Sex-specific long-term changes in body composition and lipid profiles after gastrectomy: a longitudinal study with up to 5 years of follow-up

The sex-specific long-term changes occurring in body composition and their metabolic implications after gastrectomy remain unclear. This longitudinal study examined these changes in body composition and lipid profile for up to 5 years after gastrectomy to comprehensively understand long-term health and metabolic outcomes across sexes. Seventy-two patients who underwent gastrectomy for gastric neoplasms were included in this study. Body composition was assessed using dual-energy X-ray absorptiometry (DXA) and abdominal computed tomography (CT) at baseline and 1, 2–3 years, and 4–5 years postoperatively. DXA measured appendicular skeletal muscle mass (ASM), fat mass, and lean mass, while CT assessed skeletal muscle area (SMA) and density at the L3 vertebral level and visceral and subcutaneous fat area (VFA/SFA) at the umbilical level. Lipid profiles (total cholesterol [TC], high-density, and low-density lipoprotein cholesterol [HDL-C/LDL-C]) were evaluated concurrently. Multivariate regression analysis identified predictors of lipid profile changes. In total, 40 men and 32 women with a mean (± standard deviation) age of 58.6 ± 10.6 years were included. Body weight, fat mass, lean mass, and SMA decreased during the first postoperative year and remained reduced thereafter in both sexes (all P < 0.05). VFA and SFA values decreased initially and increased marginally thereafter but remained significantly lower than baseline (all P < 0.001). In men, the ASM value was maintained during the first year and increased marginally thereafter, whereas it decreased significantly by 4–5 years ( P = 0.007) in women. In men, TC, HDL-C, and LDL-C values improved over 4–5 years, whereas only HDL-C levels improved in women. Reductions in fat mass and VFA were independently associated with LDL-C decrease. Significant sex-specific differences in long-term body composition and lipid profile outcomes were observed after gastrectomy. Women experienced persistent muscle loss and limited improvement in lipid profiles compared to men. These findings support the need for sex-specific postoperative care to prevent sarcopenia and optimize long-term metabolic health and quality of life.