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Cited by 909Body Contouring and SurgeryDiabetes, Cardiovascular Risks, and LipoproteinsAdipokines, Inflammation, and Metabolic Diseases

Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease

Open access
Klein, Samuel, Fontana, Luigi, Young, V. Leroy, Coggan, Andrew R., Kilo, Charles, Patterson, Bruce W., Mohammed, B. Selma·2004·New England Journal of Medicine
DOI 10.1056/nejmoa033179
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Abstract

Background Liposuction has been proposed as a potential treatment for the metabolic complications of obesity. We evaluated the effect of large-volume abdominal liposuction on metabolic risk factors for coronary heart disease in women with abdominal obesity. Methods We evaluated the insulin sensitivity of liver, skeletal muscle, and adipose tissue (with a euglycemic-hyperinsulinemic clamp procedure and isotope-tracer infusions) as well as levels of inflammatory mediators and other risk factors for coronary heart disease in 15 obese women before and 10 to 12 weeks after abdominal liposuction. Eight of the women had normal glucose tolerance (mean [+/-SD] body-mass index, 35.1+/-2.4), and seven had type 2 diabetes (body-mass index, 39.9+/-5.6). Results Liposuction decreased the volume of subcutaneous abdominal adipose tissue by 44 percent in the subjects with normal glucose tolerance and 28 percent in those with diabetes; those with normal oral glucose tolerance lost 9.1+/-3.7 kg of fat (18+/-3 percent decrease in total fat, P=0.002), and those with type 2 diabetes lost 10.5+/-3.3 kg of fat (19+/-2 percent decrease in total fat, P Conclusions Abdominal liposuction does not significantly improve obesity-associated metabolic abnormalities. Decreasing adipose tissue mass alone will not achieve the metabolic benefits of weight loss.

Integrity signals

Registry

Crossref · 10.1056/nejmoa033179

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

5 of 37 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Even small amounts of weight loss induced by a negative energy balance affect many variables pertaining to body-fat composition and lipid metabolism.

    “Even small amounts of weight loss induced by a negative energy balance affects many variables pertaining to body-fat composition and lipid metabolism -variables that probably contribute to the metabolic abnormalities associated with obesity.[22][23][24][25]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [22] source
    • cites [23] source

      The Rapid communication Abstract describes a cross-sectional study of intramyocellular lipids and insulin sensitivity in normal-weight adults; the Discussion addresses their correlation. Searches for weight loss, negative energy balance, and energy restriction found no passage saying that small weight losses affect body-fat composition or lipid metabolism. Page numbers were not provided in our copy. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [24] source
  • Premisecitation

    Weight loss decreases intrahepatic fat.

    “Weight loss decreases visceral fat mass, 26 intramyocellular fat, 27 intrahepatic fat, 28 fat-cell size, 29 and the rate of release of fatty acids from adipose tissue.30”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Premisecitation

    Variables pertaining to body-fat composition and lipid metabolism probably contribute to the metabolic abnormalities associated with obesity.

    “Even small amounts of weight loss induced by a negative energy balance affects many variables pertaining to body-fat composition and lipid metabolism -variables that probably contribute to the metabolic abnormalities associated with obesity.[22][23][24][25]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [22] source
    • cites [23] source
    • cites [24] source
  • Findingown data

    Measured truncal fat-free mass increased from 24.5±2.7 kg to 27.4±3.0 kg (P<0.001) in the two groups overall.

    “The measured truncal fat-free mass, which included tissue fluid, increased from 24.5±2.7 kg to 27.4±3.0kg (P<0.001) in the two groups overall.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Liposuction had no significant effect on other risk factors for coronary heart disease, including blood pressure, fasting plasma glucose, insulin, lipid concentrations, and plasma markers of inflammation and insulin resistance (C-reactive protein, tumor necrosis factor a, interleukin-6, and adiponectin).

    “In addition, liposuction had no significant effects on other risk factors for coronary heart disease, including blood pressure; fasting plasma glucose, insulin, and lipid concentrations; and concentrations of plasma markers of inflammation and insulin resistance (C-reactive protein, tumor necrosis factor a , interleukin-6, and adiponectin).”
    • Also stated in: § After Liposuction · plain
      “in contrast, liposuction in our subjects did not significantly change the plasma concentrations of any of these markers.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 14
  • May combine two claims. 14
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent advances in liposuction techniques make it possible to remove considerable amounts of subcutaneous adipose tissue.

