1
|
Aydin MA, Aykal G, Gunduz UR, Dincer A, Turker A, Turkoglu F, Guler M. Type 2 diabetes mellitus remission in sleeve gastrectomy patients: Role of enteroendocrine response and serum citrulline and I-FABP levels. Am J Surg 2024; 236:115782. [PMID: 38821725 DOI: 10.1016/j.amjsurg.2024.115782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/06/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION This prospective cohort study examines the relationship between post-sleeve gastrectomy (SG) weight loss and serum citrulline, I-FABP levels, and the I-FABP/citrulline ratio in obese patients, alongside the correlation with type 2 diabetes mellitus (T2DM) remission. METHODS 88 participants were enrolled, including 48 undergoing SG and 21 with T2DM. 40 healthy individuals served as controls. Preoperative and 1-year postoperative assessments included citrulline, I-FABP, glucose, insulin, HbA1c, and C peptide levels. RESULTS Significant weight loss and T2DM remission (11/21) were observed post-SG. Preoperatively, patients had low citrulline and high I-FABP levels, which normalized postoperatively. A positive correlation was found between the I-FABP/citrulline ratio and weight, BMI, glucose, insulin, and C peptide levels. CONCLUSION SG not only induces enterocyte dysfunction and mass recovery but also may facilitate T2DM remission and alleviate obesity-related effects on the enteroendocrine system. These findings highlight the potential beneficial effects of SG on enteroendocrine function in obese patients.
Collapse
Affiliation(s)
- Muhammed Ali Aydin
- Antalya Training and Research Hospital, Department of Biochemistry, Antalya, Turkey.
| | - Guzin Aykal
- Antalya Training and Research Hospital, Department of Biochemistry, Antalya, Turkey.
| | - Umut Riza Gunduz
- Antalya Training and Research Hospital, Department of General Surgery, Antalya, Turkey.
| | - Aydin Dincer
- Antalya Training and Research Hospital, Department of General Surgery, Antalya, Turkey.
| | - Alper Turker
- Antalya Training and Research Hospital, Department of General Surgery, Antalya, Turkey.
| | - Furkan Turkoglu
- Istanbul Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
| | - Mert Guler
- Istanbul Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
| |
Collapse
|
2
|
Pereira AM, Moura D, Pereira SS, Andrade S, Almeida RFD, Nora M, Monteiro MP, Guimarães M. Beyond Restrictive: Sleeve Gastrectomy to Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy as a Spectrum of One Single Procedure. Obes Facts 2024; 17:364-371. [PMID: 38801818 PMCID: PMC11299966 DOI: 10.1159/000539104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a restrictive/hypoabsorptive procedure recommended for patients with obesity class 3. For safety reasons, SADI-S can be split into a two-step procedure by performing a sleeve gastrectomy (SG) first. This stepwise approach also provides an unprecedented opportunity to disentangle the weight loss mechanisms triggered by each component. The objective was to compare weight trajectories and post-prandial endocrine and metabolic responses of patients with obesity class 3 submitted to SADI-S or SG as the first step of SADI-S. METHODS Subjects submitted to SADI-S (n = 7) or SG (n = 7) at a tertiary referral public academic hospital underwent anthropometric evaluation and a liquid mixed meal tolerance test (MMTT) pre-operatively and at 3, 6, and 12 months post-operatively. RESULTS Anthropometric parameters, as well as metabolic and micronutrient profiles, were not significantly different between groups, neither before nor after surgery. There were no significant differences in fasting or post-prandial glucose, insulin, C-peptide, ghrelin, insulin secretion rate, and insulin clearance during the MMTT between subjects submitted to SADI-S and SG. There was no lost to follow-up. CONCLUSIONS The restrictive component seems to be the main driver for weight loss and metabolic adaptations observed during the first 12 months after SADI-S, given that the weight trajectories and metabolic profiles do not differ from SG. These data provide support for surgeons' choice of a two-step SADI-S without jeopardizing the weight loss outcomes.
