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Visceral fat area

Improvements in pulmonary function in RYGB patients

The improvements in pulmonary function 6 months after LRYGB were independently associated with the extent of weight loss and, in particular, baseline of VFA

Baseline of visceral fat area (VFA) and weight loss (WL) correlate with improved pulmonary function after roux-en-y gastric bypass (RYGB) in Chinese obese patients with BMI 28–35 and type 2 diabetes, according to a study published online in BMC Endocrine Disorders. In the study, ‘Baseline of visceral fat area and decreased body weight correlate with improved pulmonary function after Roux-en-Y Gastric Bypass in Chinese obese patients with BMI 28–35 kg/m2 and Type 2 diabetes: a 6-month follow-up’, the researchers from Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China found that VFA and weight loss decreased after bariatric surgery and were correlated to improved respiratory performance, as evidenced by the increases in lung volumes (FEV1, FEV1 [%pred], FVC, and FVC [%pred]). The improvements in pulmonary function 6 months after LRYGB were independently associated with the extent of weight loss and, in particular, baseline of VFA.

“We propose that patients who have more visceral fat may obtain greater benefit from RYGB surgery than those with less visceral fat,” they write. “However, further studies with higher sample size and long-term follow-up are needed to more conclusively establish the link between VFA and pulmonary functional improvement.

The study was designed to examine changes in body fat distribution and metabolic parameters after RYGB and whether these changes correlated with improved lung function. The researchers conducted a retrospective review of 32 ethnic Chinese with obesity with BMI28–35  and type 2 diabetes (T2DM), focusing on metabolic outcomes and pulmonary function 6 months after RYGB.

Outcomes

The results revealed that forced expiratory volume during first second (FEV1), percentage of forced expiratory volume during first second (FEV1 [%pred]), forced vital capacity (FVC), and percentage of forced vital capacity (FVC [%pred]) all improved significantly after RYGB. These increases all were negatively correlated with decreases in body weight and VFA. The improvements of FEV1, FEV1 [%pred] and FVC were also negatively correlated with baseline of body weight and VFA. Furthermore, increases in FEV1 and FVC were independently associated with baseline of VFA (β=−0.003, p=0.000; β=−0.004, p=0.002, respectively).

Figure 1: FEV1, FEV1 (%pred), FVC, and FVC (%pred) increased significantly after surgery. Although the FEV1/FVC ratio did not change significantly, a tendency toward an increase was evident (p<0.1)

Increases in FEV1, FEV1(%pred), FVC and FVC(%pred) were negatively correlated with baseline and decreases in weight and VFA. Although increase in FVC(%pred) were not significantly correlated with baseline in weight and VFA, a possible correlation was evident (p<0.1). Furthermore, significant negative correlations were evident between increases in FEV1(%pred), FVC and FVC(%pred) and decreases in BMI, and between increases in FVC(%pred) and baseline of BMI. Increase in FEV1 was positively correlated with increase in HDL-c level. Significantly negative correlations were evident between increase in FEV1 (%pred) and decrease in TG level. Changes in pulmonary function were not significantly correlated with baseline of lipid metabolism.

“To the best of our knowledge, this is the first study to address the relationship between VFA and pulmonary function in obese T2DM Chinese patients…Because respiratory failure(blood gas analysis suggests type I or type II respiratory failure) was a contraindication for surgery, we enrolled patients with mild or moderate abnormal lung function, without apparent symptoms of dyspnoea,” they write. “We believed that studying a population with a higher BMI may suggest more benefit, especially if they were symptomatic. Considering the risks of anaesthesia, we cannot yet enrol patients with apparent breathing difficulties.”

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