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Wysocki M, Mizera M, Karpińska I, Ptaszkiewicz K, Małczak P, Pisarska-Adamczyk M, Kania M, Major P. Analysis of Changes in Glucose and Lipid Metabolism in Patients with Clinically Severe Obesity and Type 2 Diabetes Mellitus Undergoing Laparoscopic Sleeve Gastrectomy-Prospective Observational Study. Obes Surg 2024; 34:467-478. [PMID: 38105282 PMCID: PMC10811010 DOI: 10.1007/s11695-023-06991-8] [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: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION We still lack studies providing analysis of changes in glucose and lipid metabolism after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes mellitus (DM2). We aimed to investigate postoperative changes in glucose and lipid metabolism after LSG in patients with DM2. MATERIAL AND METHODS Prospective, observational study included patients with BMI ≥ 35 kg/m2 and ≤ 50 kg/m2, DM2 < 10 years of duration, who were qualified for LSG. Perioperative 14-day continuous glucose monitoring (CGM) began after preoperative clinical assessment and OGTT, then reassessment 1 and 12 months after LSG. Thirty-three patients in mean age of 45 ± 10 years were included in study (23 females). RESULTS EBMIL before LSG was 17 ± 11.7%, after 1 month-36.3 ± 12.8%, while after 12 months-66.1 ± 21.7%. Fifty-two percent of the patients had DM2 remission after 12 months. None required then insulin therapy. 16/33 patients initially on oral antidiabetics still required them after 12 months. Significant decrease in HbA1C was observed: 5.96 ± 0.73%; 5.71 ± 0.80; 5.54 ± 0.52%. Same with HOMA-IR: 5.34 ± 2.84; 4.62 ± 3.78; 3.20 ± 1.99. In OGTT, lower increase in blood glucose with lesser insulin concentrations needed to recover glucose homeostasis was observed during follow-ups. Overtime perioperative average glucose concentration in CGM of 5.03 ± 1.09 mmol/L significantly differed after 12 months, 4.60 ± 0.53 (p = 0.042). Significantly higher percentage of glucose concentrations above targeted compartment (3.9-6.7 mmol/L) was observed in perioperative period (7% ± 4%), than in follow-up (4 ± 6% and 2 ± 1%). HDL significantly rose, while triglyceride levels significantly decreased. CONCLUSIONS Significant improvement in glucose and lipid metabolism was observed 12 months after LSG and changes began 1 month after procedure.
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Affiliation(s)
- Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Cracow, Os. Zlotej Jesieni 1, 31-826, Cracow, Poland.
| | - Magdalena Mizera
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Izabela Karpińska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Kuba Ptaszkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | | | - Michał Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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Yildirim V, Sheraton VM, Brands R, Crielaard L, Quax R, van Riel NA, Stronks K, Nicolaou M, Sloot PM. A data-driven computational model for obesity-driven diabetes onset and remission through weight loss. iScience 2023; 26:108324. [PMID: 38026205 PMCID: PMC10665812 DOI: 10.1016/j.isci.2023.108324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Obesity is a major risk factor for the development of type 2 diabetes (T2D), where a sustained weight loss may result in T2D remission in individuals with obesity. To design effective and feasible intervention strategies to prevent or reverse T2D, it is imperative to study the progression of T2D and remission together. Unfortunately, this is not possible through experimental and observational studies. To address this issue, we introduce a data-driven computational model and use human data to investigate the progression of T2D with obesity and remission through weight loss on the same timeline. We identify thresholds for the emergence of T2D and necessary conditions for remission. We explain why remission is only possible within a window of opportunity and the way that window depends on the progression history of T2D, individual's metabolic state, and calorie restrictions. These findings can help to optimize therapeutic intervention strategies for T2D prevention or treatment.
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Affiliation(s)
- Vehpi Yildirim
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Vivek M. Sheraton
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, 1100 DD Amsterdam, the Netherlands
| | - Ruud Brands
- AMRIF B.V., Agro Business Park, 6708 PW Wageningen, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, 3584 CL Utrecht, the Netherlands
| | - Loes Crielaard
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
| | - Natal A.W. van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, the Netherlands
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, 1100 DD Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, 1081 BT Amsterdam, the Netherlands
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
| | - Peter M.A. Sloot
- Institute for Advanced Study, University of Amsterdam, 1012 GC Amsterdam, the Netherlands
- Computational Science Lab, University of Amsterdam, 1098 XH Amsterdam, the Netherlands
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Dan W, Wang X, Wu J, Gu Y, Liu S, Zhang H, Chang X, Shi C, Yan H, Xia M, Wang L, Jiao H, Wu H, Lou W, Gao X, Bian H, Wang J, Huang LH. The early effects of sleeve gastrectomy on postprandial chylomicron triglycerides during the progression of type 2 diabetes. Clin Chim Acta 2023; 549:117558. [PMID: 37709114 DOI: 10.1016/j.cca.2023.117558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND It remains unclear whether early sleeve gastrectomy (SG) improves postprandial very-low-density lipoprotein (VLDL) as well as chylomicron triglycerides (TGs) in a weight-independent manner in patients with or without type 2 diabetes (DM). Herein we investigated the early effects of SG on postprandial VLDL and chylomicron kinetics. METHODS A liquid meal test was performed before and after 1 week of SG. The plasma was collected for postprandial triglyceride-rich lipoprotein kinetics analyses, including VLDLs and chylomicrons, isolated by high-speed ultracentrifugation. Lipidomics and metabolomics were used to profile lipid and metabolite compositions of plasma and postprandial chylomicrons. De novo fatty acid synthesis in intestinal epithelial cells treated with chylomicron metabolites was examined using RT-PCR, immunoblotting, and free fatty acid measurement. RESULTS We found that patients with DM had markedly higher VLDL TGs than patients without DM, and such an increase was still retained after SG. In contrast, SG significantly decreased postprandial chylomicron TGs, but surprisingly, the degree of the reduction in patients with DM was less prominent than in patients without DM, confirmed by untargeted lipidomics analysis. Moreover, 5 unique metabolites potentially linked to de novo fatty acid synthesis from the pathway analysis were discovered by further metabolomic analysis of postprandial chylomicrons from patients with DM who underwent SG and verified by In vitro intestinal epithelial cell culture experiments. CONCLUSIONS SG in 1 week did not impact postprandial VLDL but decreased chylomicron TGs. Patients with DM keep higher postprandial chylomicron TG concentrations than patients without it after SG, potentially through some unique metabolites that increase intestinal fatty acid synthesis. These results implicate the timing for SG to reach lower intestinal fatty acid synthesis and postprandial chylomicron TG production is prior to the diagnosis of DM to potentially reduce cardiovascular risks.
