Laparoscopic sleeve gastrectomy differentially affects serum concentrations of FGF‐19 and FGF‐21 in morbidly obese subjects

Abstract

Objective: Fibroblast growth factor (FGF)-19 and FGF-21 are novel metabolic regulators that improve insulin resistance and obesity in rodents. The aim of the study was to assess the effects of laparoscopic sleeve gastrectomy (LSG) on serum concentrations of FGF-19 and FGF-21 along with circulating bile acids and other relevant hormonal and biochemical parameters. Design and Methods: Seventeen females with obesity undergoing LSG and 15 lean healthy females were included into the study. Anthropometric and biochemical parameters, serum concentrations of FGF-19 and -21, insulin, adiponectin, leptin, C-reactive protein, resistin, amylin (total), ghrelin (active), glucagon-like peptide 1 (GLP-1, active), glucose-dependent insulinotropic peptide (GIP, total), peptide YY (PYY, total), pancreatic polypeptide (PP), and bile acids, and mRNA expression of selected adipokines and inflammatory markers in bioptic samples of subcutaneous fat were assessed at baseline and 6, 12, and 24 months after LSG. Results: LSG markedly decreased body weight, BMI, waist circumference, and insulin levels and improved systemic inflammation and lipid levels. FGF-19 concentrations increased and FGF-21 concentrations decreased after LSG along with increased adiponectin and decreased leptin, amylin, and ghrelin levels. GLP-1, GIP, PP, and circulating bile acids were not affected by LSG. PYY decreased significantly 24 months after surgery only. mRNA expression analysis in subcutaneous fat showed markedly reduced proinflammatory state. Conclusions: Our results indicate that increased FGF-19 and decreased ghrelin concentrations could have partially contributed to the improvement of systemic inflammation and some metabolic parameters after LSG, while changes of FGF-21 are rather secondary because of weight loss.

Effects of the Intragastric Balloon MedSil® on Weight Loss, Fat Tissue, Lipid Metabolism, and Hormones Involved in Energy Balance

“…The same results were published in 23 non-diabetic, morbidly obese subjects 1 year after laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy [38]. However, a recently published work describes significant decreases in levels of FGF21 in 17 obese females undergoing laparoscopic sleeve gastrectomy [39], which is in accordance with our results.…”

Endocrine effects of duodenal–jejunal exclusion in obese patients with type 2 diabetes mellitus

“…Thus, its increase could directly contribute to improved diabetes control observed in our study, although it still remains to be seen whether such effects are indeed present in humans (Mraz et al 2011). Nevertheless, some previous studies including our data have documented that metabolic improvements after selected types of bariatric operations are also accompanied by increased FGF19 levels (Gerhard et al 2013, Haluzikova et al 2013.…”

Mechanisms of enterohepatic fibroblast growth factor 15/19 signaling in health and disease

“…In this regard, FGF19 levels were found to be restored in obese patients that underwent bariatric surgery pointing to a potential active role of FGF19 for the improvement of glycemic control [79][80][81][82]. In line with this notion, a recent mechanistic study in mice provided evidence for a substantial contribution of Fxr-mediated BA signaling to the beneficial effects arising from vertical sleeve gastrectomy [83].…”