Summary: In a prediction-model study in patients undergoing laparoscopic sleeve gastrectomy, a nomogram combining preoperative HDL cholesterol and visceral adipose tissue predicted 12-month visceral fat reduction with good accuracy (validation AUC 0.88), offering a tool for individualised preoperative counselling.
PICO Summary
| Element | Detail |
|---|---|
| Population | 177 patients undergoing laparoscopic sleeve gastrectomy (132 modelling, 45 validation); China. |
| Intervention | A nomogram combining preoperative HDL-C and visceral adipose tissue to predict 12-month VAT reduction. |
| Comparison | Conventional reliance on individual anthropometric or metabolic parameters. |
| Outcome | Preoperative VAT and HDL-C were independent predictors of VAT loss. The nomogram showed an AUC of 0.7 (training) and 0.88 (validation), with good calibration and favourable decision-curve analysis. |
Expert Commentary
This is a prognostic-modelling study rather than a treatment trial, and on those terms it is a sensible piece of work addressing a real question: visceral fat reduction is more metabolically meaningful than scale weight, and patients vary in how much VAT they shed after sleeve gastrectomy, so a preoperative predictor could sharpen counselling. Using two cheap, routinely available inputs, HDL-C and baseline VAT, is pragmatic, and a validation AUC of 0.88 is encouraging. My caveats are those that apply to every nomogram. It is single-centre, the training AUC of 0.7 is considerably more modest than the validation figure, which itself rests on only 45 patients, and external validation in other populations and imaging protocols is essential before trusting it broadly. I would also temper the claim that it clearly beats single parameters, since the study demonstrates the combined model’s performance more than a formal head-to-head. Can I use this with my patients? Cautiously, as a counselling aid rather than a gatekeeping tool. It could help set realistic expectations about visceral fat change before sleeve gastrectomy, but it should never be used to deny surgery, and it needs outside validation first.
References
Sun Y, Wang L, Zhu G, Chen X, Lian D, Zhang N, Xu G. HDL-C and visceral adipose tissue as combined predictors of visceral fat changes following laparoscopic sleeve gastrectomy. BMC Surg. 2025;25(1):343. doi:10.1186/s12893-025-03069-3