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Affiliation(s)
- Wei Dan
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China
| | - Xinmei Wang
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China
| | - Jiaqi Wu
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China
| | - Yu Gu
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China
| | - Shuangshuang Liu
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China
| | - Hongye Zhang
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China
| | - Xinxia Chang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chenye Shi
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hongmei Yan
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingfeng Xia
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Liu Wang
- Second Affiliated Hospital of Army Military Medical University, Chongqing 400037, China
| | - Heng Jiao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Haifu Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wenhui Lou
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hua Bian
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Jiaxi Wang
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China.
| | - Li-Hao Huang
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200433, China; Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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4
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Yildirim V, ter Horst KW, Gilijamse PW, van Harskamp D, Schierbeek H, Jansen H, Schimmel AW, Nieuwdorp M, Groen AK, Serlie MJ, van Riel NA, Dallinga-Thie GM. Bariatric surgery improves postprandial VLDL kinetics and restores insulin-mediated regulation of hepatic VLDL production. JCI Insight 2023; 8:e166905. [PMID: 37432744 PMCID: PMC10543721 DOI: 10.1172/jci.insight.166905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/06/2023] [Indexed: 07/12/2023] Open
Abstract
Dyslipidemia in obesity results from excessive production and impaired clearance of triglyceride-rich (TG-rich) lipoproteins, which are particularly pronounced in the postprandial state. Here, we investigated the impact of Roux-en-Y gastric bypass (RYGB) surgery on postprandial VLDL1 and VLDL2 apoB and TG kinetics and their relationship with insulin-responsiveness indices. Morbidly obese patients without diabetes who were scheduled for RYGB surgery (n = 24) underwent a lipoprotein kinetics study during a mixed-meal test and a hyperinsulinemic-euglycemic clamp study before the surgery and 1 year later. A physiologically based computational model was developed to investigate the impact of RYGB surgery and plasma insulin on postprandial VLDL kinetics. After the surgery, VLDL1 apoB and TG production rates were significantly decreased, whereas VLDL2 apoB and TG production rates remained unchanged. The TG catabolic rate was increased in both VLDL1 and VLDL2 fractions, but only the VLDL2 apoB catabolic rate tended to increase. Furthermore, postsurgery VLDL1 apoB and TG production rates, but not those of VLDL2, were positively correlated with insulin resistance. Insulin-mediated stimulation of peripheral lipoprotein lipolysis was also improved after the surgery. In summary, RYGB resulted in reduced hepatic VLDL1 production that correlated with reduced insulin resistance, elevated VLDL2 clearance, and improved insulin sensitivity in lipoprotein lipolysis pathways.
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Affiliation(s)
- Vehpi Yildirim
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Mathematics, Erzurum Technical University, Erzurum, Turkey
| | | | | | - Dewi van Harskamp
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Henk Schierbeek
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hans Jansen
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Alinda W.M. Schimmel
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Albert K. Groen
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Natal A.W. van Riel
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Geesje M. Dallinga-Thie
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Louca P, Meijnikman AS, Nogal A, Asnicar F, Attaye I, Vijay A, Kouraki A, Visconti A, Wong K, Berry SE, Leeming ER, Mompeo O, Tettamanzi F, Baleanu AF, Falchi M, Hadjigeorgiou G, Wolf J, Acherman YIZ, Van de Laar AW, Gerdes VEA, Michelotti GA, Franks PW, Segata N, Mangino M, Spector TD, Bulsiewicz WJ, Nieuwdorp M, Valdes AM, Menni C. The secondary bile acid isoursodeoxycholate correlates with post-prandial lipemia, inflammation, and appetite and changes post-bariatric surgery. Cell Rep Med 2023; 4:100993. [PMID: 37023745 PMCID: PMC10140478 DOI: 10.1016/j.xcrm.2023.100993] [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: 08/11/2022] [Revised: 10/12/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
Abstract
Primary and secondary bile acids (BAs) influence metabolism and inflammation, and the gut microbiome modulates levels of BAs. We systematically explore the host genetic, gut microbial, and habitual dietary contribution to a panel of 19 serum and 15 stool BAs in two population-based cohorts (TwinsUK, n = 2,382; ZOE PREDICT-1, n = 327) and assess changes post-bariatric surgery and after nutritional interventions. We report that BAs have a moderately heritable genetic component, and the gut microbiome accurately predicts their levels in serum and stool. The secondary BA isoursodeoxycholate (isoUDCA) can be explained mostly by gut microbes (area under the receiver operating characteristic curve [AUC] = ∼80%) and associates with post-prandial lipemia and inflammation (GlycA). Furthermore, circulating isoUDCA decreases significantly 1 year after bariatric surgery (β = -0.72, p = 1 × 10-5) and in response to fiber supplementation (β = -0.37, p < 0.03) but not omega-3 supplementation. In healthy individuals, isoUDCA fasting levels correlate with pre-meal appetite (p < 1 × 10-4). Our findings indicate an important role for isoUDCA in lipid metabolism, appetite, and, potentially, cardiometabolic risk.
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Affiliation(s)
- Panayiotis Louca
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | - Abraham S Meijnikman
- Department of (Experimental) Vascular Medicine, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | - Ana Nogal
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | | | - Ilias Attaye
- Department of (Experimental) Vascular Medicine, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | - Amrita Vijay
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, NG5 1PB Nottingham, UK; Inflammation, Recovery and Injury Sciences, School of Medicine, University of Nottingham, NG5 1PB Nottingham, UK
| | - Afroditi Kouraki
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, NG5 1PB Nottingham, UK; Inflammation, Recovery and Injury Sciences, School of Medicine, University of Nottingham, NG5 1PB Nottingham, UK
| | - Alessia Visconti
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | - Kari Wong
- Metabolon, Research Triangle Park, Morrisville, NC, USA
| | - Sarah E Berry
- Department of Nutritional Sciences, King's College London, London, UK
| | - Emily R Leeming
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | - Olatz Mompeo
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | - Francesca Tettamanzi
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | - Andrei-Florin Baleanu
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | - Mario Falchi
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | | | | | | | | | - Victor E A Gerdes
- Department of (Experimental) Vascular Medicine, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | | | - Paul W Franks
- Lund University Diabetes Center, Lund University, Malmö, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Massimo Mangino
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK; NIHR Biomedical Research Centre at Guy's and St Thomas' Foundation Trust, SE1 9RT London, UK
| | - Tim D Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK
| | | | - Max Nieuwdorp
- Department of (Experimental) Vascular Medicine, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | - Ana M Valdes
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, NG5 1PB Nottingham, UK; Inflammation, Recovery and Injury Sciences, School of Medicine, University of Nottingham, NG5 1PB Nottingham, UK.
| | - Cristina Menni
- Department of Twin Research & Genetic Epidemiology, King's College London, SE1 7EH London, UK.
