Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease.
Level 4 - case-series / case-control
Prospective before-and-after interventional study without a separate control group
PubMed 15201411 · doi:10.1056/NEJMoa033179
What was done
Researchers evaluated the metabolic effects of large-volume abdominal liposuction in 15 obese women (8 with normal glucose tolerance, mean BMI 35.1; 7 with type 2 diabetes, mean BMI 39.9). Outcomes were measured before and 10 to 12 weeks after surgery. Insulin sensitivity of liver, skeletal muscle, and adipose tissue was assessed using a euglycemic-hyperinsulinemic clamp procedure with isotope-tracer infusions. Blood pressure, plasma glucose, insulin, lipids, and inflammatory mediators (C-reactive protein, interleukin-6, tumor necrosis factor alpha, and adiponectin) were also assessed.
What was found
Subcutaneous abdominal adipose tissue volume decreased by 44% in subjects with normal glucose tolerance and by 28% in those with diabetes. Total fat mass decreased by 9.1 ± 3.7 kg (18 ± 3% decrease, P=0.002) in the normal glucose tolerance group and by 10.5 ± 3.3 kg (19 ± 2% decrease, P<0.001) in the diabetes group. Liposuction did not significantly alter insulin sensitivity in muscle, liver, or adipose tissue; did not significantly alter plasma concentrations of CRP, IL-6, TNF-alpha, or adiponectin; and did not significantly affect blood pressure, plasma glucose, insulin, or lipid levels in either group.
Why it matters
These findings show that surgical removal of subcutaneous adipose tissue alone does not yield the metabolic or cardiovascular improvements associated with diet- or lifestyle-induced weight loss.
Limits
The study sample was very small (n=15), restricted entirely to women, and lacked an unoperated control group or dietary weight-loss comparator. Assessments were limited to a single post-operative timeframe (10 to 12 weeks), and the intervention did not remove visceral adipose tissue.
Cited by
- supports Studies show that removing substantial body fat via liposuction does not improve any cardiometabolic outcomes.