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Lobão SL, Oliveira AS, Bressan J, Pinto SL. Contribution of Ultra-Processed Foods to Weight Gain Recurrence 5 Years After Metabolic and Bariatric Surgery. Obes Surg 2024; 34:2492-2498. [PMID: 38762612 DOI: 10.1007/s11695-024-07291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The aim of this study was to evaluate evolution of ultra-processed food intake and recurrent weight gain in patients who underwent Roux-en-Y gastric bypass. MATERIALS AND METHODS This study is an observational longitudinal study that evaluated patients who underwent metabolic and bariatric surgery at four time points: before surgery and at 3, 12, and 60 months after surgery. Anthropometric and dietary intake data were collected through two 24-h dietary recalls. All foods consumed were classified according to degree of processing. Recurrent weight gain was considered the difference between current weight and nadir weight. RESULTS The sample consisted of 58 patients with a mean age of 38.7 ± 8.9 years and 68% female. After 60 months, mean excess weight loss and recurrent weight gain were 73.6 ± 27.2% and 22.5 ± 17.4%. Calorie and macronutrient intake decreased significantly between the pre-surgery period, and 3 and 12 months post-surgery; however, there was no significant difference after 60 months. In relation to food groups or macronutrients, no difference was observed between the pre-surgery period and 60 months post-surgery. The contribution of unprocessed or minimally processed foods to calorie intake gradually decreased after 3 months post-surgery. CONCLUSION The profile of dietary intake after 60 months of metabolic and bariatric surgery tends to approach that of the pre-surgery period. The contribution of unprocessed and minimally processed foods to calorie intake decreased after 60 months, while ultra-processed food contribution increased.
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Affiliation(s)
- Stephany L Lobão
- Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/N - Plano Diretor Norte, AlCNO 14, Bloco D, Palmas, TO CEP 77001-090, Brazil
| | - Adler S Oliveira
- Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/N - Plano Diretor Norte, AlCNO 14, Bloco D, Palmas, TO CEP 77001-090, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, MG, Brazil
| | - Sônia L Pinto
- Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/N - Plano Diretor Norte, AlCNO 14, Bloco D, Palmas, TO CEP 77001-090, Brazil.
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Liu Y, Kimita W, Bharmal SH, Petrov MS. Response to lowering plasma glucose is characterised by decreased oxyntomodulin: Results from a randomised controlled trial. Diabetes Metab Syndr 2024; 18:103052. [PMID: 38901179 DOI: 10.1016/j.dsx.2024.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/13/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND With the prevalence of diabetes reaching an epidemic level, there is a growing interest in the investigation of its remission. Proglucagon-derived peptides (PGDP) have been shown to have a glucose-regulating effect. However, whether they play a role in diabetes remission remains poorly understood. AIM To investigate changes in plasma levels of PGDP in glycaemic responders versus non-responders. METHODS The study was a randomised placebo-controlled trial comprising 18 adults with prediabetes (registered at www. CLINICALTRIALS gov as NCT03889210). Following an overnight fast, participants consumed ketone β-hydroxybutyrate (KEβHB)-supplemented beverage and placebo beverage in crossover manner. Serial blood samples were collected from baseline to 150 min at 30-min intervals. The endpoints were changes in glucagon-like peptide-1 (GLP-1), glicentin, oxyntomodulin, glucagon, and major proglucagon fragment (MPGF). Participants were stratified into the 'responders' and 'non-responders' subgroups based on their glycaemic changes following the ingestion of KEβHB. The area under the curve (AUC) was calculated to estimate the accumulated changes in the studied PGDP and compared using paired-t test between the KEβHB and placebo beverages. RESULTS Responders had a significantly greater reduction in plasma glucose compared with non-responders following acute ketosis (p < 0.001). The AUC0-150 for oxyntomodulin was significantly lower following the KEβHB beverage compared with the placebo (p = 0.045) in responders, but not in non-responders (p = 0.512). No significant differences in AUCs0-150 were found for GLP-1, glicentin, glucagon, and MPGF in either responders or non-responders. CONCLUSION Oxyntomodulin is involved in lowering plasma glucose and may play an important role in diabetes remission.
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Affiliation(s)
- Yutong Liu
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Wandia Kimita
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Sakina H Bharmal
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand.
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Gan HW, Cerbone M, Dattani MT. Appetite- and Weight-Regulating Neuroendocrine Circuitry in Hypothalamic Obesity. Endocr Rev 2024; 45:309-342. [PMID: 38019584 PMCID: PMC11074800 DOI: 10.1210/endrev/bnad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
Since hypothalamic obesity (HyOb) was first described over 120 years ago by Joseph Babinski and Alfred Fröhlich, advances in molecular genetic laboratory techniques have allowed us to elucidate various components of the intricate neurocircuitry governing appetite and weight regulation connecting the hypothalamus, pituitary gland, brainstem, adipose tissue, pancreas, and gastrointestinal tract. On a background of an increasing prevalence of population-level common obesity, the number of survivors of congenital (eg, septo-optic dysplasia, Prader-Willi syndrome) and acquired (eg, central nervous system tumors) hypothalamic disorders is increasing, thanks to earlier diagnosis and management as well as better oncological therapies. Although to date the discovery of several appetite-regulating peptides has led to the development of a range of targeted molecular therapies for monogenic obesity syndromes, outside of these disorders these discoveries have not translated into the development of efficacious treatments for other forms of HyOb. This review aims to summarize our current understanding of the neuroendocrine physiology of appetite and weight regulation, and explore our current understanding of the pathophysiology of HyOb.