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Li Y, Liu J, Zhou B, Li X, Wu Z, Meng H, Wang G. Reducing the 10-year risk of ischemic cardiovascular disease to receive early cardiovascular benefits from bariatric surgery for obesity in China. Front Cardiovasc Med 2022; 9:978682. [PMID: 36304549 PMCID: PMC9592844 DOI: 10.3389/fcvm.2022.978682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular risk due to obesity can be improved greatly by bariatric surgery. However, there is no research involving appropriate model for evaluating cardiovascular disease risk reduction in bariatric surgery for obesity in China. We selected the ischemic cardiovascular disease (ICVD) risk score that accurately predict cardiovascular risk in Chinese adults to evaluate the 10-year risk of ICVD and estimated early cardiovascular benefits of bariatric surgery in obese Chinese patients through its reduction. Methods From 2017 to 2019 we followed up 107 patients 6 months after surgery and measured the ICVD 10-year risk and other cardiovascular factors before and after surgery. Results There were significant reductions in the ICVD total score (p < 0.001) and ICVD 10-year risk (%) (p < 0.001) 6 months post-operation compared with baseline. Furthermore, we found significant reductions in body mass index (BMI), body adiposity index (BAI), low-density lipoprotein (LDL), small dense-low-density lipoprotein (sd-LDL) and triglycerides (TG) 6 months after surgery compared with pre-operation (all p < 0.05). The decrease in ICVD total score was correlated with excess BMI loss (%EBMIL), reduced BAI, reduced LDL, reduced sd-LDL and reduced TG respectively (all p < 0.05) at 6 months post-operation. Moreover, there were significant reductions in the ICVD total score in the male subgroup [3 (3, 5) vs. 2.5 (2, 4), p < 0.001] and female subgroup [3 (2, 4) vs. 2 (1, 3), p < 0.001] 6 months post-operation compared with baseline. At last there were also significant reductions in the ICVD total score in the diabetic subgroup [5 (4, 6) vs. 4 (3, 5), p < 0.001] and non-diabetic subgroup [2 (2,3) vs. 2 (1, 2), p < 0.001] 6 months post-operation compared with baseline. Conclusions Bariatric surgery could provide early cardiovascular benefits for patients with obesity in China by reducing the 10-year risk of ICVD. Both men and women with obesity achieved cardiovascular benefits according to bariatric surgery, so did diabetic and non-diabetic patients.
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Affiliation(s)
- Yinhui Li
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Biao Zhou
- Department of General Surgery and Obesity, Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Xiaohui Li
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Wu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hua Meng
- Department of General Surgery and Obesity, Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China,*Correspondence: Hua Meng
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China,Guang Wang
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Early effects of Roux-en-Y gastric bypass on dietary fatty acid absorption and metabolism in people with obesity and normal glucose tolerance. Int J Obes (Lond) 2022; 46:1359-1365. [PMID: 35459799 DOI: 10.1038/s41366-022-01123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) surgery markedly increases the rate of intestinal nutrient exposure after food intake, accelerates intestinal absorption of dietary glucose and protein, and alters the postprandial gut hormone response. However, our understanding of postprandial fat absorption and metabolism after RYGB is incomplete. METHODS Stable palmitate tracers were administered intravenously (K-[2,2-2H2]palmitate) and orally with a mixed meal ([U-13C16]palmitate) to study fatty acid absorption and metabolism before and 3 months after RYGB in 10 participants with obesity and normal glucose tolerance. RESULTS There was a tendency toward reduced fasting plasma nonesterified palmitate concentrations after RYGB, but neither fasting palmitate kinetics nor fasting triacylglycerol (TAG) concentrations changed compared with before surgery. Postprandial TAG concentrations were numerically, but nonsignificantly, reduced 3-4 h after meal intake after compared with before RYGB. However, the postprandial appearance of the oral palmitate tracer in the plasma TAG pool and overflow into the nonesterified palmitate pool were initially faster but overall reduced after RYGB by 50% (median, IQR: [47;64], P = 0.004) and 46% (median, IQR: [33;70], P = 0.041), respectively. The maximal postprandial suppression of plasma nonesterified palmitate concentrations was slightly greater but shorter lasting after RYGB ('time × visit' interaction: P < 0.001), without detectable effects of surgery on the rate of appearance and disappearance of plasma palmitate. CONCLUSION RYGB resulted in an initially accelerated but overall ~50% reduced 4-h postprandial systemic appearance of dietary palmitate in participants with obesity and normal glucose tolerance. This is likely a result of faster but incomplete intestinal fat absorption combined with enhanced chylomicron-TAG clearance, but it needs further investigation in studies specifically designed to investigate these mechanisms.
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Camastra S, Palumbo M, Santini F. Nutrients handling after bariatric surgery, the role of gastrointestinal adaptation. Eat Weight Disord 2022; 27:449-461. [PMID: 33895917 PMCID: PMC8933374 DOI: 10.1007/s40519-021-01194-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/10/2021] [Indexed: 01/19/2023] Open
Abstract
Bariatric surgery determines a rearrangement of the gastrointestinal tract that influences nutrient handling and plays a role in the metabolic changes observed after surgery. Most of the changes depend on the accelerated gastric emptying observed in Roux-en-Y gastric bypass (RYGB) and, to a lesser extent, in sleeve gastrectomy (SG). The rapid delivery of meal into the jejunum, particularly after RYGB, contributes to the prompt appearance of glucose in peripheral circulation. Glucose increase is the principal determinant of GLP-1 increase with the consequent stimulation of insulin secretion, the latter balanced by a paradoxical glucagon increase that stimulates EGP to prevent hypoglycaemia. Protein digestion and amino acid absorption appear accelerated after RYGB but not after SG. After RYGB, the adaptation of the gut to the new condition participates to the metabolic change. The intestinal transit is delayed, the gut microbioma is changed, the epithelium becomes hypertrophic and increases the expression of glucose transporter and of the number of cell secreting hormones. These changes are not observed after SG. After RYGB-less after SG-bile acids (BA) increase, influencing glucose metabolism probably modulating FXR and TGR5 with an effect on insulin sensitivity. Muscle, hepatic and adipose tissue insulin sensitivity improve, and the gut reinforces the recovery of IS by enhancing glucose uptake and through the effect of the BA. The intestinal changes observed after RYGB result in a light malabsorption of lipid but not of carbohydrate and protein. In conclusion, functional and morphological adaptations of the gut after RYGB and SG activate inter-organs cross-talk that modulates the metabolic changes observed after surgery.Level of evidence Level V, narrative literature review.
