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Change in Adipokines and Gastrointestinal Hormones After Bariatric Surgery: a Meta-analysis. Obes Surg 2023; 33:789-806. [PMID: 36607567 DOI: 10.1007/s11695-022-06444-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The study aimed to perform a meta-analysis about the change in adipokines and gastrointestinal hormones after bariatric surgery in patients with obesity. MATERIALS AND METHODS We searched the Cochrane Central Register of Controlled Trials, EMBASE, and PubMed for related articles and used Review Manager 5.4 for data aggregation. Sensitivity and subgroup analysis were also conducted when feasible. RESULTS As a result, 95 articles involving 6232 patients were included in the meta-analysis. After bariatric surgery, the levels of leptin, ghrelin, C-reactive protein (CRP), interleukin-6 (IL-6), high-sensitivity C-reactive protein (Hs-CRP), tumor necrosis, factor-α (TNF-α), and interleukin-1β (IL-1β) reduced, while adiponectin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) levels increased significantly. Subgroup analysis indicated that there was a more significant reduction in leptin level with a longer follow-up time. OAGB had a greater effect on increasing adiponectin level compared with other procedures. SG procedure would bring about reduced ghrelin, while BPD resulted in increased ghrelin. Meta-regression analysis found that publication year, study design, number of patients, preoperative age, preoperative BMI, and quality assessment score were not significantly related to change in leptin, adiponectin, and ghrelin levels. CONCLUSION Bariatric surgery was associated with a significant decrease in leptin, ghrelin, CRP, IL-6, Hs-CRP, TNF-α, and IL-1β, as well as increase in adiponectin, GLP-1, and PYY levels.
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Gao Z, Yang J, Liang Y, Yang S, Zhang T, Gong Z, Li M. Changes in Gastric Inhibitory Polypeptide (GIP) After Roux-en-Y Gastric Bypass in Obese Patients: a Meta-analysis. Obes Surg 2022; 32:2706-2716. [PMID: 35597875 DOI: 10.1007/s11695-022-05959-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 01/19/2023]
Abstract
This meta-analysis aimed to evaluate changes in GIP after RYGB in obese patients. We searched PubMed, EMBASE, and CENTRAL for relevant studies from database inception through July 2021. Articles were eligible for inclusion if they reported pre-operative and post-operative fasting GIP levels. We found fasting GIP levels had a decreasing tendency. The decrease in fasting glucose and postprandial GIP levels was also observed. Subgroup analysis indicated diabetic subjects tended to have a more obvious fasting GIP reduction compared to non-diabetic individuals. Meta-regression showed that the amount of weight loss (% total body weight), gastric pouch volume, alimentary limb length, and biliopancreatic limb length were not related to fasting GIP decrease. Fasting GIP levels decreased significantly after RYGB in obese people, especially in diabetic patients.
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Affiliation(s)
- Zhiguang Gao
- Department of Gastrointestinal Surgery, The affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, 523320, China.
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuzhi Liang
- Department of Medical Imaging, The affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, 523320, China
| | - Sen Yang
- Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Tao Zhang
- Department of Gastrointestinal Surgery, The affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, 523320, China
| | - Zuyuan Gong
- Department of Gastrointestinal Surgery, The affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, 523320, China
| | - Min Li
- Department of Gastrointestinal Surgery, The affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, 523320, China
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3
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Lischka J, Schanzer A, Hojreh A, Ba Ssalamah A, Item CB, de Gier C, Walleczek N, Metz TF, Jakober I, Greber‐Platzer S, Zeyda M. A branched-chain amino acid-based metabolic score can predict liver fat in children and adolescents with severe obesity. Pediatr Obes 2021; 16:e12739. [PMID: 33058486 PMCID: PMC7988615 DOI: 10.1111/ijpo.12739] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Eighty percent of adolescents with severe obesity suffer from non-alcoholic fatty liver disease (NAFLD). Non-invasive prediction models have been tested in adults, however, they performed poorly in paediatric populations. OBJECTIVE This study aimed to investigate novel biomarkers for NAFLD and to develop a score that predicts liver fat in youth with severe obesity. METHODS From a population with a BMI >97th percentile aged 9-19 years (n = 68), clinically thoroughly characterized including MRI-derived proton density fat fraction (MRI-PDFF), amino acids and acylcarnitines were measured by HPLC-MS. RESULTS In children with NAFLD, higher levels of plasma branched-chain amino acids (BCAA) were determined. BCAAs correlated with MRI-PDFF (R = 0.46, p < .01). We identified a linear regression model adjusted for age, sex and pubertal stage consisting of BCAAs, ALT, GGT, ferritin and insulin that predicted MRI-PDFF (R = 0.75, p < .01). ROC analysis of this model revealed AUCs of 0.85, 0.85 and 0.92 for the detection of any, moderate and severe steatosis, respectively, thus markedly outperforming previously published scores. CONCLUSION BCAAs could be an important link between obesity and other metabolic pathways. A BCAA-based metabolic score can predict steatosis grade in high-risk children and adolescents and may provide a feasible alternative to sophisticated methods like MRI or biopsy in the future.