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Affiliation(s)
- Hoong-Wei Gan
- Department of Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
- Genetics & Genomic Medicine Research & Teaching Department, University College London Great Ormond Street Institute for Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Manuela Cerbone
- Department of Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
- Genetics & Genomic Medicine Research & Teaching Department, University College London Great Ormond Street Institute for Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Mehul Tulsidas Dattani
- Department of Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
- Genetics & Genomic Medicine Research & Teaching Department, University College London Great Ormond Street Institute for Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Li S, Zhu H, Chen JDZ. Intestinal Electrical Stimulation Synchronized With Intestinal Slow Wave Ameliorates Glucagon-Induced Hyperglycemia in Rats. Neuromodulation 2024; 27:312-320. [PMID: 37897473 DOI: 10.1016/j.neurom.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Synchronized intestinal electrical stimulation (SIES), in which intestinal electrical stimulation (IES) is delivered in synchronization with the intrinsic slow wave of small intestine, was previously reported to be more potent in accelerating small intestine transit than IES delivered at fixed frequency and phase. We hypothesized that SIES is more potent in suppressing postprandial blood glucose by enhancing the release of glucagon-like peptide-1 (GLP-1) and insulin. MATERIALS AND METHODS Rats underwent long-term implant of two pairs of electrodes at the duodenum for IES and SIES, respectively. Acute hyperglycemia was induced with glucagon, and the oral glucose tolerance test was performed on separate days with IES, SIES, or sham (no stimulation). RESULTS 1. Glucagon reduced the percentage of normal slow wave in sham (70.9% ± 4.1%) from (84.9% ± 2.6%, p = 0.006) of control, which was ameliorated by SIES (82.5% ± 3.3%, p = 0.031). 2. IES and SIES reduced glucagon-induced increase of blood glucose (192 mg/dl) at 30 minutes by 17% and 20%, respectively. SIES showed a further inhibitory effect at 60 minutes (147 vs 171 mg/dl, p = 0.003, vs sham). 3. Compared with sham (139 pg/ml), GLP-1 at 30 minutes was increased in both IES (158 pg/ml) and SIES (169 pg/ml). GLP-1 level was still high at 60 minutes in rats with SIES. 4. At 30 minutes, the plasma insulin level was increased by 18.8 μIU/ml with SIES, which was significantly higher than that with sham (7.1 μIU/ml, p < 0.001) and IES (13.2 μIU/ml, p = 0.041). CONCLUSION SIES is more effective than IES in reducing glucagon-induced acute hyperglycemia by enhancing the release of GLP-1 and insulin.
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Affiliation(s)
- Shiying Li
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Hongbing Zhu
- Transtimulation Research Inc, Oklahoma City, OK, USA
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI, USA.
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García-Honores L, Caballero-Alvarado J, Bustamante-Cabrejos A, Lozano-Peralta K, Zavaleta-Corvera C. LAPAROSCOPIC SLEEVE GASTRECTOMY VERSUS LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS FOR WEIGHT LOSS IN OBESE PATIENTS: WHICH IS MORE EFFECTIVE? A SYSTEMATIC REVIEW AND META-ANALYSIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1782. [PMID: 38088727 PMCID: PMC10712920 DOI: 10.1590/0102-672020230064e1782] [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: 03/14/2023] [Accepted: 08/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS To determine if LSG is more effective than RYLGB for weight loss. METHODS A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.
