Cardiac fat pat change after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis

Published:December 13, 2022DOI:


      Cardiac fat pad is a metabolically active organ that plays a role in energy homeostasis and cardiovascular diseases and generates inflammatory cytokines. Many studies have shown remarkable associations between cardiac fat thickness and cardiovascular diseases, making it a valuable target for interventions. Our meta-analysis aimed to investigate the effects of the 2 most popular bariatric surgeries (sleeve gastrectomy [SG] and Roux-en-Y gastric bypass [RYGB]) in cardiac fat pad reduction. A systematic review of the literature was done by searching in Scopus, Web of Science, Cochrane, and PubMed for articles published by September 16, 2022. This review followed the meta-analysis rules based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the inclusion criteria out of 128 potentially useful studies, including a total number of 822 patients. The results of subgroup analysis on the type of surgery showed that bariatric surgeries decreased the mean fat pad diameter, but the reduction was greater in SG than in RYGB. Epicardial and pericardial fat type showed a significant decrease of fat pad diameter. The results of subgroup analysis indicated RYGB had a significant reduction in mean fat pad volume. Computed tomography scan and cardiac magnetic resonance imaging showed a significant reduction of the mean cardiac fat pad volume. Epicardial and paracardial fat type showed a significant decrease in volume. The cardiac fat pad diameter and volume were significantly reduced after bariatric surgeries. SG showed greater reduction in fat pad diameter in comparison with RYGB, and RYGB had a significant reduction in mean fat pad volume.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Panteliou E.
        • Miras A.
        What is the role of bariatric surgery in the management of obesity?.
        Climacteric. 2017; 20: 97-102
        • Welbourn R.
        • Hollyman M.
        • Kinsman R.
        • Dixon J.
        • Liem R.
        • Ottosson J.
        • et al.
        Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018.
        Obes Surg. 2019; 29: 782-795
        • Ignat M.
        • Vix M.
        • Imad I.
        • D'Urso A.
        • Perretta S.
        • Marescaux J.
        • et al.
        Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss.
        Br J Surg. 2017; 104: 248-256
        • Mazurek T.
        • Zhang L.
        • Zalewski A.
        • et al.
        Human epicardial adipose tissue is a source of inflammatory mediators.
        Circulation. 2003; 108: 2460-2466
        • Bertaso A.G.
        • Bertol D.
        • Duncan B.B.
        • Foppa M.
        Epicardial fat: definition, measurements and systematic review of main outcomes.
        Arq Bras Cardiol. 2013; 101: e18-e28
        • Villasante Fricke A.C.
        • Iacobellis G.
        Epicardial adipose tissue: clinical biomarker of cardio-metabolic risk.
        Int J Mol Sci. 2019; 20: 5989
        • Lazaros G.
        • Antonopoulos A.
        • Antoniades C.
        • Tousoulis D.
        The role of epicardial fat in pericardial diseases.
        Curr Cardiol Rep. 2018; 20: 40
        • Wu Y.
        • Zhang A.
        • Hamilton D.J.
        • Deng T.
        Epicardial fat in the maintenance of cardiovascular health.
        Methodist Debakey Cardiovasc J. 2017; 13: 20-24
        • Ding J.
        • Kritchevsky S.B.
        • Harris T.B.
        • Burke G.L.
        • Detrano R.C.
        • Szklo M.
        • et al.
        The association of pericardial fat with calcified coronary plaque.
        Obesity (Silver Spting). 2008; 16: 1914-1919
        • Ngo D.T.
        • Gokce N.
        Epicardial adipose tissue: a benign consequence of obesity?.
        Circ Cardiovasc Imaging. 2015; 8: 10
        • Iacobellis G.
        • Malavazos A.E.
        • Corsi M.M.
        Epicardial fat: from the biomolecular aspects to the clinical practice.
        Int J Biochem Cell Biol. 2011; 43: 1651-1654
        • Launbo N.
        • Zobel E.H.
        • von Scholten B.J.
        • Færch K.
        • Jørgensen P.G.
        • Christensen R.H.
        Targeting epicardial adipose tissue with exercise, diet, bariatric surgery or pharmaceutical interventions: a systematic review and meta-analysis.
        Obes Rev. 2021; 22e13136
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Ansaldo A.M.
        • Montecucco F.
        • Sahebkar A.
        • Dallegri F.
        • Carbone F.
        Epicardial adipose tissue and cardiovascular diseases.
        Int J Cardiol. 2019; 278: 254-260
        • de Barros F.
        • Negrão M.G.
        • Negrão G.G.
        Weight loss comparison after sleeve and roux-en-y gastric bypass: systematic review.
        Arq Bras Cir Dig. 2019; 32: e1474
