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Abdominal liposuction: Can large-volume affect insulin action or coronary disease risk factors?


Dr. Young
New Orleans — Patients are being misled if they are told large-volume abdominal liposuction will change their risk factor profile for coronary disease or affect insulin action in a positive fashion, says a presenter here at the annual meeting of the American Society for Aesthetic Plastic Surgery.

"Other researchers had claimed that large volume liposuction increased insulin sensitivity and improved cardiovascular risks," says Dr. Leroy Young, a plastic surgeon in private practice at Body Aesthetic in St. Louis. "We found that getting rid of your fat alone won't get rid of your risk factors."

Study profile The study enrolled 15 obese women before and 10 weeks to 12 weeks after abdominal liposuction between November 2001 and March 2003.

All had stable weight for at least two months and had been sedentary for at least six months before entering the study.

Eight of the women had normal glucose tolerance, with their mean body mass index being 35.1, while the other seven women had type 2 diabetes, with a body mass index of 39.9. The mean age of the women with normal glucose tolerance was 42, and the mean age of women with diabetes was 52. The diabetic women were treated with two or three hypoglycemic medications such as glipizide, glyburide or metformin.

An average of 16 liters of superficial and deep subcutaneous fat was removed from the subjects with normal oral glucose tolerance while an average of 17 liters was removed from the subjects with type 2 diabetes.

Liposuction decreased the volume of subcutaneous abdominal adipose tissue by 44 percent with normal glucose tolerance and 28 percent in those with diabetes. Additionally, subjects with normal oral glucose tolerance lost 9.1 kg and those with type 2 diabetes lost 10.5 kg of fat.

"The problem with some of the other studies is that they often incorporated diet or exercise programs as part of the process," Dr. Young says. "What we wanted to do was find out if removing the subcutaneous fat from the abdomen in large amounts would affect these parameters."

Dr. Young's study was published in the New England Journal of Medicine in June 2004.

Significance "The significant thing about what we did is we removed about 12 percent of body weight," he explains. "That is normally enough, that if you lost it by diet and exercise, you would see improvement in insulin sensitivity and cardiovascular risk factors. In other words, we removed enough fat, so it should have had an effect. The reason that doesn't happen appears to be because it doesn't induce a negative caloric state."

Plasma glucose measured 89 mg/dl before liposuction among the normal glucose tolerant patients and measured 90 mg/dl after liposuction. It measured 121 mg/dl before liposuction among the type 2 diabetes patients and measured 123 mg/dl after liposuction.

Low-density lipoproteins measured 113 mg/dl before liposuction and 110 mg/dl after liposuction among normal glucose tolerant subjects. High-density lipoproteins measured 45 mg/dl before liposuction and 45 mg/dl after liposuction. Low-density lipoprotein measured 113 mg/dl before liposuction and 110mg/dl after liposuction.

Among the diabetic women, LDL cholesterol measured 82 mg/dl before liposuction and 80 mg/dl after liposuction. HDL cholesterol measured 44 mg/dl before liposuction and measured 43 mg/dl after liposuction.

Measurements of mediators of inflammation in the subjects such as leptin, adiponectin, tumor necrosis factor and C-reactive protein all showed no improvement, according to Dr. Young.

Subjects were followed closely following the procedure to ensure they did not go on a diet or start a new exercise program.

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