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Affiliation(s)
- Laura García-Honores
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
| | - Jose Caballero-Alvarado
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Regional Hospital of Trujillo, Department of surgery - Trujillo, La Libertad, Peru
| | - Alexander Bustamante-Cabrejos
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Alta Complejidad Virgen de la Puerta Hospital, Department of surgery - Trujillo, La Libertad, Peru
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Anazco D, Ghusn W, Campos A, Cifuentes L, Fansa S, Tama E, Bublitz JT, Gala K, Hurtado MD, Olson JE, Acosta A. Type 2 Diabetes Remission in Patients with Heterozygous Variants in the Leptin-Melanocortin Pathway after Roux-en-Y Gastric Bypass: A Matched Case-Control Study. Obes Surg 2023; 33:3502-3509. [PMID: 37798511 DOI: 10.1007/s11695-023-06859-x] [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: 08/07/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is associated with a high rate of type 2 diabetes (T2D) remission. Carriers of heterozygous variants in the leptin-melanocortin pathway (LMP) are more likely to experience weight recurrence after RYGB. Our aim was to investigate if carrier status and associated weight regain affects the rate of T2D remission after RYGB. METHODS Carriers of LMP variants with a diagnosis of T2D prior to RYGB (N = 16) were matched to non-carriers (N = 32) based on sex, age, and BMI. We assessed for post-operative T2D remission status post-surgery on a yearly basis, for up to 15 years. Our primary endpoint was the proportion of patients achieving T2D remission at 1 year. We conducted a survival analysis for all patients that achieved remission at least at one time-point to evaluate for maintenance of T2D remission by using a log-rank test. RESULTS Both carriers and non-carriers had similar baseline and procedural characteristics. The proopiomelanocortin gene in the LMP pathway had the most variants (n = 5, 31%). Carriers had a lower total body weight loss percentage at nadir (28.7% ± 6.9) than non-carriers (33.7% ± 8.8, p = 0.04). The proportion of patients achieving T2D remission at 1 year was 68.8% for carriers and 71.9% for non-carriers (p = 1.0). Survival curves for maintenance of first remission were similar for both groups (p = 0.73), with a median survival of 8 years for both carriers and non-carriers. CONCLUSIONS Despite inferior weight loss outcomes at nadir, carriers had similar T2D remission rates when compared to non-carriers. Weight-independent metabolic benefits of RYGB might contribute to this observation.
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Affiliation(s)
- Diego Anazco
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Alejandro Campos
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Sima Fansa
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Elif Tama
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Joshua T Bublitz
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55902, USA
| | - Khushboo Gala
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
| | - Maria D Hurtado
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Janet E Olson
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55902, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55902, USA.
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Çeler Ö, Er HC, Sancak S, Çırak E, Özdemir A, Sertbaş Y, Karip AB, Esen Bulut N, Aydın MT, Altun H, Memişoğlu K. The Effects of Laparoscopic Sleeve Gastrectomy (LSG) on Obesity-Related Type 2 Diabetes Mellitus: a Prospective Observational Study from a Single Center. Obes Surg 2023; 33:2695-2701. [PMID: 37490195 DOI: 10.1007/s11695-023-06707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The objective of the study is to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on mid- to long-term regulation of blood glucose in patients with obesity and type 2 diabetes mellitus (T2DM) MATERIALS AND METHODS : In this prospective and observational single-center study, a total of 234 patients with obesity and a diagnosis of T2DM who underwent LSG between 2015 and 2020 were evaluated. The demographics and laboratory data, consisting of body mass index (BMI), glycosylated hemoglobin (HbA1c%), and fasting plasma glucose (FPG) and total weight loss (TWL%), were compared preoperative and postoperative at 12th and 18th months and annual follow-up for seven consecutive years. RESULTS The mean age of 234 patients (female(n)/male(n):191/43) included in the study was 44.69±9.72 years, while the preoperative mean BMI, FPG, and HbA1c values were 47.9±6.82, 132.09±42.84 mg/dl, and 7.02±1.35% respectively. The mean rate of weight loss (TWL%), which was 34.7 in the 18 months, decreased to 23.15 in the 7th year. While the HbA1c % value was 7.02±1.35 in the preoperative, it was found 5.71 ± 0.75 (p<0.001) and 6.30 ± 1.77 (p<0.05) at the 18th month and 7th year after the operation, respectively. While the DM remission rate was 71.1% at the postoperative 18th month, it was 45.4% at the 7th year, despite the patients regaining weight in the follow-ups. CONCLUSIONS Our study revealed that LSG resulted in high remission rates that continued for 7 years after the surgery, although sustained improvement or remission of diabetes despite some weight regain after the first 18 months.
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Affiliation(s)
- Özgen Çeler
- Department of Internal Medicine, Endocrinology and Metabolism Disorders, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Atasehir, 34752, Istanbul, Turkey.