    “Recent advances in liposuction techniques now make it possible to remove considerable amounts of subcutaneous adipose tissue.9”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] source

      The Objectives and Measurements sections discuss classifying and measuring facial wrinkles, not liposuction. Searches for liposuction, subcutaneous fat removal, and suction lipectomy found no passage addressing whether recent techniques permit removal of considerable amounts of adipose tissue. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Both abdominal subcutaneous fat mass and visceral fat mass are associated with insulin resistance.

    “Although both the abdominal subcutaneous fat mass and the visceral fat mass are associated with insulin resistance, 2”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Findingown data

    Insulin infusion during stage 1 caused the expected decreases in the rates of appearance of glucose, glycerol, and free fatty acids, and insulin infusion during stage 2 caused the expected increase in the rate of disappearance of glucose in both subjects with normal glucose tolerance and those with type 2 diabetes.

    “Insulin infusion during stage 1 caused the expected decreases in the rates of appearance of glucose, glycerol, and free fatty acids, and insulin infusion during stage 2 caused the expected increase in the rate of disappearance of glucose both in subjects with normal glucose tolerance and in those with type 2 diabetes (Fig. 2 and 3).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The decrease in measured fat mass was consistent with the amount of fat aspirated during liposuction; approximately 60 percent of the liposuction aspirate was composed of fat.

    “The decrease in measured fat mass was consistent with the amount of fat aspirated during liposuction; approximately 60 percent of the liposuction aspirate was composed of fat.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Large-volume abdominal liposuction decreased the volume of subcutaneous abdominal adipose tissue by 44 percent in women with normal glucose tolerance and by 28 percent in women with type 2 diabetes.

    “Liposuction decreased the volume of subcutaneous abdominal adipose tissue by 44 percent in the subjects with normal glucose tolerance and 28 percent in those with diabetes”
    • Also stated in: § body composition · plain
      “Liposuction decreased the volume of subcutaneous abdominal adipose tissue by 44 percent in the subjects with normal glucose tolerance and 28 percent in those with diabetes, whereas the volumes of visceral adipose tissue and thigh adipose tissue did not change significantly (Fig. 1 and Table 1).”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Plasma insulin concentrations after liposuction were similar to those before liposuction for both stages of the clamp procedure in subjects with normal glucose tolerance and in subjects with type 2 diabetes.

    “In the subjects with normal glucose tolerance, plasma insulin concentrations after liposuction were similar to those before liposuction for both stages 1 and 2 of the clamp procedure”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Liposuction did not significantly alter plasma concentrations of C-reactive protein, interleukin-6, tumor necrosis factor alpha, and adiponectin.

    “did not significantly alter plasma concentrations of C-reactive protein, interleukin-6, tumor necrosis factor a , and adiponectin”
    • Also stated in: § circulating inflammatory mediators and other risk factors for coronary heart disease · plain
      “but it did not significantly alter the concentrations of other circulating cytokines or of C-reactive protein (Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Liposuction did not significantly change the volume of visceral adipose tissue or thigh adipose tissue.

    “whereas the volumes of visceral adipose tissue and thigh adipose tissue did not change significantly”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Successful long-term weight management is difficult to achieve, and the majority of obese persons who lose weight by implementing lifestyle changes regain their lost weight over time.

    “However, successful long-term weight management is difficult to achieve, and the majority of obese persons who lose weight by implementing lifestyle changes regain their lost weight over time.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Abdominal liposuction provides a unique opportunity to evaluate the importance of subcutaneous abdominal fat in the pathogenesis of insulin resistance and in the risk of coronary heart disease in persons with abdominal obesity.

    “Therefore, abdominal liposuction provides a unique opportunity to evaluate the importance of subcutaneous abdominal fat in the pathogenesis of insulin resistance and in the risk of coronary heart disease in persons with abdominal obesity.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: It is not known whether one or both of the abdominal subcutaneous and visceral fat depots are actually involved in the pathogenesis of insulin resistance or whether they are simply associated with the metabolic complications of obesity.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In six of the seven subjects with type 2 diabetes, hypoglycemic medications were not changed after the clamp procedure; in one, rosiglitazone (4 mg per day) was stopped, and glipizide and metformin were continued.

    “In six of them, the medications were not changed after the clamp procedure; in one, rosiglitazone (4 mg per day) was stopped, and glipizide and metformin were continued.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    Weight stability was carefully maintained before and after liposuction to eliminate the confounding effects of changes in energy balance on the study end points.

    “Weight stability was carefully maintained before and after liposuction to eliminate the confounding effects of changes in energy balance on the study end points.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The 10-to-12-week delay between liposuction and the repeat studies was intended to eliminate the confounding effects of postsurgical inflammation on the study end points.