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Affiliation(s)
- Stefania Camastra
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy. .,Interdepartmental Research Center "Nutraceuticals and Food for Health", University of Pisa, Pisa, Italy.
| | - Maria Palumbo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Ferruccio Santini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.,Interdepartmental Research Center "Nutraceuticals and Food for Health", University of Pisa, Pisa, Italy
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Ackerman M, Serra E, Flecha P, Nogueira JP. Selective effect of laparoscopic Roux-en-Y gastric bypass on lipid metabolism. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:68-74. [PMID: 34879979 DOI: 10.1016/j.arteri.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Bariatric surgery (BS) has shown to reduce cardiovascular morbidity and mortality in obesity. The BS has improved the dyslipidemia of the insulin resistant patient, our objective was to evaluate if there was a difference in the lipid profile between the laparoscopic roux-en-Y gastric bypass (RYGB) technique vs. the sleeve gastrectomy (SG) technique at 18 months of follow-up. METHODS An observational, open, prospective study of morbidly obese patients who underwent bariatric surgery at 18-month follow-up. Anthropometric analysis, body composition, energy expenditure at rest, glucose, insulin, HbA1c, LDL, HDL, TG and CT were performed. RESULTS Absence baseline differences were found in the proportion of patients with hypertension, diabetes, steatosis, and sex between the RYGB vs SG groups. A reduction of TG was observed at 6 months in favor of RYGB vs SG: 108.60±34.86 vs. 124.59±44.58, P = 0.044), however, a decrease in both LDL levels was found at 12 and 18 months in favor of the RYGB vs. SG group: 96.23±24.33 vs. 107.83±28.88, P = 0.025; 90.98±20.62 vs 106.22±31.48, P = 0.003; the decrease in CT was observed only at 18 months in favor of the RYGB vs. SG group: 171.39±25.058 vs. 186.89±31.81, P = 0.005. CONCLUSIóN: RYBG has shown to be more effective in reducing LDL and CT levels compared to SG, which provides an additional benefit of RYGB in relation to the lipid profile of the patient.
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Affiliation(s)
- Marianela Ackerman
- Cátedra de Medicina Interna, Facultad de Medicina Universidad Nacional del Nordeste (UNNE), Corrientes, Argentina; Departamento de Nutrición y Diabetes, Centro de Endocrinología y Nutrición (CIEN), Corrientes, Argentina
| | - Edgardo Serra
- Departamento de Cirugía Bariátrica y Metabólica, Centro de Endocrinología y Nutrición (CIEN), Corrientes, Argentina
| | - Pablo Flecha
- Instituto Modelo de Gastroenterología, Formosa, Argentina
| | - Juan Patricio Nogueira
- Centro de Investigación en Nutrición, Endocrinología y Metabolismo (CIENM), Facultad de Ciencias de la Salud, Universidad Nacional de Formosa, Formosa, Argentina.
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Piché ME, Tardif I, Auclair A, Poirier P. Effects of bariatric surgery on lipid-lipoprotein profile. Metabolism 2021; 115:154441. [PMID: 33248063 DOI: 10.1016/j.metabol.2020.154441] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
Most patients with severe obesity will present some lipid-lipoprotein abnormalities. The atherogenic dyslipidemia associated with severe obesity is characterized by elevated fasting and postprandial triglyceride levels, low high-density lipoprotein cholesterol concentrations, and increased proportion of small and dense low-density lipoproteins. Bariatric surgery has been proven safe and successful in terms of long-term weight loss and improvement in obesity co-existing metabolic conditions including lipid-lipoprotein abnormalities. Nevertheless, bariatric surgery procedures are not all equivalent. We conducted a comprehensive critical analysis of the literature related to severe obesity, bariatric surgery and lipid-lipoprotein metabolism/profile. In this review, we described the metabolic impacts of different bariatric surgery procedures on the lipid-lipoprotein profile, and the mechanisms linking bariatric surgery and dyslipidemia remission based on recent epidemiological, clinical and preclinical studies. Further mechanistic studies are essential to assess the potential of bariatric/metabolic surgery in the management of lipid-lipoprotein abnormalities associated with severe obesity. Understanding the beneficial effects of various bariatric surgery procedures on the lipid-lipoprotein metabolism and profile may result in a wider acceptance of this strategy as a long-term metabolic treatment of lipid-lipoprotein abnormalities in severe obesity and help clinician to develop an individualized and optimal approach in the management of dyslipidemia associated with severe obesity. BRIEF SUMMARY: Abnormal lipid-lipoprotein profile is frequent in patients with severe obesity. Significant improvements in lipid-lipoprotein profile following bariatric surgery occur early in the postoperative period, prior to weight loss, and persists throughout the follow-up. The mechanisms that facilitate the remission of dyslipidemia after bariatric surgery, may involve positive effects on adipose tissue distribution/function, insulin sensitivity, liver fat content/function and lipid-lipoprotein metabolism.
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Affiliation(s)
- Marie-Eve Piché
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec, Canada; Faculty of Medicine, Laval University, Quebec, Canada
| | - Isabelle Tardif
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec, Canada
| | - Audrey Auclair
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec, Canada; Faculty of Pharmacy, Laval University, Quebec, Canada.
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Stahel P, Xiao C, Nahmias A, Lewis GF. Role of the Gut in Diabetic Dyslipidemia. Front Endocrinol (Lausanne) 2020; 11:116. [PMID: 32231641 PMCID: PMC7083132 DOI: 10.3389/fendo.2020.00116] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/21/2020] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with increased risk of cardiovascular disease (CVD). In insulin resistant states such as the metabolic syndrome, overproduction and impaired clearance of liver-derived very-low-density lipoproteins and gut-derived chylomicrons (CMs) contribute to hypertriglyceridemia and elevated atherogenic remnant lipoproteins. Although ingested fat is the major stimulus of CM secretion, intestinal lipid handling and ultimately CM secretory rate is determined by numerous additional regulatory inputs including nutrients, hormones and neural signals that fine tune CM secretion during fasted and fed states. Insulin resistance and T2D represent perturbed metabolic states in which intestinal sensitivity to key regulatory hormones such as insulin, leptin and glucagon-like peptide-1 (GLP-1) may be altered, contributing to increased CM secretion. In this review, we describe the evidence from human and animal models demonstrating increased CM secretion in insulin resistance and T2D and discuss the molecular mechanisms underlying these effects. Several novel compounds are in various stages of preclinical and clinical investigation to modulate intestinal CM synthesis and secretion. Their efficacy, safety and therapeutic utility are discussed. Similarly, the effects of currently approved lipid modulating therapies such as statins, ezetimibe, fibrates, and PCSK9 inhibitors on intestinal CM production are discussed. The intricacies of intestinal CM production are an active area of research that may yield novel therapies to prevent atherosclerotic CVD in insulin resistance and T2D.