| | - Hatice Cansu Er
- Department of Internal Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Atasehir, 34752, Istanbul, Turkey
| | - Seda Sancak
- Department of Internal Medicine, Endocrinology and Metabolism Disorders, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Atasehir, 34752, Istanbul, Turkey
| | - Elif Çırak
- Department of Internal Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Atasehir, 34752, Istanbul, Turkey
| | - Ali Özdemir
- Department of Internal Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Atasehir, 34752, Istanbul, Turkey
| | - Yaşar Sertbaş
- Department of Internal Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Atasehir, 34752, Istanbul, Turkey
| | - Aziz Bora Karip
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, 34752, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, 34752, Istanbul, Turkey
| | - Mehmet Timuçin Aydın
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, 34752, Istanbul, Turkey
| | - Hasan Altun
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, 34752, Istanbul, Turkey
- Interbariatrics Clinic, Şişli, 34365, Istanbul, Turkey
| | - Kemal Memişoğlu
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Atasehir, 34752, Istanbul, Turkey
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Yin M, Wang Y, Han M, Liang R, Li S, Wang G, Gang X. Mechanisms of bariatric surgery for weight loss and diabetes remission. J Diabetes 2023; 15:736-752. [PMID: 37442561 PMCID: PMC10509523 DOI: 10.1111/1753-0407.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Obesity and type 2 diabetes(T2D) lead to defects in intestinal hormones secretion, abnormalities in the composition of bile acids (BAs), increased systemic and adipose tissue inflammation, defects of branched-chain amino acids (BCAAs) catabolism, and dysbiosis of gut microbiota. Bariatric surgery (BS) has been shown to be highly effective in the treatment of obesity and T2D, which allows us to view BS not simply as weight-loss surgery but as a means of alleviating obesity and its comorbidities, especially T2D. In recent years, accumulating studies have focused on the mechanisms of BS to find out which metabolic parameters are affected by BS through which pathways, such as which hormones and inflammatory processes are altered. The literatures are saturated with the role of intestinal hormones and the gut-brain axis formed by their interaction with neural networks in the remission of obesity and T2D following BS. In addition, BAs, gut microbiota and other factors are also involved in these benefits after BS. The interaction of these factors makes the mechanisms of metabolic improvement induced by BS more complicated. To date, we do not fully understand the exact mechanisms of the metabolic alterations induced by BS and its impact on the disease process of T2D itself. This review summarizes the changes of intestinal hormones, BAs, BCAAs, gut microbiota, signaling proteins, growth differentiation factor 15, exosomes, adipose tissue, brain function, and food preferences after BS, so as to fully understand the actual working mechanisms of BS and provide nonsurgical therapeutic strategies for obesity and T2D.
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Affiliation(s)
- Mengsha Yin
- Department of Endocrinology and MetabolismThe First Hospital of Jilin UniversityChangchunChina
| | - Yao Wang
- Department of OrthopedicsThe Second Hospital Jilin UniversityChangchunChina
| | - Mingyue Han
- Department of Endocrinology and MetabolismThe First Hospital of Jilin UniversityChangchunChina
| | - Ruishuang Liang
- Department of Endocrinology and MetabolismThe First Hospital of Jilin UniversityChangchunChina
| | - Shanshan Li
- Department of Endocrinology and MetabolismThe First Hospital of Jilin UniversityChangchunChina
| | - Guixia Wang
- Department of Endocrinology and MetabolismThe First Hospital of Jilin UniversityChangchunChina
| | - Xiaokun Gang
- Department of Endocrinology and MetabolismThe First Hospital of Jilin UniversityChangchunChina
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Bottino R, Carbone A, Formisano T, D'Elia S, Orlandi M, Sperlongano S, Molinari D, Castaldo P, Palladino A, Barbareschi C, Tolone S, Docimo L, Cimmino G. Cardiovascular Effects of Weight Loss in Obese Patients with Diabetes: Is Bariatric Surgery the Additional Arrow in the Quiver? Life (Basel) 2023; 13:1552. [PMID: 37511927 PMCID: PMC10381712 DOI: 10.3390/life13071552] [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: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity is an increasingly widespread disease worldwide because of lifestyle changes. It is associated with an increased risk of cardiovascular disease, primarily type 2 diabetes mellitus, with an increase in major cardiovascular adverse events. Bariatric surgery has been shown to be able to reduce the incidence of obesity-related cardiovascular disease and thus overall mortality. This result has been shown to be the result of hormonal and metabolic effects induced by post-surgical anatomical changes, with important effects on multiple hormonal and molecular axes that make this treatment more effective than conservative therapy in determining a marked improvement in the patient's cardiovascular risk profile. This review, therefore, aimed to examine the surgical techniques currently available and how these might be responsible not only for weight loss but also for metabolic improvement and cardiovascular benefits in patients undergoing such procedures.
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Affiliation(s)
- Roberta Bottino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Andreina Carbone
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Saverio D'Elia
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Massimiliano Orlandi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Simona Sperlongano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Pasquale Castaldo
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Alberto Palladino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Consiglia Barbareschi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
| | - Salvatore Tolone
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mini-Invasive and Obesity Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Ludovico Docimo
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mini-Invasive and Obesity Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Giovanni Cimmino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Napoli, Italy
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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10
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Dieterle MP, Husari A, Prozmann SN, Wiethoff H, Stenzinger A, Röhrich M, Pfeiffer U, Kießling WR, Engel H, Sourij H, Steinberg T, Tomakidi P, Kopf S, Szendroedi J. Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS): Review of the Literature of a Rare Cause of Hyperinsulinemic Hypoglycemia. Biomedicines 2023; 11:1732. [PMID: 37371827 PMCID: PMC10296556 DOI: 10.3390/biomedicines11061732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Differential diagnosis of hypoglycemia in the non-diabetic adult patient is complex and comprises various diseases, including endogenous hyperinsulinism caused by functional β-cell disorders. The latter is also designated as nesidioblastosis or non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS). Clinically, this rare disease presents with unspecific adrenergic and neuroglycopenic symptoms and is, therefore, often overlooked. A combination of careful clinical assessment, oral glucose tolerance testing, 72 h fasting, sectional and functional imaging, and invasive insulin measurements can lead to the correct diagnosis. Due to a lack of a pathophysiological understanding of the condition, conservative treatment options are limited and mostly ineffective. Therefore, nearly all patients currently undergo surgical resection of parts or the entire pancreas. Consequently, apart from faster diagnosis, more elaborate and less invasive treatment options are needed to relieve the patients from the dangerous and devastating symptoms. Based on a case of a 23-year-old man presenting with this disease in our department, we performed an extensive review of the medical literature dealing with this condition and herein presented a comprehensive discussion of this interesting disease, including all aspects from epidemiology to therapy.