Collapse
Affiliation(s)
- Ana Marta Pereira
- Department of General Surgery, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Diogo Moura
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Sofia S Pereira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal,
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal,
| | - Sara Andrade
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal
| | - Rui Ferreira de Almeida
- Department of General Surgery, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mário Nora
- Department of General Surgery, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Mariana P Monteiro
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal
| | - Marta Guimarães
- Department of General Surgery, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal
| |
Collapse
|
3
|
Ferreira FP, Pereira SS, Costa MM, Guimarães M, Albrechtsen NJW, Holst JJ, Nora M, Monteiro MP. Individuals with type 2 diabetes have higher density of small intestinal neurotensin-expressing cells. Mol Cell Biochem 2023; 478:2779-2787. [PMID: 36920577 PMCID: PMC10627918 DOI: 10.1007/s11010-023-04698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Neurotensin (NT) is a gastro-intestinal hormone involved in several pathways that regulate energy and glucose homeostasis. NT was hypothesized to act in synergy with incretin hormones to potentiate its anti-diabetic effects. Additionally, circulating NT levels were shown to rise after bariatric surgery-induced weight loss. Knowledge of NT-secreting cells distribution along the small intestine and its variation according to diabetes status could provide insights on NT role in mediating type 2 diabetes (T2D) improvement after bariatric surgery. So, our aims were to characterize NT-expressing cell distribution along the human small intestine and to compare the relative density of NT-expressing cells in the small intestine of individuals with and without T2D undergoing bariatric surgery for obesity treatment. Autopsy-derived small intestine fragments (n = 30) were obtained at every 20 cm along the entire intestinal length. Additionally, jejunum biopsies (n = 29) were obtained during elective gastric bypass interventions from patients with (n = 10) or without T2D (n = 18). NT-expressing cells were identified by immunohistochemistry and quantified via computerized morphometric analysis. NT-expressing cell density increased along the human small intestine. NT-expressing cell density was significantly higher from 200 cm distal to the duodenojejunal flexure onward, as well as in subjects with T2D when compared to those without T2D. NT-expressing cell density increases along the human small gut, and a higher density is found in individuals with T2D. This finding suggests a potential role for NT in the mechanisms of disease and T2D improvement observed after bariatric surgery.
Collapse
Affiliation(s)
- Filipa P Ferreira
- Department of Anatomy, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Sofia S Pereira
- Department of Anatomy, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal.
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
| | - Madalena M Costa
- Department of Anatomy, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Marta Guimarães
- Department of Anatomy, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- Department of General Surgery, Centro Hospitalar de Entre Douro E Vouga, Santa Maria da Feira, Portugal
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, 2100, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Mário Nora
- Department of General Surgery, Centro Hospitalar de Entre Douro E Vouga, Santa Maria da Feira, Portugal
| | - Mariana P Monteiro
- Department of Anatomy, UMIB-Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| |
Collapse
|
4
|
Pereira SS, Guimarães M, Monteiro MP. Towards precision medicine in bariatric surgery prescription. Rev Endocr Metab Disord 2023; 24:961-977. [PMID: 37129798 PMCID: PMC10492755 DOI: 10.1007/s11154-023-09801-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 05/03/2023]
Abstract
Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.
Collapse
Affiliation(s)
- Sofia S Pereira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Marta Guimarães
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
- Department of General Surgery, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho, 4050-220, Santa Maia da Feira, Portugal
| | - Mariana P Monteiro
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal.
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal.
| |
Collapse
|
5
|
Differences in the effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass on gut hormones: systematic and meta-analysis. Surg Obes Relat Dis 2021; 17:444-455. [DOI: 10.1016/j.soard.2020.10.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/18/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
|
6
|
Guimarães M, Pereira SS, Holst JJ, Nora M, Monteiro MP. Can Metabolite and Hormone Profiles Provide a Rationale for Choosing Between Bariatric Procedures? Obes Surg 2021; 31:2174-2179. [PMID: 33511559 DOI: 10.1007/s11695-021-05246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE There are no formal guidelines for choosing among different bariatric surgery procedures for obesity treatment. So, our aim was to evaluate whether post-absorptive metabolite and hormone profiles could aid the surgeon decision when considering bariatric surgery interventions. MATERIALS AND METHODS Subjects (N=38) previously submitted to biliopancreatic diversion with duodenal switch (BPD-DS, n=9), single anastomosis duodenal-ileum bypass with sleeve gastrectomy (SADI-S, n= 9), long biliopancreatic limb Roux-en-Y gastric bypass (RYGB-M, n= 11), and classic RYGB (RYGB-C, n= 9) underwent a mixed meal test to evaluate post-absorptive glucose, total amino acid (AA), insulin, and GLP-1 profiles. RESULTS Glucose, AA, insulin, and GLP-1 excursions were lower after BPD-DS when compared to other surgeries. SADI-S resulted in lower glucose but similar AA and insulin excursions when compared to RYGB-M. The highest GLP-1 excursion was observed after RYGB-M. There were no significant differences in glucose or AA post-prandial excursions between RYGB procedures, yet insulin excursion was higher after RYGB-C when compared to RYGB-M. CONCLUSION Post-prandial metabolite excursions diverge across bariatric procedures being lowest after BPD-DS, intermediate after SADI-S, and highest after RYGB, in parallel with the anti-diabetic efficacy and malabsorption risk reported for each type of intervention. SADI-S and RYGB-M seem to elicit similar post-prandial hormonal profiles, with potentially lower risk of protein malnutrition when compared to BPD-DS. Post-absorptive metabolite and hormone profiles could provide a rationale as decision-aid when choosing among bariatric surgery interventions, as long as these findings are validated in future trials.
Collapse
Affiliation(s)
- Marta Guimarães
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Sofia S Pereira
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Mário Nora
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal.
| |
Collapse
|