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Kolovou GD, Watts GF, Mikhailidis DP, Pérez-Martínez P, Mora S, Bilianou H, Panotopoulos G, Katsiki N, Ooi TC, Lopez-Miranda J, Tybjærg-Hansen A, Tentolouris N, Nordestgaard BG. Postprandial Hypertriglyceridaemia Revisited in the Era of Non-Fasting Lipid Profile Testing: A 2019 Expert Panel Statement, Narrative Review. Curr Vasc Pharmacol 2019; 17:515-537. [DOI: 10.2174/1570161117666190503123911] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/01/2019] [Accepted: 04/11/2019] [Indexed: 12/17/2022]
Abstract
Postprandial hypertriglyceridaemia, defined as an increase in plasma triglyceride-containing
lipoproteins following a fat meal, is a potential risk predictor of atherosclerotic cardiovascular disease
and other chronic diseases. Several non-modifiable factors (genetics, age, sex and menopausal status)
and lifestyle factors (diet, physical activity, smoking status, obesity, alcohol and medication use) may
influence postprandial hypertriglyceridaemia. This narrative review considers the studies published over
the last decade that evaluated postprandial hypertriglyceridaemia. Additionally, the genetic determinants
of postprandial plasma triglyceride levels, the types of meals for studying postprandial triglyceride response,
and underlying conditions (e.g. familial dyslipidaemias, diabetes mellitus, metabolic syndrome,
non-alcoholic fatty liver and chronic kidney disease) that are associated with postprandial hypertriglyceridaemia
are reviewed; therapeutic aspects are also considered.
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Affiliation(s)
- Genovefa D. Kolovou
- Cardiology Department and LDL-Apheresis Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Gerald F. Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Australia
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - Pablo Pérez-Martínez
- Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Helen Bilianou
- Department of Cardiology, Tzanio Hospital, Piraeus, Greece
| | | | - Niki Katsiki
- First Department of Internal Medicine, Division of Endocrinology-Metabolism, Diabetes Center, AHEPA University Hospital, Thessaloniki, Greece
| | - Teik C. Ooi
- Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - José Lopez-Miranda
- Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Implementation of Low Glycemic Index Diet Together with Cornstarch in Post-Gastric Bypass Hypoglycemia: Two Case Reports. Nutrients 2018; 10:nu10060670. [PMID: 29799438 PMCID: PMC6024813 DOI: 10.3390/nu10060670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
Post-bariatric hypoglycemia (PBH) is an increasingly recognized long-term complication of bariatric surgery. The nutritional treatment of PBH includes a high-fiber diet and the restriction of soluble and high-glycemic index carbohydrates; however, these measures are not always enough to prevent hypoglycemia. We evaluated the efficacy of uncooked cornstarch, a low-glycemic index carbohydrate characterized by slow intestinal degradation and absorption, in addition to a high-fiber diet, for the treatment of PBH. We report the cases of two young women suffering from severe postprandial and fasting hypoglycemia following Roux-en-Y gastric bypass (RYGB). The patients underwent Continuous Glucose Monitoring (CGM) before and 12–16 weeks after the administration of uncooked cornstarch (respectively 1.25 g/kg b.w. and 1.8 g/kg b.w.) in addition to a high-fiber diet. In both patients, CGM showed more stable glucose levels throughout monitoring, a remarkable reduction of the time spent in hypoglycemia (<55 mg/dL) both during the day (−11% for both patients) and the night (−22% and −32%), and the improvement of all glycemic variability indexes. Our report, within the limit of only two cases, suggests that the implementation of a dietary intervention through the addition of uncooked cornstarch reduces daily glycemic fluctuations and hypoglycemic episodes in patients with PBH.
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Griffo E, Cotugno M, Nosso G, Saldalamacchia G, Mangione A, Angrisani L, Rivellese AA, Capaldo B. Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up. Obes Surg 2018; 26:1247-53. [PMID: 26435537 DOI: 10.1007/s11695-015-1891-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients. METHODS A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed. RESULTS The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p ≤ 0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p < 0.05); in contrast, fasting LDL cholesterol decreased only after RYGB (p < 0.05). Post-meal glucose concentrations decreased while early insulin response significantly improved after both procedures (p < 0.001 for both). Postprandial triglycerides decreased after both procedures (p < 0.05) while postprandial LDL cholesterol decreased only after RYGB (p < 0.05). Meal-GLP-1 increased postoperatively in both groups although to a greater extent after RYGB (p < 0.001 vs. SG). GIP decreased after both procedures, especially after RYGB (p = 0.003). At multivariate analysis, GLP-1 peak was the best predictor of LDL reduction (β = -0.552, p = 0.039) while the improvement of HOMA-IR (β = 0.574, p = 0.014) and weight loss (β = 0.418, p = 0.036) predicted triglycerides reduction. CONCLUSIONS Both surgical procedures markedly reduce fasting and postprandial triglycerides and increase HDL cholesterol levels. LDL cholesterol decreases only after RYGB through a mechanism likely mediated by the restoration of GLP-1.
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Affiliation(s)
- E Griffo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | - M Cotugno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Nosso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - A Mangione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - L Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
| | - A A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - B Capaldo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
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Nosso G, Lupoli R, Saldalamacchia G, Griffo E, Cotugno M, Costabile G, Riccardi G, Capaldo B. Diabetes remission after bariatric surgery is characterized by high glycemic variability and high oxidative stress. Nutr Metab Cardiovasc Dis 2017; 27:949-955. [PMID: 28969883 DOI: 10.1016/j.numecd.2017.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM To evaluate glycemic variability (GV) and oxidative stress in patients who achieved type 2 diabetes (T2DM) remission after bariatric surgery (BS). METHODS AND RESULTS Twenty-two patients (M/F10/12, age 50 ± 9 years, BMI 31 ± 6 kg/m2) who were in remission of T2DM (T2DM remitters) after BS since at least 1 year and 22 age-, sex- and BMI-matched control subjects were studied. Of the BS group, eleven subjects had undergone Roux-en-Y gastric bypass (RYGB) and eleven subjects sleeve gastrectomy (SG). Oral glucose tolerance test (OGTT), 7 days-continuous glucose monitoring, 24-h urinary excretion of 8-isoprostaglandin F2α (8-isoPGF2α) and dietary intake evaluation were performed. According to general linear model for repeated measures, glucose and insulin response during OGTT were significantly different in T2DM remitter than in control subjects (p < 0.001, for both). All measures of GV (standard deviation, coefficient of variation and mean amplitude of glucose excursions) were significantly higher in T2DM remitters than in controls, (p < 0.001 for all). These indexes were higher among RYGB than SG patients (p < 0.05). The time spent out of the 60-160 mg/dl range was significantly longer in T2DM remitters undergoing RYGB than in controls (p < 0.02). Mean 24-h urinary 8-isoPGF2α excretion was significantly higher in T2DM remitters than that of control subjects (p = 0.04). All GV indexes were directly correlated with blood glucose levels at 30 and 60 min during OGTT (p < 0.05-0.001). CONCLUSION Remission of T2DM after BS is characterized by high GV and high oxidative stress in the face of fasting blood glucose and HbA1c within the normal range.
