Gut Hormone Profiles Following Bariatric Surgery Favor an Anorectic State, Facilitate Weight Loss, and Improve Metabolic Parameters

Roux, Carel W. le; Aylwin, Simon; Batterham, Rachel L.; Borg, Cynthia-Michelle; Coyle, Frances; Prasad, Vyas; Shurey, Sandra; Ghatei, Mohammad A.; Patel, Ameet G.; Bloom, Stephen R.

doi:10.1097/01.sla.0000183349.16877.84

Cited by 890 publications

(744 citation statements)

References 44 publications

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“…Despite equivalent weight loss, the post-RYGB group showed markedly better glucose tolerance by oral glucose tolerance testing than did the post-AGB group. Similarly, leRoux et al 27 observed better glucose tolerance in people following RYGB than after equivalent weight loss from AGB, and the estimated insulin sensitivity of the post-RYGB group was equivalent to that of lean counterparts, despite a significantly higher BMI in the post-surgical patients. Korner et al 28 also observed better glucose tolerance following a standardized test meal in a cross-sectional analysis of patients who had undergone RYGB compared with AGB, with equal postoperative BMI values.…”

Section: Mechanisms Of Diabetes Improvement Following Bariatric Surgerymentioning

confidence: 81%

“…Nevertheless, recent studies clearly show that meal-stimulated secretion of GLP-1 and other L-cell peptides such as peptide YY is, indeed, substantially and durably increased after RYGB, whereas this does not occur after AGB. 27,28,40,41 Consistent with elevated postprandial GLP-1 secretion, post-RYGB patients display an increased incretin effect. 25,40 As GLP-1 not only enhances insulin secretion but can also increase proliferation and decrease apoptosis of b cells, 39 it is a candidate mediator of the increase in b-cell mass that is claimed by some investigators to accompany post-RYGB hyperinsulinemic hypoglycemia.…”

Section: The Lower Intestinal Hypothesismentioning

confidence: 99%

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Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

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Bariatric surgery is currently the most effective method to promote major, sustained weight loss. Roux-en-Y gastric bypass (RYGB), the most commonly performed bariatric operation, ameliorates virtually all obesity-related comorbid conditions, the most impressive being a dramatic resolution of type 2 diabetes mellitus (T2DM). After RYGB, 84% of patients with T2DM experience complete remission of this disease, and virtually all have improved glycemic control. Increasing evidence indicates that the impact of RYGB on T2DM cannot be explained by the effects of weight loss and reduced energy intake alone. Weightindependent antidiabetic actions of RYGB are apparent because of the very rapid resolution of T2DM (before weight loss occurs), the greater improvement of glucose homeostasis after RYGB than after an equivalent weight loss from other means, and the occasional development of very late-onset, pancreatic b-cell hyperfunction. Several mechanisms probably mediate the direct antidiabetic impact of RYGB, including enhanced nutrient stimulation of L-cell peptides (for example, GLP-1) from the lower intestine, intriguing but still uncharacterized phenomena related to exclusion of the upper intestine from contact with ingested nutrients, compromised ghrelin secretion, and very probably other effects that have yet to be discovered. Research designed to prioritize these mechanisms and identify potential additional mechanisms promises to help optimize surgical design and might also reveal novel pharmaceutical targets for diabetes treatment. Keywords: diabetes; gastric bypass; bariatric surgery; ghrelin; GLP-1 Bariatric operations traditionally have been thought to cause weight loss through gastric restriction and/or intestinal malabsorption. Restrictive operations such as adjustable gastric banding (AGB) create a small pouch in the proximal stomach to reduce functional gastric capacity and retard gastric emptying. Malabsorptive procedures such as biliopancreatic diversion (BPD) leave much of the stomach intact but divert ingested food from the stomach to the ileum; thus, only a small segment of the distal bowel can absorb nutrients. The typical proximal Roux-en-Y gastric bypass (RYGB) creates gastric restriction and also causes food to bypass most of the stomach and a short segment of the proximal intestine, primarily the duodenum, leaving enough intact small bowel in digestive continuity to avoid clinically significant malabsorption. RYGB causes weight loss through gastric restriction and additional mechanisms involving changes in gut hormones and other processes under active investigation. 1-14 RYGB and BPD produce the highest and most rapid rates of remission of type 2 diabetes mellitus (T2DM). Remission of diabetes after RYGBAlthough bariatric surgery was designed to facilitate weight loss, anecdotal reports of rapid postoperative remission of T2DM emerged as early as the 1970s. In 1995, Pories et al. 4 reported long term results from 608 severely obese patients who underwent gastric bypass, with a 93% follow-up rate ov...

