By Will Boggs, MD
NEW YORK (Reuters Health) – Depletion of intramyocellular fat after biliopancreatic diversion reverses insulin resistance in patients with morbid obesity, according to a report in the January issue of Diabetes.
Biliopancreatic diversion (BPD) results in weight loss that may, in turn, improve insulin-mediated glucose disposal, the authors explain. They hypothesized that BPD might selectively deplete intramyocellular fat and wondered whether this contributed to the reversal of insulin resistance.
Dr. Ele Ferrannini, from the University of Pisa, Italy, and colleagues assessed intramyocellular fat and various measures of insulin sensitivity in 17 morbidly obese patients after BPD (8 patients) or hypocaloric diet (9 patients) and in 7 nonobese controls.
After 6 months, the BPD group had lost significantly more weight (33 kg, or 24% of initial weight) than had the diet group (14 kg, or 9% of initial weight), the report indicates, but only the BPD group lost a significant amount of their fat mass (17 kg).
Intramyocellular and perivascular fat was markedly decreased only in the BPD patients, the authors report.
Moreover, the results indicate, only the BPD patients saw significant reductions in both plasma insulin and leptin.
Both groups of obese patients experienced some improvements in insulin sensitivity, the researchers note, but in the BPD group insulin resistance was fully reversed.
The authors conclude "that lipid deprivation selectively depletes intramyocellular lipid stores and induces a normal metabolic state…despite a persistent excess of total body fat mass."
"As far as I am aware, there are no other proven methods for selectively depleting intramyocellular fat in humans," Dr. Ferrannini told Reuters Health. "Vertical gastroplasty (the other surgical approach to morbid obesity) and some drastic dietary lipid deprivation regimens are obvious candidates, but I have not seen published studies to that effect."
"The main message is that when accurate clinical and psychological assessment of a morbidly obese patient identifies him or her as eligible for bariatric surgery, the possibility of normalizing metabolism could be weighed in," Dr. Ferrannini concluded. "The converse, that normalizing metabolism should be an indication for biliopancreatic diversion, is at present unjustifiable."
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