Article

Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration

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Abstract

No randomized studies in humans have examined whether fat returns after removal or where it returns. We undertook a prospective, randomized-controlled trial of suction lipectomy in nonobese women to determine if adipose tissue (AT) is defended and if so, the anatomic pattern of redistribution. Healthy women with disproportionate AT depots (lower abdomen, hips, or thighs) were enrolled. Baseline body composition measurements included dual-energy X-ray absorptiometry (DXA) (a priori primary outcome), abdominal/limb circumferences, subcutaneous skinfold thickness, and magnetic resonance imaging (MRI) (torso/thighs). Participants (n = 32; 36 ± 1 year) were randomized to small-volume liposuction (n = 14, mean BMI: 24 ± 2 kg/m2) or control (n=18, mean BMI: 25 ± 2) following baseline. Surgery group participants underwent liposuction within 2–4 weeks. Identical measurements were repeated at 6 weeks, 6 months, and 1 year later. Participants agreed not to make lifestyle changes while enrolled. Between-group differences were adjusted for baseline level of the outcome variable. After 6 weeks, percent body fat (%BF) by DXA was decreased by 2.1% in the lipectomy group and by 0.28% in the control group (adjusted difference (AD): −1.82%; 95% confidence interval (CI): −2.79% to −0.85%; P = 0.0002). This difference was smaller at 6 months, and by 1 year was no longer significant (0.59% (control) vs. −0.41% (lipectomy); AD: −1.00%; CI: −2.65 to 0.64; P = 0.23). AT reaccumulated differently across various sites. After 1 year the thigh region remained reduced (0.77% (control) vs. −1.83% (lipectomy); AD: −2.59%; CI: −3.91 to −1.28; P = 0.0001), but AT reaccumulated in the abdominal region (0.64% (control) vs. 0.42% (lipectomy); AD: −0.22; CI: −2.35 to 1.91; P = 0.84). Following suction lipectomy, BF was restored and redistributed from the thigh to the abdomen.

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... 8 There are limitations to these outcome measurements, including subjectivity and operator-dependency. 8,14 Higher resolution ultrasound, magnetic resonance imaging (MRI), 3-dimensional (3D) imaging analysis, and diffuse optical spectroscopic imaging have been used to characterize changes in adipose tissue. 8,[15][16][17][18][19] Another imaging approach that can be used to evaluate body composition changes following nonsurgical fat reduction is dualenergy X-ray absorptiometry (DEXA). DEXA measures 3 principal components of the body based on their differential X-ray attenuation properties: bone mineral content, fat mass of soft tissues, and lean mass of soft tissues. ...
... 21 Previous studies have shown the successful use of this technique to quantify adipose tissue changes in patients after surgical and nonsurgical fat reduction procedures. 14,18,20,22 The current case series study evaluates changes in body composition (lean and fat mass) using DEXA in patients following cryolipolysis treatment. ...
... 22 Although this study evaluates the use of DEXA analysis after cryolipolysis treatment, previous studies have reported its utility in assessing fat changes after surgical and nonsurgical fat reduction procedures. 14,18,20,22 One advantage of DEXA scanning is the ability to quantitatively assess region-specific changes in fat content and distribution. The images obtained by DEXA allow objective and visible evidence of improvement after cryolipolysis. ...
Article
Objectives: Cryolipolysis provides a nonsurgical treatment option for reducing excess subcutaneous fat. Although widely used, clinical outcomes such as photographs, patient questionnaires, and caliper measurements may be affected by subjectivity and operator- dependency. The current case series study evaluated changes in body composition using dual-energy X-ray absorptiometry (DEXA) in patients who underwent cryolipolysis treatment. Methods: between 2019 and 2020, 5 patients underwent cryolipolysis at a dermatology practice in São Paulo, Brazil. Patients were treated in different body regions using a cryolipolysis medical device (CoolSculpting®; ZELTIQ Aesthetics, Inc., Pleasanton, CA, USA) with the CoolAdvantage™ or CoolAdvantage Plus™ vacuum applicators (ZELTIQ Aesthetics, Inc). Pre- and post-treatment, body weight and abdominal circumference were recorded. Fat and lean mass measurements were also obtained using a total body scanner. Results: five patients (4 females, 1 male; mean age, 34 years) were treated in a total of 8 areas (2 cases in the flank, 3 cases in the abdomen, and 3 cases in the back). Three months post-treatment, body weight was reduced in 3 out of 5 (60.0%) patients, and abdominal circumference was reduced in 2 out of 3 (66.7%) patients. Most patients showed reductions in total fat mass (80.0%) and lean mass (60.0%). The percentage change in body weight was also correlated with the percentage change in total fat mass (R=0.81). Region-specific alterations in fat content were also observed. Conclusions: most patients showed changes in body composition, including lower fat mass (5%-36% reductions) 3 months after cryolipolysis treatment. The results suggest that DEXA can be used to objectively visualize and quantify body composition changes following cryolipolysis treatment.
... To verify the computational predictions, we performed a survey in the literature about partial lipectomy [31][32][33][34][35][36][37]. We found, amazingly, that these real surgeries support what we predicted. ...
... Similar to our model predictions, fat restoration was indeed absent in some experiments (Fig. 3A, the solid black curve) [36,39,40]. However, the scenario was different in some other experiments [33,41,42], in which fat restoration was actually observed in the end (Fig. 3A, the dashed black curve). ...
... If N adipo is changed to 2000, then full fat restoration will be observed. Therefore, the leanocentric model can explain both observations: non-compensation [36,39,40] corresponds to the fixed N adipo =(1-x%)$ 2000 and compensation [33,41,42] corresponds to the gradual increase of N adipo from (1-x%)$ 2000 to 2000 during the model run. ...
Article
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Background The lipostatic set‐point theory, ascribing fat mass homeostasis to leptin mediated central feedback regulation targeting the body’s fat storage, has caused a variety of conundrums. We recently proposed a leanocentric locking‐point theory and the corresponding mathematical model, which not only resolve these conundrums but also provide valuable insights into weight control and health assessment. This paper aims to further test the leanocentric theory. Methods Partial lipectomy is a touchstone to test both the leanocentric and lipostatic theories. Here we perform in silico lipectomy by using a mathematical model embodying the leanocentric theory to simulate the long‐term body fat change after removing some fat cells in the body. Results The mathematical modeling uncovers a phenomenon called post‐surgical fat loss, which was well‐documented in real partial lipectomy surgeries; thus, the phenomenon can serve as an empirical support to the leanocentric theory. On the other hand, the leanocentric theory, but not the lipostatic theory, can well explain the post‐surgical fat loss. Conclusions The leanocentric locking‐point theory is a promising theory and deserves further testing. Partial lipectomy surgeries are beneficial to obese patients for quite a long period.
... This increase in adipose tissue after liposuction was also observed in another prospective randomised, controlled study conducted in the US. 171 Patients with normal weight who had undergone liposuction for lipoedema showed an increase in the adipose tissue removed by liposuction within 1 year postoperatively. 171 The fat accumulated in both visceral as well as subcutaneous depots. ...
... 171 Patients with normal weight who had undergone liposuction for lipoedema showed an increase in the adipose tissue removed by liposuction within 1 year postoperatively. 171 The fat accumulated in both visceral as well as subcutaneous depots. 171 The authors of this study also provided information about which regions of the body were particularly affected by the increase in adipose tissue, namely, the abdominal region. ...
... 171 The fat accumulated in both visceral as well as subcutaneous depots. 171 The authors of this study also provided information about which regions of the body were particularly affected by the increase in adipose tissue, namely, the abdominal region. Fat accumulated more slowly in the hip and thigh regions. ...
... Diese Zunahme an Fettgewebe nach Liposuktion wurde auch in einer prospektiven randomisiert-kontrollierten Studie von Hernandez und Eckel von der University of Colorado in Denver beobachtet [40]. In dieser -zumindest in den USA -vielfach beachteten Studie (die auch in der New York Times kommentiert wurde [41]) haben normalgewichtige Patientinnen nach erfolgter Liposuktion binnen eines Jahres die abgesaugte Fettmasse wieder zugenommen. ...
... In dieser -zumindest in den USA -vielfach beachteten Studie (die auch in der New York Times kommentiert wurde [41]) haben normalgewichtige Patientinnen nach erfolgter Liposuktion binnen eines Jahres die abgesaugte Fettmasse wieder zugenommen. "We provide strong evidence that adipose tissue is, indeed, restored to the baseline level when it is removed surgically" [40]. Die Autoren dieser Studie geben aber auch Auskunft darüber, in welchen Körperregionen die Fettgewebszunahme vor allem stattgefunden hat: "Fat reaccumulated preferentially in the abdominal region …and more slowly in the hip and thigh region" [40]. ...
... "We provide strong evidence that adipose tissue is, indeed, restored to the baseline level when it is removed surgically" [40]. Die Autoren dieser Studie geben aber auch Auskunft darüber, in welchen Körperregionen die Fettgewebszunahme vor allem stattgefunden hat: "Fat reaccumulated preferentially in the abdominal region …and more slowly in the hip and thigh region" [40]. Die Wiederzunahme von Fettgewebe konnte im Rahmen dieser Untersuchung sowohl in viszeralen als auch in subkutanen Depots nachgewiesen werden: "fat reaccumulated in both the visceral and subcutanous depots" [40]. ...
Article
Zusammenfassung Um das Lipödem ranken sich zahlreiche Mythen! In diesem vierten Beitrag unserer Artikelserie setzen wir uns mit dem Stellenwert der Liposuktion beim Lipödem auseinander. Wir diskutieren das von vielen die Liposuktion durchführenden Ärzten verbreitete Statement: „Die Liposuktion führt zu ausgeprägter und dauerhafter Verbesserung des Lipödems“. Wir konnten zeigen, dass zwischen den oft euphorischen Versprechungen der chirurgisch tätigen Kollegen und der aktuellen Studienlage zur Liposuktion eine erhebliche Lücke klafft. Sowohl Studienqualität als auch Studiensetting weisen erhebliche Mängel auf, Mängel, die Zweifel an diesem verbreiteten Statement aufkommen lassen. Eine ähnliche Lücke klafft darüber hinaus zwischen den Empfehlungen der S1-Leitlinie Lipödem und der tatsächlichen „Absaugpraxis“ bei adipösen Lipödempatientinnen. Die in den Leitlinien empfohlene „kritische Indikationsstellung“ bei gleichzeitigem Auftreten von Lipödem und Adipositas findet kaum Gehör. Es kann daher nicht genug betont werden, dass Liposuktion keine Methode ist, um Adipositas zu behandeln. Gleichwohl kann die Liposuktion durchaus zu einer Verbesserung des Lipödems beitragen. Entscheidend für den Therapieerfolg ist die Auswahl der Patientinnen, die aufgrund – medizinischer – Kriterien erfolgen muss. Darüber sollte die Liposuktion in ein Gesamtkonzept eingebunden werden, welches psychosoziale, ernährungs- und sportmedizinische Gesichtspunkte berücksichtigt.
... A total of seven studies met the inclusion criteria and were included in this review. Objective measurement of SAT was carried out using the following techniques: ultrasound, [2,9] dual-energy X-ray absorptiometry (DXA), [5,10,11] magnetic resonance imaging (MRI), [11] computed tomography (CT), [12] and three-dimensional (3D) imaging volumetric analysis [4] [ Table 1]. ...
... A total of seven studies met the inclusion criteria and were included in this review. Objective measurement of SAT was carried out using the following techniques: ultrasound, [2,9] dual-energy X-ray absorptiometry (DXA), [5,10,11] magnetic resonance imaging (MRI), [11] computed tomography (CT), [12] and three-dimensional (3D) imaging volumetric analysis [4] [ Table 1]. ...
... DXA is a tool used to measure body composition using differences in the attenuation of two X-rays as they penetrate tissue [5] and has been shown to provide accurate and objective visual improvement of body composition following liposuction. [5,10,11] Pre-and postoperative DXA scans can be used to measure and compare total fat mass, total lean mass, total bone mineral mass, and body weight. One advantage offered by this modality is the possibility of visualizing the entire body and body fat redistribution patterns. ...
Article
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Currently, no reliable gold standard exists for the objective outcome measurement following liposuction. The purpose of this systematic review was to summarize reported methods of monitoring liposuction results by objectively measuring subcutaneous adipose tissue. A systematic literature search was performed to identify relevant articles that described techniques for objectively quantifying adipose tissue following traditional liposuction. The search included published articles in three electronic databases—Ovid MEDLINE, Embase, and PubMed. Subcutaneous adipose tissue was estimated using the following techniques: ultrasound, dual-energy X-ray absorptiometry, magnetic resonance imaging, computed tomography, and three-dimensional imaging volumetric analysis. Reported benefits of liposuction objective measurements included providing patients with a quantitative assessment of the liposuction results pre- and postoperatively, detecting significant changes in body fat deposits, and following patterns of fat redistribution. This review provides a summary of various techniques for quantification of liposuction results. More studies are needed to study the clinical relevancy and impact of the various imaging modalities reviewed as well as to develop automated volumetric measurement technology with improved accuracy, efficacy, and reproducibility.
... Several previous studies were conducted to evaluate the efficacy of lipectomy and the possibility of re-accumulation of body fat; however, in most cases they were inconclusive (Benatti et al., 2012;Hernandez et al., 2011). In addition, the metabolic effect of subcutaneous lipectomy is still unclear. ...
