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J Clin Endocrinol Metab. 2014 Mar;99(3):898-907. doi: 10.1210/jc.2013-3253. Epub 2014 Jan 1.

Association of adipose tissue and liver fibrosis with tissue stiffness in morbid obesity: links with diabetes and BMI loss after gastric bypass.

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Institute of Cardiometabolism and Nutrition (M.A., S.R., Y.L., C.P., J.A.-W., J.-D.Z., J.T., K.C.), Assistance Publique-Hôpitaux de Paris, Pitié-Salpétrière Hospital, 75013 Paris, France; INSERM, U872 (M.A., S.R., Y.L., C.P., J.A.-W., J.-D.Z., J.T., K.C.), Nutriomique, 75006 Paris, France; Université Pierre et Marie Curie-Paris 6 (M.A., S.R., Y.L., C.P., J.A.-W., J.-D.Z., J.T., K.C.), Centre de Recherche des Cordeliers, Unité Mixte de Recherche S 872, 75006 Paris, France; Echosens (M.A., Y.L., M.S., V.M.), Research and Development Department, 75013 Paris, France; Assistance Publique-Hôpitaux de Paris (G.L.N., F.C.), Université Pierre et Marie Curie-Paris 6, Liver Center, 75006 Paris, France; Assistance Publique-Hôpitaux de Paris (J.-L.B.), Ambroise Paré Hospital, Surgery Department, 92100 Boulogne-Billancourt, France; Institut de Recherche et Développement (J.-D.Z.), Unité Mixte Internationale 209, Unité de Modélisation Mathématique et Informatique de Systèmes Complexes, Institut de Recherche pour le Developpement, IRD, 93143 Bondy, France; Assistance Publique-Hôpitaux de Paris (P.B.), Beaujon Hospital, Pathology Department, 92118 Clichy, France; Centre de Recherche Bichat-Beaujon (P.B.), INSERM, U773, University Paris-Diderot, 92100, Boulogne-Billancourt, France; and Assistance Publique-Hôpitaux de Paris (A.T.), Chirurgie digestive et hépato-bilio-pancréatique, Pitié-Salpêtrière Hospital, 75013 Paris, France.



Liver and white adipose tissue (WAT) develop inflammation and fibrosis.


The aim of the study was to evaluate the bioclinical relevance of WAT fibrosis in morbid obesity and diabetes and the relationships with tissue stiffness measured using a novel device.


Observational and longitudinal studies were conducted in a hospital nutrition department.


Biopsies of liver and subcutaneous WAT (scWAT) and omental adipose tissue were collected from 404 obese bariatric surgery candidates, of whom 243 were clinically characterized before surgery and 3, 6, and 12 months after surgery. In 123 subjects, liver and scWAT stiffness was assessed noninvasively using vibration-controlled transient elastography (VCTE).


Bariatric surgery was performed for some patients.


Adipose tissue fibrosis and stiffness and their link to obesity phenotypes were measured.


scWAT fibrosis was positively associated with liver fibrosis (fibrosis score ≥2) (ϱ= 0.14; P = .01). VCTE-evaluated liver and scWAT stiffness was positively correlated with immunohistochemistry-determined liver (ϱ= 0.46; P = .0009) and scWAT fibrosis (ϱ= 0.48; P = .0001). VCTE-evaluated scWAT stiffness measures negatively associated with dual-energy x-ray absorptiometry-evaluated body fat mass (R = -0.25; P = .009) and were correlated with metabolic variables. Diabetic subjects showed increased scWAT stiffness. Participants less responsive to gastric bypass were older and more frequently diabetic, and they had increased body mass index, serum IL-6, and scWAT and liver fibrosis. Subjects with no diabetes and normal liver had higher fat mass and lower tissue fibrosis and stiffness.


scWAT stiffness was associated with tissue fibrosis, obesity, and diabetes-related traits. Noninvasive evaluation of scWAT stiffness might be useful in clinical practice.

[Indexed for MEDLINE]

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