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Original Research |
Cattedra di Medicina Interna II (G.B., G.M., S.M., M.B., A.G., A.V.G., G.G.), CNR Centro di Fisiopatologia dello Shock, Università Cattolica del Sacro Cuore, Rome, ITALY
e Cattedra di Chirurgia Sostitutiva e dei Trapianti d’Organo (M.C.), CNR Centro di Fisiopatologia dello Shock, Università Cattolica del Sacro Cuore, Rome, ITALY
Address reprint requests to: Giuseppe Benedetti, MD, Università Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Istituto di Medicina Interna & Geriatria, Largo Gemelli 8, 00168 Roma - ITALY
Objectives: 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 the 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 malabsorption, 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.
Key words: weight loss, obesity, metabolism, energy expenditure, bariatric surgery
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