... Several studies have reported a compensatory increase in visceral fat following the removal of subcutaneous fat in humans (Benatti et al., 2012;Hernandez et al., 2011). It has been also postulated that when the body fat is surgically removed, it well be recovered within a period of weeks to months by compensatory adipose tissue expansion (Coelho et al., 2009), with a predominate hypertrophy of retroperitoneal fat (Hausman, Lu, Ryan, Flatt, & Harris, 2004). ...
Article
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New findings: What is the central question of this study? What is the impact and drawbacks of subcutaneous lipectomy on body metabolism? What is the main finding and its importance? We found that subcutaneous lipectomy resulted in deterioration of hepatic functions, atherosclerotic lipid profile and disturbed redox state. Thus, while our results support lipectomy as an effective treatment for obesity, lipectomy induces unfavorable changes in health. Abstract: The number of obese older adults is on the rise, although the data about proper treatment of obesity in elderly is controversial. The present study was designed to investigate the effectiveness and consequences of partial subcutaneous lipectomy, as a rapid medical intervention against increased accumulation of body fat, in adult obese rats. The study was conducted on adult (9 - 12 months) female rats, where obesity was induced by bilateral surgical ovariectomy. They were randomized into two main groups; short term (5-weeks) and long term (10-weeks). Both groups were subdivided into: control, ovariectomized (OVX) and ovariectomized lipectomized rat groups. Rats were subjected to measurement of body weight (BW) and calculation of body mass index (BMI). Fasting blood glucose, lipid profile and plasma levels of; total proteins, albumin, liver enzymes, malondialdehyde (MDA), leptin and adiponectin were determined. The content of both blood and hepatic tissue of reduced glutathione was estimated. In addition, histological study of the liver, aorta and peri-renal fat were performed. Compared to controls, OVX rats showed significant increase in BW, BMI and plasma levels of; liver enzymes, MDA and leptin. Histological study revealed vacuolated ballooned hepatocytes and enlarged irregular visceral adipocytes with atherosclerotic changes in the wall of aorta. Following subcutaneous lipectomy, rats exhibited significant fasting hyperglycemia, dyslipidemia, lowered plasma albumin and disturbed redox state with aggravation of the histological changes. The findings indicate that, although subcutaneous lipectomy appears to be effective in combating obesity in older females, yet it has unfavorable effects on both metabolic and hepatic functions. This article is protected by copyright. All rights reserved.
... liposuction, patients had their fat mass restored but redistributed from the thigh to the abdomen [41]. Similarly, Herbst et al. highlighted the body's defense mechanisms in fat maintenance and restoration postliposuction, noting tissue growth within and outside the treated areas, with regrowth outside treated areas observed in 61% of women after 6 months [42]. ...
Article
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Lipedema, a chronic and painful disorder primarily affecting women without a definitive cure, has traditionally been managed with conservative therapy, notably complete decongestive therapy, across many countries. Recently, liposuction has been explored as a potential surgical treatment, prompting this study to evaluate its effectiveness as possibly the first-line therapy for lipedema. Through extensive literature searches in databases such as CrossRef, Web of Science, PubMed, and Google Scholar up to December 2023, and using the Newcastle-Ottawa Scale for quality assessment, the study selected seven studies for inclusion. Results showed significant post-operative improvements in spontaneous pain, edema, bruising, mobility, and quality of life among lipedema patients undergoing liposuction. However, over half of the patients still required conservative therapy after surgery. Despite these promising results, the study suggests caution due to lipedema's complexity, significant reliance on self-reported data, and limitations of the studies reviewed. Thus, while liposuction may offer symptomatic relief, it should be considered an adjunct, experimental therapy rather than a definitive cure, emphasizing the need for a comprehensive approach to care.
... Visceral fat exhibits a stronger correlation with brain atrophy compared to age, BMI, hypertension, and type 2 diabetes mellitus [24]. While this intervention may alleviate limb pain, it does not address the fundamental issue [25][26][27]. ...
Article
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Objective The aim of this study is to assess the prevalence of HLA-DQ2 and HLA-DQ8 in women diagnosed with lipedema. Methods Leukocyte histocompatibility antigen (HLA) tests of 95 women diagnosed with lipedema were analyzed using non-probabilistic sampling for convenience. The prevalence of HLA-DQ2 and HLA-DQ8 was compared to the general population. Results The prevalence of HLA-DQ2+ was 47.4%, that of HLA-DQ8+ was 22.2%, the presence of any celiac disease associated HLA (HLA-DQ2+ or HLA-DQ8+) was 61.1%, both HLA (HLA-DQ2+ and HLA-DQ8+) was 7.4%, and the absence of celiac disease associated HLA was 39%. Compared to the general population, there was a significantly higher prevalence of HLA-DQ2, HLA-DQ8, any HLA, and both HLAs in lipedema patients. The mean weight of patients with HLA-DQ2+ was significantly lower than the overall study population, and their mean BMI significantly differed from the overall mean BMI. Conclusion Lipedema patients seeking medical assistance have a higher prevalence of HLA-DQ2 and HLA-DQ8. Considering the role of gluten in inflammation, further research is needed to establish if this association supports the benefit of gluten withdrawal from the diet in managing lipedema symptoms.
... 42 , 43 Using dual-energy x-ray absorptiometry scans and magnetic resonance imaging, a clinical trial observed compensatory abdominal FM deposition in a 12-month period after thigh liposuction. 44 Other retrospective human studies reported an increase in breast size after abdomen and thigh liposuction surgeries, which was postulated to be due to an altered ratio of androgen-to-estrogen levels, 39-41 but this may not be the only explanation. ...
Article
Background Bariatric surgery averts obesity-induced insulin resistance and the metabolic syndrome. By contrast surgical fat removal is considered merely an aesthetic endeavor. The aim of this paper is to establish whether surgical fat removal, like bariatric surgery, exerts measurable, lasting metabolic benefits. Methods PubMed, Embase and Scopus were searched using the Polyglot Search Translator to find studies examining quantitative expression of metabolic markers. Quality assessment was done utilizing the MethodologicAl STandard for Epidemiological Research (MASTER) scale. The robust-error meta-regression (REMR) model was employed for this synthesis. Results Twenty-two studies with 493 participants were included. Insulin sensitivity improved gradually with a maximum reduction of fasting insulin and HOMA-IR of 17 pmol/L and 1 point respectively at post-operative day 180. Peak metabolic benefits manifest as a reduction of 2 units in body mass index, 3 kg of fat mass, 5 cm of waist circumference, 15 µg/L of serum leptin, 0.75 pg/ml of tumor necrosis factor alpha, 0.25mmol/L total cholesterol and 3.5 mmHg of systolic and diastolic blood pressure were observed at day 50 but were followed by a return to preoperative levels by day 180. Serum high density lipoproteins peaked at 50 days post-surgery, before falling below the baseline. No significant changes were observed in lean body mass, serum adiponectin, resistin, interleukin 6, C- reactive protein, triglyceride, low density lipoproteins, free fatty acids and fasting blood glucose. Conclusion Surgical fat removal exerts several metabolic benefits in the short term but only improvements in insulin sensitivity last beyond 6 months.
... Therefore, the inability of gfSAT to expand may be a determinant in unhealthy fat distribution promoting central fat depots. Interestingly, a prospective randomized controlled trial in non-obese women showed that following suction lipectomy, body fat was redistributed from the thigh to the abdomen, suggesting that lack of gfSAT is counterbalanced by the development of aSAT [62]. Concerning human BAT, few studies are available. ...
Article
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The amount and the distribution of body fat exhibit trajectories that are sex- and human species-specific and both are determinants for health. The enhanced accumulation of fat in the truncal part of the body as a risk factor for cardiovascular and metabolic diseases is well supported by epidemiological studies. In addition, a possible independent protective role of the gluteofemoral fat compartment and of the brown adipose tissue is emerging. The present narrative review summarizes the current knowledge on sexual dimorphism in fat depot amount and repartition and consequences on cardiometabolic and reproductive health. The drivers of the sex differences and fat depot repartition, considered to be the results of complex interactions between sex determination pathways determined by the sex chromosome composition, genetic variability, sex hormones and the environment, are discussed. Finally, the inter- and intra-depot heterogeneity in adipocytes and progenitors, emphasized recently by unbiased large-scale approaches, is highlighted.
... Given that fat distribution is one parameter that modifies the impact of obesity on health, knowledge about whether fat tissue removed through SSFR is replaced by new fat tissue and if this occurs in the same or at different anatomical sites is important since the latter may have worse effects. Previous studies reported that the fat could return to sites other than that from which fat has been removed, such as the breast, hip, and thigh regions [80,81], but this is not always the case [82]. There is also the possibility that new fat may accumulate at sites where fat does not commonly accumulate (ectopic fat) and such ectopic adipose tissues may deposit in several organs/tissues (intramuscular/cardiac/hepatic) in the body with adverse consequences [83,84]. ...
Article
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Although obesity is a preventable disease, maintaining a normal body weight can be very challenging and difficult, which has led to a significant increase in the demand for surgical subcutaneous fat removal (SSFR) to improve physical appearance. The need for SSFR is further exacerbated because of the global rise in the number of bariatric surgeries, which is currently the single most durable intervention for mitigating obesity. Fat tissue is now recognized as a vital endocrine organ that produces several bioactive proteins. Thus, SSFR-mediated weight (fat) loss can potentially have significant metabolic effects; however, currently, there is no consensus on this issue. This review focuses on the metabolic sequelae after SSFR interventions for dealing with cosmetic body appearance. Data was extracted from existing systematic reviews and the diversity of possible metabolic changes after SSFR are reported along with gaps in the knowledge and future directions for research and practice. We conclude that there is a potential for metabolic sequelae after SSFR interventions and their clinical implications for the safety of the procedures as well as for our understanding of subcutaneous adipose tissue biology and insulin resistance are discussed.
... It was also accompanied by both an increase in perirenal fat mass and fat cell size. Several studies have reported a compensatory increase in VAT following the removal of SAT in humans [22,23]. It was postulated that when body fat is surgically removed, it will be recovered by compensatory expansion at intact depots rather than regrowth of the fat mass in aspirated depots, with a predominant hypertrophy of the retroperitoneal pad of fat [24,25]. ...
Article
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Purpose: The deleterious effect of visceral adipose tissue accumulation is well known. However, the recent trend in liposuction is mal-directed toward easily accessible subcutaneous fat for the purpose of body shaping. The aim of the present study is to probe the metabolic effects of subcutaneous abdominal adipose tissue lipectomy in ovariectomized obese rats as well as the role of adipokines in these changes. Methods: The study was conducted on young female rats randomized into two main groups according to the duration of the experiment, namely, 5-week and 10-week. Both groups were subdivided as follows: sham-operated, ovariectomized, and ovariectomized lipectomized rat groups. The rats underwent measurement of body weight (BW) and determination of body mass index (BMI). Fasting blood glucose, lipid profile, liver function, plasma malondialdehyde, leptin, and adiponectin were estimated, and the content of both blood and hepatic tissue of reduced glutathione was assessed. In addition, histological study of the liver, aorta, and perirenal fat of all rat groups was performed. Results: Ovariectomy-induced obesity is marked by a significant increase in BW and BMI. Following subcutaneous lipectomy, the rats exhibited significant weight gain accompanied by fasting hyperglycemia, dyslipidemia, deterioration of synthetic function of the liver, and disturbed oxidant/antioxidant status. Histological examination revealed fatty infiltration of aortic and hepatic tissues. Conclusion: Despite the immediate positive effect of subcutaneous lipectomy for weight loss and/or body shaping, multiple delayed hazards follow the procedure, which should be carefully considered.
... Previous studies observed a regain of body weight to baseline after 12 months because of compensatory fat growth in the abdominal region. 39,40 For lipedema patients, in contrast, large-volume liposuction as performed in this study appears to sustainably reduce body weight and body mass index. However, based on the data of this study, no recommendation can be made regarding an appropriate amount of lipoaspirate per patient. ...
Article
Background: Despite an increasing demand for surgical treatment of lipedema, the evidence for liposuction is still limited to five peer-reviewed publications. Little is known about the influence of disease stage, patient age, body mass index, or existing comorbidities on clinical outcomes. Considering the chronically progressive nature of lipedema, it was hypothesized that younger patients with lower body mass index and stage would report better results. Methods: This retrospective, single-center, noncomparative study included lipedema patients who underwent liposuction between July of 2009 and July of 2019. After a minimum of 6 months since the last surgery, all patients completed a disease-related questionnaire. The primary endpoint was the need for complex decongestive therapy based on a composite score. Secondary endpoints were the severity of complaints (i.e., spontaneous pain, sensitivity to pressure, feeling of tension, bruising, impairment of body image) measured on a visual analogue scale. Results: One hundred six patients underwent a total of 298 large-volume liposuctions (mean lipoaspirate, 6355 ± 2797 ml). After a median follow-up of 20 months (interquartile range, 10 to 42 months), a median complex decongestive therapy score reduction of 37.5 percent (interquartile range, 0 to 88.8 percent; p < 0.0001) was observed. An improvement in lipedema-associated symptoms was also observed (p < 0.0001). The percentage reduction in complex decongestive therapy scores was greater in patients with a body mass index less than or equal to 35 kg/m2; (compared to higher body mass index; p < 0.0001) and in stage I and II patients (compared to stage III patients; p = 0.0019). Conclusion: Liposuction reduces the severity of symptoms and the need for conservative treatment in lipedema patients, especially if it is performed in patients with a body mass index below 35 kg/m2; at an early stage of the disease. Clinical question/level of evidence: Therapeutic, IV.
