Regional fat-re-accumulation following lipectomy in pre- and postmenopausal women

描述（由申请人提供）：脂肪切除术是当今美国最常进行的美容手术，被美国美容整形外科学会认为是永久性的，但尚未进行长期随访研究来验证这一说法。事实上，动物研究表明，脂肪切除术后快速脂肪组织（AT）再积累是常见的，甚至可能伴随着疾病风险的不利变化。最近的人类研究集中在腹部脂肪切除术作为降低肥胖绝经前妇女代谢性疾病风险的一种手段。然而，这些研究均未评价AT再蓄积或报告代谢结局的长期（>6个月）变化，也未评价股骨AT切除的效果，尽管这是女性脂肪切除术的常见部位，尽管下半身肥胖具有明显的心脏保护益处。此外，这些研究均未纳入腹部AT蓄积风险增加的绝经后女性。我们的总体工作假设是，在雌激素缺乏的患者中，通过脂肪切除术去除股动脉AT将加重代谢性疾病的风险（通过餐后脂血症测量）。 与绝经前妇女相反，绝经后妇女将在腹部而不是股骨区域积累AT。本研究的总体目的是确定：1）脂肪切除术后局部（腹部与股动脉）AT再蓄积是否存在绝经相关差异; 2）餐后甘油三酯清除和膳食脂肪酸储存后股动脉AT质量的变化（去除和恢复）。此外，我们推测，绝经期相关的餐后脂血症和膳食脂肪酸处理的差异将决定股骨脂肪切除术对这些参数的影响程度。将绝经前和绝经后女性（n=80）随机分配至股骨脂肪切除术组或对照组（无手术）。所有合格的志愿者将在研究开始时以及脂肪切除术后2、8和14个月接受测试。测量将包括身体成分评估、膳食测试和AT活检，以评估以下方面与脂肪切除术相关的变化：1）腹部和股骨脂肪量; 2）全身性餐后甘油三酯波动;和3）AT中膳食脂肪酸的储存。这些研究旨在评价股骨脂肪切除术对绝经前和绝经后女性局部AT再蓄积和代谢性疾病风险的影响。

DESCRIPTION (provided by applicant): Lipectomy is the most frequently performed aesthetic surgery in the U.S. today and is considered permanent, by The American Society for Aesthetic Plastic Surgery, but no long term follow-up studies have been done to verify this assertion. Indeed, animal studies suggest rapid adipose tissue (AT) re-accumulation after lipectomy is common and may even be accompanied by unfavorable changes in disease risk. Recent studies in humans have focused on abdominal lipectomy as a means of reducing metabolic disease risk in obese premenopausal women. However, none of these studies evaluated AT re-accumulation or reported long-term (>6 mo) changes in metabolic outcomes, and none have evaluated the effect of removing femoral AT despite this being a common site for lipectomy in women and despite the apparent cardioprotective benefit of lower body adiposity. Further, none of these studies included postmenopausal women who are at an increased risk of abdominal AT accumulation. It is our overall working hypothesis that removal of femoral AT by lipectomy will worsen metabolic disease risk (as measured by postprandial lipemia) in estrogendeficient postmenopausal women who, in contrast to premenopausal women, will accumulate AT in the abdominal rather than the femoral region. The global aims of this study are to determine whether: 1) there are menopause-related differences in regional (abdominal vs. femoral) AT re-accumulation following lipectomy; and 2) changes (removal and regain) in femoral AT mass alter postprandial triglyceride clearance and storage of meal-derived fatty acids. Further, we postulate that menopause-related differences in postprandial lipemia and handling of dietary fatty acids will determine the degree to which femoral lipectomy worsens these parameters. Pre- and postmenopausal women (n=80) will be randomly assigned to either femoral lipectomy or control (no surgery). All eligible volunteers will undergo testing at the beginning of the study and at 2, 8, and 14 months following lipectomy. Measurements will include body composition assessments, meal tests and AT biopsies to assess lipectomy-related changes in: 1) abdominal and femoral fat mass; 2) systemic postprandial triglyceride excursions; and 3) storage of dietary fatty acids in AT. These studies are designed to evaluate the effect of femoral lipectomy on regional AT re-accumulation and metabolic disease risk in pre- and postmenopausal women.