Metabolic and hepatic phenotypes in sarcopenic obesity and impact of bariatric surgery

Sarcopenic obesity (SO) is associated with cardiometabolic disorders and steatotic liver disease and carries major health risks. We assessed the hepatic and metabolic clinical phenotype associated with SO in patients with obesity undergoing bariatric surgery (BS). We also evaluated whether weight-lo...

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Published in:Clinical nutrition (Edinburgh, Scotland) Scotland), 2024-12, Vol.43 (12), p.254-264
Main Authors: Zambon Azevedo, Vittoria, Bel Lassen, Pierre, Aron-Wisnewsky, Judith, Genser, Laurent, Charlotte, Frederic, Bedossa, Pierre, Ponnaiah, Maharajah, Pais, Raluca, Clément, Karine, Oppert, Jean-Michel, Ratziu, Vlad
Format: Article
Language:English
Subjects:
Absorptiometry, Photon
Adult
Bariatric surgery
Bariatric Surgery - methods
Body Composition
Diabetes Mellitus, Type 2 - complications
Fatty Liver - physiopathology
Female
Humans
Liver - metabolism
Male
Metabolic dysfunction-associated steatotic liver disease
Middle Aged
Obesity
Obesity - complications
Obesity - physiopathology
Obesity - surgery
Phenotype
Sarcopenia
Sarcopenia - epidemiology
Weight Loss
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Summary:Sarcopenic obesity (SO) is associated with cardiometabolic disorders and steatotic liver disease and carries major health risks. We assessed the hepatic and metabolic clinical phenotype associated with SO in patients with obesity undergoing bariatric surgery (BS). We also evaluated whether weight-loss and metabolic improvement post-surgery differ between patients with and without SO. 972 consecutive patients from a single-center BS cohort who underwent whole-body dual-energy X-ray absorptiometry (DXA) and peri-operative liver biopsy were included. SO was diagnosed using the AIM-SO score, an AI-assisted unbiased clustering algorithm based on body composition. One-year post-surgery, 862 patients were reassessed for AIM-SO score changes. Pre-operatively, 207 (21.3 %) patients were diagnosed with SO. These patients had significantly higher prevalence of type-2 diabetes (T2D), arterial hypertension and obstructive sleep apnea (OSA) compared to patients without SO (all p ≤ 0.003). Patients with SO had more severe liver damage: higher grades of moderate/advanced steatosis (64.2 % vs. 47.3 %), steatohepatitis (44.4 % vs. 32.3 %) and advanced fibrosis (12.1 % vs. 6.0 %) (all p ≤ 0.01). One-year post-BS, 58.5 % of patients had remission of SO. Patients with persistent SO exhibited less weight-loss than those with SO remission (−23.8 kg vs. −29.1 kg, p 
ISSN:0261-5614
1532-1983
1532-1983
DOI:10.1016/j.clnu.2024.10.037