... However, because liposuction is limited to removal of subcutaneous fat, these studies cannot address the significance of ectopic fat and visceral abdominal fat (VAT) for cardiometabolic health (see later section, ''Exercise targets 'unhealthy' fat'').The lack of improvement in cardiometabolic risk profile after liposuction may be due in part to redistribution of body fat after this procedure. Compensatory increases in VAT have been reported after liposuction (Benatti et al., 2012;Hernandez et al., 2011;Seretis et al., 2015b). Importantly, exercise may prevent this from occurring (Benatti et al., 2012). ...
Article
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We propose a weight-neutral strategy for obesity treatment on the following grounds: (1) the mortality risk associated with obesity is largely attenuated or eliminated by moderate-to-high levels of cardiorespiratory fitness (CRF) or physical activity (PA), (2) most cardiometabolic risk markers associated with obesity can be improved with exercise training independent of weight loss and by a magnitude similar to that observed with weight-loss programs, (3) weight loss, even if intentional, is not consistently associated with lower mortality risk, (4) increases in CRF or PA are consistently associated with greater reductions in mortality risk than is intentional weight loss, and (5) weight cycling is associated with numerous adverse health outcomes including increased mortality. Adherence to PA may improve if health care professionals consider PA and CRF as essential vital signs and consistently emphasize to their patients the myriad benefits of PA and CRF in the absence of weight loss.
... Fat redistribution on the abdomen has been demonstrated by dual x-ray absorptiometry scans after suction lipectomy of the thigh in women with disproportionate tissue on the lower abdomen, hips, or thighs 33 ; it is unclear if any of these women had lipedema. Swanson followed 58 female participants without lipedema who had liposuction or a combination of liposuction and abdominoplasty for 5-19 months post procedure and found no redistribution of fat to the breasts or upper body. ...
Article
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Background: Lipedema is a loose connective tissue disease affecting the limbs of women, that is difficult to lose by diet, exercise, or bariatric surgery. Publications from Europe demonstrate that lipedema reduction surgery improves quality of life for women with lipedema. There are no comparable studies in the United States (USA). The aim of this study was to collect data from women with lipedema in the USA who have undergone lipedema reduction surgery in the USA to determine if quality of life, pain, and other measures improved after lipedema reduction surgery. Methods: Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing lipedema reduction surgery in the USA. Significance set at P < 0.05 was determined by ANOVA, Tukey's multiple comparison test, or paired t-test. Results: Quality of life improved in 84% and pain improved in 86% of patients. Ambulation improved most in lipedema Stage 3 (96%). Weight loss occurred in all stages by 3 months after surgery. Complications included growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema. Conclusions: Women with lipedema noticed significant benefits after lipedema reduction surgery in the USA. Prospective studies are needed to assess benefits and complications after lipedema reduction surgery in the USA.
... Apparently, because VAT is hormonally active tissue and drains its secretes into the portal vein which supplies blood flow to the liver, VAT accumulated in obesity is particularly hazardous for the liver. Contrary to VAT, SAT, due to its reduced lipolytic rate and strong avidity for free fatty acids (FFAs), regulates the central adiposity, as removal of thigh fat by liposuction was followed by AT re-accumulation and redistribution preferentially in the abdominal space and protects liver from excessive FFAs deposition characteristic for metabolic syndrome [62][63][64]. Women, when compared to men, have higher percent of body fat; however, the different pattern of its distribution seen in a woman's body (in subcutaneous gluteal-femoral fat) is associated with lower metabolic risk [65], although women with so-called upper body obesity (evidenced by a waist-to-hip ratio >0.85) suffer from the same metabolic complications as men [66]. Interestingly, the differences in AT depots go beyond straightforward division SAT vs. VAT, as it has been recently demonstrated that abdominal SAT is characterized by smaller adipocytes and a peculiar pattern of gene expression compared to femoral AT in overweight/obese women [67]. ...
Article
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Lipofilling (LF) is a largely employed technique in reconstructive and esthetic breast surgery. Over the years, it has demonstrated to be extremely useful for treatment of soft tissue defects after demolitive or conservative breast cancer surgery and different procedures have been developed to improve the survival of transplanted fat graft. The regenerative potential of LF is attributed to the multipotent stem cells found in large quantity in adipose tissue. However, a growing body of pre-clinical evidence shows that adipocytes and adipose-derived stromal cells may have pro-tumorigenic potential. Despite no clear indication from clinical studies has demonstrated an increased risk of cancer recurrence upon LF, these observations challenge the oncologic safety of the procedure. This review aims to provide an updated overview of both the clinical and the pre-clinical indications to the suitability and safety of LF in breast oncological surgery. Cellular and molecular players in the crosstalk between adipose tissue and cancer are described, and heterogeneous contradictory results are discussed, highlighting that important issues still remain to be solved to get a clear understanding of LF safety in breast cancer patients.
... In view of limited available data, Bertsch et al. [20] suggested a rigorous patient selection focused on lower BMI. A prospective randomized study on women with disproportional adipose tissue deposits demonstrated an accumulation of abdominal adipose tissue after thigh liposuction to an extent that outweighed the initial body fat loss in the thigh region [21]. Another study reported an average reduction in leg volume of 6.9% after liposuction in patients with lipoedema after 4-5 sessions [17]. ...
Article
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Introduction: Lipoedema is characterized as subcutaneous lipohypertrophy in association with soft-tissue pain affecting female patients. Recently, the disease has undergone a paradigm shift departing from historic reiterations of defining lipoedema in terms of classic edema paired with the notion of weight loss-resistant leg volume towards an evidence-based, patient-centered approach. Although lipoedema is strongly associated with obesity, the effect of bariatric surgery on thigh volume and weight loss has not been explored. Material and methods: In a retrospective cohort study, thigh volume and weight loss of 31 patients with lipoedema were analyzed before and 10-18 and ≥19 months after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Fourteen patients, with distal leg lymphoedema (i.e., with healthy thighs), who had undergone bariatric surgery served as controls. Statistical analysis was performed using a linear mixed-effects model adjusted for patient age and initial BMI. Results: Adjusted initial thigh volume in patients with lipoedema was 23,785.4 mL (95% confidence interval [CI] 22,316.6-25,254.1). Thigh volumes decreased significantly in lipoedema and control patients (baseline vs. 1st follow-up, p < 0.0001 and p = 0.0001; baseline vs. 2nd follow-up, p < 0.0001 and p = 0.0013). Adjusted thigh volume reduction amounted to 33.4 and 37.0% in the lipoedema and control groups at the 1st follow-up, and 30.4 and 34.7% at the 2nd follow-up, respectively (lipoedema vs. control p > 0.999 for both). SG and RYGB led to an equal reduction in leg volume (operation type × time, p = 0.83). Volume reduction was equally effective in obese and superobese patients (weight category × time, p = 0.43). Conclusion: SG and RYGB lead to a significant thigh volume reduction in patients with lipoedema.
... In adults, homeostasis of adipose tissue mass is controlled by a negative feedback loop comprised of the hormone leptin and a set of neural targets that regulate food intake and metabolism (Friedman and Halaas, 1998). Surgical lipectomy leads to restoration of the removed fat presumably as a result of reduced levels of leptin (Hernandez et al., 2011;Reyne et al., 1983;Knittle and Hirsch, 1968). Reduced leptin signaling also leads to obesity in ob mice that lack leptin, and in animals fed a high fat diet (HFD) which causes leptin resistance (Friedman and Halaas, 1998). ...
Article
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Adipogenesis in adulthood replaces fat cells that turn over and can contribute to the development of obesity. However, the proliferative potential of adipocyte progenitors in vivo is unknown (Faust et al., 1976; Faust et al., 1977; Hirsch and Han, 1969; Johnson and Hirsch, 1972). We addressed this by injecting labeled wild-type embryonic stem cells into blastocysts derived from lipodystrophic A-ZIP transgenic mice, which have a genetic block in adipogenesis. In the resulting chimeric animals, wild-type ES cells are the only source of mature adipocytes. We found that when chimeric animals were fed a high-fat-diet, animals with low levels of chimerism showed a significantly lower adipose tissue mass than animals with high levels of chimerism. The difference in adipose tissue mass was attributed to variability in the amount of subcutaneous adipose tissue as the amount of visceral fat was independent of the level of chimerism. Our findings thus suggest that proliferative potential of adipocyte precursors is limited and can restrain the development of obesity.
... In adults, homeostasis of adipose tissue mass is controlled by a negative feedback loop comprised of the hormone leptin and a set of neural targets that regulate food intake and metabolism (Friedman and Halaas, 1998). Surgical lipectomy leads to restoration of the removed fat presumably as a result of reduced levels of leptin (Hernandez et al., 2011;Reyne et al., 1983;Knittle and Hirsch, 1968). Reduced leptin signaling also leads to obesity in ob mice that lack leptin, and in animals fed a high fat diet (HFD) which causes leptin resistance (Friedman and Halaas, 1998). ...
Article
Full-text available
Adipogenesis in adulthood replaces fat cells that turn over and can contribute to the development of obesity. However, the proliferative potential of adipocyte progenitors in vivo is unknown (Faust et al., 1976; Faust et al., 1977; Hirsch and Han, 1969; Johnson and Hirsch, 1972). We addressed this by injecting labeled wild-type embryonic stem cells into blastocysts derived from lipodystrophic A-ZIP transgenic mice, which have a genetic block in adipogenesis. In the resulting chimeric animals, wild-type ES cells are the only source of mature adipocytes. We found that when chimeric animals were fed a high-fat-diet, animals with low levels of chimerism showed a significantly lower adipose tissue mass than animals with high levels of chimerism. The difference in adipose tissue mass was attributed to variability in the amount of subcutaneous adipose tissue as the amount of visceral fat was independent of the level of chimerism. Our findings thus suggest that proliferative potential of adipocyte precursors is limited and can restrain the development of obesity.
... In adults, homeostasis of adipose tissue mass is controlled by a negative feedback loop comprised of the hormone leptin and a set of neural targets that regulate food intake and metabolism (Friedman and Halaas, 1998). Surgical lipectomy leads to restoration of the removed fat presumably as a result of reduced levels of leptin (Hernandez et al., 2011;Reyne et al., 1983;Knittle and Hirsch, 1968). Reduced leptin signaling also leads to obesity in ob mice that lack leptin, and in animals fed a high fat diet (HFD) which causes leptin resistance (Friedman and Halaas, 1998). ...
Article
Full-text available
Adipogenesis in adulthood replaces fat cells that turn over and can contribute to the development of obesity. However, the proliferative potential of adipocyte progenitors in vivo is unknown (Faust et al., 1976; Faust et al., 1977; Hirsch and Han, 1969; Johnson and Hirsch, 1972). We addressed this by injecting labeled wild-type embryonic stem cells into blastocysts derived from lipodystrophic A-ZIP transgenic mice, which have a genetic block in adipogenesis. In the resulting chimeric animals, wild-type ES cells are the only source of mature adipocytes. We found that when chimeric animals were fed a high-fat-diet, animals with low levels of chimerism showed a significantly lower adipose tissue mass than animals with high levels of chimerism. The difference in adipose tissue mass was attributed to variability in the amount of subcutaneous adipose tissue as the amount of visceral fat was independent of the level of chimerism. Our findings thus suggest that proliferative potential of adipocyte precursors is limited and can restrain the development of obesity.
... In particular, gluteo-femoral adipose tissues may play a key role in determining the level of central adiposity and hence the susceptibility to cardiometabolic consequences of adiposity. Recent RCTs have suggested that peripheral fat storage could protect from the expansion of central fat depots among women.283 Therefore, the increased susceptibility to CHD observed for central body fat distribution measures among women could be the result of a reduction in 'cardio-protective' ...
Thesis
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Background Excess adiposity is a known risk factor for coronary heart disease (CHD). However, the underlying mechanisms have not been fully elucidated, and the relevance of different adiposity phenotypes remains unclear. Methods The UK Biobank is a prospective study of 500 000 adults enrolled between 2006 and 2010 across the UK. Correlates of adiposity at baseline were explored for established and emerging cardiovascular risk factors. Cox regression analyses were used to obtain adjusted hazard ratios (HRs) for the associations of usual levels of body-mass index (BMI), body fat %, trunk fat % , waist circumference (WC), waist-to-height ratio (WHTR) and waist-to-hip ratio (WHR), or with genetically elevated BMI-adjusted WHR (WHRadjBMI) and BMI with incident CHD. Results Among 455 148 participants without prior cardiovascular disease, 13 114 first-ever CHD events occurred over a mean follow-up period of 8 years. Measurement error and within-person variability was less extreme for BMI (regression dilution ratio: 0.92) than other measures, particularly WHR (0.66). Adiposity measures were closely correlated with each other at baseline, as well as with a number of socio-demographic, lifestyle and biological characteristics. In analyses adjusted for age, sex, socio-economic status, smoking and alcohol consumption, increasing usual levels of adiposity (i.e. corrected for regression dilution) were positively and log-linearly associated with CHD risk across all measures. Associations were notably stronger for central adiposity, particularly WHR (HR per usual SD 1.34, 95% CI 1.31-1.38) compared with BMI (1.24, 1.22-1.26). The relevance of usual WHR to CHD was particularly strong among women (1.41, 1.35-1.48), and remained strongly associated with CHD after adjustment for BMI. The observed prospective associations were partially mediated by blood pressure, lipids and insulin resistance, which explained at least half of the observed excess risk. Additional adjustment for glomerular filtration rate, liver enzymes and inflammatory markers completely attenuated associations with all measures except WHTR and WHR, which remained independently associated with CHD risk. Genetically elevated adiposity measures were associated with CHD risk (HR per SD higher WHRadjBMI: 1.31, 1.11 – 1.55; BMI: 1.22, 1.06 - 1.41), and with cardiometabolic traits. Conclusion Adiposity measures demonstrated strong, positive and approximately log-linear associations with CHD risk, with no evidence of threshold effects within the ranges studied in this UK population. Central body fat distribution was associated with higher CHD risk compared with BMI and likely involves distinct and independent mechanisms.
