Key result
Metabolic adaptation present 1 year after laparoscopic sleeve gastrectomy vanished by 5 years post-surgery, with no significant difference between measured and predicted resting energy expenditure (P=0.112).
Why the study?
Resting energy expenditure decreases after weight loss more than expected, but it is unclear whether metabolic adaptation or slowing persists in the long term after laparoscopic sleeve gastrectomy.
Does laparoscopic sleeve gastrectomy induce persistent metabolic adaptation at 5 years in patients with obesity?
Cohort (n=37)
Does laparoscopic sleeve gastrectomy induce persistent metabolic adaptation at 5 years in patients with obesity?
Metabolic slowing observed 1 year after sleeve gastrectomy in patients with prediabetes or type 2 diabetes does not persist at 5 years.
Metabolic adaptation after sleeve gastrectomy appears transient; leaves open durability of energy expenditure changes in obesity.
BACKGROUND: Resting energy expenditure (REE) decreases after weight loss more than expected according to body composition changes. Metabolic adaptation (MA) or metabolic slowing represents the difference between measured (m) and predicted (p) REE, and it is not clear whether it persists in the long-term. The aim of this study is to evaluate MA occurring 1 year (V1) and 5 years (V5) after laparoscopic sleeve gastrectomy (LSG) in patients with obesity and normal glucose tolerance, prediabetes (preDM) and type 2 diabetes (T2DM). METHODS: We reassessed 37 patients (14 males/23 females) of 44.8 ± 10 years old, since they registered all the biochemical, body composition, and REE assessments at baseline (V0), V1, and V5. Physical activity (PA) was assessed by interview and questionnaire. RESULTS: Patients displayed a percentage of weight loss of 31.5 ± 7.4% at V1 and a weight regain of 8.9 ± 7.5% at V5. Comparing V1 and V5, fat mass showed a slight increase (P = 0.011), while free fat mass remained unchanged (P = 0.304). PA improved at V1 (P < 0.001), remaining stable at V5 (P = 0.9). Measured REE (mREE) displayed a 31.2% reduction with a corresponding decrease of predicted REE (pREE) of 21.4% at V1, compared with V0 (P = 0.005), confirming a significant MA at V1. Conversely, no difference between mREE and pREE was observed at V5 (P = 0.112). CONCLUSION: Our results suggested that only patients with preDM and T2DM displayed MA at V1, which vanished 5 years after LSG. Patients who practiced more PA prevent MA after surgery-induced wight loss.
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Bettini et al. (2022) conducted a cohort in Obesity with normal glucose tolerance, prediabetes, or type 2 diabetes (n=37). Laparoscopic sleeve gastrectomy vs. Baseline (pre-surgery) was evaluated on Metabolic adaptation (difference between measured and predicted resting energy expenditure) (p=0.112). Metabolic adaptation present 1 year after laparoscopic sleeve gastrectomy vanished by 5 years post-surgery, with no significant difference between measured and predicted resting energy expenditure (P=0.112).
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