    “The 10-to-12-week delay was intended to eliminate the confounding effects of postsurgical inflammation on our study end points.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The decrease in body fat was greater than the total decrease in body weight because of abdominal-tissue edema, which often persists for months after liposuction.

    “The decrease in body fat was greater than the total decrease in body weight, however, because of abdominal-tissue edema, which often persists for months after liposuction.16”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The insulin infusion rates used in the clamp protocol result in plasma insulin concentrations that provide an optimal range for evaluating the effect of insulin on glucose production and lipolysis (stage 1) and on glucose disposal (stage 2).

    “These insulin infusion rates result in plasma insulin concentrations that provide an optimal range for evaluating the effect of insulin on glucose production and lipolysis (stage 1) and on glucose disposal (stage 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A total weight loss of about 12 percent usually results in marked improvement in the metabolic abnormalities associated with obesity and improves insulin sensitivity, blood pressure, serum lipid concentrations, and circulating markers of inflammation.

    “This amount of weight loss usually results in marked improvement in the metabolic abnormalities associated with obesity and improves insulin sensitivity, 18 blood pressure, 19 and concentrations of serum lipids 20 and circulating markers”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [18] source
    • cites [19] Stevens VJ, 2001, Ann Intern Med source
    • cites [20] Dattilo AM, 1992, Am J Clin Nutr source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    All subjects had had a stable weight (with fluctuations of not more than 2 percent of the body weight) for at least two months and had been sedentary (exercising for less than one hour per week) for at least six months before entering the study.

    “All the subjects had had a stable weight (with fluctuations of not more than 2 percent of the body weight) for at least two months and had been sedentary (exercising for less than one hour per week) for at least six months before entering the study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The number of subjects to be enrolled was determined as the estimated number needed for the study to detect a statistically significant effect of liposuction on glucose kinetics with a power of at least 0.8, if the subjects had lost a similar amount of body fat by dieting.

    “The number of subjects to be enrolled was determined as the estimated number needed for the study to detect a statistically significant effect of liposuction on glucose kinetics with a power of at least 0.8, if the subjects had lost a similar amount of body fat by dieting.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Adipose tissue is an important endocrine organ that produces several bioactive proteins, including interleukin-6, tumor necrosis factor a, and adiponectin.

    “Adipose tissue is now recognized as an important endocrine organ that produces several bioactive proteins, including interleukin-6, tumor necrosis factor a , and adiponectin.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Interleukin-6 and tumor necrosis factor a can cause insulin resistance and atherosclerosis by impairing insulin signaling, stimulating lipolysis and fatty acid release, increasing hepatic synthesis of C-reactive protein, and increasing systemic inflammation.

    “Interleukin-6 and tumor necrosis factor a can cause insulin resistance and atherosclerosis by impairing insulin signaling, stimulating lipolysis and fatty acid release, increasing hepatic synthesis of C-reactive protein, and increasing systemic inflammation, [32][33][34]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [32] source
    • cites [33] Kern PA, 2001, Am J Physiol Endocrinol Metab source
    • cites [34] source

  • May combine two claims.

    Premisecitation

    Liposuction does not alter visceral fat mass, the size of the remaining fat cells, intramyocellular fat, or intrahepatic fat.

    “In contrast, liposuction removes sub-cutaneous abdominal fat and reduces the total number of body fat cells, without altering visceral fat mass, 31 the size of the remaining fat cells, 10 intramyocellular fat, or intrahepatic fat.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] source
    • cites [10] source

  • May combine two claims.

    Premisecitation

    Liposuction removes subcutaneous abdominal fat and reduces the total number of body fat cells.

    “In contrast, liposuction removes sub-cutaneous abdominal fat and reduces the total number of body fat cells, without altering visceral fat mass, 31 the size of the remaining fat cells, 10 intramyocellular fat, or intrahepatic fat.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] source
    • cites [10] source
22 of 22

  • The paper relies on this without support.

    It is not known whether one or both of the abdominal subcutaneous and visceral fat depots are actually involved in the pathogenesis of insulin resistance or whether they are simply associated with the metabolic complications of obesity.

    “it is not known whether one or both of these fat depots are actually involved in the pathogenesis of insulin resistance or whether they are simply associated with the metabolic complications of obesity.”

  • The paper relies on this without support.

    Diet-induced weight loss improves the metabolic complications of abdominal obesity.

    “Diet-induced weight loss improves the metabolic complications of abdominal obesity.”

  • The paper relies on this without support.

