Laparoscopic sleeve gastrectomy induces sustained changes in gray and white matter brain volumes and resting functional connectivity in obese patients.

Background: Obesity is associated with decreased brain gray- (GM) and white-matter (WM) volumes in regions. Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery associated with neuroplastic changes in patients with obesity at 1 month postLSG. Objective: To investigate whether LSG can induce sustained neuroplastic recovery of brain structural abnormalities, and whether structural changes are accompanied by functional alterations. Setting: University hospital, longitudinal study. Methods: Structural magnetic resonance imaging and voxel-based morphometry analysis were employed to assess GM/WM volumes in 30 obese participants at preLSG and 1 and 3 months postLSG. One-way analysis of variance modeled time effects on GM/WM volumes, and then alterations in resting-state functional connectivity (RSFC) were assessed. Results: Significant time effects on GM volumes were in caudate (F = 11.20), insuia (INS; F = 10.11), posterior cingulate cortex (PCC; F = 13.32), and inferior frontal gyrus (F = 12.18), and on WM volumes in anterior cingulate cortex (F = 15.70), PCC (F = 15.56), and parahippocampus (F = 17.96, P-FDR < .05). Post hoc tests showed significantly increased GM volumes in caudate (mean change +/- SEM .018 +/- .005 and P = .001, .031 +/- .007 and P < .001), INS (.027 +/- .008 and P = .003, 043 +/- .009 and P < .001), and PCC (.008 +/- .004 and P = .042, .026 +/- .006 and P < .001), and increased WM volumes in anterior cingulate cortex (.029 +/- .006 and P < .001, .041 +/- .008 and P < .001), PCC (.017 +/- .004 and P < .001, .032 +/- .006 and P < .001), and parahippocampus (.031 -+/- .008 and P =.001, .075 +/- .013 and P < .001) at 1 and 3 months postLSG compared with preLSG. Significant increases in GM volumes were in caudate (.013 +/- .006 and P = .036), PCC (.019 +/- .006 and P = .006), and inferior frontal gyrus (.019 +/- .005 and P = .001), and in WM volumes in anterior cingulate cortex (.012 +/- .005 and P = .028), PCC (.014 +/- .006 and P = .017), and parahippocampus (.044 +/- .014 and P = .003) at 3 relative to 1 month postLSG. GM volumes in INS and PCC showed a positive correlation at 1 (r = .57, P = .001) and 3 months postLSG (r = .55, P = .001). GM volume in INS and PCC were positively correlated with RSFC of INS-PCC (r = .40 and P = .03, r = .55 and P = .001) and PCC-INS (r = .37 and P = .046, r = .57 and P < .001) at 1 month postLSG. GM volume in INS was also positively correlated with RSFC of INS-PCC (r = .44, P = .014) and PCC-INS (r = .38, P = .037) at 3 months postLSG. Conclusion: LSG induces sustained structural brain changes, which might mediate long-term benefits of bariatric surgery in weight reduction. Associations between regional GM volume and RSFC suggest that LSG-induced structural changes contribute to RSFC changes. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.