Evaluation of Resting Energy Expenditure in Subjects with Severe Obesity and Its Evolution After Bariatric Surgery

Enzamaria Fidilio, Marta Comas, Miguel Giribés, Guillermo Cárdenas, Ramón Vilallonga, Fiorella Palma, Rosa Burgos Peláez, Rafael Simó, Andreea Ciudin, Enzamaria Fidilio, Marta Comas, Miguel Giribés, Guillermo Cárdenas, Ramón Vilallonga, Fiorella Palma, Rosa Burgos Peláez, Rafael Simó, Andreea Ciudin

Abstract

Purpose: One major determinant of weight loss is resting energy expenditure (REE). However, data regarding REE is scarce in patients with severe obesity (SO)-BMI>50kg/m2. Most studies used equation in order to estimate REE and not indirect calorimetry (IC) (gold standard). Additionally, there is no reliable data on the impact of bariatric surgery (BS) on REE.

Objectives: (a) To evaluate the REE in patients with SO; (b) to compare REE measured by IC (mREE) to that calculated by Mifflin St-Jeor equation (eREE); (c) to evaluate the impact of BS on REE and the relationship with evolution post-BS.

Material and methods: Single-center observational study including consecutive patients with SO between January 2010 and December 2015, candidates for BS. mREE was determined at baseline, and 1 and 12 months post-BS by IC, using a Vmax metabolic monitor.

Results: Thirty-nine patients were included: mean age 46.5±11.77 years, 64.1%women. Preoperative mREE was 2320.38±750.81 kcal/day. One month post-BS, the mREE significantly decreased (1537.6 ± 117.46 kcal/day, p = 0.023) and remained unchanged at 12 months (1526.00 ± 123.35 kcal/day; p =0.682). Reduction in mREE after the BS was a predictor of reaching successful weight loss (nadir) and weight regain (5 years follow-up) (AUCROC of 0.841 (95%CI [0.655-0.909], p=0.032) and AUCROC of 0.855 (95% CI [0.639-0.901]), p= 0.027, respectively). eREE was not valid to identify these changes.

Conclusion: In patients with SO, a significant reduction of mREE occurs 1 month post-BS, unchanged at 12 months, representing the major conditioning of successful weight loss and maintenance post-BS.

Keywords: Bariatric surgery; Resting energy expenditure; Severe obesity.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the inclusion of the patients in the study. BMI, body mass index; BS, bariatric surgery; IC, indirect calorimetry; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy
Figure 2
Figure 2
Changes in measured resting energy expenditure and body mass index before and after bariatric surgery. BMI, body mass index; mREE, measured resting energy expenditure; 1m, 1 month after bariatric surgery; 12m, 12 months after bariatric surgery. Repeated-measures ANOVA for: A BMI and B mREE before and after BS, p < 0.001. Results after Bonferroni correction are indicated if significant differences were found. *p < 0.05; **p < 0.01
Figure 3
Figure 3
The predictive capacity of the reduction in mREE at 12 months from baseline for: A EWL<50% at nadir and B weight regain after 5 years follow-up

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