Effect of intragastric balloon-induced weight loss on body composition, fatty liver, and comorbidities in Egyptian middle-aged obese women: a 6-month follow-up study

Background
Paralleling the increasing prevalence of obesity in the Egyptian population, metabolic syndrome and liver steatosis are also on the rise. Body composition measurement is used to describe the percentages of fat, bone, water, and muscle in human bodies. The available classic weight loss treatments such as low-calorie diet, exercise, behavioral modification, and pharmacotherapy usually achieve only limited weight loss. The BioEnterics Intragastric Balloon (BIB) is an endoscopic liquid-filled device for the treatment of obesity.
Aim
The aim of this study was to examine the safety of BIB insertion in a group of obese middle-aged Egyptian women treated with intragastric balloon to induce weight loss for 6 months and report its effect on their anthropometric measurements, body composition, fatty liver, and comorbidities.
Patients and methods
During the period from February 2012 until August 2013, 47 consecutive middle-aged female patients were enrolled for BIB insertion. Inclusion criteria were mainly based on the BMI (≥30.0 kg/m) and on associated comorbidities. Apart from physical and anthropometric evaluation, body composition analysis was performed using a bioelectrical impedance analyzer to estimate fat mass, body fat percentage, and fat-free mass. The Adult Treatment Panel III criteria were used to diagnose metabolic syndrome, and ultrasound evaluation of the liver for the presence and grade of steatosis was performed. BIB placement was carried out after diagnostic endoscopy, under intravenous conscious or unconscious sedation.
Results
The total percentage of complications from BIB insertion was 12.8%, which were mostly mild and reversible. Three (6.4%) patients had their gastric balloon removed early (two voluntarily and one due to de-novo peptic ulcer) and were excluded from the study, whereas the remaining 44 patients continued their 6-month therapy duration. Overall, BIB insertion significantly reduced weight from a mean value of 96.82 ± 14.18 kg at baseline to 83.45 ± 12.03 kg after 6 months ( < 0.001). The mean value for the amount of weight lost at endpoint was 13.36 ± 3.29 kg, whereas the mean value for BMI lost at the time of BIB removal was 5.12 ± 1.20 kg/m, which was a significant reduction compared with baseline values ( < 0.001). No significant change occurred in the liver size over the 6-month study period ( = 0.12), whereas a significant decrease in the grade of steatosis was noted. Body fat mass and body fat percentage with bioelectrical impedance analyzer were significantly reduced ( < 0.001). However, there was also a significant decline in fat-free mass ( < 0.001). Significant favorable changes in the biochemical markers of metabolic syndrome, homeostasis model assessment of insulin resistance index, and liver profile also occurred. An overall 4.6% of patients showed resolution, whereas 31.8% showed improvement in the features of metabolic syndrome.
Conclusion
This study provides anthropometric, biochemical, and body composition evidence on significant improvement in metabolic syndrome, obesity-associated comorbidities, and fatty liver after weight loss induced by the minimally invasive and relatively safe technique. However, it is recommended to continue a weight-reducing diet after BIB removal for achieving long-term effectiveness and to add exercise programs to dietary restriction for promoting more favorable change in body composition.