Effect of Laparoscopic Sleeve Gastrectomy on Fasting Gastrointestinal, Pancreatic, and Adipose-Derived Hormones and on Non-Esterified Fatty Acids

Abstract

BackgroundAlterations in gastrointestinal, pancreatic, and adipose hormone levels may have a greater role in weight loss than initially appreciated. The laparoscopic sleeve gastrectomy (LSG) operation is now the most frequently performed bariatric operation in many countries, but there are relatively few data regarding its molecular effects. We sought to characterize the effect of LSG on fasting plasma levels of selected hormones and on non-esterified fatty acids (NEFA), and to compare these to levels in non-obese control individuals.Materials and MethodsThe levels of nine plasma hormones were measured using a multiplex bead-based assay at baseline and at 3 months after operation in 11 obese patients undergoing LSG. NEFA levels were also measured. The levels were compared to those for 22 age- and sex-matched non-obese individuals.ResultsAt baseline, obese patients showed significantly higher expression of C-peptide, insulin, and leptin and significantly lower ghrelin, glucose-dependent insulinotropic peptide (GIP), and resistin compared to non-obese controls (p < 0.05). LSG resulted in a reduction in BMI from 42.5 ± 6.47 kg/m2 at operation to 35.2 ± 5.14 kg/m2 at 3 months (42 % mean excess weight loss, p < 0.001). LSG led to a significant decrease in ghrelin, glucagon-like peptide-1 (GLP-1), glucagon, leptin, plasminogen activator inhibitor-1 (PAI-1), and NEFA.ConclusionLSG induces marked early changes in the fasting levels of factors thought to be important regulators of obesity and metabolic health. These changes differ somewhat from the findings for operations with a malabsorptive component, suggesting that subtle differences exist in the mechanisms of weight loss between LSG and other bariatric operations.

Comparison of Sleeve Gastrectomy and Conservatory Treatment Effect on Biochemical and Hormonal Profile of Obese Type 2 Diabetes Subjects: CREDOR Randomized Controlled Study Results

“…A less pronounced but also significant (p=0.003) decrease of leptin was recorded in the control group, so that finally the change at one year was not significant between the two groups (p=0.51). The decrease of leptin levels in sleeve gastrectomy patients was previously reported [33,37,38,41] and is explained by the decrease of fat tissue mass in parallel with weight loss (in our study percentage of fat mass decreased from 32.7% to 20.3% in the surgical group). For the control group, the decrease in leptin levels was disproportionate when compared with the modest weight loss.…”

“…Overall, the difference between the two study groups at one year was significant, with p=0.0016. The decreased level of ghrelin in sleeve gastrectomy patients was expected, being previously reported [32,33] and explained by the reduction of ghrelin secreting cells following resection of the gastric fundus during the surgical procedure [34]. The increased ghrelin levels in the control group might explain weight regain that occurred between 6 months and 12 months in these patients (data not shown).…”

Pattern of Biliary Disease Following Laparoscopic Sleeve Gastrectomy in Adolescents

“…This finding is significant because it promotes the possibility of a post‐LSG metabolic shift as another contributor to AP. Pancreatic hormone levels, for example, were shown to undergo dramatic shifts in the immediate postoperative period following LSG, different from those affected after RYGB . Thus, pancreatic endocrine and exocrine function may undergo significant alteration after LSG, creating an environment that leads to AP when combined with local inflammation from the procedure.…”

“…Acute pancreatitis (AP), although rare, has also been reported following metabolic surgical procedures . Whereas some have suggested a purely obstructive etiology for AP, others have promoted the possibility of post‐LSG metabolic shifts or technical factors contributing to its development . Most of these analyses have been performed in adults; however, younger age groups may suffer different types of biliary complications, possibly related to a higher sensitivity to changes in physiology .…”

Ist Diabetes heilbar durch bariatrische Chirurgie? – Mechanismen der Verbesserung der diabetischen Stoffwechsellage durch chirurgische Adipositastherapie –

“…In der Pathogenese der Insulinresistenz und des Typ-2-Diabetes spielen freie Fettsäuren eine wesentliche Rolle. Nach bariatrischen Operationen fallen FFS deutlich ab [41,42], insbesondere nach RYGB [43]. Von Hoffstedt et al [41] wird nun auch der Metabolismus des Fettgewebes vor und bis zu 5 Jahre nach RYGB bei adipösen Frauen untersucht.…”