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Affiliation(s)
- Martin Philipp Dieterle
- Division of Oral Biotechnology, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Ayman Husari
- Department of Orthodontics, Center for Dental Medicine, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Sophie Nicole Prozmann
- Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Hendrik Wiethoff
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Uwe Pfeiffer
- Pfalzklinikum for Psychiatry and Neurology AdÖR, Weinstr. 100, 76889 Klingenmünster, Germany
| | | | - Helena Engel
- Cancer Immune Regulation Group, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Thorsten Steinberg
- Division of Oral Biotechnology, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Pascal Tomakidi
- Division of Oral Biotechnology, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Stefan Kopf
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, 69120 Heidelberg, Germany
| | - Julia Szendroedi
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, 69120 Heidelberg, Germany
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11
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Liu T, Zou X, Ruze R, Xu Q. Bariatric Surgery: Targeting pancreatic β cells to treat type II diabetes. Front Endocrinol (Lausanne) 2023; 14:1031610. [PMID: 36875493 PMCID: PMC9975540 DOI: 10.3389/fendo.2023.1031610] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Pancreatic β-cell function impairment and insulin resistance are central to the development of obesity-related type 2 diabetes mellitus (T2DM). Bariatric surgery (BS) is a practical treatment approach to treat morbid obesity and achieve lasting T2DM remission. Traditionally, sustained postoperative glycemic control was considered a direct result of decreased nutrient intake and weight loss. However, mounting evidence in recent years implicated a weight-independent mechanism that involves pancreatic islet reconstruction and improved β-cell function. In this article, we summarize the role of β-cell in the pathogenesis of T2DM, review recent research progress focusing on the impact of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on pancreatic β-cell pathophysiology, and finally discuss therapeutics that have the potential to assist in the treatment effect of surgery and prevent T2D relapse.
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Affiliation(s)
- Tiantong Liu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Xi Zou
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rexiati Ruze
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Xu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
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12
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Nakamura Y, Horie I, Kanetaka K, Eguchi S, Nakamichi S, Hongo R, Takashima M, Kawakami A, Abiru N. Exenatide challenge in oral glucose tolerance test is insufficient for predictions of glucose metabolism and insulin secretion after sleeve gastrectomy (SG) in obese patients with type 2 diabetes: a pilot study to establish a preoperative model to estimate β-cell function following augmented glucagon-like peptide-1 secretion after SG. Endocr J 2022; 69:1457-1465. [PMID: 35896344 DOI: 10.1507/endocrj.ej22-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The postoperative increase in glucagon-like peptide-1 (GLP-1) is the main factor to improve glucose metabolism following sleeve gastrectomy (SG) in obese patients with type 2 diabetes. We investigated whether the β-cell responsiveness to an injection of exogenous GLP-1 in the preoperative period could determine the postoperative glucose tolerance in 18 patients underwent SG. In the preoperative period, a regular oral glucose tolerance test (OGTT) and an exenatide-challenge during OGTT (Ex-OGTT) were performed to evaluate the β-cell function and its responsiveness to GLP-1. The postoperative glucose tolerance was evaluated by another regular OGTT performed at 3 months after SG. The significant decrease in glucose levels with enhanced secretions of insulin and GLP-1 was observed in OGTT at 3 months after SG. The area under the curve of glucose from 0 to 120 minutes (AUC glucose0-120 min) and the insulinogenic index (I.I.) in OGTT at 3 months post-SG were significantly improved compared to those in preoperative period, but comparable with those in Ex-OGTT. AUC glucose0-120 min and I.I. in OGTT at 3 months post-SG were significantly correlated with not only those in Ex-OGTT, but also those in the preoperative regular OGTT. Conversely, the correlations calculated by the Spearman's ρ were stronger in the latter than the former. This exenatide-challenge protocol might be useful to estimate glucose tolerance and insulin secretion after SG, however, it may be insufficient to improve predictability of a patient who is likely to achieve a significant benefit on glucose metabolism from receiving SG.