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Section: Mechanisms Of Diabetes Improvement Following Bariatric Surgerymentioning

confidence: 81%

Section: The Lower Intestinal Hypothesismentioning

confidence: 99%

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

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“…Six months after vertical banded gastroplasty, fasting plasma GLP-1 concentrations did not change significantly, but the area under the curve during an oral glucose tolerance test strikingly increased [48]. However, in another study involving patients submitted to gastric banding, GLP-1 levels after a test meal were similar to body-weight-matched obese controls [15]. It is pertinent to add that fasting levels of PYY and GLP-1 are generally low, and changes in these anorexigenic signals occur in the post-prandial period.…”

Section: Discussionmentioning

confidence: 91%

“…In humans, fasting and post-prandial plasma levels of PYY increase progressively 6 and 12 months after vertical banded gastroplasty surgery [46]. Some authors have found that the PYY area under the curve after a test meal was also superior in obese patients submitted to gastric banding when compared weight-matched obese controls [15], although in another similar study, this was not found to be the case [47]. Six months after vertical banded gastroplasty, fasting plasma GLP-1 concentrations did not change significantly, but the area under the curve during an oral glucose tolerance test strikingly increased [48].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there is growing evidence that bariatric surgery is able to interfere with the systems that regulate appetite and satiety [8][9][10]14]. Gastrointestinal hormones are important signals that regulate food intake: changes in the levels of ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1) observed after obesity surgery have been hypothesized to mediate the anorexigenic effect of these surgical procedures [15]. However, results from several human studies have been contradictory [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Increase in Ghrelin Levels After Weight Loss in Obese Zucker Rats is Prevented by Gastric Banding

et al. 2007

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Background Gastric banding is thought to decrease appetite in addition to the mechanical effects of food restriction, although this has been difficult to demonstrate in human studies. Our aim was to investigate the changes in orexigenic signals in the obese Zucker rat after gastric banding. Methods Obese Zucker rats ( fa/fa) were submitted to gastric banding (GBP), sham gastric banding fed ad libitum (sham), or sham operation with food restriction, pair-fed to the gastric banding group (sham-PF). Lean Zucker rats ( fa/+) were used as additional controls. Body weight and food intake were daily recorded for 21 days after surgery when epididymal fat was weighed and fasting ghrelin and hypothalamic NPY mRNA expression were measured. Results Gastric banding in obese Zucker rats resulted in a significant decrease of cumulative body weight gain and food intake. Furthermore, gastric banded rats were leaner than Sham-PF, as expressed by a significantly lower epididymal fat weight. Ghrelin levels of gastric banded rats were not increased when compared to sham-operated animals fed ad libitum and were significantly lower than the levels of weight matched sham-PF rats (1116.9±103.3 g GBP vs 963.2±54.3 g sham, 3,079.5±221.6 sham-PF and 2,969.9±150.9 g lean rats, p<0.001); hypothalamic NPY mRNA expression was not increased in GBP when compared to sham-operated rats. Conclusion In obese Zucker rats, GBP prevents the increase in orexigenic signals that occur during caloric deprivation. Our data support the hypothesis that sustained weight loss observed after gastric banding does not depend solely on food restriction.

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Medication Utilization and Annual Health Care Costs in Patients With Type 2 Diabetes Mellitus Before and After Bariatric Surgery

Makary¹,

Clark²,

Shore³

et al. 2010

Arch Surg

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Gut Hormone Profiles Following Bariatric Surgery Favor an Anorectic State, Facilitate Weight Loss, and Improve Metabolic Parameters

Abstract: Following RYGB and JIB, a pleiotropic endocrine response may contribute to the improved glycemic control, appetite reduction, and long-term changes in body weight.

Cited by 890 publications

References 44 publications

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Increase in Ghrelin Levels After Weight Loss in Obese Zucker Rats is Prevented by Gastric Banding

Medication Utilization and Annual Health Care Costs in Patients With Type 2 Diabetes Mellitus Before and After Bariatric Surgery

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