        • Kokkinos A.
        • Alexiadou K.
        • Liaskos C.
        • A
        • et al.
        Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity.
        Obes Surg. 2013; 23: 31-38
        • Foppa M.
        • Pond K.
        • Jones D.D.
        • Kissinger K.V.
        • Goddu B.
        • Schneider B.
        • Kissinger K.V.
        • Manning W.J.
        Subcutaneous fat thickness, but not epicardial fat thickness, parallel weight reduction after bariatric surgery: a cardiac magnetic resonance study.
        J Cardiovasc Magn Reson. 2013; 15: E54
        • Schwarzwald C.C.
        Equine echocardiography.
        Vet Clin North Am Equine Pract. 2019; 35: 43-64
        • Liu B.
        • Gao S.
        • Li S.
        A comprehensive comparison of CT, MRI, positron emission tomography or positron emission tomography/CT, and diffusion weighted imaging-MRI for detecting the lymph nodes metastases in patients with cervical cancer: a meta-analysis based on 67 studies.
        Gynecol Obstet Invest. 2017; 82: 209-222
        • Cha M.J.
        • Oh S.
        The relationship between pericardial fat and atrial fibrillation.
        J Atr Fibrillation. 2013; 5: 676
        • Kaya B.C.
        • Elkan H.
        The impact of weight loss after laparoscopic sleeve gastrectomy on early markers of atherosclerotic vascular disease: a prospective study.
        Kardiolo Pol. 2020; 78: 674-680
        • Sarmiento-Cobos M.
        • Aleman R.
        • Gomez C.O.
        • et al.
        Weight loss following bariatric surgery decreases pericardial fat thickness lowering the risk of developing coronary artery disease.
        Surg Obes Relat Dis. 2021; 17: 390-397
        • Altin C.
        • Erol V.
        • Aydin E.
        • et al.
        Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: a prospective study.
        Nutr Metab Cardiobasc Dis. 2018; 28: 501-509
        • Cekici Y.
        • Kaya B.C.
        • Elkan H.
        The effect of laparoscopic sleeve gastrectomy on subclinical atherosclerosis in patients with severe obesity.
        Obes Surg. 2021; 31: 738-745
        • Tokhi B.
        • Humphrey T.
        • Harris E.
        • Castillo A.
        • Makaryus A.
        • Zeltser R.
        Effects of bariatric surgery on epicardial fat pat remodeling.
        J Am Coll Cardiol. 2020; 75: 1597
        • Castillo A.
        • Rivera E.
        • Typhair C.
        • et al.
        Echocardiographic assessment of epicardial fat pad and cardiac remodeling after bariatric surgery.
        J Am Coll Cardiol. 2021; 77: 1342
        • Willens H.J.
        • Byers P.
        • Chirinos J.A.
        • Labrador E.
        • Hare J.M.
        • de Marchena E.
        Effects of weight loss after bariatric surgery on epicardial fat measured using echocardiography.
        Am J Cardiol. 2007; 99: 1242-1245
        • Graziani F.
        • Leone A.M.
        • Cialdella P.
        • et al.
        Effects of bariatric surgery on cardiac remodeling: clinical and pathophysiologic implications.
        Eur Heart J. 2013; 34: 4356
        • Kovac N.
        • Grymyr L.M.
        • Gerdts E.
        • et al.
        Markers of subclinical atherosclerosis in severe obesity and one year after bariatric surgery.
        J Clin Med. 2022; 11: 2237
        • Castagneto-Gissey L.
        • Angelini G.
        • Mingrone G.
        • et al.
        The early reduction of left ventricular mass after sleeve gastrectomy depends on the fall of branched-chain amino acid circulating levels.
        EBioMedicine. 2022; 76: 103864
        • Sarmiento-Cobos M.
        • Valera R.
        • Fonnegra C.B.
        • et al.
        Ventricular conduction improvement after pericardial fat reduction triggered by rapid weight loss in subjects with obesity undergoing bariatric surgery.
        Surg Obes Relat Dis. 2022; 18: 288-294
        • van Schinkel L.D.
        • Sleddering M.A.
        • Lips M.A.
        • et al.
        Effects of bariatric surgery on pericardial ectopic fat depositions and cardiovascular function.
        Clin Endocrinol (Oxf). 2014; 81: 689-695
        • Gaborit B.
        • Jacquier A.
        • Kober F.
        • et al.
        Effects of bariatric surgery on cardiac ectopic fat: lesser decrease in epicardial fat compared to visceral fat loss and no change in myocardial triglyceride content.
        J Am Coll Cariol. 2012; 60: 1381-1389
        • Luaces M.
        • Paiva M.
        • Secades Gonzalez S.
        • et al.
        Long-term changes in epicardial adipose tissue after bariatric surgery: a CMR study.
        J Am Coll Cardiol. 2013; 61
        • Abdesselam I.
        • Dutour A.
        • Kober F.
        • et al.
        Time course of change in ectopic fat stores after bariatric surgery.
        J Am Coll Cardiol. 2016; 67: 117-119

      Linked Article