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Affiliation(s)
- Yuta Nakamura
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Ichiro Horie
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Kengo Kanetaka
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Susumu Eguchi
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Seiko Nakamichi
- Department of General Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Ryoko Hongo
- Department of Nutrition Science, Faculty of Nursing and Nutrition, University of Nagasaki, Nagasaki 851-2195, Japan
| | - Miwa Takashima
- Nutritional Management Division, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Atsushi Kawakami
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Norio Abiru
- Department of Endocrinology and Metabolism, Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
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13
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Kwon Y, Lee S, Kim D, ALRomi A, Park SH, Lee CM, Kim JH, Park S. Biliopancreatic Limb Length as a Potential Key Factor in Superior Glycemic Outcomes After Roux-en-Y Gastric Bypass in Patients With Type 2 Diabetes: A Meta-Analysis. Diabetes Care 2022; 45:3091-3100. [PMID: 36455123 DOI: 10.2337/dc22-0835] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Optimal length of biliopancreatic (BP) and Roux limb in Roux-en-Y gastric bypass (RYGB) for improved glycemic control are not known. PURPOSE To investigate how the lengths of the BP and Roux limbs in RYGB differentially affect postoperative glycemic outcomes in patients with type 2 diabetes. DATA SOURCES We conducted a systematic literature search using the PubMed, Embase, and the Cochrane Library databases. STUDY SELECTION We included studies that reported glycemic outcomes after RYGB and lengths of the BP and Roux limbs. DATA EXTRACTION A total of 28 articles were included for data extraction. Glycemic outcomes after RYGB were assessed on the basis of two definitions: remission and improvement. DATA SYNTHESIS We categorized the included studies into four groups according to the BP and Roux limb lengths. The type 2 diabetes remission/improvement rates were as follows: long BP-long Roux group 0.80 (95% CI 0.70-0.90)/0.81 (0.73-0.89), long BP-short Roux group 0.76 (0.66-0.87)/0.82 (0.75-0.89), short BP-long Roux group 0.57 (0.36-0.78)/0.64 (0.53-0.75), and short BP-short Roux group 0.62 (0.43-0.80)/0.53 (0.45-0.61). Meta-regression analysis also showed that a longer BP limb resulted in higher postoperative type 2 diabetes remission and improvement rates, whereas a longer Roux limb did not. There was no significant difference or heterogeneity in baseline characteristics, including diabetes-related variables, among the four groups. LIMITATIONS Not all included studies were randomized controlled trials. CONCLUSIONS Longer BP limb length led to higher rates of type 2 diabetes remission and improvement by 1 year after RYGB in comparisons with the longer Roux limb length.
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Affiliation(s)
- Yeongkeun Kwon
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Sungho Lee
- Department of Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Dohyang Kim
- Department of Statistics, Daegu University, Gyeongbuk, South Korea
| | - Ahmad ALRomi
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Shin-Hoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Chang Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Han Kim
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
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14
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Campanello M, Lindskog S, Zilling T. Linear and circular stapled gastrojejunal anastomoses in Roux-en-Y gastric bypass: stomal diameter at onset and at long-term follow-up. ANZ J Surg 2022; 92:2896-2900. [PMID: 36128948 DOI: 10.1111/ans.17988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/30/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the laparoscopic Roux-en-Y gastric bypass procedure, the gastrojejunal stoma is constructed with either a circular (CSD) or a linear stapling device (LSD). The diameter of the stoma following stapling with the 21 mm CSD is expected to be approximately 12 mm (diameter of the anvil). Measuring the stoma diameter after linear stapling is a little more complex since the remaining opening in the linear anastomosis is closed by hand. The aim of this prospective randomized study was to follow up on changes in the diameter of gastrojejunal stomata after laparoscopic Roux-en-Y gastric bypass using either a CSD or an LSD between that at construction and at a long-term follow-up of 12-72 months later. METHODS Twenty patients were randomly assigned to gastrojejunostomy with either a 21 mm CSD or a 45 mm LSD. Directly after completion of the surgery, the diameter of the gastrojejunal stoma was measured using a Fogarty occlusion catheter and again at follow-up 12-72 months later. RESULTS Five patients were lost for follow-up, and 15 patients remained. The mean diameter of the CSD stomata at construction was 19.3 ± 5.3 mm (mean ± SD) and increased to 26.4 ± 6.6 mm at follow-up after a mean of 46 months (P = 0.02). The corresponding figures for the LSD stomata were 26.2 ± 4.1 mm, increasing to 32.7 ± 3.0 mm also after a mean follow-up of 46 months (P = 0.03). CONCLUSIONS The mean diameter of the circular stapled gastrojejunostomy stomata at construction was 20 mm, that is, considerably larger than the 12 mm expected. After a mean of 5 years, the mean diameter had increased by 37%. The mean diameter of the linear stapled stomata increased by 25%.
