Effects of meal composition on postprandial incretin, glucose and insulin responses after surgical and medical weight loss

Abstract

SummaryBackgroundMeal tolerance tests are frequently used to study dynamic incretin and insulin responses in the postprandial state; however, the optimal meal that is best tolerated and suited for hormonal response following surgical and medical weight loss has yet to be determined.ObjectiveTo evaluate the tolerability and effectiveness of different test meals in inducing detectable changes in markers of glucose metabolism in individuals who have undergone a weight loss intervention.MethodsSix individuals who underwent surgical or medical weight loss (two Roux‐en‐Y gastric bypass, two sleeve gastrectomy and two medical weight loss) each completed three meal tolerance tests using liquid‐mixed, solid‐mixed and high‐fat test meals. The tolerability of each test meal, as determined by the total amount consumed and palatability, as well as fasting and meal‐stimulated glucagon‐like peptide, glucose‐dependent insulinotropic polypeptide, insulin and glucose were measured.ResultsAmong the six individuals, the liquid‐mixed meal was better and more uniformly tolerated with a median meal completion rate of 99%. Among the four bariatric surgical patients, liquid‐mixed meal stimulated on average a higher glucagon‐like peptide (percent difference: 83.7, 89), insulin secretion (percent difference: 155.1, 158.7) and glucose‐dependent insulinotropic polypeptide (percent difference: 113.5, 34.3) compared with solid‐mixed and high‐fat meals.ConclusionsThe liquid‐mixed meal was better tolerated with higher incretin and insulin response compared with the high‐fat and solid‐mixed meals and is best suited for the evaluation of stimulated glucose homeostasis.

A high carbohydrate, but not fat or protein meal attenuates postprandial ghrelin, PYY and GLP-1 responses in Chinese men

“…Gastric emptying is more prolonged after a solid meal compared to a liquid meal [ 44 ] which might affect peptide release from enterocytes consequently. However, in a pilot study, liquid-mixed meal showed to be better and more uniformly tolerated among the study subjects, with a greater stimulated incretin and insulin response compared to a solid-mixed meal [ 45 ]. The study was limited to a small sample size despite a very well characterized cohort of lean and obese individuals.…”

Intestinal Adaptations after Bariatric Surgery: Consequences on Glucose Homeostasis

“…In summary, the altered glycemic and hormonal response to a liquid meal in RYGB and VSG patients is likely to be mediated by the accelerated nutrient flow after both surgeries, which increases the surface of contact between the meal and the intestine. However, it is worth noting that amixed meal test may differ in many ways with the daily diet pattern of patients [46] and that thehormonal responses observed experimentally may not occur during small solid meals [47,48].…”

Mechanisms of Weight Loss After Sleeve Gastrectomy and Adjustable Gastric Banding: Far More Than Just Restriction

“…Romero and colleagues found that GIP response to a mixed liquid meal was markedly increased after SG, although it did not differ from that of matched nonoperative controls. Lee et al performed a meal tolerance test in individuals with obesity, showing that GIP levels were higher in an SG group in comparison with a medical weight lossgroup. The authors hypothesized that the intact proximal intestine where K cells are located causes an increase of GIP secretion.…”