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Affiliation(s)
- G Nosso
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - R Lupoli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - E Griffo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - M Cotugno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Costabile
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - B Capaldo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy.
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Does Bariatric Surgery Improve Obesity Associated Comorbid Conditions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:545-570. [PMID: 28585216 DOI: 10.1007/978-3-319-48382-5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Obesity is a constantly growing health problem which reduces quality of life and life expectancy. Bariatric surgery for obesity is taken into account when all other conservative treatment modalities have failed. Comparison of the multidisciplinary programs with bariatric surgery regarding to weight loss showed that substantial and durable weight reduction have been achieved only with bariatric surgical treatments. However, the benefits of weight loss following bariatric procedures are still debated regarding the pro-inflammatory and metabolic profile of obesity.
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Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2017; 27:2194-2206. [DOI: 10.1007/s11695-017-2762-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Comparison of Effects of Sleeve Gastrectomy and Gastric Bypass on Lipid Profile Parameters in Indian Obese: a Case Matched Analysis. Obes Surg 2017; 27:2606-2612. [PMID: 28451932 DOI: 10.1007/s11695-017-2692-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obesity is associated with increased mortality due to higher cardiovascular risk. A proportion of this risk is attributed to impaired lipid profile in the form of high levels of serum total cholesterol, triglycerides, and low levels of HDL cholesterol. Both sleeve gastrectomy (LSG) and gastric bypass (LGB) have been shown to have favourable effects on lipid profile with some variability in improvement. We aimed to study the difference in changes in lipid profile after LSG and LGB. METHODS We performed a retrospective case-matched study comparing effects of LSG and LGB on lipid profile of patients who underwent bariatric surgery from September 2014 to September 2015. The matching was done based on criteria of age and body mass index (BMI). RESULTS Out of a total of 92 selected patients, 69 patients underwent LSG and 23 patients underwent LGB. There was a significant improvement in serum triglycerides and HDL cholesterol with no significant reduction in serum total cholesterol in both LSG and LGB group. There was a significant reduction in cardiovascular risk calculated as total cholesterol: HDL cholesterol ratio following bariatric surgery (p = 0.002). CONCLUSION Both LSG and LGB have similar effects on lipid profile cardiovascular risk attributed to it in Indian obese. Thus, sleeve gastrectomy may be considered as effective as a gastric bypass for dyslipidaemia improvement in Indian patients.
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Grenier-Larouche T, Carreau AM, Carpentier AC. Early Metabolic Improvement After Bariatric Surgery: The First Steps Toward Remission of Type 2 Diabetes. Can J Diabetes 2017; 41:418-425. [PMID: 28318939 DOI: 10.1016/j.jcjd.2016.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/23/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023]
Abstract
The introduction of bariatric surgery into clinical practice in the 1980s was followed by a relatively long watch-and-wait period before the very rapid accumulation of scientific literature, over the past decade, concerning its clinical effectiveness and safety and its mechanisms of action in the treatment of obesity. These surgical procedures now emerge as the most effective therapeutic modality to induce long-term remission of type 2 diabetes. Recent research has shed light on the potential mechanisms leading to the profound improvement of glucose homeostasis following most bariatric surgery procedures. These mechanisms can be classified as weight loss dependent and independent, both playing sequential and then synergistic antidiabetes roles. Many groups, including our own, have contributed to our understanding of the relative roles of these mechanisms at differing time periods following these procedures. Here we summarize what we currently know about the mechanisms underlying the very rapid, weight loss-independent improvement in glucose homeostasis after bariatric surgery. Beyond its impact in the field of bariatric surgery, this new knowledge about the very rapid in vivo "reverse engineering" of type 2 diabetes actually provides unique insights into the intricate and complex mechanisms linking nutrition and obesity with the development of this disease.
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Affiliation(s)
- Thomas Grenier-Larouche
- Department of Medicine, Division of Endocrinology, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anne-Marie Carreau
- Department of Medicine, Division of Endocrinology, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - André C Carpentier
- Department of Medicine, Division of Endocrinology, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Sherbrooke, Quebec, Canada.
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Nemati R, Lu J, Tura A, Smith G, Murphy R. Acute Changes in Non-esterified Fatty Acids in Patients with Type 2 Diabetes Receiving Bariatric Surgery. Obes Surg 2016; 27:649-656. [PMID: 27530911 DOI: 10.1007/s11695-016-2323-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this study was to compare acute changes of non-esterified fatty acids (NEFA) in relation to beta cell function (BCF) and insulin resistance in obese patients with type 2 diabetes (T2D) who underwent laparoscopic gastric bypass (GBP), laparoscopic sleeve gastrectomy (SG) or very low calorie diet (VLCD). METHODS In a non-randomised study, fasting plasma samples were collected from 38 obese patients with T2D, matched for age, body mass index (BMI) and glycaemic control, who underwent GBP (11) or SG (14) or VLCD (13). Samples were collected the day before and 3 days after the intervention, during a 75-g oral glucose tolerance test. Glucose, insulin, c-peptide, glucagon like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) were measured, and individual NEFAs were measured using a triple-quadrupole liquid chromatography-mass spectrometry (LC-MS/MS). BCF by mathematical modelling and insulin resistance were estimated. RESULTS Palmitic acid significantly decreased after each intervention. Monounsaturated/polyunsaturated ratio (MUFA/PUFA) and unsaturated/saturated fat ratios increased after each intervention. BCF was improved only after VLCD. Linoleic acid was positively correlated with total insulin secretion (p = 0.03). Glucose sensitivity correlated with palmitic acid (p = 0.01), unsaturated/saturated ratio (p = 0.0008) and MUFA/PUFA (p = 0.009). HOMA-IR correlated with stearic acid (p = 0.03), unsaturated/saturated ratio (p = 0.005) and MUFA/PUFA (p = 0.009). GIP AUC0-120 correlated with stearic acid (p = 0.04), but not GLP-1. CONCLUSIONS GBP, SG and VLCD have similar acute effects on decreasing palmitic acid. Several NEFAs correlated with BCF parameters and HOMA-IR.