... Conversely, women accumulate subcutaneous fat in the gluteofemoral area [172,173]. Interestingly, liposuction of thigh fat is followed by re-accumulation of fat in the abdominal area, suggesting a protective role of peripheral fat storage from the expansion of central fat depots [174]. ...
Article
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This paper reviews our present knowledge on the contribution of ceramide (Cer), sphingomyelin (SM), dihydroceramide (DhCer) and sphingosine-1-phosphate (S1P) in obesity and related co-morbidities. Specifically, in this paper, we address the role of acyl chain composition in bodily fluids for monitoring obesity in males and females, in aging persons and in situations of environmental hypoxia adaptation. After a brief introduction on sphingolipid synthesis and compartmentalization, the node of detection methods has been critically revised as the node of the use of animal models. The latter do not recapitulate the human condition, making it difficult to compare levels of sphingolipids found in animal tissues and human bodily fluids, and thus, to find definitive conclusions. In human subjects, the search for putative biomarkers has to be performed on easily accessible material, such as serum. The serum “sphingolipidome” profile indicates that attention should be focused on specific acyl chains associated with obesity, per se, since total Cer and SM levels coupled with dyslipidemia and vitamin D deficiency can be confounding factors. Furthermore, exposure to hypoxia indicates a relationship between dyslipidemia, obesity, oxygen level and aerobic/anaerobic metabolism, thus, opening new research avenues in the role of sphingolipids.
... Sometimes, you even gain more than what you lost and that's called the rebound phenomenon. Even in liposuction wherein we literally remove subcutaneous fat, if the patient cannot maintain weight before the surgical procedure was done; fat will be re-deposited in the visceral area w/c is definitely bad if not worse [17]. So what is the secret to achieving weight loss, weight maintenance? ...
Article
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... Die Lübecker Kollegen ignorieren hierbei die Bedeutung der Zunahme an vorwiegend viszeralem Fett in der Abdominalregion, was bekanntlich mit einem erhöhten kardiovaskulären Risiko einhergeht. Dieses nach Liposuktion beobachtbare Phänomen wurde bereits in der -in den USA vielbeachteten -prospektiven, randomisiert-kontrollierten Studie der Kollegen der University of Colorado bestätigt [12]. ...
Article
Das Erfreuliche an Leserbriefen ist die Möglichkeit der Replik, in der im Artikel offensichtlich unzureichend präzise Dargestelltes präzisiert werden kann. Dass die wissenschaftliche Auseinandersetzung um das Lipödem bei den Lesern der Phlebologie auf großes Interesse stößt, zeigt auch die Rankingliste der „meistgelesenen“ Artikel dieser Zeitschrift, in der sowohl unsere Artikel über die Mythen des Lipödems als auch die Leserbriefe zu diesen Artikeln unter den Top Ten platziert sind 1. Insofern danken wir den Autoren aus Lübeck für die Gelegenheit, ihre erwähnten Kritikpunkte aufzugreifen. Bemerkenswert erscheint uns in diesem Zusammenhang, dass zu unserer Artikelserie bislang nur Leserbriefe von die Liposuktion durchführenden Kollegen die Redaktion erreicht haben – nicht eine kritische Rückmeldung erhielten wir bisher von konservativen Behandlern.
... This procedure has also been employed experimentally through parietal LIPEC, presenting controversial results concerning compensatory increases of WAT and the mobility of lipids among fat territories. This controversy is observed in both experimental [12,13] and clinical studies [14][15][16][17]. Strong evidence points to changes taking place in the parietal WAT after its resection, including fat deposition in non-lipectomized areas. ...
Article
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Background Mobility of fat deposited in adipocytes among different fatty territories can play a crucial role in the pathogenesis of obesity-related diseases. Our goal was to investigate which of the remaining fat pads assume the role of accumulating lipids after surgical removal of parietal WAT (lipectomy; LIPEC) in rats of both sexes displaying MSG-induced obesity. Methods The animals entered the study straight after birth, being separated according to gender and randomly divided into CON (control, saline-treated) and MSG (monosodium glutamate-treated) groups. Next, the animals underwent LIPEC or sham-operated surgery (SHAM). Obesity was induced by the injection of MSG (4 mg/g/day) during neonatal stage (2nd to 11th day from birth). LIPEC was performed on the 12th week, consisting in the withdrawal of parietal WAT. On the 16th week, the following WATs were isolated and collected: peri-epididymal-WAT (EP-WAT); parametrial-WAT (PM-WAT); omental-WAT (OM-WAT); perirenal-WAT (PR-WAT) and retroperitoneal-WAT (RP-WAT). Results The adiposity index was significantly increased in both male (3.2 ± 0.2** vs 1.8 ± 0.1) and female (4.9 ± 0.7* vs 2.6 ± 0.3) obese rats compared to their respective control groups. LIPEC in obese animals produced fat accumulation in visceral fat sites in a more accentuated manner in female (3.6 ± 0.3** vs 2.8 ± 0.3 g/100 g) rather than in male (1.8 ± 0.2* vs 1.5 ± 0.1 g/100 g) rats compared to obese non-lipectomized animals. Among the visceral WATs, the greater differences were observed between gonadal WATs of obese lipectomized rats, with higher accumulation having been observed in PM-WAT (2.8 ± 0.3* vs 2.1 ± 0.2 g/100 g) rather than in EP-WAT (1.0 ± 0.1 ± 0.9 ± 0.1 g/100 g) when compared to obese non-lipectomized animals. Conclusions The results of the present study led us to conclude that obesity induced by MSG treatment occurs differently in male and female rats. When associated with parietal LIPEC, there was a significant increase in the deposition of visceral fat, which was significantly higher in obese female rats than in males, indicating that fat mobility among WATs in lipectomized-obese rats can occur more expressively in particular sites of remaining WATs.
... Metabolic out- comes of peripheral adipose tissue removal have also been examined in humans, but these studies have inherent experimental limitations due to variations in amount of adipose tissue removed, study duration and age range. 18- 22 Yet, studies by Hernandez et al. support that subcuta- neous adipose tissue is protective because its removal caused redistribution of lipids to the abdomen 20 and wor- sened postprandial blood lipid concentration. 23 Rodent research supports and extends findings in humans. ...
Article
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The protective effects of lower body subcutaneous adiposity are linked to the depot functioning as a ”metabolic sink” receiving and sequestering excess lipid. This postulate, however, is based on indirect evidence. Mechanisms that mediate this protection are unknown. Here we directly examined this with progressive subcutaneous adipose tissue removal. Ad libitum chow fed mice underwent sham surgery, unilateral or bilateral removal of inguinal adipose tissue or bilateral removal of both inguinal and dorsal adipose tissue. Subsequently mice were separated into 5 week chow or 5 or 13 week HFD groups (N = 10 per group). Primary outcome measures included adipocyte distribution, muscle and liver triglycerides, glucose tolerance, circulating adipocytokines and muscle insulin sensitivity. Subcutaneous adipose tissue removal caused lipid accumulation in femoral muscle proximal to excision, however, lipid accumulation was not proportionally inverse to adipose tissue quantity excised. Accumulative adipose removal was associated with an incremental reduction in systemic glucose tolerance in 13 week HFD mice. Although insulin-stimulated pAkt/Akt did not progressively decrease among surgery groups following 13 weeks of HFD, there was a suppressed pAkt/Akt response in the non-insulin stimulated (saline-injected) 13 week HFD mice. Hence, increases in lower body subcutaneous adipose removal resulted in incremental decreases in the effectiveness of basal insulin sensitivity of femoral muscle. The current data supports that the subcutaneous depot protects systemic glucose homeostasis while also protecting proximal muscle from metabolic dysregulation and lipid accumulation. Removal of the “metabolic sink” likely leads to glucose intolerance because of decreased storage space for glucose and/or lipids.
... In contrast, selective SAT removal is associated with worse metabolic profiles in both animals and humans, indicating that SAT acts as a metabolic sink and protects against metabolic syndrome [68,69]. This is further exemplified by adipose redistribution from SAT to VAT following liposuction [70]. Studies in premenopausal women show that SAT through its highly active LPL takes up most of the fatty acids from circulation and meals, acting as a metabolic sink preventing ectopic fat accumulation in liver and muscle [71]. ...
Article
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Purpose of review: Sex differences are pervasive in metabolic and cardiovascular traits, yet they have often been ignored in human and animal model research. Sex differences can arise from reversible hormonal effects, from irreversible organizational (developmental) processes, and from gene expression differences from the X and Y chromosomes. We briefly review our current understanding of the impact of these factors in metabolic traits and disorders, with an emphasis on the recent literature. Recent findings: Novel sex differences continue to be identified for metabolic and cardiovascular traits. For example, it is now clear that gut microbiota tend to differ between men and women, with potentially large implications for disease susceptibility. Also, tissue-specific gene regulation differs between men and women, contributing to differential metabolism. These new insights will open up personalized therapeutic avenues for cardiometabolic diseases. Summary: Sex differences in body fat distribution, glucose homeostasis, insulin signaling, ectopic fat accumulation, and lipid metabolism during normal growth and in response to hormonal or nutritional imbalance are mediated partly through sex hormones and the sex chromosome complement. Most of these differences are mediated in a tissue-specific manner. Important future goals are to better understand the interactions between genetic variation and sex differences, and to bring an understanding of sex differences into clinical practice.
... По факту удаление подкожного жира вело к снижению количества подкожных адипоцитов, обеспечивающих безопасное накопление жира, что определяло накопление избыточного жира в висцеральном депо и эктопически в печени. Реаккумуляция жира в организме после липосакции у людей также связана с перераспределением от подкожного до висцерального отложения жира [43]. Эти данные свидетельствуют о том, что удаление ПЖТ повышает риск метаболических нарушений, поскольку лишает организма буфера для отложения триглицеридов. ...
Article
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Sex differences in regulation of adipose tissue Sulaieva ON, Belemets NI This review is focused on sex differences in regulation of adipose tissue. The heterogeneity of structural and functional features as well as differences in regulation of visceral and subcutaneous adipose tissues are discussed. It was shown that estrogens have pleiotropic protective impact by direct influence on adipocytes and indirect effect through hypothalamic regulation of sympathetic innervation of adipose tissue, modulating lipolysis, proliferation of preadipocytes and hyperplasia, as well as transformation of white adipocytes to brown ones. The high volume of subcutaneous adipose tissue in women is determined by the effects of estrogens and is the main factor that provides female special resistance to metabolic diseases. In general, an increase of subcutaneous fat is more favorable for metabolic profile. In contrast, visceral fat depot is associated with insulin resistance and the development of associated pathology. Key words: adipose tissue, sex differences, oestrogen, visceral and subcutaneous fat, white and brown adipocytes
... In rodents and humans with an intact leptin axis, changes in body weight imposed by either overfeeding or dietary restriction are rapidly reversed when ad libitum feeding is resumed by coordinate reduced energy expenditure and hyperphagia [1,2]. In addition, when non-obese individuals undergo liposuction, adipose tissue is redistributed to other depots, leading to the same overall level of adiposity within a year [3]. These observations support the concept that individuals regulate their body weight and adiposity at a level ("set point") influenced by genetics, developmental factors, and the environment. ...
Article
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Maintenance of reduced body weight is associated both with reduced energy expenditure per unit metabolic mass and increased hunger in mice and humans. Lowered circulating leptin concentration, due to decreased fat mass, provides a primary signal for this response. However, leptin deficient (Lepob/ob) mice (and leptin receptor deficient Zucker rats) reduce energy expenditure following weight reduction by a necessarily non-leptin dependent mechanisms. To identify these mechanisms, Lepob/ob mice were fed ad libitum (AL group; n = 21) or restricted to 3 kilocalories of chow per day (CR group, n = 21). After losing 20% of initial weight (in approximately 2 weeks), the CR mice were stabilized at 80% of initial body weight for two weeks by titrated refeeding, and then released from food restriction. CR mice conserved energy (-17% below predicted based on body mass and composition during the day; -52% at night); and, when released to ad libitum feeding, CR mice regained fat and lean mass (to AL levels) within 5 weeks. CR mice did so while their ad libitum caloric intake was equal to that of the AL animals. While calorically restricted, the CR mice had a significantly lower respiratory exchange ratio (RER = 0.89) compared to AL (0.94); after release to ad libitum feeding, RER was significantly higher (1.03) than in the AL group (0.93), consistent with their anabolic state. These results confirm that, in congenitally leptin deficient animals, leptin is not required for compensatory reduction in energy expenditure accompanying weight loss, but suggest that the hyperphagia of the weight-reduced state is leptin-dependent.
