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CONTEXT: Laparoscopic sleeve gastrectomy (LSG) is a recognized effective procedure of bariatric surgery but a poor response in weight loss may still represent a clinical problem. To date there are no validated predictors useful to better perform patient selection.OBJECTIVE: to establish the association of baseline anthropometric, metabolic and psychologic features with the percent total (%TWL) and excess (%EWL) weight loss 12 months after surgery.DESIGN: retrospective longitudinal analysis of a set of data about obese attending the outpatients service of a single obesity center from June 2016 to June 2019.PATIENTS: 106 obese patients underwent LSG with pre-surgery evaluation and follow-up at 12 months after surgery.MAIN OUTCOME: weight loss 12 months after LSG.RESULTS: patients who achieved a %TWL higher than the observed median (≥34%) were younger, with a lower fasting plasma glucose and HbA1c, with a lower prevalence of hypertension and with a lower score in the impulsiveness scale, compared to the patients with a %TWL <34%. Similar findings were found when was considered %EWL. Multivariable stepwise regression analysis showed that younger age, lower impulsiveness, higher than normal urinary free cortisol and lower HbA1c were associates with higher %TWL, explaining about 31.5% of the outcome.CONCLUSION: metabolic and psychologic features at baseline were independently associated with weight loss and explained a non-negligible effect on the response to LSG. These data suggest that careful metabolic and psychologic profiling could help in sharper indications and personalized pre- and post-surgical follow-up protocols in candidates for LSG.

Context: Insulin resistance and diabetes may influence separately or in combination whole body energy metabolism. Objective: To assess the impact of insulin resistance and/or overt type 2 diabetes on resting energy expenditure (REE) in class 3 obese individuals. Design and Setting: Retrospective, cross-sectional analysis of a set of data about individuals attending the outpatients service of a single center of bariatric surgery between January 2015 and December 2017. Patients: We screened 382 patients in which abnormal thyroid function was excluded, and segregated them in three groups of subjects: patients with type 2 diabetes (T2DM; n=70), non-diabetic insulin-resistant patients with HOMA-IR ≥ 3 (n=236), non-diabetic insulin-sensitive patients with HOMA-IR < 3 (n=75). Main Outcome Measure: Resting energy expenditure (REE), body composition and insulin resistance assessed using indirect calorimetry, bioimpedance and HOMA-IR. Results: Non-diabetic insulin-sensitive patients resulted to be younger, with lower BMI and higher prevalence of female subjects; meanwhile, non-diabetic but insulin-resistant patients and T2DM patients were not different in terms of anthropometric parameters. REE was higher in T2DM than in non-diabetic insulin-resistant and insulin-sensitive individuals when expressed as percent of the predicted REE (based on Harris Benedict equation) (p<0.0001) or when adjusted for kg of free fat mass (p<0.0001) and was found to be higher also in insulin-resistant vs insulin-sensitive patients (p<0.001). The respiratory quotient was different between groups (0.87±0.11, 0.86±0.12 and 0.91±0.14 in T2DM, insulin-resistant and insulin-sensitive patients, respectively; p<0.03). Regression analysis confirmed that HOMA-IR was independently associated with the REE (R2=0.110, p<0.001). Conclusion: Class 3 obese patients with normal insulin sensitivity are characterized by reduced fasting REE in comparison to insulin-resistant obese patients and obese patients with shor

Giuseppina Manzoni,1 Alice Oltolini,1 Silvia Perra,1 Emanuele Muraca,1 Stefano Ciardullo,1,2 Mattia Pizzi,3 Giovanna Castoldi,2 Guido Lattuada,1 Pietro Pizzi,3 Gianluca Perseghin1,2 1Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; 2Department of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy; 3Centre for Obesity Research, Policlinico di Monza, Monza, ItalyCorrespondence: Gianluca PerseghinDepartment of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, Monza, MB 20900, ItalyTel +39 039 281 0430Email gianluca.perseghin@policlinicodimonza.itContext: Insulin resistance and diabetes may influence separately or in combination whole body energy metabolism.Objective: To assess the impact of insulin resistance and/or overt type 2 diabetes on resting energy expenditure (REE) in class 3 obese individuals.Design and Setting: Retrospective, cross-sectional analysis of a set of data about individuals attending the outpatients service of a single center of bariatric surgery between January 2015 and December 2017.Patients: We screened 382 patients in which abnormal thyroid function was excluded, and segregated them in three groups of subjects: patients with type 2 diabetes (T2DM; n=70), non-diabetic insulin-resistant patients with HOMA-IR ≥ 3 (n=236), non-diabetic insulin-sensitive patients with HOMA-IR < 3 (n=75).Main Outcome Measure: Resting energy expenditure (REE), body composition and insulin resistance assessed using indirect calorimetry, bioimpedance and HOMA-IR.Results: Non-diabetic insulin-sensitive patients resulted to be younger, with lower BMI and higher prevalence of female subjects; meanwhile, non-diabetic but insulin-resistant patients and T2DM patients were not different in terms of anthropometric parameters. REE was higher in T2DM than in non-diabetic insulin-resistant and insulin-sensitive individuals when expressed as percent of the predicte