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Degree of Weight Loss is not Correlated With Improvement in Insulin Resistance Following Gastric Bypass in the Severely Obese
Richard Perugini, Vera Freeman, Joshua Felsher, Donald Czerniach, Demetrius EM Litwin, John Kelly
UMass Memorial Medical Center, Worcester, MA
Objective: Gastric bypass (GB) cures both insulin resistance (IR) and diabetes mellitus (DM), though the mechanism is poorly understood. Postoperative weight loss is thought to account for improvements in insulin-glucose homeostasis. We studied whether postoperative weight loss was correlated with improvements in IR in a non diabetic population undergoing gastric bypass.
Design: Retrospective review of an inception cohort. Fasting insulin and glucose levels were drawn on days 0, 12, 40, 180, and 365. Homeostasis model of assessment was used to estimate insulin resistance (HOMA-IR). Patients were categorized as high IR if HOMA-IR > 2.3. Weight loss was calculated as percent of excess body weight (%EBW). We performed linear regression analysis between %EBW lost and delta HOMA-IR.
Setting: academic medical center
Patients: 107 consecutive patients
Interventions: Laparoscopic gastric bypass
Main Outcome Measures:
Results: Patients in the high IR group (n = 47) experienced a marked reduction in HOMA-IR, from 3.4 + 1.1 preoperatively to 1.6 + 0.9 (p = 2.5 x 10-6) at 365 days. The change in IR was not correlated with %EBW lost in the high IR group at 12 days (r = 0.03), 40 days (r = 0.02), 180 days (r = 0.18), or 365 days (r = 0.32) postoperatively.
Conclusions: Resolution of IR following gastric bypass is not correlated with amount of weight loss up to one year postoperatively. This study suggests that degree of weight loss should not be utilized as a measure of success following gastric bypass, if the ultimate endpoint in question is metabolic improvement.
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