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Affiliation(s)
- Magnus Campanello
- Department of Surgery, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Lindskog
- Department of Surgery, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Halland Regional Hospital Varberg, Region Halland, Varberg, Sweden
| | - Thomas Zilling
- Department of Surgery, Halland Regional Hospital Varberg, Region Halland, Varberg, Sweden.,Faculty of Medicine, Lund University Lund, Sweden
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15
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Laparoscopic sleeve gastrectomy for morbid obesity improves gut microbiota balance, increases colonic mucosal-associated invariant T cells and decreases circulating regulatory T cells. Surg Endosc 2022; 36:7312-7324. [PMID: 35182212 DOI: 10.1007/s00464-022-09122-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) for morbid obesity may improve gut microbiota balance and decrease chronic inflammation. This study examines the changes in gut microbiota and immune environment, including mucosal-associated invariant T cells (MAIT cells) and regulatory T cells (Treg cells) caused by LSG. METHODS Ten morbidly obese patients underwent LSG at our institution between December 2018 and March 2020. Flow cytometry for Th1/Th2/Th17 cells, Treg cells and MAIT cells in peripheral blood and colonic mucosa and 16S rRNA analysis of gut microbiota were performed preoperatively and then 12 months postoperatively. RESULTS Twelve months after LSG, the median percent total weight loss was 30.3% and the median percent excess weight loss was 66.9%. According to laboratory data, adiponectin increased, leptin decreased, and chronic inflammation improved after LSG. In the gut microbiota, Bacteroidetes and Fusobacteria increased after LSG, and indices of alpha diversity increased after LSG. In colonic mucosa, the frequency of MAIT cells increased after LSG. In peripheral blood, the frequency of Th1 cells and effector Treg cells decreased after LSG. CONCLUSIONS After LSG for morbid obesity, improvement in chronic inflammation in obesity is suggested by change in the constituent bacterial species, increase in the diversity of gut microbiota, increase in MAIT cells in the colonic mucosa, and decrease in effector Treg cells in the peripheral blood.
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16
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Ceriani V, Pinna F, Galantino A, Zakaria AS, Manfrini R, Pontiroli AE, Folli F. Biliopancreatic Diversion (BPD), Long Common Limb Revisional Biliopancreatic Diversion (BPD + LCL-R), Roux-en-Y Gastric Bypass [RYGB] and Sleeve Gastrectomy (SG) mediate differential quantitative changes in body weight and qualitative modifications in body composition: a 5-year study. Acta Diabetol 2022; 59:39-48. [PMID: 34453598 PMCID: PMC8758656 DOI: 10.1007/s00592-021-01777-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 01/01/2023]
Abstract
AIMS Bariatric surgeries induce profound weight loss (decrease in body mass index, BMI), through a decrease in fat mass (FM) and to a much lesser degree of fat-free mass (FFM). Some reports indicate that the weight which is lost after gastric bypass (RYGB) and sleeve gastrectomy (SG) is at least partially regained 2 years after surgery. Here we compare changes in BMI and body composition induced by four bariatric procedures in a 5 years follow-up study. METHODS We analyzed retrospectively modifications in BMI, FM and FFM obtained through Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and a long common limb revisional biliopancreatic diversion (reduction of the gastric pouch and long common limb; BPD + LCL-R). Patients were evaluated at baseline and yearly for 5 years. Of the whole cohort of 565 patients, a subset of 180 patients had all yearly evaluations, while the remaining had incomplete evaluations. Setting University Hospital. RESULTS In a total of 180 patients evaluated yearly for 5 years, decrease in BMI and FM up to 2 years was more rapid with RYGB and SG than BPD and BPD + LCL-R; with RYGB and SG both BMI and FM slightly increased in the years 3-5. At 5 years, the differences were not significant. When analysing the differences between 2 and 5 years, BPD + LCL-R showed a somewhat greater effect on BMI and FM than RYGB, BPD and SG. Superimposable results were obtained when the whole cohort of 565 patients with incomplete evaluation was considered. CONCLUSIONS All surgeries were highly effective in reducing BMI and fat mass at around 2 years; with RYGB and SG both BMI and FM slightly increased in the years 3-5, while BPD and BPD + LCL-R showed a slight further decreases in the same time interval.
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Affiliation(s)
| | | | - Antonio Galantino
- Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Ahmed S Zakaria
- Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - Roberto Manfrini
- Endocrinologia E Malattie Metaboliche, Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy
- Unità Dipartimentale Di Diabetologia E Malattie Metaboliche, ASST Santi Paolo E Carlo, Milan, Italy
| | - Antonio E Pontiroli
- Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
| | - Franco Folli
- Endocrinologia E Malattie Metaboliche, Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
- Unità Dipartimentale Di Diabetologia E Malattie Metaboliche, ASST Santi Paolo E Carlo, Milan, Italy.
