Adipocyte size threshold matters: link with risk of type 2 diabetes and improved insulin resistance after gastric bypass

J Clin Endocrinol Metab. 2014 Aug;99(8):E1466-70. doi: 10.1210/jc.2014-1074. Epub 2014 Apr 29.


Context: Adipocyte volume has been associated with insulin resistance and type 2 diabetes.

Objective: Our purpose was to identify an adipocyte volume threshold linked with increased insulin resistance risk, and to examine its association with insulin resistance improvement after bariatric surgery.

Setting and design: We investigated two cohorts of Caucasian women, candidates for bariatric surgery, from two institutional centers in France (age 42.0 ± 11.5 years; body mass index, 47.6 ± 6.9 kg/m(2)) and Germany (age 41.3 ± 11.2 years; body mass index, 49.5 ± 8.1 kg/m(2)). 38% of the subjects had gastric bypass surgery and were followed for 6 months after the intervention. We defined a group of subjects with type 2 diabetes or at risk of type 2 diabetes (DRD) and investigated the relations between adipocyte volume and this status before and after surgery.

Results: In both cohorts, subjects with DRD presented enlarged adipocytes (France, P = 3×10(-4); Germany, P =3×10(-10)) and we were able to determine thresholds in each cohort above which diabetes risk was potentially increased (France: 1003±42 pL, Germany: 798±32 pL). Subjects above those adipocyte thresholds were less prone to disappearance of the DRD status after bypass surgery (France, risk ratio = 2.1, P = .024; Germany, risk ratio = 1.3, P = .05).

Conclusions: We show in two cohorts of morbidly obese subjects that a specific adipocyte volume threshold may predict an increased risk for obesity-associated type 2 diabetes. However, this threshold might be established for each specific investigation site. Having a high adipocyte size is associated with a lower improvement of insulin resistance after bypass surgery in both cohorts.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipocytes / pathology*
  • Adult
  • Cell Size
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Female
  • France / epidemiology
  • Gastric Bypass*
  • Germany / epidemiology
  • Humans
  • Insulin Resistance*
  • Middle Aged
  • Obesity, Morbid / pathology
  • Obesity, Morbid / surgery*
  • Postoperative Period
  • Risk Factors