    Liposuction does not induce a negative energy balance.

    “Our results suggest that induction of a negative energy balance, not simply a decrease in the mass of adipose tissue, is critical for achieving the metabolic benefits of weight loss.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The data from the present study and our earlier study demonstrate that liposuction does not result in short-term or long-term improvement in most of the key metabolic risk factors for CHD.

    “The data from the present study and our earlier study demonstrate that liposuction does not result in short-term or long-term improvement in most of the key metabolic risk factors for CHD.”

    From Long-term Effects of Large-volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease (2008) · cites this paper as [5]

    The Abstract reports no significant improvement in insulin sensitivity or coronary heart disease risk factors after liposuction. The Evaluation after Liposuction section says measurements were repeated 10–12 weeks after surgery; this paper does not establish the claimed lack of improvement over both short- and long-term periods. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Removal of large amounts of abdominal subcutaneous adipose tissue (~10 kg) by liposuction did not improve CHD risk factors or insulin sensitivity when subjects were evaluated ~10 weeks after the procedure.

    “Our data demonstrated that removal of large amounts of abdominal subcutaneous adipose tissue (SAT) (~10 kg) did not improve CHD risk factors or insulin sensitivity when subjects were evaluated ~10 weeks after the liposuction procedure was performed.”

    From Long-term Effects of Large-volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease (2008) · cites this paper as [5]

  • These long-term results are consistent with our findings obtained 10 weeks after large-volume liposuction.

    “These long-term results are consistent with our findings obtained 10 weeks after large-volume liposuction (5) and make it unlikely that persistent postsurgical inflammation masked the metabolic benefits of liposuction that we reported previously.”

    From Long-term Effects of Large-volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease (2008) · cites this paper as [5]

  • It is unlikely that persistent postsurgical inflammation masked the metabolic benefits of liposuction that we reported previously.

    “These long-term results are consistent with our findings obtained 10 weeks after large-volume liposuction (5) and make it unlikely that persistent postsurgical inflammation masked the metabolic benefits of liposuction that we reported previously.”

    From Long-term Effects of Large-volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease (2008) · cites this paper as [5]

  • Removal of subcutaneous fat by liposuction does not appear to produce beneficial metabolic changes.

    “The removal of subcutaneous fat by liposuction does not appear to produce beneficial metabolic changes (182).”

    From Cardiac remodeling in obesity (2008) · cites this paper as [182]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Glucose-tracer dose conversions disagree

    Minor

    The priming dose gives 22.5 μmol for 4.1 mg of the glucose tracer. At that same conversion, the stated 0.46 mg infusion rate corresponds to about 2.5 μmol, not 0.25 μmol, per minute per kilogram.

  • Post-liposuction insulin variability is misconverted

    Minor

    The paper specifies a factor of 6 for converting insulin from μU/ml to pmol/liter. An SD of 6 μU/ml therefore converts to 36 pmol/liter, not the reported 48.

    Reported 48 · recomputed 36

  • Triglyceride estimate lies outside its confidence interval

    Minor

    For the normal-glucose-tolerance group, the reported triglyceride change is −30 mg/dl, but its stated 95% confidence interval runs only from −22 to +2 mg/dl.

3 of 3

Cites

Flagged first, then by citations

1 of the 43 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Horowitz JF, 1999, Am J Physiol, 276, E278
  2. Ballor DL, 1994, Int J Obes Relat Metab Disord, 18, 35
  3. Klein S, 1996, Am J Physiol, 270, E739

Cited by

Sorted by citations

Related

Authors
Klein, S., Fontana, L., Young, V. L., Coggan, A. R., Kilo, C., Patterson, B. W., & Mohammed, B. S.
Affiliations
Washington University in St. Louis (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2004-06-17
Volume
350
Issue
25
Pages
2549-2557
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa033179
OpenAlex
W1973382595
Cited by
909
References
43
Citations by year
2026: 6 · 2025: 11 · 2024: 15 · 2023: 20 · 2022: 24 · 2021: 24 · 2020: 21 · 2019: 23 · 2018: 36 · 2017: 26 · 2016: 25 · 2015: 42 · 2014: 39 · 2013: 36 · 2012: 39
FWCI
53.59
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Body Contouring and Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
liposuction, abdominal obesity, insulin sensitivity, coronary risk factors, type 2 diabetes, adipose tissue, glucose disposal, lipolysis
MeSH terms
Abdomen, Adipose Tissue, Adult, Blood Glucose, Body Composition, Body Constitution, Cholesterol, Diabetes Mellitus, Type 2

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

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