Prediabetes leaves lasting fat tissue changes after bariatric surgery
The findings of a new study presented at the European Congress on Obesity (ECO) in Istanbul, Turkey, reveal a fascinating and potentially concerning aspect of prediabetes. According to Camila Milad, author of the study and a researcher at Hospital Clinic de Barcelona, Spain, prediabetes may leave a lasting molecular 'footprint' on adipose (fat) tissue, making weight loss maintenance after bariatric surgery more challenging.
This research highlights a critical aspect of obesity management, suggesting that prediabetes could be a significant factor in the variable long-term outcomes of bariatric surgery. The study's findings indicate that prediabetes is associated with persistent changes in fat tissue, which may limit its ability to fully adapt to weight loss.
What makes this particularly intriguing is the potential mechanism behind these changes. Milad explains that the fat tissue of women with prediabetes does not fully recover its normal function after weight loss, leading to a persistent impairment in lipid metabolism. This means that even after successful weight loss, the body may struggle to process fats efficiently, which could hinder the long-term benefits of bariatric surgery.
The study involved 78 women with severe obesity, aged 25 to 65 years, who had a BMI of 39 to 49 kg/m². Participants were divided into two groups based on their fasting glucose and HbA1c levels. The group with prediabetes showed higher glucose and insulin responses during a mixed-meal test, a higher prevalence of fatty liver (hepatic steatosis), and an unfavourable lipid profile compared to the group with normal glucose tolerance.
One year after surgery, both groups showed marked improvements in glycaemic and metabolic parameters. However, the key finding was that gene activity in fat tissue remained distinct between the groups. In women with prediabetes, genes involved in lipid metabolism were less active, particularly key regulators like SREBF1 and FADS2, indicating a persistent impairment in the ability of adipose tissue to handle fats efficiently.
This blunted lipid metabolism was accompanied by higher cholesterol levels and greater weight regain over three years of follow-up in the prediabetes group. In contrast, women with normal glucose tolerance showed activation of genes involved in lipid metabolism and cholesterol handling, suggesting better fat tissue adaptation to weight loss.
Dr Ana de Hollanda, the lead author, emphasizes the importance of these findings. She states that the study shows prediabetes is associated with persistent changes in fat tissue that are not fully reversed by bariatric surgery. These alterations in lipid metabolism may reduce the ability of adipose tissue to adapt after weight loss, potentially contributing to weight regain over time.
However, de Hollanda also notes that these changes may not be permanent and could be modified through targeted interventions. The next steps for the research team include investigating whether these molecular alterations can be reversed and identifying strategies to improve adipose tissue function and its ability to adapt after weight loss. They also aim to determine if similar patterns of adipose tissue dysfunction are present in other patient populations and whether they could be used to identify individuals at higher risk of weight regain.
While the study has some limitations, including its observational nature and the lack of causal relationship establishment, it highlights the importance of understanding the underlying mechanisms of weight loss and regain in patients with prediabetes. Larger and more diverse studies are needed to confirm these findings and explore potential interventions.
In my opinion, this study raises important questions about the long-term effectiveness of bariatric surgery in patients with prediabetes. It suggests that prediabetes may be a significant factor in the variable outcomes of weight loss surgeries, and it emphasizes the need for personalized approaches to obesity management. The findings also highlight the potential role of targeted interventions in improving adipose tissue function and reducing the risk of weight regain.
What this really suggests is that prediabetes could be a critical factor in the success or failure of weight loss interventions, and it may require more comprehensive strategies to address the underlying molecular changes in fat tissue. This research opens up new avenues for exploration in the field of obesity management, emphasizing the importance of understanding the complex interplay between prediabetes, fat tissue, and weight loss.
