Impact of preoperative visceral fat proportion on type 2 diabetes in patients with low body mass index after gastrectomy

Abstract

Background: Metabolic surgery is an effective option for treatment of type 2 diabetes. Although body mass index (BMI) has several limitations in differentiating the metabolic risks of the same weight of muscle and fat, it is used as the basis of indication for metabolic surgery. Objectives: Since visceral fat is highly associated with metabolic disease, we evaluated the effectiveness of visceral fat proportion (VFP) for predicting metabolic risk preoperatively. Setting: University hospital. Methods: Fifty-two type 2 diabetes patients with BMI <= 35 kg/cm(2) who underwent gastrectomy for gastric cancer were included. Pre- and postoperative VFPs were measured using abdominal computed tomography. Multivariate logistic regression analysis was performed to estimate the effect of VFP on type 2 diabetes. Receiver operating curve analysis was used to estimate the effectiveness of VFP as a predictor of type 2 diabetes improvement. Results: Thirty-three of the 52 patients (63%) showed improved type 2 diabetes postoperatively. Low preoperative VFP (odds ratio [OR] = .913; 95% confidence interval [CI] = .835-.999; P = .048) and low glycated hemoglobin level (OR = .357; 95% CI = .172-.742; P = .006) were associated with type 2 diabetes improvement 2 years after gastrectomy. The area under the curve was 70.2%, indicating moderate accuracy. Conclusions: Preoperative VFP might be a reasonable predictive factor for type 2 diabetes improvement after gastrectomy for patients with a BMI <= 35 kg/cm(2). High -quality studies of visceral fat for metabolic function are needed in the future. (Surg Obes Relat Dis 2017;13:1361-1368.) (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.