Obesity Surgery

, Volume 19, Issue 12, pp 1664–1671 | Cite as

Noninvasive Evaluation of Abdominal Fat and Liver Changes Following Progressive Weight Loss in Severely Obese Patients Treated with Laparoscopic Gastric Bypass

  • Federica del GenioEmail author
  • Gianmattia del Genio
  • Ilario De Sio
  • Maurizio Marra
  • Lucia Alfonsi
  • Carmine Finelli
  • Franco Contaldo
  • Fabrizio Pasanisi
Research Clinical



Obesity is a chronic complex disease, consequence of an unbalance between energy intake and expenditure and of the interaction between predisposing genotype and facilitating environmental factors. The aim of the study was to evaluate body composition, abdominal fat, and metabolic changes in a group of severely obese patients before and after laparoscopic gastric bypass (LGBP) at standardized (10% and 25%) total weight loss.


Twenty-eight patients (14 M, 14 F; age 41.71 ± 6.9 years; body mass index (BMI) 49.76 ± 5.8 kg/m2) were treated with laparoscopic gastric bypass. All evaluations before surgery and after achieving ~10% and ~25% weight loss (WL). Body composition was assessed by bioimpedance analysis; resting metabolic rate (RMR) was measured by indirect calorimetry.


Body weight, BMI, and waist circumference significantly decreased at 10% and 25% WL. We observed a significant reduction of both RMR (2,492 ± 388 at entry vs. 2,098 ± 346.6 at 10% WL vs. 2,035 ± 312 kcal per 24 h at 25% WL, p = 0.001 vs. baseline) as well as of RMR corrected for fat-free mass (FFM; 35.7 ± 6.7 vs. 34.9 ± 9.0 at 10% WL vs. 33.5 ± 5.4 at 25% WL kilocalorie per kilogram FFM × 24 h, p = 0.041 vs. baseline). Body composition analysis showed a relative increase in FFM and a reduction of fat mass at 25% WL. A significant reduction in blood glucose, insulin, homeostasis model assessment index was observed. Ultrasonography showed a marked decrease in the signs of hepatic steatosis.


In conclusion, our study confirms that LGBP is a safe procedure in well-selected severely obese patients and has early favorable effects on both metabolic parameters and body composition. Longer-term observations are required for in-depth evaluation of body composition changes.