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Affiliation(s)
- Julia Lischka
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Center for Pediatrics, Medical University of ViennaViennaAustria
| | - Andrea Schanzer
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Center for Pediatrics, Medical University of ViennaViennaAustria
| | - Azadeh Hojreh
- Comprehensive Center for Pediatrics, Medical University of ViennaViennaAustria,Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Ahmed Ba Ssalamah
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Chike Bellarmine Item
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Charlotte de Gier
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Center for Pediatrics, Medical University of ViennaViennaAustria
| | - Nina‐Katharina Walleczek
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Center for Pediatrics, Medical University of ViennaViennaAustria
| | - Thomas F. Metz
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Ivana Jakober
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Susanne Greber‐Platzer
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Center for Pediatrics, Medical University of ViennaViennaAustria
| | - Maximilian Zeyda
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Center for Pediatrics, Medical University of ViennaViennaAustria
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4
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Thirteen weeks of supplementation of vitamin D and leucine-enriched whey protein nutritional supplement attenuates chronic low-grade inflammation in sarcopenic older adults: the PROVIDE study. Aging Clin Exp Res 2019; 31:845-854. [PMID: 31049877 PMCID: PMC6583678 DOI: 10.1007/s40520-019-01208-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
Background A chronic low-grade inflammatory profile (CLIP) is associated with sarcopenia in older adults. Protein and Vitamin (Vit)D have immune-modulatory potential, but evidence for effects of nutritional supplementation on CLIP is limited. Aim To investigate whether 13 weeks of nutritional supplementation of VitD and leucine-enriched whey protein affected CLIP in subjects enrolled in the PROVIDE-study, as a secondary analysis. Methods Sarcopenic adults (low skeletal muscle mass) aged ≥ 65 years with mobility limitations (Short Physical Performance Battery 4–9) and a body mass index of 20–30 kg/m2 were randomly allocated to two daily servings of active (n = 137, including 20 g of whey protein, 3 g of leucine and 800 IU VitD) or isocaloric control product (n = 151) for a double-blind period of 13 weeks. At baseline and after 13 weeks, circulating interleukin (IL)-8, IL-1 receptor antagonist (RA), soluble tumor-necrosis-factor receptor (sTNFR)1, IL-6, high-sensitivity C-reactive protein, pre-albumin and 25-hydroxyvitamin(OH)D were measured. Data-analysis included repeated measures analysis of covariance (corrected for dietary VitD intake) and linear regression. Results IL-6 and IL-1Ra serum levels showed overall increases after 13 weeks (p = 0.006 and p < 0.001, respectively). For IL-6 a significant time × treatment interaction (p = 0.046) was observed, with no significant change over time in the active group (p = 0.155) compared to control (significant increase p = 0.012). IL-8 showed an overall significant decrease (p = 0.03). The change in pre-albumin was a significant predictor for changes in IL-6 after 13 weeks. Conclusions We conclude that 13 weeks of nutritional supplementation with VitD and leucine-enriched whey protein may attenuate the progression of CLIP in older sarcopenic persons with mobility limitations. Electronic supplementary material The online version of this article (10.1007/s40520-019-01208-4) contains supplementary material, which is available to authorized users.