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Affiliation(s)
- Reza Nemati
- School of Applied Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jun Lu
- School of Applied Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,School of Interprofessional Health Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Institute of Biomedical Technology, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Tura
- Metabolic Unit, Institute of Neuroscience, National Research Council, 35127, Padua, Italy
| | - Greg Smith
- Department of Pharmacology, University of New South Wales, Sydney, Australia
| | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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Lipids and bariatric procedures Part 2 of 2: scientific statement from the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and Obesity Medicine Association (OMA) 1. Surg Obes Relat Dis 2016; 12:468-495. [DOI: 10.1016/j.soard.2016.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
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Dash S, Xiao C, Lewis GF. Effects of bariatric surgery on hepatic and intestinal lipoprotein particle metabolism. Curr Opin Lipidol 2016; 27:14-8. [PMID: 26628436 DOI: 10.1097/mol.0000000000000252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Insulin resistance and type 2 diabetes, driven largely by obesity, are characterized by an increase in triglyceride-rich lipoproteins (TRLs) due to both reduced TRL clearance from the circulation and increased production by the liver (apoB-100 containing VLDLs) and intestine (apoB-48 containing chylomicrons). Bariatric surgery is the only treatment currently that leads to marked, sustained weight loss. Here, we will review the effects of bariatric surgery on circulating triglyceride/TRL and TRL production and clearance. RECENT FINDINGS Bariatric surgery leads to a marked reduction in fasting and postprandial plasma triglyceride. Only one study to date has assessed TRL kinetics after bariatric surgery and has reported a reduction in TRL apoB-100 concentration (i.e. the number of VLDL particles) due to reduced production and increased clearance and reduced TRL apoB-48 concentration (the number of chylomicron particles) due to reduced production. Some bariatric surgery studies have reported no/weak correlation between weight loss and improvements in triglyceride/TRL, suggesting that as yet unidentified factors beyond weight loss may contribute to the marked changes in TRL that occur postbariatric surgery. SUMMARY Available data suggest that bariatric surgery reduces triglyceride and intestinal and hepatic TRL production with increased clearance of hepatic TRL particles. These effects of bariatric surgery on TRL kinetics need to be confirmed with additional studies. Further studies are also needed to compare the effects of various bariatric surgery procedures on TRL kinetics and to elucidate underlying mechanisms.
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Affiliation(s)
- Satya Dash
- aDepartment of Medicine bDepartment of Physiology and Banting and Best Diabetes Centre cDivision of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Wang Y, Zhang X, Zhong M, Liu T, Zhang G, Liu S, Guo W, Wei M, He Q, Sun D, Hu S. Improvements of Glucose and Lipid Metabolism After Jejuno-ileal Circuit Procedure in a Non-obese Diabetic Rat Model. Obes Surg 2015; 26:1768-76. [PMID: 26660687 DOI: 10.1007/s11695-015-1997-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In a recent study, we showed a jejuno-ileal circuit (JIC) procedure that effectively improved glucose homeostasis, but the intrinsic mechanism requires further studies. Furthermore, the role of JIC in lipid metabolism is also unknown. Given that adiposity aggravates insulin sensitivity, we hypothesize that the JIC procedure improves fat metabolism and thus further contributes to diabetic remission. The aim of this study was to investigate the effects of JIC surgery on lipid metabolism and glucose homeostasis in a non-obese diabetic rat model. METHODS Fourteen high-fat diet and low-dose streptozotocin-induced diabetic rats were randomly divided into JIC and sham-JIC groups. Body weight, food intake, glucose tolerance, insulin resistance, serum lipid parameters, glucagon-like peptide 1 (GLP-1), and adipose-derived hormones were measured. At 12 weeks postoperatively, the expressions of hepatic fatty acid synthase (FAS) and acetyl-CoA carboxylase (ACC) were measured by Western blot. The lipid content of liver was assessed by hematoxylin-eosin staining and Oil Red O staining. The enteroendocrine cells in the distal ileum were examined by immunohistochemical staining. RESULTS Relative to the sham group, the JIC rats exhibited significant improvements in glucose tolerance, insulin resistance, and dyslipidemia without weight loss, showing increased GLP-1 and adiponectin and decreased leptin. JIC also reduced the expression of FAS and ACC in the liver, exhibited improved hepatic fat content, and raised the levels of GLP-1 and chromogranin A in the distal gut. CONCLUSIONS JIC alleviated lipometabolic disorders in hyperglycemic rats, which may contribute to the amelioration of insulin sensitivity and glycemic control.
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Affiliation(s)
- Yanmin Wang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Mingwei Zhong
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Teng Liu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Wei Guo
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Meng Wei
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Dong Sun
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China.
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Katsanos CS, Madura JA, Roust LR. Essential amino acid ingestion as an efficient nutritional strategy for the preservation of muscle mass following gastric bypass surgery. Nutrition 2015; 32:9-13. [PMID: 26456190 DOI: 10.1016/j.nut.2015.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/18/2015] [Accepted: 07/12/2015] [Indexed: 12/18/2022]
Abstract
Loss of skeletal muscle in patients who have undergone gastric bypass is a consistent observation. Skeletal muscle constitutes the largest protein/amino acid pool in the body, and loss of skeletal muscle has important implications in health and disease. Sustaining a given level of muscle protein requires a balance between the rates of muscle protein synthesis and breakdown. Current evidence suggests that reduced rate of protein synthesis is implicated in the loss of muscle after gastric bypass. This is not surprising given a less than optimal dietary protein intake after the procedure and because, unlike other macronutrients, protein/amino acids are not stored in the body. Ingesting essential amino acids (EAAs), which cannot be synthesized de novo and have the primary role in the regulation of muscle protein synthesis, can potentially ameliorate loss of muscle protein after gastric bypass. At the same time, ingestion of EAAs provides a more efficient nutritional approach (i.e., greater stimulation of protein synthesis relative to the amount of amino acids ingested) to enhance muscle protein synthesis compared with the ingestion of intact protein. Changing current dietary practices toward increasing ingestion of EAAs provides an approach that can potentially prevent loss of lean body tissue and ultimately achieve a more sustained level of health in patients who have undergone gastric bypass.
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Affiliation(s)
- Christos S Katsanos
- Center for Metabolic and Vascular Biology, Arizona State University, Scottsdale, AZ, USA; College of Medicine, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
| | - James A Madura
- College of Medicine, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Lori R Roust
- College of Medicine, Mayo Clinic in Arizona, Scottsdale, AZ, USA
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25
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Penney NC, Kinross J, Newton RC, Purkayastha S. The role of bile acids in reducing the metabolic complications of obesity after bariatric surgery: a systematic review. Int J Obes (Lond) 2015; 39:1565-74. [PMID: 26081915 DOI: 10.1038/ijo.2015.115] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 03/05/2015] [Accepted: 05/31/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery is currently the most efficacious treatment for obesity and its associated metabolic co-morbidities, such as diabetes. The metabolic improvements occur through both weight-dependent and weight-independent mechanisms. Bile acids (BAs) have emerged as key signalling molecules that have a central role in modulating many of the physiological effects seen after bariatric surgery. This systematic review assesses the evidence from both human and animal studies for the role of BAs in reducing the metabolic complications of obesity following bariatric surgery. METHODS We conducted a systematic search of Medline and Embase databases to identify all articles investigating the role of BAs in mediating the metabolic changes observed following bariatric surgery in both animal and human studies. Boolean logic was used with relevant search terms, including the following MeSH terms: 'bile acids and salts', 'bariatric surgery', 'metabolic surgery', 'gastrointestinal tract/surgery' and 'obesity/surgery'. RESULTS Following database searches (n=1197), inclusion from bibliography searches (n=2) and de-duplication (n=197), 1002 search results were returned. Of these, 132 articles were selected for full-text review, of which 38 articles were deemed relevant and included in the review. The findings support the effects of BAs on satiety, lipid and cholesterol metabolism, incretins and glucose homoeostasis, energy metabolism, gut microbiota and endoplasmic reticulum stress following bariatric surgery. Many of these metabolic effects are modulated through the BA receptors FXR and TGR5. We also explore a possible link between BAs and carcinogenesis following bariatric surgery. CONCLUSIONS Overall there is good evidence to support the role of BAs in the metabolic effects of bariatric surgery through the above mechanisms. BAs could serve as a novel therapeutic pharmacological target for the treatment of obesity and its associated co-morbidities.
