is also an increased risk of some forms of cancer (e.g. colon, breast, and prostate cancer) as well as mental illness (depression and low self-esteem). Bariatric surgery is indicated for those with a BMI >35 kg/m2. Unfortunately, there are an increasing number of patients seeking bariatric surgery who are super obese (BMI >50 kg/m2), a condition more difficult to treat because of insufficient weight loss with standard operations, like the Roux-en-Y Gastric Bypass (RYGB). Therefore some surgeons advocate the Duodenal Switch (DS) in super obese patients, because DS results in greater and more sustained weight loss. However, DS is a technically more challenging operation and is associated with an increased risk of malnutrition and surgical complications. There are also concerns about an excessive loss of fat-free mass during weight loss after RYGB and especially after DS.

This thesis focuses on weight-loss, effect on comorbidities, quality of life and complications after DS and RYGB, respectively, with comparisons between the two procedures in patients with super obesity. 

DS resulted in a superior weight loss compared to RYGB (paper I, II and III) and body composition after weight loss did not differ compared with non-operated controls with the same BMI after surgery, for neither DS nor RYGB (paper I). Both DS and RYGB resulted in an improved metabolic control (paper II and III), but the effect on diabetes and hypertension was greater and maintained in the long-term after DS (paper III). Both DS and RYGB resulted in an improved physical quality of life, with greater improvements after DS (paper III). However, complications and long-term adverse effects were more common after DS (paper II and IV).

In conclusion, the superior weight loss and greater improvements in several obesity-related comorbidities after DS must be weighed against the increased risk of complications and long-term adverse effects compared to RYGB. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 76
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1550
Keywords
Body composition, fat-free mass, resting metabolic rate, bariatric surgery, obesity, Roux-en-Y Gastric Bypass, Duodenal Switch, air-displacement plethysmography, Bod Pod, indirect calorimetry assessment, BAROS, quality of life, weight loss, diabetes, hypertension, dyslipidmia, depression, pain, antidepressants, opioids, complications, healthcare consumption, adverse events
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-377036 (URN)978-91-513-0593-6 (ISBN)
Public defence
2019-05-17, Grönwallsalen, Ingång 70, BV, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
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Supervisors
Available from: 2019-04-18 Created: 2019-02-25 Last updated: 2019-06-18

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Skogar, MartinHolmbäck, UlfHedberg, JakobRisérus, UlfSundbom, Magnus

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