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Jirapinyo P, Jin DX, Qazi T, Mishra N, Thompson CC. A Meta-Analysis of GLP-1 After Roux-En-Y Gastric Bypass: Impact of Surgical Technique and Measurement Strategy. Obes Surg 2018; 28:615-626. [PMID: 28871519 DOI: 10.1007/s11695-017-2913-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for diabetes. Glucagon-like peptide-1 (GLP-1) is a gut hormone that is important to glucose homeostasis. OBJECTIVE This study aimed to assess GLP-1 level and its predictors after RYGB. METHODS The study design was a meta-analysis. The data sources were MEDLINE, EMBASE, Web of Science, and the Cochrane Databases. The study selection composed of studies with pre- and post-RYGB levels. The main outcomes were as follows: Primary outcome was the change in postprandial GLP-1 levels after RYGB. Secondary outcomes included the changes in fasting glucose, fasting insulin, and fasting GLP-1 levels after RYGB. Meta-regression to determine predictors of changes in GLP-1 levels was performed. Outcomes were reported using Hedge's g. RESULTS Twenty-four studies with 368 patients were included. Postprandial GLP-1 levels increased after RYGB (Hedge's g = 1.29, p < 0.0001), while fasting GLP-1 did not change (p = 0.23). Peak postprandial GLP-1 levels gave the most consistent results (I 2 = 9.11). Fasting glucose and insulin levels decreased after RYGB (p < 0.0001). Roux limb length was a significant predictor for amount of GLP-1 increase (β = - 0.01, p = 0.02). Diabetes status, amount of weight loss, length of biliopancreatic limb, and time of measurement were not significant predictors (p > 0.05). CONCLUSION Postprandial GLP-1 levels increase after RYGB, while fasting levels remain unchanged. Shorter Roux limb length is associated with greater increase in postprandial GLP-1, which may lead to better glycemic control in this population.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - David X Jin
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Taha Qazi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Nitin Mishra
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Tamboli RA, Antoun J, Sidani RM, Clements BA, Eckert EA, Marks-Shulman P, Gaylinn BD, Williams DB, Clements RH, Albaugh VL, Abumrad NN. Metabolic responses to exogenous ghrelin in obesity and early after Roux-en-Y gastric bypass in humans. Diabetes Obes Metab 2017; 19:1267-1275. [PMID: 28345790 PMCID: PMC5568950 DOI: 10.1111/dom.12952] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/11/2022]
Abstract
AIMS Ghrelin is a gastric-derived hormone that stimulates growth hormone (GH) secretion and has a multi-faceted role in the regulation of energy homeostasis, including glucose metabolism. Circulating ghrelin concentrations are modulated in response to nutritional status, but responses to ghrelin in altered metabolic states are poorly understood. We investigated the metabolic effects of ghrelin in obesity and early after Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS We assessed central and peripheral metabolic responses to acyl ghrelin infusion (1 pmol kg-1 min-1 ) in healthy, lean subjects (n = 9) and non-diabetic, obese subjects (n = 9) before and 2 weeks after RYGB. Central responses were assessed by GH and pancreatic polypeptide (surrogate for vagal activity) secretion. Peripheral responses were assessed by hepatic and skeletal muscle insulin sensitivity during a hyperinsulinaemic-euglycaemic clamp. RESULTS Ghrelin-stimulated GH secretion was attenuated in obese subjects, but was restored by RYGB to a response similar to that of lean subjects. The heightened pancreatic polypeptide response to ghrelin infusion in the obese was attenuated after RYGB. Hepatic glucose production and hepatic insulin sensitivity were not altered by ghrelin infusion in RYGB subjects. Skeletal muscle insulin sensitivity was impaired to a similar degree in lean, obese and post-RYGB individuals in response to ghrelin infusion. CONCLUSIONS These data suggest that obesity is characterized by abnormal central, but not peripheral, responsiveness to ghrelin that can be restored early after RYGB before significant weight loss. Further work is necessary to fully elucidate the role of ghrelin in the metabolic changes that occur in obesity and following RYGB.
