Sarcopenic Obesity Is Associated with High Insulin Resistance and New-Onset Diabetes Following Pancreaticoduodenectomy

Background: Sarcopenic obesity, characterized by reduced skeletal muscle mass accompanied by excessive visceral fat accumulation, has recently gained attention as a crucial determinant of metabolic dysfunction. Although pancreaticoduodenectomy (PD) is increasingly performed with improved surgical outcomes, the incidence and risk factors for new-onset diabetes after PD remain incompletely understood. This study investigated the impact of sarcopenic obesity on postoperative glucose metabolism. Methods: A total of 613 patients without preexisting diabetes who underwent PD between 2015 and 2023 were retrospectively analyzed. Diabetes status was evaluated preoperatively and at 3 months postoperatively (Cohort 1), and a subset of 143 patients was reassessed at 1 year (Cohort 2). Sarcopenic obesity was defined as a visceral fat area/skeletal muscle index >2.5 m2. Diabetes was defined according to the American Diabetes Association criteria. Results: At 3 months after surgery, 8.2% (50/613) of patients developed diabetes. Independent predictors included hypertension (odds ratio [OR], 2.45), elevated preoperative hemoglobin A1c (OR, 2.31), and receipt of adjuvant chemotherapy (OR, 3.15). At 1 year, 9.8% (14/143) developed diabetes, with sarcopenic obesity emerging as the sole independent predictor (OR, 3.65; 95% confidence interval, 1.09 to 14.43). Additionally, patients with sarcopenic obesity had significantly higher levels of hemoglobin A1c, Cpeptide, and insulin resistance 1 year after surgery than those without sarcopenic obesity. Conclusion: Sarcopenic obesity was associated with persistent postoperative insulin resistance. These findings suggest that sarcopenic obesity constitutes a key determinant of new-onset diabetes after PD and highlight the need for preoperative assessment and targeted metabolic interventions in this high-risk population.