Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults
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Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. / Fabbrini, Elisa; Tamboli, Robyn A; Magkos, Faidon; Marks-Shulman, Pamela A; Eckhauser, Aaron W; Richards, William O; Klein, Samuel; Abumrad, Naji N.
In: Gastroenterology, Vol. 139, No. 2, 2010, p. 448-455.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults
AU - Fabbrini, Elisa
AU - Tamboli, Robyn A
AU - Magkos, Faidon
AU - Marks-Shulman, Pamela A
AU - Eckhauser, Aaron W
AU - Richards, William O
AU - Klein, Samuel
AU - Abumrad, Naji N
N1 - Copyright (c) 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
PY - 2010
Y1 - 2010
N2 - Background & aims: Visceral adipose tissue (VAT) is an important risk factor for the metabolic complications associated with obesity. Therefore, a reduction in VAT is considered an important target of obesity therapy. We evaluated whether reducing VAT mass by surgical removal of the omentum improves insulin sensitivity and metabolic function in obese patients.Methods: We conducted a 12-month randomized controlled trial to determine whether reducing VAT by omentectomy in 22 obese subjects increased their improvement following Roux-en-Y gastric bypass (RYGB) surgery in hepatic and skeletal muscle sensitivity to insulin study 1. Improvement was assessed by using the hyperinsulinemic-euglycemic clamp technique. We also performed a 3-month, longitudinal, single-arm study to determine whether laparoscopic omentectomy alone, in 7 obese subjects with type 2 diabetes mellitus (T2DM), improved insulin sensitivity study 2. Improvement was assessed by using the Frequently Sampled Intravenous Glucose Tolerance Test.Results: The greater omentum, which weighed 0.82 kg (95% confidence interval: 0.67-0.97), was removed from subjects who had omentectomy in both studies. In study 1, there was an approximate 2-fold increase in muscle insulin sensitivity (relative increase in glucose disposal during insulin infusion) and a 4-fold increase in hepatic insulin sensitivity 12 months after RYGB alone and RYGB plus omentectomy, compared with baseline values (P<.001). There were no significant differences between groups (P>.87) or group x time interactions (P>.36). In study 2, surgery had no effect on insulin sensitivity (P=.844) or use of diabetes medications.Conclusions: These results demonstrate that decreasing VAT through omentectomy, alone or in combination with RYGB surgery, does not improve metabolic function in obese patients.
AB - Background & aims: Visceral adipose tissue (VAT) is an important risk factor for the metabolic complications associated with obesity. Therefore, a reduction in VAT is considered an important target of obesity therapy. We evaluated whether reducing VAT mass by surgical removal of the omentum improves insulin sensitivity and metabolic function in obese patients.Methods: We conducted a 12-month randomized controlled trial to determine whether reducing VAT by omentectomy in 22 obese subjects increased their improvement following Roux-en-Y gastric bypass (RYGB) surgery in hepatic and skeletal muscle sensitivity to insulin study 1. Improvement was assessed by using the hyperinsulinemic-euglycemic clamp technique. We also performed a 3-month, longitudinal, single-arm study to determine whether laparoscopic omentectomy alone, in 7 obese subjects with type 2 diabetes mellitus (T2DM), improved insulin sensitivity study 2. Improvement was assessed by using the Frequently Sampled Intravenous Glucose Tolerance Test.Results: The greater omentum, which weighed 0.82 kg (95% confidence interval: 0.67-0.97), was removed from subjects who had omentectomy in both studies. In study 1, there was an approximate 2-fold increase in muscle insulin sensitivity (relative increase in glucose disposal during insulin infusion) and a 4-fold increase in hepatic insulin sensitivity 12 months after RYGB alone and RYGB plus omentectomy, compared with baseline values (P<.001). There were no significant differences between groups (P>.87) or group x time interactions (P>.36). In study 2, surgery had no effect on insulin sensitivity (P=.844) or use of diabetes medications.Conclusions: These results demonstrate that decreasing VAT through omentectomy, alone or in combination with RYGB surgery, does not improve metabolic function in obese patients.
KW - Adult
KW - Blood Glucose/metabolism
KW - Cardiovascular Diseases/blood
KW - Diabetes Mellitus, Type 2/etiology
KW - Female
KW - Gastric Bypass
KW - Glucose Clamp Technique
KW - Glucose Tolerance Test
KW - Humans
KW - Insulin/blood
KW - Insulin Resistance
KW - Intra-Abdominal Fat/metabolism
KW - Laparoscopy
KW - Lipectomy/methods
KW - Liver/metabolism
KW - Longitudinal Studies
KW - Male
KW - Middle Aged
KW - Muscle, Skeletal/metabolism
KW - Obesity/blood
KW - Omentum/surgery
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1053/j.gastro.2010.04.056
DO - 10.1053/j.gastro.2010.04.056
M3 - Journal article
C2 - 20457158
VL - 139
SP - 448
EP - 455
JO - Gastroenterology
JF - Gastroenterology
SN - 0016-5085
IS - 2
ER -
ID: 290524258