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Affiliation(s)
- Robyn A. Tamboli
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph Antoun
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Reem M. Sidani
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - B. Austin Clements
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Emily A. Eckert
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Pam Marks-Shulman
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Bruce D. Gaylinn
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA
| | | | - Ronald H. Clements
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Vance L. Albaugh
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naji N. Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
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7
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van den Broek M, de Heide LJM, Veeger NJGM, van der Wal-Oost AM, van Beek AP. Influence of dietary protein and its amino acid composition on postoperative outcomes after gastric bypass surgery: a systematic review. Nutr Rev 2016; 74:749-773. [PMID: 27864536 DOI: 10.1093/nutrit/nuw042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT Bariatric surgery is an effective method to reduce morbid obesity. Nutritional counseling is essential to achieve maximal treatment success and to avoid long-term complications. Increased dietary protein intake may improve various postoperative results. OBJECTIVE The aim of this systematic review is to examine the relationship between intake of dietary protein or supplementation with amino acids and postoperative outcomes after gastric bypass surgery. DATA SOURCES A systematic literature search was conducted in 4 electronic databases: Cochrane, Embase, PubMed, and Scopus. STUDY SELECTION The initial search retrieved 7333 hits, which included 2390 duplicates. DATA EXTRACTION Tweny-three studies with varying study designs, interventions, and outcomes were included. RESULTS Studies did not provide convincing evidence of a beneficial effect on any postoperative outcome. CONCLUSIONS The study of the influence of protein and its amino acid composition represents an important developing domain of knowledge and warrants further attention considering the popularity of bariatric surgery. Future studies should include a clear description of the quantity and composition of proteins and amino acids in the diet or supplement.
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Affiliation(s)
- Merel van den Broek
- M. van den Broek and L.J.M. de Heide are with the Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. A.M. van der Wal-Oost is with the MCL Academy, Medical Center Leeuwarden, Leeuwarden, the Netherlands. A.P. van Beek is with the Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Loek J M de Heide
- M. van den Broek and L.J.M. de Heide are with the Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. A.M. van der Wal-Oost is with the MCL Academy, Medical Center Leeuwarden, Leeuwarden, the Netherlands. A.P. van Beek is with the Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nic J G M Veeger
- M. van den Broek and L.J.M. de Heide are with the Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. A.M. van der Wal-Oost is with the MCL Academy, Medical Center Leeuwarden, Leeuwarden, the Netherlands. A.P. van Beek is with the Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alies M van der Wal-Oost
- M. van den Broek and L.J.M. de Heide are with the Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. A.M. van der Wal-Oost is with the MCL Academy, Medical Center Leeuwarden, Leeuwarden, the Netherlands. A.P. van Beek is with the Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - André P van Beek
- M. van den Broek and L.J.M. de Heide are with the Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. N.J.G.M. Veeger is with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. A.M. van der Wal-Oost is with the MCL Academy, Medical Center Leeuwarden, Leeuwarden, the Netherlands. A.P. van Beek is with the Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Abstract
Branched-chain amino acids (BCAAs) are important nutrient signals that have direct and indirect effects. Frequently, BCAAs have been reported to mediate antiobesity effects, especially in rodent models. However, circulating levels of BCAAs tend to be increased in individuals with obesity and are associated with worse metabolic health and future insulin resistance or type 2 diabetes mellitus (T2DM). A hypothesized mechanism linking increased levels of BCAAs and T2DM involves leucine-mediated activation of the mammalian target of rapamycin complex 1 (mTORC1), which results in uncoupling of insulin signalling at an early stage. A BCAA dysmetabolism model proposes that the accumulation of mitotoxic metabolites (and not BCAAs per se) promotes β-cell mitochondrial dysfunction, stress signalling and apoptosis associated with T2DM. Alternatively, insulin resistance might promote aminoacidaemia by increasing the protein degradation that insulin normally suppresses, and/or by eliciting an impairment of efficient BCAA oxidative metabolism in some tissues. Whether and how impaired BCAA metabolism might occur in obesity is discussed in this Review. Research on the role of individual and model-dependent differences in BCAA metabolism is needed, as several genes (BCKDHA, PPM1K, IVD and KLF15) have been designated as candidate genes for obesity and/or T2DM in humans, and distinct phenotypes of tissue-specific branched chain ketoacid dehydrogenase complex activity have been detected in animal models of obesity and T2DM.