Article
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Background Liposuction, an increasingly common cosmetic therapy, has been found to impact metabolic parameters in addition to aesthetics. This meta-analysis assesses the effects on weight, lipid profiles, glucose levels and insulin sensitivity. Materials and Methods A thorough literature search was conducted across PubMed, Web of Science, Cochrane Library and Scopus up to January 2024. The included studies reported on weight reduction or metabolic outcomes post-liposuction. Statistical analysis was performed using RevMan 5.4, utilising a random effects model. Results A total of 23 studies involving 779 participants were included. Significant weight reduction was observed post-liposuction (MD = −2.28 kg, 95% confidence interval [CI]: −3.14–−1.41; P < 0.00001). In addition, body mass index (BMI) decreased significantly (MD = −3.66 kg/m², 95% CI: −5.63–−1.70; P = 0.0003). Glucose levels and insulin serum concentration showed significant reductions (MD = −5.20 mg/dL, 95% CI: −8.02–−2.39; P = 0.0003; I ² = 79%) and (MD = −3.39, 95% CI: −4.56–−2.42; P < 0.00001; I ² = 74%), respectively. Changes in lipid profiles were variable: liposuction led to a non-significant reduction in low-density lipoprotein cholesterol levels (MD = −5.31 mg/dL, 95% CI: −19.43–8.81; P = 0.46) and total cholesterol levels (MD = −8.02 mg/dL, 95% CI: −20.17–4.12; P = 0.20). High-density lipoprotein cholesterol levels remained largely unchanged (MD = 0.99 mg/dL, 95% CI: −1.30–3.27; P = 0.40). Leptin and adiponectin levels also did not show a significant change. Conclusions Liposuction significantly reduces weight, BMI, glucose levels and insulin serum concentration, suggesting potential metabolic benefits. However, effects on lipid profiles and other metabolic markers are inconsistent, highlighting the need for further targeted research. The variability among studies underscores the complexity of liposuction’s systemic effects.
Article
Reactive oxygen species, when produced in a controlled manner, are physiological modulators of healthy white adipose tissue (WAT) expansion and metabolic function. By contrast, unbridled production of oxidants is associated with pathological WAT expansion and the establishment of metabolic dysfunctions, most notably insulin resistance and type 2 diabetes mellitus. NADPH oxidases (NOXs) produce oxidants in an orderly fashion and are present in adipocytes and in other diverse WAT‐constituent cell types. Recent studies have established several links between aberrant NOX‐derived oxidant production, adiposity, and metabolic homeostasis. The objective of this review is to highlight the physiological roles attributed to diverse NOX isoforms in healthy WAT and summarize current knowledge of the metabolic consequences related to perturbations in their adequate oxidant production. We detail WAT‐related alterations in preclinical investigations conducted in NOX‐deficient murine models. In addition, we review clinical studies that have employed NOX inhibitors and currently available data related to human NOX mutations in metabolic disturbances. Future investigations aimed at understanding the integration of NOX‐derived oxidants in the regulation of the WAT cellular redox network are essential for designing successful redox‐related precision therapies to curb obesity and attenuate obesity‐associated metabolic pathologies.
Chapter
Sex differences exist in adipocyte function and accumulation. Men tend to accumulate more visceral fat, which contributes to the male body shape (android) and increases cardiovascular risk. Women store more fat in their subcutaneous tissue before menopause, which provides protection against metabolic changes associated with obesity and metabolic syndrome. After menopause, women also accumulates more visceral fat, which is associated with increased risk of cardiovascular diseases seen in men. Estrogen can regulate adipose tissue function and fat deposition both directly and indirectly (through activation of receptors in adipocytes and adipose tissues). Estrogen can activate the sympathetic nervous system, which leads to more adiposity in subcutaneous fat in women. Estrogen and estrogen receptors can increase subcutaneous fat in adipocytes and inhibit accumulation of visceral fat.
Article
Liposuction is one of the most common procedures used for body contouring. In this study, we aimed to determine whether there is a weight change with VASER-assisted liposuction (VAL) procedure and the demographic factors affecting it. A total of 51 patients (30 females and 21 males) who underwent VAL between the years of 2020 and 2022 were included in the study. Participants’ weights before VAL, body mass indexes (BMI), aspiration volumes, demographic data, and weights and BMIs one month after VAL were recorded and analyzed. In addition, the fat ratio in the aspirate was determined in ten patients. The mean aspiration volume with VAL was 4832.50 ± 2373.26 ml in females and 5176.90 ± 1602.61 ml in males. Body weights (baseline, 90.34 ± 9.17 vs. 71.01 ± 8.87; one month later, 86.95 ± 8.34 vs. 66.28 ± 10.04: p < 0.001) and BMIs (baseline, 28.59 ± 2.97 vs. 26.40 ± 3.69; one month later, 27.54 ± 2.92 vs. 24.59 ± 3.76: p = 0.009) were higher in males than females, both at baseline and after VAL. There was a significant decrease in body weights and BMIs after VAL in both females (4.73 ± 4.73 kg) and males (3.39 ± 4.27 kg) (p < 0.001). However, no correlation was observed between the decrease in body weights and BMIs after VAL and gender, age, aspirate volume, and fat volume. Although there was a decrease in mean body weight and mean BMI in both males and females one month after VAL, no associations were observed between weight drop after VAL and gender, age, aspiration volume, and fat volume. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Article
Background: Obesity poses a major risk for cardiovascular diseases, while it is almost a consensus that intra-abdominal adiposity has a more deleterious effect for metabolic syndrome. In this sense, it is speculated that lipectomy or liposuction would be metabolically harmful, as it changes the abdominal-superficial adipose tissue ratio. However, the literature has shown conflicting evidence. Methods: In order to evaluate the possibility of metabolism alteration resulting from body coutouring surgery, a prospective cohort was implemented with 35 patients who underwent abdominoplasty, including some with a history of massive weight loss. Fasting blood glucose, fasting plasma insulin, triglycerides, total cholesterol and fractions were requested preoperatively and in the third postoperative month. The groups were also compared with each other. Results: No statistically significant variation between the exams collected in the preoperative period and those collected after abdominoplasty was found. There was a statistically significant difference in LDL (low-density lipoprotein; p = 0.033) and non-HDL (non-high-density lipoprotein) cholesterol (p = 0.020) between the two control tests of the groups surveyed. There were also differences in comorbidities (p = 0.006) and complications (p <0.001) between the groups. Conclusions: Abdominoplasty was not able of changing tests that assess glycemic and lipid metabolism three months after the operation. Our attention was drawn to the fact that patients who had massive weight loss had better control of LDL cholesterol (p = 0.033) and non-HDL cholesterol (p = 0.020), despite having higher weight and body mass index (p <0.001).
Article
Background: Fat manipulation procedures, such as liposuction, contain a degree of subjectivity primarily guided by the surgeon's visual or tactile perception of the underlying fat. Currently, there is no cost-effective and direct method to objectively measure fat depth and volume in real-time. Objectives: Using innovative ultrasound-based software, the authors aim to validate fat tissue volume and distribution measurements in the preoperative setting. Methods: Eighteen participants were recruited to evaluate the accuracy of the new software. Recruited participants underwent ultrasound scans within the preoperative markings of the study area before surgery. Ultrasound estimated fat profiles were generated using the in-house software and compared directly with the intra-operative aspirated fat recorded after gravity separation. Results: Participants' mean age and BMI were 47.6 (11.3) years and 25.6 (2.3) kg/m2, respectively. Evaluation of trial data showed promising results following the use of a Bland Altman agreement analysis. For the 18 patients and 44 volumes estimated, 43/44 measurements fall within an agreement of 95% compared to the clinical lipoaspirate (dry) volumes collected post-surgery. The bias was estimated at 9.15 mL with a standard deviation of 17.08 mL and 95 % confidence limits of -24.34 mL and 42.63 mL. Conclusions: Preoperative fat assessment measurements agree significantly with intraoperative lipoaspirate volumes. The pilot study demonstrates, for the first time, a novel companion tool with the prospect of supporting surgeons in surgical planning, measuring, and executing the transfer of adipose tissues.
Article
Disturbances inbody weight and adiposity in both humans and animals are met by compensatory adjustments in energy intake and energy expenditure, suggesting that body weight or fat is regulated. From a clinical viewpoint, this is likely to contribute to the difficulty that many people with obesity have in maintaining weight loss. Finding ways to modify these physiologic responses is likely to improve the long-term success of obesity treatments.
Chapter
Fat defines our body shape and our body shape often reflects our biological destiny. The regional distribution of fat emerges from the complex interplay between many players, particularly hormones, genetics, and epigenetics. Several external factors can shift this dynamic balance though, such as exercise or drugs (by design or as an unintended side effect), whereas surgical interventions that modify regional fat mass can have good, bad, or ugly consequences. This chapter draws upon the concepts introduced in previous chapters to understand how a number of different factors and interventions influence body fat distribution and considers the associated health consequences.
Article
Objectives To investigate whether BclI polymorphism in the glucocorticoid receptor gene influences hypothalamic-pituitary-adrenal (HPA) axis regulation, body composition and metabolic parameters in women with adrenal incidentalomas (AIs). Study design A cross-sectional study. Main outcome measures We analyzed 106 women with AIs. Insulin resistance was assessed using a homeostasis model while HPA activity was assessed using dexamethasone suppression tests (DST), basal ACTH, urinary free cortisol, and midnight serum cortisol level. Body composition was analyzed using dual-energy X-ray absorptiometry. DNA was obtained from peripheral blood leucocytes and BclI polymorphism was detected using PCR, RFLP and DNA sequencing. Results BclI carriers in comparison with those with wild-type BclI had less suppressed cortisol after DST-0.5 mg (126.4 ± 111.4 vs 80.9 ± 75.7 nmol/l, p = 0.026) and had a lower prevalence of impaired glucose tolerance and of type 2 diabetes mellitus (T2DM). BclI carriers had a higher percentage of leg fat mass (FM), lower left-sided limb muscle mass and a decline in total lean body mass. Duration of menopause remained a strong predictor of appendicular lean mass index (ALMI) (β=-0.125, p = 0.034). BclI polymorphism was significantly associated with sum of legs FM percentage (β=0.327, p = 0.048). T2DM was negatively associated with BclI polymorphism, after adjusting for age, truncal FM, ALMI, and sum of legs FM (OR=0.158, 95%CI 0.031–0.806, p = 0.027). Conclusions BclI polymorphism is associated with tissue-specific glucocorticoid sensitivity, relative glucocorticoid resistance of the HPA axis and peripheral adipose tissue, and glucocorticoid hypersensitivity at the muscle level. By modulating glucocorticoid and insulin sensitivity, BclI polymorphism appears to reduce the risk of T2DM in women with AIs.
Chapter
Buttock fat transfer is now the preferred method for gluteal augmentation. However, its efficacy has not been well-documented using measurements. Objectivity is needed as part of evidence-based medicine. To evaluate gluteal fat augmentation, the author evaluated 21 patients who underwent buttock fat transfer and compared them with 25 controls. Subcutaneous fat thickness was measured using depth measurements on ultrasound images. Measurements were also made on standardized before-and-after photographs. The mean fat volume injected per buttock was 287 ml (range, 70–550 ml). Ultrasound measurements detected a significant increase in the thickness of the subcutaneous fat (p ≤ 0.001), with mean increments of 0.66 cm for the right buttock and 0.86 cm for the left buttock, and no significant change for control patients. The mean calculated fat retention, based on the measured surface area injected, was 66%. Photographic measurements of buttock projection revealed a significant increase in treated patients (p < 0.01) and no significant change in control patients. There were no clinical complications at either recipient or donor sites and no evidence of oily cysts on ultrasound examinations. Photographic and ultrasound measurements are effective tools to evaluate changes in gluteal volume. The findings confirm that fat transfer effectively and safely increases buttock projection. This method may be used to compare buttock fat transfer techniques in future studies.
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Background: Weight loss is traditionally viewed as straightforward counting of calories in and calories out, with little regard to the role of the adipocytes tasked with storing said calories. However, the body executes a complex compensatory response to any intervention that depletes its energy stores. Here, the authors discuss the methods used to attain weight loss, the body's response to this weight loss, and the difficulties in maintaining weight loss. Furthermore, the authors provide an overview of the literature on the physiological effects of liposuction. Objective: To describe the role of adipose tissue in energy homeostasis, methods of weight loss, weight regain, and the effect of liposuction on endocrine signaling. Methods: The authors conducted a narrative review of representative studies. Conclusion: A variety of strategies for weight loss exist, and optimizing one's weight status may in turn optimize the aesthetic outcomes of liposuction. This is most apparent in the preferential reaccumulation of fat in certain areas after liposuction and the ability to avoid this with a negative energy balance.
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Adipose tissue is the largest dynamic organ system involved in energy storage as well as endocrine and immunological functions and, therefore, plays an important role in regulating aging and longevity. During aging, adipose tissue undergoes dramatic changes in mass, distribution, cellular composition, secretory profiles, and insulin responsiveness, leading to adipose tissue dysfunction. These changes, including the ectopic lipid deposition, accumulation of senescent cells, infiltration of immune cells, and increased secretion of proinflammatory cytokines and chemokines, not only have secondary physiological effects on a variety of organs, leading to multiorgan dysfunction and disability, but also importantly link with metabolic dysfunction and chronic low-grade systemic inflammation known as ‘inflamm-aging,’ which can be further exacerbated by age-related obesity. Adipose tissue is also frequently involved in bariatric surgeries and plastic and reconstructive surgeries. These intimate relationships make therapeutic targeting of adipose tissue an attractive approach for combating metabolic diseases, improving life quality, and extending lifespan.
