| Description |
- Background. Food insecurity is associated with increased adiposity, obesity-related comorbidities, and lower socioeconomic status. Body composition is commonly measured by bioelectrical impedance; however, artificial intelligence now allows for computed tomography (CT)-based analytical techniques. We hypothesize that food insecurity affects baseline body composition and bariatric surgery outcomes.
Methods. Fifty-four patients at Duke Health from 2017 to 2019 were included. Patients completed a six-item food security survey prior to bariatric surgery and were grouped as either food secure (FS) or food insecure (FI). Body composition analyses of pre-operative abdominal CT scans were performed using an automated high throughput algorithm to calculate cross-sectional area of skeletal muscle, visceral fat, and subcutaneous fat. Each patient was matched to previously constructed reference curves by age, sex, and race to generate a z score. Anthropometric data, comorbidities, and medications were collected pre-operatively, six months post-operatively, and twelve months post-operatively, as well as emergency visits, readmissions, reoperations, and deaths.
Results. In both groups, subcutaneous and visceral fat area were increased compared to population reference curves (p<0.05). The 14 (26%) FI patients had lower skeletal muscle area and higher subcutaneous fat area (p<0.05) than FS patients. FI patients had lower post-operative hemoglobin (p<0.05) than FS patients. The two groups had similar weight loss and reduction in obesity-related medications following bariatric surgery.
Conclusions. Patients with obesity and food insecurity have less skeletal muscle and more subcutaneous fat than those without food insecurity. Despite this, bariatric surgery remains similarly effective regardless of food security, making it a powerful tool for improving the health of patients with obesity with food insecurity and lower socioeconomic status.
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