Gasto energético de repouso em mulheres a médio e longo prazo após a cirurgia bariátrica e metabólica: associação com composição corporal, força muscular e obesidade sarcopênica

Abstract

Metabolic and Bariatric Surgery (MBS) induces weight loss and may affect Resting Energy Expenditure (REE), body composition, muscle strength, and the prevalence of Sarcopenic Obesity (SO). However, these aspects have been poorly explored during the medium- and longterm after MBS, particularly with REE as the primary outcome. The aim of this study was to evaluate REE and its association with body composition, muscle strength, and SO in women during the medium- and long-term after MBS. This cross-sectional study included women who were at least one year post-MBS. REE was assessed by Indirect Calorimetry (IC). Body composition was estimated using Bioelectrical Impedance Analysis (BIA), from which Fat Mass (FM), Fat-Free Mass (FFM), Skeletal Muscle Mass (SMM), and Skeletal Muscle Mass Index (SMMI) were predicted. Muscle strength was assessed by handgrip strength or the 30-second chair stand test. SO was defined as the presence of low muscle strength associated with low muscle mass and a high body fat percentage. Predicted REE (REEp) and adaptive thermogenesis were also calculated, as well as energy and protein intake using a 24-hour dietary recall. Biochemical data, comorbidities, and physical activity were obtained from medical records. Data from 63 women (53.1 ± 9.5 years) with a median postoperative follow-up of 91 (60 surgery, compared with those 1 to 5 years after MBS, exhibited higher body weight, body mass index (BMI), and FM (kg and %), lower percentages of FFM and SMMI, lower response to MBS, and lower Total Weight Loss (%TWL). Additionally, they presented lower REE/FM, higher REEp, lower levels of physical activity, and higher energy intake (p < 0.05), with no differences in comorbidities. REE was associated with different variables according to postoperative time. Among women 1 to 5 years after surgery, higher HDL levels and FFM (%) were associated with higher REE, whereas higher %TWL and triglyceride levels were associated with lower REE after adjustment for age, fasting glucose, protein intake (%), current triglyceride levels, and current body weight were associated with higher REE, whereas higher protein intake (%) was inversely associated with REE after adjustment for age, fasting glucose, %TWL, and FFM (%) (p < 0.05). The prevalence of SO was 57.1% (n = 36). Women with SO presented higher REE/SMM and REE/SMMI values, both of which were independently associated with SO in models adjusted for age and postoperative time. No differences were observed regarding comorbidities, physical activity, or dietary intake between women with and without SO. In conclusion, a longer postoperative time after MBS was associated with less 9favorable body composition outcomes, as well as changes in REE-related parameters, whereas SO was associated with alterations in REE adjusted for skeletal muscle mass, highlighting the importance of medium- and long-term follow-up after MBS.