Rate and Determinants of Excessive Fat-Free Mass Loss After Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
Rate and Determinants of Excessive Fat-Free Mass Loss After Bariatric Surgery Malou A. H. Nuijten 1 Maria T. E. Hopman 1
&
Valerie M. Monpellier 2 & Thijs M. H. Eijsvogels 1 & Ignace M. C. Janssen 2 & Eric J. Hazebroek 3 &
# The Author(s) 2020
Abstract Purpose Fat-free mass (FFM) loss is a concerning aspect of bariatric surgery, but little is known about its time-course and factors related with excessive FFM loss. This study examined (i) the progress of FFM loss up to 3 years post-bariatric surgery and (ii) the prevalence and determinants of excessive FFM loss. Materials and Methods A total of 3596 patients (20% males, 43.5 ± 11.1 years old, BMI = 44.2 ± 5.5 kg/m2) underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. Bioelectrical impedance analysis was performed preoperatively and 3, 6, 9, 12, 18, 24 and 36 months post-surgery. Changes in body composition were assessed by mixed model analysis. Prevalence of excessive FFM loss (based on three different cutoff values: ≥ 25%, ≥ 30% and ≥ 35% FFM loss/weight loss (= %FFML/WL)) was estimated and its determinants were assessed by linear regression analysis. Results Highest rates of FFM loss were found at 3 and 6 months post-surgery, reflecting 57% and 73% of peak FFM loss, respectively. Prevalence of excessive FFM loss ranged from 14 to 46% at 36 months post-surgery, with an older age (β = 0.14, 95%CI = 0.10–0.18, P < .001), being male (β = 3.99, 95%CI = 2.86–5.12, P < .001), higher BMI (β = 0.13, 95%CI = 0.05–0.20, P = .002) and SG (β = 2.56, 95%CI = 1.36–3.76, P < .001) as determinants for a greater %FFML/WL. Conclusion Patients lost most FFM within 3 to 6 months post-surgery. Prevalence of excessive FFM loss was high, emphasizing the need for more vigorous approaches to counteract FFM loss. Furthermore, future studies should assess habitual physical activity and dietary intake shortly after surgery in relation to FFM loss. Keywords Bariatric surgery . Fat-free mass . Body composition
Introduction Bariatric surgery is considered the most effective strategy in patients with morbid obesity to achieve long-lasting weight loss, improve quality of life and reduce comorbidities [1, 2]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04654-6) contains supplementary material, which is available to authorized users. * Maria T. E. Hopman [email protected] 1
Radboud Institute for Health Sciences, Department of Physiology (392), Radboud University Medical Center, P.O. Box 1901, 6500 HB Nijmegen, The Netherlands
2
Nederlandse Obesitas Kliniek, Huis ter Heide, The Netherlands
3
Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
However, bariatric surgery is also associated with nutritional deficiencies and excessive loss of fat-free mass (FFM) [3, 4]. Since FFM consists for 30–50% of muscle mass, it plays an important role in several metabolic mechanisms, such as functional capacity, resting energy expenditure, thermoregulatio
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