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2409. Cardiometabolic Profile Assessment of Bariatric Surgery Patients: An Initial Case Series
Authors * Denotes Presenting Author
  1. Elliot Varney *; University of Mississippi Medical Center
  2. Richard Covington; University of Mississippi Medical Center
  3. David Gordy; University of Mississippi Medical Center
  4. Julianna Sitta; University of Mississippi Medical Center
  5. Edward Florez; University of Mississippi Medical Center
  6. Seth Lirette; University of Mississippi Medical Center
  7. Candace Howard; University of Mississippi Medical Center
Objective:
To correlate the distribution of adipose tissue loss, anthropometrics, and future cardiometabolic risk of bariatric surgical patients

Materials and Methods:
For this prospective single institution case series from an ongoing prospective observational study, 8 patients were recruited, consented, underwent surgical sleeve gastrectomy and completed up to at least a 6-month post-operative follow-up. Evaluations are conducted at each pre-operative visit, surgical visit and multiple post-operative visits (6-weeks, 6-months, 12-months, and 24-months). Bone mineral density (BMD), lean body mass (LBM), total body fat (TBF), and visceral adipose tissue (VAT) were obtained from dual-energy X-ray absorptiometry (DXA) scans conducted at each visit. Vital signs, anthropometric measurements (including weight, height, and waist circumference (WC)) and fasting plasma blood samples were also collected at each visit to assess cardiometabolic function. Changes in DXA imaging metrics and associations relating anthropometrics to cardiometabolic outcomes were estimated with multilevel Gaussian mixed models with clustering at the patient level.

Results:
Each patient within this preliminary case series underwent successful sleeve gastrectomy resulting in significant weight loss with a mean weight loss of 30.2 pounds 200 days post-operatively (95%CI 21.9 - 37.6, p<0.001). While accounting for age, sex, and race, the mean change in trunk and limb adipose percentage was not significantly different (p=0.411). The mean loss in VAT mass and volume was 339.8 kg (95%CI 222.2 – 457.4) and 369.4 cc (95%CI 242.4 – 496.5), respectively (p<0.001, for both). Although there was only a slight increase in mean BMD of 0.012 g/cm2 (p=0.040), no patients experienced a decrease in BMD. When assessing the overall cardiometabolic health of these patients over time, with every 10cm decrease in WC and 10% loss in body weight there was an average 9mmHg and 11mmHg drop in systolic blood pressure, respectively (p=0.039, p=0.001). Additionally, with every 10% loss in body weight, fasting blood glucose measurements dropped by over 10 mg/dL (p=0.048). Finally, when assessing liver function, there was an increase in albumin production by 0.18 g/dL with every 10cm decrease in WC (95%CI 0.03 – 0.33, p=0.021).

Conclusion:
Our preliminary data indicates that surgical weight loss is a complex process with many potential metabolic implications for which little is known. With loss of metabolically active VAT, there is a significant improvement in blood pressure, fasting glucose levels, liver function, and potentially BMD which all may be predictable with anthropometric measures. By beginning to understand long-term cardiometabolic outcomes of bariatric surgical patients, further investigation with advanced imaging modalities can be conducted to elucidate the metabolomics and the multi-system pathology that governs obesity and its related conditions.