title: Effect of Bariatric Surgery on Adipose Tissue Glucose Metabolism in Different Depots in Patients With or Without Type 2 Diabetes.
abstract: OBJECTIVE
  We investigated fat distribution and tissue-specific insulin-stimulated glucose uptake (GU) in seven fat compartments (visceral and subcutaneous) and skeletal muscle in morbidly obese patients with (T2D) and without (ND) type 2 diabetes before and 6 months after bariatric surgery.
  
  
  METHODS
  A total of 23 obese patients (BMI 43.0 ± 3.6 kg/m(2); 9 T2D and 14 ND) were recruited from a larger, randomized multicenter SLEEVEPASS study. MRI (for fat distribution) and [(18)F]-fluorodeoxyglucose PET (for GU) studies were performed for the obese patients before and 6 months postsurgery; 10 lean subjects served as control subjects and were studied once.
  
  
  RESULTS
  At baseline, visceral fat GU was 30 ± 7% of muscle GU in control subjects and 57 ± 5% in obese patients. Visceral and deep subcutaneous fat were more abundant (despite same total fat mass) and less insulin sensitive in T2D than ND; in both, GU was impaired compared with control subjects. Postsurgery, visceral fat mass decreased (∼40%) more than subcutaneous fat (7%). Tissue-specific GU was improved, but not normalized, at all sites in T2D and ND alike. The contribution of visceral fat to whole-body GU was greater in T2D than ND but decreased similarly with surgery. Subcutaneous fat made a fourfold greater contribution to whole-body GU in obese versus lean subjects (15% vs. 4%) both before and after surgery.
  
  
  CONCLUSIONS
  Bariatric surgery leads to sustained weight loss and improves tissue-specific glucose metabolism in morbidly obese patients. We conclude that 1) enhanced visceral fat accumulation is a feature of T2D, 2) severe obesity compromises muscle insulin sensitivity more than fat insulin sensitivity, and 3) fat mass expansion is a sink for plasma glucose.
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland.
authors.forename: Prince
authors.initials: P
authors.lastname: Dadson
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Landini
authors.affiliation: Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Helmiö
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland.
authors.forename: Jarna C
authors.initials: JC
authors.lastname: Hannukainen
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland Department of Endocrinology, Turku University Hospital, Turku, Finland.
authors.forename: Heidi
authors.initials: H
authors.lastname: Immonen
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland.
authors.forename: Miikka-Juhani
authors.initials: MJ
authors.lastname: Honka
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland.
authors.forename: Marco
authors.initials: M
authors.lastname: Bucci
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Savisto
authors.affiliation: Department of Endocrinology, Turku University Hospital, Turku, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Soinio
authors.affiliation: Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland.
authors.forename: Paulina
authors.initials: P
authors.lastname: Salminen
authors.affiliation: Medical Imaging Center, Turku University Hospital, Turku, Finland Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Parkkola
authors.affiliation: Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Department of Clinical Nutrition and Obesity Center, University of Eastern Finland, Kuopio, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Pihlajamäki
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Patricia
authors.initials: P
authors.lastname: Iozzo
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Ele
authors.initials: E
authors.lastname: Ferrannini
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland Department of Endocrinology, Turku University Hospital, Turku, Finland pirjo.nuutila@utu.fi.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Nuutila
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D049268:Positron-Emission Tomography; D016032:Randomized Controlled Trials as Topic; D050151:Subcutaneous Fat / Q000378:metabolism*
chemical_list: D007328:Insulin; D005947:Glucose