Severe obesity Laparoscopic gastric bypass Ultrasound Abdominal fat Weight loss 


  1. 1.
    Renehan AG, Tyson M, Egger M, et al. Body mass index and incidence of cancer: a systematic review and metabolic prospective observational studies. Lancet. 2008;371:569–78.CrossRefGoogle Scholar
  2. 2.
    Hsu IR, Kim SP, Kabir M, et al. Metabolic syndrome, hyperinsulinemia, and cancer. Am J Clin Nutr. 2007;86:867–71.CrossRefGoogle Scholar
  3. 3.
    Olshansky SY, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352(11):1138–45.CrossRefGoogle Scholar
  4. 4.
    Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56:2655–67.CrossRefGoogle Scholar
  5. 5.
    Contaldo F, Pasanisi F, Finelli C, et al. Obesity, heart failure and sudden death. Nutr Metab Cardiovasc Dis. 2002;12(4):190–7.PubMedGoogle Scholar
  6. 6.
    Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37:917–23.CrossRefGoogle Scholar
  7. 7.
    Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–40.CrossRefGoogle Scholar
  8. 8.
    Colicchio P, Tarantino G, del Genio F, et al. Nonalcoholic fatty liver disease in young adult severely obese non-diabetic patients in South Italy. Ann Nutr Metab. 2005;49:289–95.CrossRefGoogle Scholar
  9. 9.
    Stampfer MJ, Maclure KM, Colditz GA, et al. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr. 1992;55:652–8.CrossRefGoogle Scholar
  10. 10.
    NIH. Third report of the National Cholesterol Education Program Expert Panel (Adult Treatment Panel III). Bethesda: NIH Publication; 2001. p. 01-3670.Google Scholar
  11. 11.
    Bedogni G, Bellentani S, Miglioli L, et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006;6:33.CrossRefGoogle Scholar
  12. 12.
    del Genio F, Alfonsi L, Marra M, et al. Metabolic and nutritional status changes after 10% weight loss in severely obese patients treated with laparoscopic surgery vs integrated medical treatment. Obes Surg. 2007;17(12):1592–8.CrossRefGoogle Scholar
  13. 13.
    Saverymuttu SH, Joseph AEA, Maxwell JA. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J. 1986;292:13–5.CrossRefGoogle Scholar
  14. 14.
    Ricci C, Longo R, Gioulis E, et al. Noninvasive in vivo quantitative assessment of fat content in human liver. J Hepatol. 1997;27:108–13.CrossRefGoogle Scholar
  15. 15.
    Osawa H, Mori Y. Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical amplitude. J Clin Ultrasound. 1996;24:25–9.CrossRefGoogle Scholar
  16. 16.
    Ribeiro-Filho FF, Faria AN, Azjen S, et al. Methods of estimation of visceral fat: advantages of ultrasonography. Obes Res. 2003;11:1488–94.CrossRefGoogle Scholar
  17. 17.
    Cignarelli M, DePergola G, Picca G, et al. Relationship of obesity and body fat distribution with ceruloplasmin serum levels. Int J Obes Relat Metab Disord. 1996;20:809–13.PubMedGoogle Scholar
  18. 18.
    Targher G, Tonoli M, Agostino G, et al. Ultrasonographic intra-abdominal depth and its relation to haemostatic factors in healthy males. Int J Obes Relat Metab Disord. 1996;20:882–5.PubMedGoogle Scholar
  19. 19.
    Rissanen P, Makimattila S, Vehmas T, et al. Effect of weight loss and regional fat distribution on plasma leptin concentration in obese women. Int J Obes Relat Metab Disord. 1999;23:645–9.CrossRefGoogle Scholar
  20. 20.
    Kinoshita T, Ittoh M. Longitudinal variance of fat mass deposition during pregnancy evaluated by ultrasonography: the ratio of visceral fat to subcutaneous fat in the abdomen. Gynecol Obstet Invest. 2006;61(2):115–8.CrossRefGoogle Scholar
  21. 21.
    Anonymous. Gastrointestinal surgery for severe obesity: National institutes of health consensus development conference draft statement. Obes Surg. 1991;1:257–65.CrossRefGoogle Scholar
  22. 22.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14(9):1157–64.CrossRefGoogle Scholar
  23. 23.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefGoogle Scholar
  24. 24.
    Harris ML, Flegal KM, Cowie LL, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults: the Third National Health and Nutrition Examination Survey 1988–94. Diabetes Care. 1998;21:518–24.CrossRefGoogle Scholar
  25. 25.
    Colditz GA, Willet WC, Rotnitky A, et al. Weight gain as a risk factor for clinical diabetes in women. Ann Intern Med. 1995;122:481–6.CrossRefGoogle Scholar
  26. 26.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50.CrossRefGoogle Scholar
  27. 27.
    Despres JP. The insulin-resistance-dyslipidemic syndrome of visceral obesity: effect on patient’s risk. Obes Rev. 1998;6(1):8–17.CrossRefGoogle Scholar
  28. 28.
    Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236–42.CrossRefGoogle Scholar
  29. 29.
    Hoene M, Weigert C. The role of interleukin-6 in insulin-resistance, body fat distribution and energy balance. Obes Rev. 2008;9:20–9.PubMedGoogle Scholar
  30. 30.
    Benedetti G, Mingrone G, Marcoccia S, et al. Body composition and energy expenditure after weight loss following bariatric surgery. J Am Coll Nutr. 2000;19:270–4.CrossRefGoogle Scholar
  31. 31.
    Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16:1602–8.CrossRefGoogle Scholar
  32. 32.
    de Boer JO, van Es AJH, Roovers LCA, et al. Adaptation of energy metabolism of overweight women to low-energy intake, studied with whole body calorimeters. Am J Clin Nutr. 1986;44:585–95.CrossRefGoogle Scholar
  33. 33.
    Kushner RF, Schoeller DA, Field CR, et al. Is the impedance index (ht2/R) significant in predicting total body water? Am J Clin Nutr. 1992;56(5):835–9.CrossRefGoogle Scholar
  34. 34.
    Marra M, Caldara A, Montagnese C, et al. Bioelectrical impedance phase angle in constitutionally lean females, ballet dancers and patients with anorexia nervosa. Eur J Clin Nutr. 2008; in pressGoogle Scholar
  35. 35.
    Armellini F, Zamboni M, Rigo L, et al. The contribution of sonography to the measurement of intra abdominal fat. J Clin Ultrasound. 1990;18:563–7.CrossRefGoogle Scholar
  36. 36.
    Vlachos IS, Hatziioannou A, Perelas A, et al. Sonographic assessment of regional adiposity. Am J Roentgenol. 2007;189:1545–53.CrossRefGoogle Scholar
  37. 37.
    Koda M, Senda M, Kamba M, et al. Sonographic subcutaneous and visceral fat indices represent the distribution of body fat volume. Abdom Imaging. 2007;32:387–92.CrossRefGoogle Scholar
  38. 38.
    Armellini F, Zamboni M, Robbi R, et al. Total and intra-abdominal fat measurements by ultrasound and computerized tomography. Int J Obes Relat Metab Disord. 1993;17:209–14.PubMedGoogle Scholar
  39. 39.
    Tornaghi G, Raiteri R, Pozzato C, et al. Anthropometric or ultrasonic measurements in assessment of visceral fat? A comparative study. Int J Obes Relat Metab Disord. 1994;18:771–5.PubMedGoogle Scholar
  40. 40.
    Abe T, Kawakami Y, Sugita M, et al. Use of B-mode ultrasound for visceral fat mass evaluation: comparisons with magnetic resonance imaging. Appl Human Sci. 1995;14:133–9.CrossRefGoogle Scholar
  41. 41.
    Pontiroli AE, Pizzocri P, Giacomelli M, et al. Ultrasound measurement of visceral and subcutaneous fat in morbidly obese patients before and after laparoscopic adjustable gastric banding: comparison with computerized tomography and with anthropometric measurements. Obes Surg. 2002;12:648–51.CrossRefGoogle Scholar
  42. 42.
    Stolk RP, Meijer R, Mali WP, et al. Ultrasound measurements of intra abdominal fat estimate the metabolic syndrome better than do measurements of waist circumference. Am J Clin Nutr. 2003;77:857–60.CrossRefGoogle Scholar
  43. 43.
    Minocci A, Savia G, Lucantoni R, et al. Leptin plasma concentrations are dependent on body fat distribution in obese patients. Int J Obes Relat Metab Disord. 2000;24:1139–44.CrossRefGoogle Scholar
  44. 44.
    Ribeiro-Filho FF, Faria AN, Kohlmann O Jr, et al. Ultrasonography for the evaluation of visceral fat and cardiovascular risk. Hypertension. 2001;38:713–7.CrossRefGoogle Scholar
  45. 45.
    Kim SK, Kim HJ, Hur KY, et al. Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases. Am J Clin Nutr. 2004;79:593–9.CrossRefGoogle Scholar
  46. 46.
    Leite CC, Wajchenberg BL, Radominski R, et al. Intra-abdominal thickness by ultrasonography to predict risk factors for cardiovascular disease and its correlation with anthropometric measurements. Metab. 2002;51:1034–40.CrossRefGoogle Scholar
  47. 47.
    Busetto L, Tregnaghi A, De Marchi F, et al. Liver volume and visceral obesity in women with hepatic steatosis undergoing gastric banding. Obes Res. 2002;10(5):408–11.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Federica del Genio
    • 1
    Email author
  • Gianmattia del Genio
    • 2
  • Ilario De Sio
    • 3
  • Maurizio Marra
    • 1
  • Lucia Alfonsi
    • 1
  • Carmine Finelli
    • 1
  • Franco Contaldo
    • 1
  • Fabrizio Pasanisi
    • 1
  1. 1.Department of Clinical and Experimental Medicine, Interuniversity Center for Obesity and Eating Disorder (CISRO)Federico II School of MedicineNaplesItaly
  2. 2.I Department of General and Gastroenterologic SurgerySecond UniversityNaplesItaly
  3. 3.Department of Clinical and Experimental Medicine “F. Magrassi e A. Lanzara”Second UniversityNaplesItaly

Personalised recommendations