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Affiliation(s)
- Christopher J Lynch
- Cellular and Molecular Physiology Department, The Pennsylvania State University, 500 University Drive, MC-H166, Hershey, PA 17033, USA
| | - Sean H Adams
- Arkansas Children's Nutrition Center, and Department of Pediatrics, University of Arkansas for Medical Sciences, 15 Children's Way, Little Rock, AR 72202, USA
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Takeuti TD, Terra GA, da Silva AA, Terra JA, da Silva LM, Crema E. Effect of the ingestion of the palm oil and glutamine in serum levels of GLP-1, PYY and glycemia in diabetes mellitus type 2 patients submitted to metabolic surgery. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27 Suppl 1:51-5. [PMID: 25409967 PMCID: PMC4743520 DOI: 10.1590/s0102-6720201400s100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/26/2014] [Indexed: 11/22/2022]
Abstract
Background Incretins are hormones produced by the intestine and can stimulate the secretion
of insulin, helping to diminish the post-prandial glycemia. The administration of
an emulsion of palm oil can help in the maintenance of the weight, and can
increase circulating incretins levels. Glutamine increases the concentration of
incretins in diabetic people. Both can help in metabolic syndrome. Aim To analyze the effects of ingestion of palm oil and glutamine in glycemia and in
incretins in patients with diabetes submitted to surgical duodenojejunal exclusion
with ileal interposition without gastrectomy. Methods Eleven diabetic type 2 patients were included and were operated. They were called
to laboratory follow-up without eating anything between eight and 12 hours. They
had there blood collected after the stimulus of the palm oil and glutamine taken
in different days. For the hormonal doses were used ELISA kits. Results The glycemia showed a meaningful fall between the fast and two hours after the
stimulus of the palm oil (p=0,018). With the glutamine the GLP-1 showed an
increase between the fast and one hour (p=0,32), the PYY showed an important
increase between the fast and one hour after the stimulus (p=0,06), the glycemia
showed a meaningful fall after two hours of the administration of the stimulus
(p=0,03). Conclusion Palm oil and glutamine can influence intestinal peptides and glucose
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Affiliation(s)
| | | | | | | | | | - Eduardo Crema
- Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
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Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014; 2014:CD009161. [PMID: 25121931 PMCID: PMC11060647 DOI: 10.1002/14651858.cd009161.pub2] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Preoperative carbohydrate treatments have been widely adopted as part of enhanced recovery after surgery (ERAS) or fast-track surgery protocols. Although fast-track surgery protocols have been widely investigated and have been shown to be associated with improved postoperative outcomes, some individual constituents of these protocols, including preoperative carbohydrate treatment, have not been subject to such robust analysis. OBJECTIVES To assess the effects of preoperative carbohydrate treatment, compared with placebo or preoperative fasting, on postoperative recovery and insulin resistance in adult patients undergoing elective surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 3), MEDLINE (January 1946 to March 2014), EMBASE (January 1947 to March 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1980 to March 2014) and Web of Science (January 1900 to March 2014) databases. We did not apply language restrictions in the literature search. We searched reference lists of relevant articles and contacted known authors in the field to identify unpublished data. SELECTION CRITERIA We included all randomized controlled trials of preoperative carbohydrate treatment compared with placebo or traditional preoperative fasting in adult study participants undergoing elective surgery. Treatment groups needed to receive at least 45 g of carbohydrates within four hours before surgery or anaesthesia start time. DATA COLLECTION AND ANALYSIS Data were abstracted independently by at least two review authors, with discrepancies resolved by consensus. Data were abstracted and documented pro forma and were entered into RevMan 5.2 for analysis. Quality assessment was performed independently by two review authors according to the standard methodological procedures expected by The Cochrane Collaboration. When available data were insufficient for quality assessment or data analysis, trial authors were contacted to request needed information. We collected trial data on complication rates and aspiration pneumonitis. MAIN RESULTS We included 27 trials involving 1976 participants Trials were conducted in Europe, China, Brazil, Canada and New Zealand and involved patients undergoing elective abdominal surgery (18), orthopaedic surgery (4), cardiac surgery (4) and thyroidectomy (1). Twelve studies were limited to participants with an American Society of Anaesthesiologists grade of I-II or I-III.A total of 17 trials contained at least one domain judged to be at high risk of bias, and only two studies were judged to be at low risk of bias across all domains. Of greatest concern was the risk of bias associated with inadequate blinding, as most of the outcomes assessed by this review were subjective. Only six trials were judged to be at low risk of bias because of blinding.In 19 trials including 1351 participants, preoperative carbohydrate treatment was associated with shortened length of hospital stay compared with placebo or fasting (by 0.30 days; 95% confidence interval (CI) 0.56 to 0.04; very low-quality evidence). No significant effect on length of stay was noted when preoperative carbohydrate treatment was compared with placebo (14 trials including 867 participants; mean difference -0.13 days; 95% CI -0.38 to 0.12). Based on two trials including 86 participants, preoperative carbohydrate treatment was also associated with shortened time to passage of flatus when compared with placebo or fasting (by 0.39 days; 95% CI 0.70 to 0.07), as well as increased postoperative peripheral insulin sensitivity (three trials including 41 participants; mean increase in glucose infusion rate measured by hyperinsulinaemic euglycaemic clamp of 0.76 mg/kg/min; 95% CI 0.24 to 1.29; high-quality evidence).As reported by 14 trials involving 913 participants, preoperative carbohydrate treatment was not associated with an increase or a decrease in the risk of postoperative complications compared with placebo or fasting (risk ratio of complications 0.98, 95% CI 0.86 to 1.11; low-quality evidence). Aspiration pneumonitis was not reported in any patients, regardless of treatment group allocation. AUTHORS' CONCLUSIONS Preoperative carbohydrate treatment was associated with a small reduction in length of hospital stay when compared with placebo or fasting in adult patients undergoing elective surgery. It was found that preoperative carbohydrate treatment did not increase or decrease postoperative complication rates when compared with placebo or fasting. Lack of adequate blinding in many studies may have contributed to observed treatment effects for these subjective outcomes, which are subject to possible biases.
