Physiology of Weight Loss Surgery

Park, Chan W.; Torquati, Alfonso

doi:10.1016/j.suc.2011.08.009

Cited by 30 publications

(21 citation statements)

References 75 publications

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“…Only a few minutes after being secreted into the circulation, GLP‐1 and GIP (t 1/2 ≈ 2 min) suffer rapid cleavage and inactivation by the enzyme DPP‐4 , also known as adenosine deaminase (ADA) complexing protein 2 or CD26 . The truncated inactive metabolites that arise by the removal of their two N‐terminal amino acids, GLP‐1 and GIP undergo further renal elimination . Despite DPP‐4‐mediated degradation, GLP‐1 and GIP are cleaved to a minor extent by several neutral endopeptidases and additional aminopeptidases or extracted in the liver, extremities and lungs .…”

Section: Overview Of Incretins In Health and In T2dmmentioning

confidence: 99%

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The incretin system ABCs in obesity and diabetes – novel therapeutic strategies for weight loss and beyond

2016

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Incretins are gastrointestinal-derived hormones released in response to a meal playing a key role in the regulation of postprandial secretion of insulin (incretin effect) and glucagon by the pancreas. Both incretins, glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1), have several other actions by peripheral and central mechanisms. GLP-1 regulates body weight by inhibiting appetite and delaying gastric, emptying actions that are dependent on central nervous system GLP-1 receptor activation. Several other hormones and gut peptides, including leptin and ghrelin, interact with GLP-1 to modulate appetite. GLP-1 is rapidly degraded by the multifunctional enzyme dipeptidyl peptidase-4 (DPP-4). DPP-4 is involved in adipose tissue inflammation, which is associated with insulin resistance and diabetes progression, being a common pathophysiological mechanism in obesity-related complications. Furthermore, the incretin system appears to provide the basis for understanding the high weight loss efficacy of bariatric surgery, a widely used treatment for obesity, often in association with diabetes. The present review brings together new insights into obesity pathogenesis, integrating GLP-1 and DPP-4 in the complex interplay between obesity and inflammation, namely, in diabetic patients. This in turn will provide the basis for novel incretin-based therapeutic strategies for obesity and diabetes with promising benefits in addition to weight loss. © 2016 World Obesity.

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Section: Overview Of Incretins In Health and In T2dmmentioning

confidence: 99%

“…Peptide YY is mainly secreted by colon and rectum L cells following a nutrient supply, but contrary to GLP‐1, its degradation by DPP‐4 yields a still biologically active peptide – PYY (3–36) (86). This form inhibits appetite, potentially contributing to the ileal brake.…”

Section: Incretins In Obesitymentioning

confidence: 99%

The incretin system ABCs in obesity and diabetes – novel therapeutic strategies for weight loss and beyond

2016

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“…Bariatric surgery procedures, specifically Roux‐en‐Y Gastric Bypass (Park and Torquati ) (RYGB), are associated with greater success at long‐term weight loss maintenance and sustained improvements in obesity–related comorbidities as compared to non‐surgical weight loss strategies (Falken et al. ; Gloy et al.…”

Section: Introductionmentioning

confidence: 99%

Comparison of surgical versus diet‐induced weight loss on appetite regulation and metabolic health outcomes

et al. 2019

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Bariatric surgery is associated with significant and sustained weight loss and improved metabolic outcomes. It is unclear if weight loss alone is the main mechanism of improved metabolic health. The purpose of this trial was to compare indices of appetite regulation, insulin sensitivity and energy intake ( EI ) between participants achieving 10 kg of weight loss via Roux‐en‐Y Gastric Bypass ( RYGB ) or dietary restriction ( DIET ); intake of a very low calorie liquid diet (800 kcal/d; 40% protein, 40% fat, 20% carbohydrate that matched the post‐ RYGB dietary protocol). Adults qualifying for bariatric surgery were studied before and after 10 kg of weight loss ( RYGB [ n = 6]) or DIET [ n = 17]). Appetite (hunger, satiety, and prospective food consumption [ PFC ]), appetite–related hormones, and metabolites (ghrelin, PYY , GLP ‐1, insulin, glucose, free fatty acids [ FFA ], and triglycerides [ TG ]) were measured in the fasting state and every 30 min for 180 min following breakfast. Participants were provided lunch to evaluate acute ad libitum EI , which was similarly reduced in both groups from pre to post weight loss. Fasting ghrelin was reduced to a greater extent following RYGB compared to DIET ( P = 0.04). Area under the curve ( AUC ) for ghrelin ( P = 0.01), hunger ( P < 0.01) and PFC ( P < 0.01) increased after DIET compared to RYGB , following 10 kg weight loss. Satiety AUC increased after RYGB and decreased after DIET ( P < 0.01). Glucose and insulin (fasting and AUC ) decreased in both groups. FFA increased in both groups, with a greater increase in AUC seen after RYGB versus DIET ( P = 0.02). In summary, appetite–related indices were altered in a manner that, if maintained, may promote a sustained reduction in energy intake with RYGB compared to DIET . Future work with a larger sample size and longer follow‐up will be important to confirm and extend these findings.

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“…Therefore, these anatomical and functional alterations could explain the early satiation, and subsequently, the maintenance of body weight lost over time in a majority of subjects with TG [18, 19]. …”

Section: Discussionmentioning

confidence: 99%

Impaired Enterohormone Response Following a Liquid Test Meal in Gastrectomized Patients

Santarpia¹,

Pagano²,

Cioffi³

et al. 2017

Ann Nutr Metab

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Background: Total gastrectomy (TG) is responsible for symptoms or disturbance of alimentary status (changes in body weight, food intake per meal and frequency of meal per day) which, in turn are responsible for weight loss and malnutrition. The study evaluates the gut hormone responses in totally gastrectomized (TG) patients after a liquid meal test. Methods: Twenty total gastrectomized cancer-free patients (12 M, 8 F, 56.4 ± 10.2 years, BMI 21.4 ± 2.2 kg/m²) and 10 healthy volunteers (4 M, 6 F, 48.0 ± 12.7 years, BMI 26.7 ± 3.0 kg/m² ) drank a liquid meal (1.25 kcal/mL) at the rate of 50 mL/5′ min for a maximum of 30 min. Satiety score was assessed and blood sample was taken at different time points. Results: The time response course, particularly for insulin, glucose-like pepetide-1, and cholecystokinin, significantly differed between TG patients and controls. Conclusions: Our results may help to better understand hormone responses triggered by the faster arrival of nutrients in the small bowel and to explain some post-TG symptoms.

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Physiology of Weight Loss Surgery

Cited by 30 publications

References 75 publications

The incretin system ABCs in obesity and diabetes – novel therapeutic strategies for weight loss and beyond

The incretin system ABCs in obesity and diabetes – novel therapeutic strategies for weight loss and beyond

Comparison of surgical versus diet‐induced weight loss on appetite regulation and metabolic health outcomes

Impaired Enterohormone Response Following a Liquid Test Meal in Gastrectomized Patients

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