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The features of clinical symptoms, neurotic disorders and the level of subjective control were studied in patients with fibromyalgia. The analysis of relationship between the level of subjective control and neurotic symptoms (asthenia, depression, anxiety, hypochondria) depending the severity of main clinical manifestations of the disease was carried out. It was found that high intensity of fatigue, muscle pain, stiffness, insomnia, and an increase in the number of diagnostic tender points contribute to the formation of inverse correlation between the level of subjective control and neurotic disturbances. Thus, the increase of the externality of the level of subjective control allows indicating to the formation of patients' passivity in relation to their disease, the lack of adherence to prescribed course of treatment (low compliance). Although drug therapy is the main component of complex treatment of fibromyalgia patients, patients require significantly more - successful treatment requires active involvement of patients in the therapy process, as well as changes in their attitudes and lifestyle, which can be achieved by training in so-called "schools" for patients, use of psychotherapeutic methods.
Chapter
Some investigators believe that fat returns after liposuction. To evaluate this possibility, the author undertook a prospective study among predominantly nonobese consecutive patients undergoing 301 liposuction and abdominoplasty procedures. Lower body dimensions were measured using standardized photographs taken before and at least 3 months after surgery.
Chapter
The metabolic effect of liposuction has been poorly understood. In the absence of reliable data, some investigators speculate that liposuction may cause a metabolic imbalance, causing the body to gain weight to compensate for lost fat cells. The possibility that removing subcutaneous fat may cause a deleterious increase in the relative proportion of the “bad” visceral fat volume has been considered.
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The global obesity epidemic enhanced contemporary interest in adipose tissue biology. Two structurally and functionally distinct depots, subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), are spread throughout the body. Their distribution was recognized to be a major determinant of metabolic risk. Unlike VAT, SAT showed some protective endocrine and inflammatory features that might explain the occurrence of obese but metabolically healthy persons. The unique developmental gene expression signature, angiogenesis, and adipogenic potential of SAT determines its growth ability under the positive energy balance. The overflow hypothesis suggested that when SAT is unable to expand sufficiently, fat overflows towards metabolically adverse ectopic depots. Besides white adipose tissue, recent studies found important brown adipose tissue activity responsible for thermogenesis and energy dissipation in adults as well. SAT is prone to "browning" - the appearance of particular beige adipocytes that contribute to its favorable metabolic effects. Morbid obesity, aging, hormonal status, nutrition, low physical activity, and other environmental factors impair SAT relative resistance to dysfunctional changes and promote development of metabolic disorders. The popular approach considering SAT mainly as the subject of cosmetic procedures for improving the appearance of body contours should be avoided. Complex heterogeneity of obesity revealed that a tissue of an extreme plasticity and rich interactions with vital functions of the body lies under the surface. Therapeutic manipulations to preserve and enhance healthier fat in order to correct obesity-related metabolic disorders seem to be a relevant but still unexplored opportunity.
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Adipose tissue is a metabolically active tissue. The hypertrophic fat cells of obese patients produce increased quantities of leptin and tumor necrosis factor-alpha (TNF-alpha) and are less sensitive to insulin. This study aimed to determine whether aspirating large amounts of these subcutaneous fat cells by large-volume liposuction (LVL), could change the metabolic profile in 123 obese women. All the patients had a main central body fat distribution (waist-hip ratio, 0.91+/-0.01) and a body mass index of 32.8 +/- 0.8 kg/m). They were studied for 90 days after LVL to determine their changes in insulin sensitivity, resting metabolic rate, serum adipocytokines, and inflammatory marker levels. During 3 months of follow-up evaluation, LVL resulted in a significantly improved insulin sensitivity, resting metabolic rate, serum adipocytokines, and inflammatory marker levels. Such parameters correlate with a decrease in fat mass and waist-hip ratio. Interestingly, no significant changes were seen between the first (21 days) and second (90 days) metabolic determinations after LVL. However, these findings, confirm other preliminary data published previously, and could change the actual role of LVL in the multidisciplinary treatment of obesity.
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The most common surgical procedure for obesity is liposuction, the majority of which are small-volume procedures. The effect of large-volume liposuction on cardiovascular risk and insulin sensitivity has been variable. This study was performed to evaluate the effect of the more common, smaller-volume liposuction on insulin sensitivity, inflammatory mediators, and cardiovascular risk factors. In all, 15 overweight or obese premenopausal women underwent metabolic evaluation prior to, 1 day following and 1 month following suction lipectomy of the abdomen. Metabolic evaluation included assessment of free fatty acids, glucose, insulin, insulin sensitivity by frequently sampled i.v. glucose tolerance test, and adipokines (IL-6, angiotensin II, leptin, PAI-1, adiponectin, and TNF-alpha). Free fatty acids did not change acutely although there was an almost 30% decrease in free fatty acids at 1 month. Fasting insulin levels decreased at one month from 8.3 +/- 1.1 to 5.6 +/- 1.3 microU/ml (P = 0.006). Insulin sensitivity by i.v. glucose tolerance test did not change at 1 month (4.0 +/- 0.8 to 5.0 +/- 0.7, P = 0.12) although with subgroup analysis insulin sensitivity improved in obese but not overweight participants. Several adipokines worsened acutely (IL-6 increased 15 fold and angiotensin II increased 67%), but there was no change in PAI-1, and other adipokines (adiponectin, leptin, and TNF-alpha) decreased. At the 1-month follow-up, all adipokines were similar to baseline. This study provides little evidence supporting increased or decreased cardiovascular risk although there is evidence supporting improved insulin sensitivity at one month, especially in obese women.
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Methods for the quantification of beta-cell sensitivity to glucose (hyperglycemic clamp technique) and of tissue sensitivity to insulin (euglycemic insulin clamp technique) are described. Hyperglycemic clamp technique. The plasma glucose concentration is acutely raised to 125 mg/dl above basal levels by a priming infusion of glucose. The desired hyperglycemic plateau is subsequently maintained by adjustment of a variable glucose infusion, based on the negative feedback principle. Because the plasma glucose concentration is held constant, the glucose infusion rate is an index of glucose metabolism. Under these conditions of constant hyperglycemia, the plasma insulin response is biphasic with an early burst of insulin release during the first 6 min followed by a gradually progressive increase in plasma insulin concentration. Euglycemic insulin clamp technique. The plasma insulin concentration is acutely raised and maintained at approximately 100 muU/ml by a prime-continuous infusion of insulin. The plasma glucose concentration is held constant at basal levels by a variable glucose infusion using the negative feedback principle. Under these steady-state conditions of euglycemia, the glucose infusion rate equals glucose uptake by all the tissues in the body and is therefore a measure of tissue sensitivity to exogenous insulin.
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Insulin resistance is the cornerstone for the development of non-insulin-dependent diabetes mellitus (NIDDM). Free fatty acids (FFAs) cause insulin resistance in muscle and liver and increase hepatic gluconeogenesis and lipoprotein production and perhaps decrease hepatic clearance of insulin. It is suggested that the depressing effect of insulin on circulating FFA concentration is dependent on the fraction derived from visceral adipocytes, which have a low responsiveness to the antilipolytic effect of insulin. Elevated secretion of cortisol and/or testosterone induces insulin resistance in muscle. This also seems to be the case for low testosterone concentrations in men. In addition, cortisol increases hepatic gluconeogenesis. Cortisol and testosterone have "permissive" effects on adipose lipolysis and therefore amplify lipolytic stimulation; FFA, cortisol, and testosterone thus have powerful combined effects, resulting in insulin resistance and increased hepatic gluconeogenesis. All these factors promoting insulin resistance are active in abdominal visceral obesity, which is closely associated with insulin resistance, NIDDM, and the "metabolic syndrome." In addition, the endocrine aberrations may provide a cause for visceral fat accumulation, probably due to regional differences in steroid-hormone-receptor density. In addition to the increased activity along the adrenocorticosteroid axis, there also seem to be signs of increased activity from the central sympathetic nervous system. These are the established endocrine consequences of hypothalamic arousal in the defeat and defense reactions. There is some evidence that suggests an increased prevalence of psychosocial stress factors is associated with visceral distribution of body fat. Therefore, it is hypothesized that such factors might provide a background not only to a defense reaction and primary hypertension, suggested previously, but also to a defeat reaction, which contributes to an endocrine aberration leading to metabolic aberrations and visceral fat accumulation, which in turn leads to disease.
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The metabolic syndrome is a common metabolic disorder that results from the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) will be applicable worldwide. The pathophysiology seems to be largely attributable to insulin resistance with excessive flux of fatty acids implicated. A proinflammatory state probably contributes to the syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. The fundamental approach is weight reduction and increased physical activity; however, drug treatment could be appropriate for diabetes and cardiovascular disease risk reduction.
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This abridged version of the "Anthropometric Standardisation Reference Manual" contains the heart of the original manual - complete procedures for 45 anthropometric measurements. Its style enables it to be used as a supplemental text for courses in fitness assessment and exercise prescription, kinanthropometry, body composition, nutrition, and exercise physiology. It can also be used as a reference for exercise scientists. For each of the 45 measurements included in this abridged edition, readers will find complete information on the recommended technique for making the measurement, the purpose and uses for the measurement, the literature on which the measurement technique is based, and the reliability of the measurement.
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Background: Large-volume lipoplasty changes body composition during a single surgical intervention by selectively decreasing subcutaneous adipose tissue. Positive health benefits, previously reported for a cohort of 14 women at 4 months after surgery, include significant decreases in weight, systolic blood pressure, and fasting insulin levels. Objective: In the present study, we sought to determine whether the benefits of altering body composition by large-volume liposuction observed at 4 months are sustained over longer periods of time. Methods: Subjects were seen for an additional follow-up visit approximately 1 year (range 10 to 21 months) after surgery. Fasting insulin levels were measured in the 8 patients who had preoperative fasting insulin levels higher than 12 muU/mL. Weight, systolic and diastolic blood pressure, heart rate, and body circumferences were measured in all 14 subjects. Results: Compared with data obtained before surgery and 4 months after surgery, results at 10 to 21 months after lipoplasty showed that the improvements in body weight, systolic blood pressure, and fasting insulin levels observed 4 months after the procedure had been maintained. Conclusions: Should these results be confirmed in larger studies, lipoplasty may prove to be a valuable tool for reducing some of the co-morbid conditions associated with obesity. (Aesthetic Surg J 2001;21:527-531.).
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Liposuction can aggravate metabolic complications associated with obesity. It has been shown that the recovery of weight lost through these interventions is associated with body fat redistribution toward the visceral cavity, increasing metabolic risk factors for coronary heart disease such as insulin resistance and high triglyceride levels. The aim of this study was to evaluate the consequences of liposuction on body mass redistribution and metabolic parameters 6 months after surgery and to evaluate the use of orlistat treatment (tetrahydrolipstatin) in controlling these parameters. A population of 31 women with a mean body mass index of 26.17+/-3.9 kg/m(2) and undergoing liposuction of more than 1,000 cm(3), was studied. Twelve of them were treated postsurgery with 120 mg of orlistat every 8 hours for the following 6 months. Anthropometric, analytical, and radiological (computed tomography) tests were performed to quantify visceral fat area before surgery and 6 months after surgery. Despite weight loss after liposuction, visceral fat was not modified. Patients treated with orlistat showed a greater reduction in visceral fat, although not statistically significant. Orlistat use induced a reduction in low-density lipoprotein cholesterol values of 20.0+/-22.5 mg/dL, compared with an increase of 8.46+/-20.1 mg/dL in controls (p=.07). Visceral fat does not decrease despite weight loss after liposuction. Orlistat use postliposuction might be a useful tool because it shows a tendency to reduce visceral fat and improve blood lipids profile.
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Abdominal obesity is associated with metabolic risk factors for coronary heart disease (CHD). Although we previously found that using liposuction surgery to remove abdominal subcutaneous adipose tissue (SAT) did not result in metabolic benefits, it is possible that postoperative inflammation masked the beneficial effects. Therefore, this study provides a long-term evaluation of a cohort of subjects from our original study. Body composition and metabolic risk factors for CHD, including oral glucose tolerance, insulin resistance, plasma lipid profile, and blood pressure were evaluated in seven obese (39 +/- 2 kg/m(2)) women before and at 10, 27, and 84-208 weeks after large-volume liposuction. Liposuction surgery removed 9.4 +/- 1.8 kg of body fat (16 +/- 2% of total fat mass; 6.1 +/- 1.4 kg decrease in body weight), primarily from abdominal SAT; body composition and weight remained the same from 10 through 84-208 weeks. Metabolic endpoints (oral glucose tolerance, homeostasis model assessment of insulin resistance, blood pressure and plasma triglyceride (TG), high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol concentrations) obtained at 10 through 208 weeks were not different from baseline and did not change over time. These data demonstrate that removal of a large amount of abdominal SAT by using liposuction does not improve CHD metabolic risk factors associated with abdominal obesity, despite a long-term reduction in body fat.
Article
Methods for the quantification of beta-cell sensitivity to glucose (hyperglycemic clamp technique) and of tissue sensitivity to insulin (euglycemic insulin clamp technique) are described. Hyperglycemic clamp technique. The plasma glucose concentration is acutely raised to 125 mg/dl above basal levels by a priming infusion of glucose. The desired hyperglycemic plateau is subsequently maintained by adjustment of a variable glucose infusion, based on the negative feedback principle. Because the plasma glucose concentration is held constant, the glucose infusion rate is an index of glucose metabolism. Under these conditions of constant hyperglycemia, the plasma insulin response is biphasic with an early burst of insulin release during the first 6 min followed by a gradually progressive increase in plasma insulin concentration. Euglycemic insulin clamp technique. The plasma insulin concentration is acutely raised and maintained at approximately 100 muU/ml by a prime-continuous infusion of insulin. The plasma glucose concentration is held constant at basal levels by a variable glucose infusion using the negative feedback principle. Under these steady-state conditions of euglycemia, the glucose infusion rate equals glucose uptake by all the tissues in the body and is therefore a measure of tissue sensitivity to exogenous insulin.
