Sustained improvements in brain health and metabolic markers 24 months following bariatric surgery.

IF 4.1 Q1 CLINICAL NEUROLOGY Brain communications Pub Date : 2024-10-04 eCollection Date: 2024-01-01 DOI:10.1093/braincomms/fcae336
Marianne Legault, Mélissa Pelletier, Amélie Lachance, Marie-Ève Lachance, Yashar Zeighami, Marie-Frédérique Gauthier, Sylvain Iceta, Laurent Biertho, Stephanie Fulton, Denis Richard, Alain Dagher, André Tchernof, Mahsa Dadar, Andréanne Michaud
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Abstract

Obesity and its metabolic complications are associated with lower grey matter and white matter densities, whereas weight loss after bariatric surgery leads to an increase in both measures. These increases in grey and white matter density are significantly associated with post-operative weight loss and improvement of the metabolic/inflammatory profiles. While our recent studies demonstrated widespread increases in white matter density 4 and 12 months after bariatric surgery, it is not clear if these changes persist over time. The underlying mechanisms also remain unknown. In this regard, numerous studies demonstrate that the enlargement or hypertrophy of mature adipocytes, particularly in the visceral fat compartment, is an important marker of adipose tissue dysfunction and obesity-related cardiometabolic abnormalities. We aimed (i) to assess whether the increases in grey and white matter densities previously observed at 12 months are maintained 24 months after bariatric surgery; (ii) to examine the association between these structural brain changes and adiposity and metabolic markers 24 months after bariatric surgery; and (iii) to examine the association between abdominal adipocyte diameter at the time of surgery and post-surgery grey and white matter densities changes. Thirty-three participants undergoing bariatric surgery were recruited. Grey and white matter densities were assessed from T1-weighted magnetic resonance imaging scans acquired prior to and 4, 12 and 24 months post-surgery using voxel-based morphometry. Omental and subcutaneous adipose tissue samples were collected during the surgical procedure. Omental and subcutaneous adipocyte diameters were measured by microscopy of fixed adipose tissue samples. Linear mixed-effects models were performed controlling for age, sex, surgery type, initial body mass index, and initial diabetic status. The average weight loss at 24 months was 33.6 ± 7.6%. A widespread increase in white matter density was observed 24 months post-surgery mainly in the cerebellum, brainstem and corpus callosum (P < 0.05, false discovery rate) as well as some regions in grey matter density. Greater omental adipocyte diameter at the time of surgery was associated with greater changes in total white matter density at 24 months (P = 0.008). A positive trend was observed between subcutaneous adipocyte diameter at the time of surgery and changes in total white matter density at 24 months (P = 0.05). Our results show prolonged increases in grey and white matter densities up to 24 months post-bariatric surgery. Greater preoperative omental adipocyte diameter is associated with greater increases in white matter density at 24 months, suggesting that individuals with excess visceral adiposity might benefit the most from surgery.

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减肥手术后 24 个月,大脑健康和代谢指标持续改善。
肥胖症及其代谢并发症与灰质和白质密度较低有关,而减肥手术后体重减轻则会导致这两个指标的增加。灰质和白质密度的增加与术后体重减轻和代谢/炎症状况的改善密切相关。虽然我们最近的研究表明,减肥手术后 4 个月和 12 个月,白质密度普遍增加,但这些变化是否会随着时间的推移而持续还不清楚。其潜在机制也仍然未知。在这方面,许多研究表明,成熟脂肪细胞的增大或肥厚,尤其是在内脏脂肪区,是脂肪组织功能障碍和与肥胖相关的心脏代谢异常的重要标志。我们的目标是:(i) 评估之前在减肥手术后 12 个月观察到的灰质和白质密度的增加是否在手术后 24 个月得以维持;(ii) 研究减肥手术后 24 个月这些大脑结构变化与脂肪和代谢指标之间的关联;(iii) 研究手术时腹部脂肪细胞直径与手术后灰质和白质密度变化之间的关联。研究招募了 33 名接受减肥手术的患者。灰质和白质密度是通过手术前、手术后4、12和24个月采集的T1加权磁共振成像扫描结果,采用基于体素的形态测量法进行评估的。在手术过程中收集网膜和皮下脂肪组织样本。网膜和皮下脂肪细胞的直径是通过显微镜对固定的脂肪组织样本进行测量的。采用线性混合效应模型对年龄、性别、手术类型、初始体重指数和初始糖尿病状态进行了控制。24 个月时的平均体重减轻率为 33.6 ± 7.6%。术后 24 个月,观察到白质密度普遍增加,主要集中在小脑、脑干和胼胝体(P < 0.05,假发现率),部分区域的灰质密度也有所增加。手术时网膜脂肪细胞直径越大,24 个月时白质总密度的变化越大(P = 0.008)。手术时皮下脂肪细胞直径与 24 个月时白质总密度的变化呈正相关趋势(P = 0.05)。我们的研究结果表明,在减肥手术后的 24 个月内,灰质和白质密度都会长期增加。术前网膜脂肪细胞直径越大,24 个月后白质密度的增加就越大,这表明内脏脂肪过多的人可能从手术中获益最多。
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