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Affiliation(s)
- N C Penney
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - J Kinross
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - R C Newton
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - S Purkayastha
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
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26
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Cotugno M, Nosso G, Saldalamacchia G, Vitagliano G, Griffo E, Lupoli R, Angrisani L, Riccardi G, Capaldo B. Clinical efficacy of bariatric surgery versus liraglutide in patients with type 2 diabetes and severe obesity: a 12-month retrospective evaluation. Acta Diabetol 2015; 52:331-6. [PMID: 25218924 DOI: 10.1007/s00592-014-0644-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/25/2014] [Indexed: 12/22/2022]
Abstract
AIMS To evaluate the clinical efficacy of bariatric surgery vs medical therapy with liraglutide on weight loss, glycemic control and cardiovascular risk profile in patients with type 2 diabetes and severe obesity. METHODS A retrospective evaluation was conducted in 31 patients with type 2 diabetes and severe obesity who had undergone bariatric surgery and in 31 patients with type 2 diabetes and comparable body weight who had added liraglutide to their background medical treatment in the period 2009-2013. Anthropometric parameters, glycemic control, treatment of diabetes and other comorbidities, safety and side effects before and 12 months after treatment were assessed. RESULTS Age was 47 ± 8 years (mean ± SD) in bariatric surgery and 56 ± 9 years in medical treatment group (p < 0.001); body mass index before treatment was 44 ± 7 and 40 ± 4 kg/m(2) in bariatric surgery and medical treatment, respectively (p = 0.03). Twelve months after treatment, average weight loss was 38 ± 15 kg among bariatric surgery patients, and 5 ± 8 kg in medical treatment group (p < 0.001). Glycemic control improved in both groups with greater improvement in bariatric surgery patients. The UKPDS risk score decreased in both groups, although it remained higher in medical treatment than in bariatric surgery patients (p < 0.001). Of note, almost 60 % of patients on liraglutide met the target of glycated hemoglobin <7 % (53 mmol/mol) and lost ≥5 % of body weight. CONCLUSIONS In severely obese type 2 diabetic patients, bariatric surgery reduced body weight and improved overall metabolic control to a greater extent than medical treatment. Randomized clinical studies are necessary.
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Affiliation(s)
- M Cotugno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
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27
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Padilla N, Maraninchi M, Béliard S, Berthet B, Nogueira JP, Wolff E, Nicolay A, Bégu A, Dubois N, Grangeot R, Mattei C, Vialettes B, Xiao C, Lewis GF, Valéro R. Effects of bariatric surgery on hepatic and intestinal lipoprotein particle metabolism in obese, nondiabetic humans. Arterioscler Thromb Vasc Biol 2014; 34:2330-7. [PMID: 25104797 DOI: 10.1161/atvbaha.114.303849] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The dyslipidemia of obesity and other insulin-resistant states is characterized by the elevation of plasma triglyceride-rich lipoproteins (TRL) of both hepatic (apoB-100-containing very low-density lipoprotein) and intestinal (apoB-48-containing chylomicrons) origin. Bariatric surgery is a well-established and effective modality for the treatment of obesity and is associated with improvements in several metabolic abnormalities associated with obesity, including a reduction in plasma triglycerides. Here, we have investigated the effect of bariatric surgery on TRL metabolism. APPROACH AND RESULTS Twenty-two nondiabetic, obese subjects undergoing bariatric surgery: sleeve gastrectomy (n=12) or gastric bypass (n=10) were studied. Each subject underwent 1 lipoprotein turnover study 1 month before surgery followed by a second study, 6 months after surgery, using established stable isotope enrichment methodology, in constant fed state. TRL-apoB-100 concentration was significantly reduced after sleeve gastrectomy, explained by a decrease (P<0.05) in TRL-apoB-100 production rate and an increase (P<0.05) in TRL-apoB-100 fractional catabolic rate. TRL-apoB-48 concentration was also significantly reduced after sleeve gastrectomy, explained by reduction in TRL-apoB-48 production rate (P<0.05). For gastric bypass, although TRL-apoB-100 concentration declined after surgery (P<0.01), without a significant decline in TRL-apoB-48, there was no significant change in either TRL-apoB-100 or TRL-apoB-48 production rate or fractional catabolic rate. The reduction in TRL-apoB-100 concentration was significantly associated with a reduction in plasma apoC-III in the pooled group of patients undergoing bariatric surgery. CONCLUSIONS This is the first human lipoprotein kinetic study to explore the mechanism of improvement of TRL metabolism after bariatric surgery. These effects may contribute to the decrease of cardiovascular mortality after surgery. CLINICAL TRIAL REGISTRATION URL http://www.ClinicalTrials.gov. Unique identifier: NCT01277068.
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Affiliation(s)
- Nadège Padilla
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Marie Maraninchi
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Sophie Béliard
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Bruno Berthet
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Juan-Patricio Nogueira
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Estelle Wolff
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Alain Nicolay
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Audrey Bégu
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Noémie Dubois
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Rachel Grangeot
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Catherine Mattei
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Bernard Vialettes
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Changting Xiao
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - Gary F Lewis
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.)
| | - René Valéro
- From the Aix-Marseille Université, UMR_S1062, UMR_A1260, NORT, F-13385, Marseille, France (N.P., M.M., S.B., E.W., A.N., R.V.); Department of Nutrition, Metabolic Diseases, Endocrinology (S.B., A.B., N.D., R.G., C.M., B.V., R.V.) and Department of Visceral Surgery (B.B.), AP-HM, La Timone Hospital, Marseille, France; Department of Endocrinology, Medico Moving Center Institute, Formosa, Argentina (J.P.N.); and Departments of Medicine and Physiology, and Banting and Best Diabetes Centre, University of Toronto, Ontario, Canada (G.F.L., C.X.).
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