Article
The purpose of the current study was to determine the accuracy of a given heated dorsal hand vein (HDHV) measurement in predicting a simultaneous arterial measurement and to validate this technique for use in stable isotope studies. Twenty catheterizations of the femoral artery, femoral vein, and a dorsal hand vein were performed in 13 healthy male subjects. Simultaneous blood samples were obtained from all three sites during primed continuous infusions of L-[1-13C]leucine (Leu) and L-[ring-2H5]phenylalanine (Phe) in the postabsorptive state, with or without intravenous glucose infusion. Relationships were examined by linear regression analysis, with 95% prediction intervals for femoral arterial values determined using the HDHV-derived values as independent variable. Glucose concentrations and isotopic enrichments of ketoisocaproate (KIC), Leu, and Phe were similar in HDHV- and arterial-derived blood, with slopes between 0.9414 and 1.0008, intercepts not different from zero, and r2 values of 0.7613 or greater (P < 0.05). Intercepts for KIC, Leu, and Phe concentrations all were different from zero (P < 0.05), and slopes ranged between 0.7560 and 0.8625. For each analysis the HDHV sample correlated better with the femoral arterial sample than with the femoral venous sample. These data support the use of HDHV sampling as a surrogate for direct arterial sampling but document significant limitations in the technique.
Article
Insulin resistance is the cornerstone for the development of non-insulin-dependent diabetes mellitus (NIDDM). Free fatty acids (FFAs) cause insulin resistance in muscle and liver and increase hepatic gluconeogenesis and lipoprotein production and perhaps decrease hepatic clearance of insulin. It is suggested that the depressing effect of insulin on circulating FFA concentration is dependent on the fraction derived from visceral adipocytes, which have a low responsiveness to the antilipolytic effect of insulin. Elevated secretion of cortisol and/or testosterone induces insulin resistance in muscle. This also seems to be the case for low testosterone concentrations in men. In addition, cortisol increases hepatic gluconeogenesis. Cortisol and testosterone have "permissive" effect on adipose lipolysis and therefore amplify lipolytic stimulation; FFA, cortisol, and testosterone thus have powerful combined effects, resulting in insulin resistance and increased hepatic gluconeogenesis. All these factors promoting insulin resistance are active in abdominal visceral obesity, which is closely associated with insulin resistance, NIDDM, and the "metabolic syndrome." In addition, the endocrine aberrations may provide a cause for visceral fat accumulation, probably due to regional differences in steroid-hormone-receptor density. In addition to the increased activity along the adrenocorticosteroid axis, there also seem to be signs of increased activity from the central sympathetic nervous system. These are the established endocrine consequences of hypothalamic arousal in the defeat and defense reactions. There is some evidence that suggests an increased prevalence of psychosocial stress factors is associated with visceral distribution of body fat. Therefore, it is hypothesized that such factors might provide a background not only to a defense reaction and primary hypertension, suggested previously, but also to a defeat reaction, which contributes to an endocrine aberration leading to metabolic aberrations and visceral fat accumulation, which in turn leads to disease.
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Using the tumescent technique, liposuction can remove large volumes of fat with minimal blood loss. A maximal safe dosage of dilute lidocaine using the tumescent technique is estimated to be 35 mg/kg. The slow infiltration of a local anesthetic solution of lidocaine and epinephrine minimizes the rate of systemic absorption and reduces the potential for toxicity. Dilution of lidocaine (0.05% of 0.1%) and epinephrine (1:1,000,000) further delays absorption and reduces the magnitude of peak plasma lidocaine concentrations. Using the tumescent technique for liposuction, peak plasma lidocaine levels occur 12 hours after the initial injection. Clinically significant local anesthesia persists for up to 18 hours. For liposuction, it is not necessary to use local anesthetics, which are longer acting and potentially more cardiotoxic than lidocaine.
Article
A method for estimating the cholesterol content of the serum low-density lipoprotein fraction (Sf- 0.20)is presented. The method involves measure- ments of fasting plasma total cholesterol, tri- glyceride, and high-density lipoprotein cholesterol concentrations, none of which requires the use of the preparative ultracentrifuge. Cornparison of this suggested procedure with the more direct procedure, in which the ultracentrifuge is used, yielded correlation coefficients of .94 to .99, de- pending on the patient population compared. Additional Keyph rases hyperlipoproteinemia classifi- cation #{149} determination of plasma total cholesterol, tri- glyceride, high-density lipoprotein cholesterol #{149} beta lipo proteins
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The effects of surgical ablation of adipose tissue were studied in male New Zealand rabbits. They were lipectomized or sham-operated either at 6 or 12 months, ages at which size and number of adipocytes are, respectively, stabilized in this species. The lipectomized animals were subjected to removal of about 80% of the perirenal and omental and to the totality of the dorsoscapular and inguinal fat tissues. Approximately 35 and 48% of the total body fat were, thus, surgically removed, respectively, in 6- and 12-month-old rabbits. All rabbits were killed 3 months after surgery and were carefully dissected. There was no significant difference in food consumption and body weight gain between lipectomized and sham-operated rabbits. Surgical removal of dorsoscapular, inguinal, and omental fat did not lead to regeneration whereas regeneration of the perirenal fat was substantial. At sacrifice the perirenal weight reached approximately 55% of the initial weight. Regeneration of perirenal adipose tissue in adults proceeded at roughly the same rate as after lipectomy in younger rabbits. These results suggest that adipose tissue regeneration in the rabbit is site dependent.
Article
To determine the effects of suction lipectomy on regional adipose tissue metabolism, nine women had repetitive circumferential measurements and biopsies of subcutaneous adipose tissue from a lipectomy site (site A) and a nonlipectomy site (site B) up to 12 months following lipectomy. Maximum reductions from preoperative baseline in weight, body mass index, and circumferences of sites A and B occurred at 3 months. Because of variable long-term compliance (6 to 12 months), we created a "last visit" time-point to assess adequately the effects of lipectomy for each individual. Not all subjects maintained reduction in site circumferences from 3 months to the last visit. The change in circumference of site A for that period was highly correlated with the change in circumference of site B (r = 0.828, p = 0.005). The change in circumference of site B, but not site A, at 3 months was related to the weight change above the weight of adipose tissue removed at suction lipectomy. Five subjects who were "sustained responders" to the lipectomy procedure were able to maintain or decrease circumferences of sites A and B from 3 months to the last visit. In contrast, four "limited responders" actually increased circumference of site A and had either no change or increased circumference of site B from 3 months to the last visit. The changes in circumference in both sites between 3 months and the last visit related to changes in body weight over the same interval. Ultimately, the decrement in circumference of site A was 3.4 percent (-2.4 cm) greater than that of site B (p = 0.0001). The response to lipectomy in site B, but not site A, between 3 months and the last visit was related to the change in fasting adipose tissue lipoprotein lipase from baseline to 3 months (r = 0.728, p = 0.026). This change in lipase activity in the control region may represent a metabolic defense of body weight in response to adipose tissue removal in the lipectomy site.
Article
Long day-housed Siberian hamsters show compensatory mass increases in inguinal (I) white adipose tissue (WAT) after epididymal WAT pad (EWAT) removal (x) but do not increase EWAT mass after IWATx. This study tested whether EWAT is specifically unresponsive to IWATx or whether EWAT lacks responsiveness to body fat deficits in general. We also tested whether the compensatory mass increases that occur after side-specific body fat removal are unilateral or bilateral. Therefore EWAT and/or IWAT was removed unilaterally or bilaterally. The compensatory changes in WAT mass by the intact fat pads were measured 12 wk later. EWAT did not compensate for removal of its contralateral mate. Retroperitoneal WAT and IWAT showed greater compensatory mass increases ipsilateral to the side of fat pad removal when EWAT or IWAT pads were removed unilaterally but not after removal of larger amounts of body fat. These results suggest the following: 1) in general, the greater the lipectomy-induced lipid deficit, the greater is the relative fat pad mass compensation; 2) the restoration of body fat content after lipectomy may involve mechanisms that can detect the side of the lipid deficit and enhance fat deposition on this side; and 3) EWAT does not show compensatory mass increases after lipectomy.
Article
The Zucker fat rat inherits obesity and hyperinsulinemia, exhibits insulin resistance, and is, therefore, a model of adult onset, or type II, diabetes. The purpose of this study was to determine if excision of fat depots from the infant Zucker (fa+/fa+) rat would affect growth, fat cell number, hyperinsulinism, and hyperlipidemia. In the experimental design, 10 percent of the total body weight (inguinal and interscapular depots) was excised at 6 weeks of age from 18 fat and 18 lean (fa+/fa-) litter mates, with 18 fat and 18 lean rats serving as nonoperated controls. At intervals, serum glucose, insulin, cholesterol, and triglycerides were measured. Initially, the operated fat group was significantly (p < 0.01) lighter than the nonoperated group. By 9 weeks postoperatively, the operated fat rat group had regained weight and continued to grow at the same rate as the nonoperated fat rats because of intra-abdominal fat depots. Lipectomy had no effect on growth rate of the lean rat group. Although lipectomy caused no consistent change in serum glucose or insulin levels, it caused a significant decrease in lipid levels. For example, the operated fat rats had a reduction in cholesterol from 876 to 171 mg/dl by 15 weeks postoperatively, and serum cholesterol persisted at about 50 percent of the nonoperated group throughout the rest of the study (38 weeks postoperatively). Even a greater reduction in triglyceride levels occurred, for example, from 7415 to 1082 mg/dl at 24 weeks postoperatively. Lipectomy did not cause a change in lipid levels in the lean group. It is concluded that the lipectomy in the Zucker fat group is an excellent model to evaluate the effects of changes in fat cell number on lipid metabolism.
Article
Routine liposuction has very low perioperative complication rates and is thus considered to be innocuous. Some authors have even proposed that large-volume liposuction could be therapeutic. However, because subcutaneous adipose tissue has nutritional and thermodynamic metabolic functions proportional to the absolute amount and the distribution of fat, it is possible that removal of subcutaneous adipose tissue might be detrimental. We measured the amount of fat removed by large-volume (>1000 cc) liposuction and expressed the results in terms of absolute and relative changes in total body fat and in visceral adipose tissue (nonsubcutaneous adipose tissue) in 63 normal weight to mildly obese women (n = 51) and men (n = 12). Aspiration of 1.5 +/- 0.7 kg (mean +/- SD) of lipid in women removed 9.2 +/- 3.2 percent of body fat or 10.5 percent of subcutaneous adipose tissue corresponding to a 12-percent increase in the ratio of visceral to subcutaneous adipose tissue. One third of the women (n = 17) had a mean increase of 16 percent (range 13 to 21 percent) in the proportion of visceral fat. In the 12 men, aspiration of 1.7 +/- 0.6 kg of lipid removed 9.8 +/- 2.9 percent of body fat or 12.7 +/- 3.6 percent of subcutaneous adipose tissue, resulting in a 14-percent increase in the ratio of visceral to subcutaneous fat. The correlation between aspirate and body mass index was 0.57 (p < 0.001). Although large-volume subcutaneous liposuction removed relatively little body fat, it led to significant increases in the proportion of visceral adipose tissue. Because the proportion of visceral adipose tissue is a risk factor for metabolic complications of obesity, the metabolic effects of large-volume liposuction need to be evaluated.
Article
The mechanisms involved in body weight regulation in humans include genetic, physiological, and behavioral factors. Stability of body weight and body composition requires that energy intake matches energy expenditure and that nutrient balance is achieved. Human obesity is usually associated with high rates of energy expenditure. In adult individuals, protein and carbohydrate stores vary relatively little, whereas adipose tissue mass may change markedly. A feedback regulatory loop with three distinct steps has been recently identified in rodents: 1) a sensor that monitors the size of adipose tissue mass is represented by the amount of leptin synthesized by adipose cells (a protein encoded by the ob gene) which determines the plasma leptin levels; 2) hypothalamic centers, with specific leptin receptors, which receive and integrate the intensity of the signal; and 3) effector systems that influence the two determinants of energy balance, i.e., energy intake and energy expenditure. With the exception of a few very rare cases, the majority of obese human subjects have high plasma leptin levels that are related to the size of their adipose tissue mass. However, the expected regulatory responses (reduction in food intake and increase in energy expenditure) are not observed in obese individuals. Thus obese humans are resistant to the effect of endogenous leptin, despite unaltered hypothalamic leptin receptors. Whether defects in the leptin signaling cascade play a role in the development of human obesity is a field of great actual interest that needs further research. Present evidences suggest that genetic and environmental factors influence eating behavior of people prone to obesity and that diets that are high in fat or energy dense undermine body weight regulation by promoting an overconsumption of energy relative to need.