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Affiliation(s)
- Mark D Smith
- Southland HospitalDepartment of General SurgeryKew RoadInvercargillNew Zealand9840
| | - John McCall
- Dunedin School of Medicine, University of OtagoDepartment of Surgical SciencesPO Box 913DunedinNew Zealand9054
| | - Lindsay Plank
- University of AucklandDepartment of SurgeryPrivate Bag 92019AucklandNew Zealand1142
| | - G Peter Herbison
- Dunedin School of Medicine, University of OtagoDepartment of Preventive & Social MedicinePO Box 913DunedinNew Zealand9054
| | - Mattias Soop
- Salford Royal NHS Foundation TrustDepartment of SurgeryStott LaneSalfordUK
| | - Jonas Nygren
- Institution of Clinical Sciences at Danderyds HospitalCentre for Gastrointestinal Disease, Ersta Hospital and Karolinska InstitutetStockholmSweden
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Intravenous alanyl-L-glutamine balances glucose–insulin homeostasis and facilitates recovery in patients undergoing colonic resection. Eur J Anaesthesiol 2014; 31:212-8. [DOI: 10.1097/eja.0b013e328360c6b9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Nunes EA, Gonçalves-Neto LM, Ferreira FB, dos Santos C, Fernandes LC, Boschero AC, Calder PC, Rafacho A. Glucose intolerance induced by glucocorticoid excess is further impaired by co-administration with β-hydroxy-β-methylbutyrate in rats. Appl Physiol Nutr Metab 2013; 38:1137-46. [DOI: 10.1139/apnm-2012-0456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Glucocorticoid (GC) excess alters glucose homeostasis and promotes modifications in murinometric and anthropometric parameters in rodents and humans, respectively. β-hydroxy-β-methylbutyrate (HMB), a leucine metabolite, has been proposed as a nutritional strategy for preventing muscle wasting, but few data regarding its effects on glucose homeostasis are available. Here, we analyzed whether the effects of GC excess on glucose homeostasis may be attenuated or exacerbated by the concomitant ingestion of HMB. Adult Wistar rats (90-days-old) were assigned to four groups: (1) vehicle treated (Ctl), (2) dexamethasone (DEX) treated (Dex), (3) HMB treated (Hmb), and (4) DEX plus HMB treated (DexHmb). Dex groups received DEX (1 mg·kg body weight (BW)−1, intraperitoneal) for 5 consecutive days. HMB groups ingested HMB (320 mg·kg BW−1, oral gavage) for the same 5 days. HMB ingestion did not attenuate the effects of DEX on food intake and body weight loss, changes in masses of several organs, insulin resistance, and glucose intolerance (p > 0.05). In fact, in DexHmb rats, there was increased fasting glycemia and exacerbated glucose intolerance with the main effect attributed to DEX treatment (p < 0.05). HMB exerted no attenuating effect on plasma triacylglycerol levels from DexHmb rats, but it seems to attenuate the lipolysis induced by β-adrenergic stimulation (20 μmol·L−1isoproterenol) in fragments of retroperitoneal adipose tissue from DexHmb rats. Therefore, HMB does not attenuate the diabetogenic characteristics of GC excess. In fact, the data suggest that HMB may exacerbate GC-induced glucose intolerance.
