PMID- 20457158 OWN - NLM STAT- MEDLINE DCOM- 20100812 LR - 20220330 IS - 1528-0012 (Electronic) IS - 0016-5085 (Print) IS - 0016-5085 (Linking) VI - 139 IP - 2 DP - 2010 Aug TI - Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. PG - 448-55 LID - 10.1053/j.gastro.2010.04.056 [doi] AB - BACKGROUND & AIMS: Visceral adipose tissue (VAT) is an important risk factor for the metabolic complications associated with obesity. Therefore, a reduction in VAT is considered an important target of obesity therapy. We evaluated whether reducing VAT mass by surgical removal of the omentum improves insulin sensitivity and metabolic function in obese patients. METHODS: We conducted a 12-month randomized controlled trial to determine whether reducing VAT by omentectomy in 22 obese subjects increased their improvement following Roux-en-Y gastric bypass (RYGB) surgery in hepatic and skeletal muscle sensitivity to insulin study 1. Improvement was assessed by using the hyperinsulinemic-euglycemic clamp technique. We also performed a 3-month, longitudinal, single-arm study to determine whether laparoscopic omentectomy alone, in 7 obese subjects with type 2 diabetes mellitus (T2DM), improved insulin sensitivity study 2. Improvement was assessed by using the Frequently Sampled Intravenous Glucose Tolerance Test. RESULTS: The greater omentum, which weighed 0.82 kg (95% confidence interval: 0.67-0.97), was removed from subjects who had omentectomy in both studies. In study 1, there was an approximate 2-fold increase in muscle insulin sensitivity (relative increase in glucose disposal during insulin infusion) and a 4-fold increase in hepatic insulin sensitivity 12 months after RYGB alone and RYGB plus omentectomy, compared with baseline values (P<.001). There were no significant differences between groups (P>.87) or group x time interactions (P>.36). In study 2, surgery had no effect on insulin sensitivity (P=.844) or use of diabetes medications. CONCLUSIONS: These results demonstrate that decreasing VAT through omentectomy, alone or in combination with RYGB surgery, does not improve metabolic function in obese patients. CI - Copyright (c) 2010 AGA Institute. Published by Elsevier Inc. All rights reserved. FAU - Fabbrini, Elisa AU - Fabbrini E AD - Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, Missouri, USA. FAU - Tamboli, Robyn A AU - Tamboli RA FAU - Magkos, Faidon AU - Magkos F FAU - Marks-Shulman, Pamela A AU - Marks-Shulman PA FAU - Eckhauser, Aaron W AU - Eckhauser AW FAU - Richards, William O AU - Richards WO FAU - Klein, Samuel AU - Klein S FAU - Abumrad, Naji N AU - Abumrad NN LA - eng SI - ClinicalTrials.gov/NCT00212160 SI - ClinicalTrials.gov/NCT00270439 GR - P60 DK020593/DK/NIDDK NIH HHS/United States GR - DK 37948/DK/NIDDK NIH HHS/United States GR - P30 DK058404/DK/NIDDK NIH HHS/United States GR - P30 DK056341/DK/NIDDK NIH HHS/United States GR - UL1 RR024992/RR/NCRR NIH HHS/United States GR - R01 DK070860/DK/NIDDK NIH HHS/United States GR - DK 70860/DK/NIDDK NIH HHS/United States GR - R01 DK070860-05/DK/NIDDK NIH HHS/United States GR - P30 DK020593/DK/NIDDK NIH HHS/United States GR - UL1 TR000448/TR/NCATS NIH HHS/United States GR - R01 DK037948/DK/NIDDK NIH HHS/United States GR - DK 56341/DK/NIDDK NIH HHS/United States GR - DK20593/DK/NIDDK NIH HHS/United States GR - DK058404/DK/NIDDK NIH HHS/United States GR - RR024992/RR/NCRR NIH HHS/United States GR - UL1 RR024975/RR/NCRR NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20100507 PL - United States TA - Gastroenterology JT - Gastroenterology JID - 0374630 RN - 0 (Blood Glucose) RN - 0 (Insulin) SB - IM MH - Adult MH - Blood Glucose/metabolism MH - Cardiovascular Diseases/blood/etiology/physiopathology/*prevention & control MH - Diabetes Mellitus, Type 2/etiology/physiopathology/*surgery MH - Female MH - *Gastric Bypass MH - Glucose Clamp Technique MH - Glucose Tolerance Test MH - Humans MH - Insulin/blood MH - *Insulin Resistance MH - Intra-Abdominal Fat/metabolism/physiopathology/*surgery MH - Laparoscopy MH - Lipectomy/*methods MH - Liver/metabolism/physiopathology MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Muscle, Skeletal/metabolism/physiopathology MH - Obesity/blood/complications/physiopathology/*surgery MH - Omentum/*surgery MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome PMC - PMC2910849 MID - NIHMS207887 COIS- Conflicts of interest: There are no financial conflicts with the subject matter or materials discussed in this manuscript with any of the authors. EDAT- 2010/05/12 06:00 MHDA- 2010/08/13 06:00 PMCR- 2011/08/01 CRDT- 2010/05/12 06:00 PHST- 2010/02/03 00:00 [received] PHST- 2010/04/23 00:00 [revised] PHST- 2010/04/30 00:00 [accepted] PHST- 2010/05/12 06:00 [entrez] PHST- 2010/05/12 06:00 [pubmed] PHST- 2010/08/13 06:00 [medline] PHST- 2011/08/01 00:00 [pmc-release] AID - S0016-5085(10)00668-2 [pii] AID - 10.1053/j.gastro.2010.04.056 [doi] PST - ppublish SO - Gastroenterology. 2010 Aug;139(2):448-55. doi: 10.1053/j.gastro.2010.04.056. Epub 2010 May 7.