Article
Antiretroviral therapy has improved the prospects for people infected with HIV, but some develop a syndrome of profound body habitus and metabolic alterations that include truncal enlargement. The purpose of this study was to define the body-composition changes associated with this syndrome by using techniques with the power to estimate regional body composition. We compared whole-body and regional skeletal muscle and adipose tissue contents measured by magnetic resonance imaging and dual-energy X-ray absorptiometry (DXA) in 26 HIV-infected patients and 26 matched control subjects. Twelve of the HIV-infected patients had evidence of truncal enlargement. HIV-infected men and women who noted truncal enlargement had similar amounts of skeletal muscle and subcutaneous adipose tissue but greater visceral adipose tissue than HIV-infected patients without truncal enlargement; these values were larger in men (P < 0.001) than in women (P = 0.08). The ratio of visceral to subcutaneous adipose tissue was greater in both men (P < 0.02) and women (P = 0.05) with truncal enlargement. Two subjects with MRI-confirmed visceral adiposity syndrome (VAS) were not taking protease inhibitors. CD4+ lymphocyte counts were higher (P < 0.001) and plasma viral burdens tended to be lower (P = 0.08) in HIV-infected patients with VAS. There was significantly more visceral adipose tissue in the subgroup of HIV-infected patients with truncal enlargement than in those without this sign. VAS occurs in both men and women, is associated with higher CD4+ lymphocyte counts and lower plasma HIV viral burdens, and is not limited to those receiving protease inhibitor therapy.
Article
The insulin resistance syndrome X is related to excess intra-abdominal adipose tissue. With lipectomy of >50% of subcutaneous adipose tissue (SQAT) in nonhibernating, adult female Syrian hamsters on high-fat (HF; 50 calorie%) diet and measurements of oral glucose tolerance, oral [(14)C]oleic acid disposal, serum triglycerides, serum leptin, liver fat, perirenal (PR) adipose tissue cellularity, and body composition, we studied the role of SQAT. Sham-operated (S) animals on HF or low-fat (LF; 12.5 calorie%) diets served as controls. After 3 mo there was no visible regrowth of SQAT but HF diet led to similar levels of body weight and body fat in lipectomized and sham-operated animals. Lipectomized (L) animals had more intra-abdominal fat as a percentage of total body fat, higher insulinemic index, a strong trend toward increased liver fat content, and markedly elevated serum triglycerides compared with S-HF and S-LF. Liver and PR adipose tissue uptake of fatty acid were similar in L-HF and S-HF but reduced vs. S-LF, and were inversely correlated with liver fat content and insulin sums during the oral glucose tolerance test. In summary, lipectomy of SQAT led to compensatory fat accumulation implying regulation of total body fat mass. In conjunction with HF diet these lipectomized hamsters developed a metabolic syndrome with significant hypertriglyceridemia, relative increase in intra-abdominal fat, and insulin resistance. We propose that SQAT, via disposal and storage of excess ingested energy, acts as a metabolic sink and protects against the metabolic syndrome of obesity.
Article
In this study, the authors investigated the physiologic effects of the altered body composition that results from surgical removal of large amounts of subcutaneous adipose tissue. Fourteen women with body mass indexes of greater than > 27 kg/m2 underwent measurements of fasting plasma insulin, triglycerides, cholesterol, body composition by dual-energy x-ray absorptiometry (DXA), resting energy expenditure, and blood pressure before and after undergoing large-volume ultrasound-assisted liposuction. There were no significant intraoperative complications. Body weight had decreased by 5.1 kg (p < 0.0001) by 6 weeks after liposuction, with an additional 1.3-kg weight loss (p < 0.05) observed between 6 weeks and 4 months after surgery, for a total weight loss of 6.5 kg (p < 0.00006). Body mass index decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5 kg/m2 (p < 0.0001). This change in body weight was primarily the result of decreases in body fat mass: as assessed by DXA, lean body mass did not change (43.8 +/- 3.1 kg to 43.4 +/- 3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg (p < 0.0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5 mIU/ml before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and systolic blood pressure (132.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein cholesterol, plasma triglycerides, and resting energy expenditure values were not significantly altered after liposuction. In conclusion, over a 4-month period, large-volume liposuction decreased weight, body fat mass, systolic blood pressure, and fasting insulin levels without detrimental effects on lean body mass, bone mass, resting energy expenditure, or lipid profiles. Should these improvements be maintained over time, liposuction may prove to be a valuable tool for reducing the comorbid conditions associated with obesity.
Article
The aim of this study was to identify the effects of surgically removing subcutaneous fat on the metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment. An open clinical trial with a non-intervention parallel group was carried out on 12 young, obese women. After randomization, six volunteers were selected to the surgical intervention consisting of large-volume liposuction; the other six women were considered as the non-intervention group. Metabolic profiles and insulin tolerance tests to assess insulin sensitivity were performed on all volunteers before intervention or non-intervention and 21 - 28 days afterwards. There were a significant decrease in glucose (4.9 +/- 0.4 vs. 4.6 +/- 0.2 mmol/l, p < 0.05) and uric acid (250.8 +/- 56.2 vs. 224.0 +/- 53.4 micromol/l, p < 0.05) levels after liposuction; insulin sensitivity improved after the surgical intervention (4.3 +/- 0.9 vs. 5.3 +/- 0.8 %/min, p = 0.046). In conclusion, surgical removal of subcutaneous fat by large-volume liposuction led to an improvement in insulin sensitivity and a decrease in glucose and uric acid concentrations.
Article
Liposuction has been proposed as a potential treatment for the metabolic complications of obesity. We evaluated the effect of large-volume abdominal liposuction on metabolic risk factors for coronary heart disease in women with abdominal obesity. We evaluated the insulin sensitivity of liver, skeletal muscle, and adipose tissue (with a euglycemic-hyperinsulinemic clamp procedure and isotope-tracer infusions) as well as levels of inflammatory mediators and other risk factors for coronary heart disease in 15 obese women before and 10 to 12 weeks after abdominal liposuction. Eight of the women had normal glucose tolerance (mean [+/-SD] body-mass index, 35.1+/-2.4), and seven had type 2 diabetes (body-mass index, 39.9+/-5.6). Liposuction decreased the volume of subcutaneous abdominal adipose tissue by 44 percent in the subjects with normal glucose tolerance and 28 percent in those with diabetes; those with normal oral glucose tolerance lost 9.1+/-3.7 kg of fat (18+/-3 percent decrease in total fat, P=0.002), and those with type 2 diabetes lost 10.5+/-3.3 kg of fat (19+/-2 percent decrease in total fat, P<0.001). Liposuction did not significantly alter the insulin sensitivity of muscle, liver, or adipose tissue (assessed by the stimulation of glucose disposal, the suppression of glucose production, and the suppression of lipolysis, respectively); did not significantly alter plasma concentrations of C-reactive protein, interleukin-6, tumor necrosis factor alpha, and adiponectin; and did not significantly affect other risk factors for coronary heart disease (blood pressure and plasma glucose, insulin, and lipid concentrations) in either group. Abdominal liposuction does not significantly improve obesity-associated metabolic abnormalities. Decreasing adipose tissue mass alone will not achieve the metabolic benefits of weight loss.
Article
The metabolic syndrome is a common metabolic disorder that results from the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) will be applicable worldwide. The pathophysiology seems to be largely attributable to insulin resistance with excessive flux of fatty acids implicated. A proinflammatory state probably contributes to the syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. The fundamental approach is weight reduction and increased physical activity; however, drug treatment could be appropriate for diabetes and cardiovascular disease risk reduction.
Article
Liposuction is one of the more common elective surgical procedures in the US and is supposed to be on the increase. There are no reported studies specifically addressing the metabolic sequelae of liposuction in obesity. The aim of the present study was to investigate the role of large-volume liposuction on insulin resistance and circulating inflammatory markers in obese people. Thirty healthy premenopausal obese (body mass index (BMI) from 30 to 45) and 30 age-matched normal weight (BMI<25) women were studied. In obese women, insulin sensitivity, as measured by the Homeostasis Model Assessment (HOMA=fasting plasma glucose x fasting serum insulin divided by 25), as well as serum adiponectin, the novel adipocytokine with insulin sensitising properties, were significantly lower, as compared with nonobese women (p<0.01), indicating insulin resistance; on the contrary, serum concentrations of the proinflammatory cytokines IL-6, IL-18 and TNF-alpha, as well as the sensitive marker of inflammation C-reactive protein, were significantly higher (p<0.01). All obese women were submitted to a single large volume liposuction (superwet technique): the mean aspirate volume was 3540 ml (range 2550-4670), corresponding to a net lipid loss of 2.7+/-0.7 kg (mean+/-SD). After six months of stable body weight after liposuction, women were less insulin resistant (p<0.05), had reduced concentrations of IL-6, IL-18, TNF-alpha and CRP (p<0.05-0.02), and increased serum levels of adiponectin (p<0.02) and HDL-cholesterol (p<0.05). There was a significant correlation between the amount of fat aspirate and changes in HOMA (r=0.28, p<0.05), TNF-alpha (r=0.31, p<0.02), and adiponectin (r=-0.34, p<0.02), as well as between the decrease in TNF-alpha and the increase in adiponectin after the surgical procedure (r=-0.45, p<0.01). Our study demonstrates that liposuction is safe and free of metabolic sequelae in obese women, pending a careful screening of the patient. Moreover, it is associated with amelioration of insulin resistance and reduced circulating markers of vascular inflammation which may help obese subjects to reduce their cardiovascular risk.
Article
Obesity is a major risk factor for coronary heart disease, and surgical treatment of obese patients as part of a multidisciplinary approach seems to provide faster results than diet therapy. The aim of this study was to evaluate the effect of dermolipectomy on insulin action and inflammatory markers in 20 obese women. At baseline and 40 days after dermolipectomy, 20 obese women underwent indirect calorimetry and hyperinsulinaemic glucose clamp. Twenty obese nonsmoking females (age range 25--40 years) volunteered for the study. All subjects had a stable body weight for 2 months before the study. No patient was affected by cardiovascular and/or pulmonary disease, type 2 diabetes, thyroid dysfunction, acute or chronic hepatitis, renal insufficiency or cancer. No patients was receiving any drug therapy and all measurements were made during the follicular phase of the menstrual cycle. At baseline, fat mass (FM) correlated with plasma triglycerides (r=.58, P<0.009), free fatty acids (FFA) (r=0.73, P<0.001), insulin (r=0.70, P<0.002), leptin (r=0.55, P<0.01), adiponectin (r=-0.32, P<0.02) and resistin (r=0.31, P<0.01), insulin sensitivity (IS) (r=-0.59, P<0.005) and respiratory quotient (Rq) (r=0.62, P<0.002). With regard to inflammatory markers, FM was significantly correlated with plasma interleukin (IL)-6 (r=0.71, P<0.001), IL-10 (r=-0.67, P<0.002), tumour necrosis factor-alpha (TNF-alpha) (r=0.78, P<0.001) and soluble IL-6 receptor (sIL-6r) (r=-0.65, P<0.003). Dermolipectomy resulted in a significant decline in total FM of 2.3+/- 0.2 kg. A significant decline in BMI was also observed (30.0+/- 0.08 vs. 31.1+/- 0.7 kg/m(2)). After 40 days a significant decline in plasma resistin (P<0.001) and inflammatory markers and an increase in plasma adiponectin (P<0.03) were observed. Those metabolic changes were accompanied by a significant improvement in insulin-mediated glucose uptake (P<0.001), substrate oxidation and degree of inflammation. Changes in FM following dermolipectomy correlated with the changes in IS (P<0.01), substrate oxidation and FFA (P<0.001). In obese patients, dermolipectomy is associated with weight lost, improved glucose handling and lower inflammatory markers.
Article
Liposuction is the most common cosmetic operation performed. To the authors' knowledge, no report has examined patients' attitudes and postoperative opinions, lifestyle changes, weight gain changes, and satisfaction with their liposuction procedure in general and by specific site. The authors report on data from a survey provided to patients by two plastic surgeons at the University of Texas Southwestern Medical Center at Dallas. Six hundred questionnaires were mailed to all patients who had liposuction surgery performed between 1999 and 2003. There were 108 undeliverable surveys; 209 completed surveys were returned (34.8 percent of 600 and 42.5 percent of 492 surveys). Data were analyzed using the chi-square test. A p value of less than 0.05 was considered significant. The majority of patients (80 percent) were satisfied with their results. Fifty-three percent thought that their appearance was either "excellent" or "very good." With regard to satisfaction by site treated, 60 percent or more of the responders were "very satisfied" or "satisfied" with their results. Weight gain was reported in 43 percent of the responders, with 56 percent of them gaining between 5 and 10 pounds 6 months after their surgery. Fat return was reported in 65 percent of the responders. The abdomen was the most common location for fat return. As a group, 79.7 percent would have the procedure again and 86 percent would recommend the procedure to family or friends. Approximately 75 percent of responders described their postoperative discomfort as mild to moderate, with 60 percent indicating that their discomfort lasted less than 7 days (39.8 percent indicated their pain lasted longer than 7 days); 83 percent indicated that they only needed to use narcotics for 7 days of less. When responders were divided into groups, the great majority of patients were satisfied with the surgery and their results. Despite postoperative pain, fat return, and weight gain, patients were willing to have the procedure again and recommend it to others. Those patients who were unsatisfied and were less likely to refer patients were those who had the lowest opinion of their appearance.
Article
A 44-year-old woman desires weight reduction. She has a history of hypertension, daytime somnolence, and osteoarthritis. Her weight is 215 lb (98 kg), her waist circumference is 40 in. (102 cm), and her body-mass index is 32.7. Her blood pressure is 140/92 mm Hg. What would you advise?
Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study
  • Giese
Effect of lipectomy on growth and development of hyperinsulinemia and hyperlipidemia in the Zucker rat
  • Liszka