Prospective Longitudinal Trends in Body Composition and Clinical Outcomes 3 Years Following Sleeve Gastrectomy

  • Shiri Sherf-DaganEmail author
  • Shira Zelber-Sagi
  • Assaf Buch
  • Nir Bar
  • Muriel Webb
  • Nasser Sakran
  • Asnat Raziel
  • David Goitein
  • Andrei Keidar
  • Oren Shibolet
Original Contributions


Background and Aims

Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG).


A prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery.


Sixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss “failure” (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up.


Weight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.


Bariatric surgery Clinical parameters Excess weight loss Fat mass Fat free mass 



Bioelectrical impedance analysis


Body mass index


C-reactive protein


Dual X-ray absorptiometry


Excess weight loss


Fat free mass


Fat mass


Hemoglobin A1c


Hepato-renal index


High-density lipoprotein cholesterol


Homeostasis model assessment


Ideal body weight


Insulin resistance


Low-density lipoprotein cholesterol


Nonalcoholic fatty liver disease


Randomized clinical trial


Roux-en-Y gastric bypass


Resting metabolic rate


Sleeve gastrectomy


Total cholesterol


Waist circumference


Author Contributions

The authors’ responsibilities were as follows—SSD, OS, SZS, NS, DG, AR, and AD designed the research; SSD, AB, NB, and MW performed the research; SSD and SZS analyzed the data; SSD, SZS, and OS wrote the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

Funding Information

This study was supported (in part) by grant no. 3-10470 from the Chief Scientist Office of the Ministry of Health, Israel. The funding source did not have a role in the design, conduct, and analysis of the study or the decision to submit the manuscript for publication.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were approved by the institutional review board and in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The RCT study was pre-registered in the NIH registration website (TRIAL no. NCT01922830).

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Shiri Sherf-Dagan
    • 1
    • 2
    • 3
    Email author
  • Shira Zelber-Sagi
    • 1
    • 4
  • Assaf Buch
    • 5
    • 6
  • Nir Bar
    • 1
    • 2
  • Muriel Webb
    • 1
  • Nasser Sakran
    • 7
    • 8
    • 9
  • Asnat Raziel
    • 7
  • David Goitein
    • 2
    • 7
    • 10
  • Andrei Keidar
    • 11
  • Oren Shibolet
    • 1
    • 2
  1. 1.Department GastroenterologyTel-Aviv Medical CenterTel AvivIsrael
  2. 2.Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael
  3. 3.Department of NutritionAssuta Medical CenterTel AvivIsrael
  4. 4.School of Public Health, Faculty of Social Welfare and Health SciencesUniversity of HaifaHaifaIsrael
  5. 5.Institute of Endocrinology, Metabolism and HypertensionTel-Aviv Sourasky Medical CenterTel AvivIsrael
  6. 6.School of Nutritional SciencesThe Hebrew University of JerusalemRehovotIsrael
  7. 7.Israeli Center for Bariatric Surgery (ICBS), Assia Medical GroupAssuta Medical CenterTel AvivIsrael
  8. 8.Department of Surgery AEmek Medical CenterAfulaIsrael
  9. 9.Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael
  10. 10.Department of Surgery CSheba Medical CenterRamat GanIsrael
  11. 11.Department of General Surgery, Assuta Ashdod Public HospitalThe Ben-Gurion UniversityBe’er ShevaIsrael

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