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Affiliation(s)
- Everson A. Nunes
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Luiz M. Gonçalves-Neto
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Francielle B.D. Ferreira
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Cristiane dos Santos
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
| | - Luiz C. Fernandes
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Paraná, Curitiba, Brazil
| | - Antonio C. Boschero
- Department of Functional and Structural Biology, Institute of Biology, State University of Campinas, Campinas, Brazil
| | - Philip C. Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alex Rafacho
- Department of Physiological Sciences, Centre of Biological Sciences, Federal University of Santa Catarina, 88040-900 Florianópolis, Brazil
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Beta-hydroxy-beta-methylbutyrate supplementation in health and disease: a systematic review of randomized trials. Amino Acids 2013; 45:1273-92. [PMID: 24057808 DOI: 10.1007/s00726-013-1592-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/05/2013] [Indexed: 12/13/2022]
Abstract
Beta-hydroxy-beta-methylbutyrate (HMB), a metabolite of the branched-chain amino acid leucine, is extensively used by athletes and bodybuilders in order to increase strength, muscle mass and exercise performance. We performed a systematic review of the clinical literature on the effectiveness of HMB supplementation in healthy and pathological conditions (i.e. training programs, aging, acute and chronic diseases, and after bariatric surgery). We reviewed all clinical trials indexed in Medline that tested HMB supplementation as well as all the experimental data regarding HMB intracellular mechanisms of action. Search terms included: randomized controlled trials, controlled clinical trials, single- and double-blind method, HMB, proteolytic pathways, muscle atrophy, cachexia, and training. We found out 13 studies testing HMB in healthy young trained subjects, 11 in healthy young untrained subjects, 9 in patients affected by chronic diseases (i.e. cancer, HIV, chronic obstructive pulmonary disease), and 6 in elderly subjects. The indexed studies support that HMB is effective in preventing exercise-related muscle damage in healthy trained and untrained individuals as well as muscle loss during chronic diseases. Most of the selected studies showed the effectiveness of HMB in preventing exercise-related muscle damage in healthy trained and untrained individuals as well as muscle loss during chronic diseases. The usual dose of 3 g/day may be routinely recommended to maintain or improve muscle mass and function in health and disease. The safety profile of HMB is unequivocal. Further, well-designed clinical studies are needed to confirm effectiveness and mode of action of HMB, particularly in pathological conditions.
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Mansour A, Hosseini S, Larijani B, Pajouhi M, Mohajeri-Tehrani MR. Nutrients related to GLP1 secretory responses. Nutrition 2013; 29:813-20. [PMID: 23415393 DOI: 10.1016/j.nut.2012.11.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/04/2012] [Accepted: 11/23/2012] [Indexed: 12/25/2022]
Abstract
The hormone glucagon-like peptide (GLP-1) is secreted from gut endocrine L cells in response to ingested nutrients. The activities of GLP-1 include stimulating insulin gene expression and biosynthesis, improving β-cell proliferation, exogenesis, and survival. Additionally, it prevents β-cell apoptosis induced by a variety of cytotoxic agents. In extrapancreatic tissues, GLP-1 suppresses hunger, delays gastric emptying, acts as an ileal brake, and increases glucose uptake. The pleiotropic actions of GLP-1, especially its glucose-lowering effect, gave rise to the suggestion that it is a novel approach to insulin resistance treatment. Hormones secreted from the gut including GLP-1, which are involved in the regulation of insulin sensitivity and secretions, have been found to be affected by nutrient intake. In recent years, there has been a growing interest in the effect nutrients may have on GLP-1 secretion; some frequently studied dietary constituents include monounsaturated fatty acids, fructooligosaccharides, and glutamine. This review focuses on the influence that the carbohydrate, fat, and protein components of a meal may have on the GLP-1 postprandial responses.
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Affiliation(s)
- Asieh Mansour
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Chan CP, Wang BY, Cheng CY, Lin CH, Hsieh MC, Tsou JJ, Lee WJ. Randomized Controlled Trials in Bariatric Surgery. Obes Surg 2012; 23:118-30. [DOI: 10.1007/s11695-012-0798-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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