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17
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Lo T, Lee Y, Tseng CY, Hu Y, Connelly MA, Mantzoros CS, Karp JM, Tavakkoli A. Daily transient coating of the intestine leads to weight loss and improved glucose tolerance. Metabolism 2022; 126:154917. [PMID: 34687727 PMCID: PMC8666968 DOI: 10.1016/j.metabol.2021.154917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Roux-en-Y gastric bypass surgery (RYGB) has been shown to be the gold standard treatment for obesity associated type-2-diabetes (T2D), however many T2D patients do not qualify or are reluctant to proceed with surgery due to its potential risks and permanent changes to GI anatomy. We have previously described a novel oral formulation, LuCI, that provides a transient coating of the proximal bowel and mimics the effects of RYGB. Herein, we aim to investigate the outcome of chronic LuCI administration on weight and glucose homeostasis. METHODS Sprague-Dawley rats on a high fat diet achieving diet-induced obesity (DIO) received 5 weeks of daily LuCI or normal saline as control (n = 8/group). Daily weights and glucose tolerance were monitored throughout the experiment. At 5 weeks, systemic blood was sampled through a surgically placed jugular vein catheter, before and during an intestinal glucose bolus, to investigate changes in key hormones involved in glucose metabolism. To elucidate the effects of LuCI on nutrient absorption, fecal output and food intake were measured simultaneously with the analysis of homogenized stool samples performed using bomb calorimetry. RESULTS At 5 weeks, LuCI animals weighted 8.3% less and had lower fasting glucose levels than Controls (77.6 ± 3.8 mg/dl vs. 99.1 ± 2.7 mg/dl, P < 0.001). LuCI-treated animals had lower baseline insulin and HOMA-IR. Post-prandially, LuCI group had increased GLP-1 and GIP secretion following a glucose challenge. Serum lipid analysis revealed lowered LDL levels highlighting the potential to not only improve glucose control but also modify cardiovascular risk. We then investigated whether LuCI's effect on proximal bowel exclusion may play a role in energy balance. Bomb calorimetry analysis suggested that LuCI reduced calorie absorption with no difference in caloric consumption. CONCLUSION We demonstrated that LuCI recapitulates the physical and hormonal changes seen after RYGB and can ameliorate weight gain and improve insulin sensitivity in a DIO rat model. Since LuCI's effect is transient and without systemic absorption, LuCI has the potential to be a novel therapy for overweight or obese T2D patients.
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Affiliation(s)
- Tammy Lo
- Laboratory for Surgical and Metabolic Research, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yuhan Lee
- Department of Anesthesiology, Perioperative, and Pain Medicine, Center for Nanomedicine, Center for Regenerative Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Harvard Stem Cell Institute, Harvard-MIT, Division of Health Sciences and Technology, Boston, MA, USA
| | - Chung-Yi Tseng
- Department of Anesthesiology, Perioperative, and Pain Medicine, Center for Nanomedicine, Center for Regenerative Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Harvard Stem Cell Institute, Harvard-MIT, Division of Health Sciences and Technology, Boston, MA, USA
| | - Yangshuo Hu
- Department of Anesthesiology, Perioperative, and Pain Medicine, Center for Nanomedicine, Center for Regenerative Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Harvard Stem Cell Institute, Harvard-MIT, Division of Health Sciences and Technology, Boston, MA, USA
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, NC, USA
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
| | - Jeffrey M Karp
- Department of Anesthesiology, Perioperative, and Pain Medicine, Center for Nanomedicine, Center for Regenerative Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Harvard Stem Cell Institute, Harvard-MIT, Division of Health Sciences and Technology, Boston, MA, USA.
| | - Ali Tavakkoli
- Laboratory for Surgical and Metabolic Research, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of General and GI Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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18
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Dang JT, Mocanu V, Park H, Laffin M, Tran C, Hotte N, Karmali S, Birch DW, Madsen K. Ileal microbial shifts after Roux-en-Y gastric bypass orchestrate changes in glucose metabolism through modulation of bile acids and L-cell adaptation. Sci Rep 2021; 11:23813. [PMID: 34893681 PMCID: PMC8664817 DOI: 10.1038/s41598-021-03396-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/29/2021] [Indexed: 01/03/2023] Open
Abstract
Roux-en-Y gastric bypass (RYGB)-induced glycemic improvement is associated with increases in glucagon-like-peptide-1 (GLP-1) secreted from ileal L-cells. We analyzed changes in ileal bile acids and ileal microbial composition in diet-induced-obesity rats after RYGB or sham surgery to elucidate the early and late effects on L-cells and glucose homeostasis. In early cohorts, there were no significant changes in L-cell density, GLP-1 or glucose tolerance. In late cohorts, RYGB demonstrated less weight regain, improved glucose tolerance, increased L-cell density, and increased villi height. No difference in the expression of GLP-1 genes was observed. There were lower concentrations of ileal bile acids in the late RYGB cohort. Microbial analysis demonstrated decreased alpha diversity in early RYGB cohorts which normalized in the late group. The early RYGB cohorts had higher abundances of Escherichia-Shigella but lower abundances of Lactobacillus, Adlercreutzia, and Proteus while the late cohorts demonstrated higher abundances of Escherichia-Shigella and lower abundances of Lactobacillus. Shifts in Lactobacillus and Escherichia-Shigella correlated with decreases in multiple conjugated bile acids. In conclusion, RYGB caused a late and substantial increase in L-cell quantity with associated changes in bile acids which correlated to shifts in Escherichia-Shigella and Lactobacillus. This proliferation of L-cells contributed to improved glucose homeostasis.
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Affiliation(s)
- Jerry T Dang
- Division of General Surgery, Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Valentin Mocanu
- Division of General Surgery, Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Heekuk Park
- Department of Medicine, Columbia University, New York City, NY, USA
| | - Michael Laffin
- Division of General Surgery, Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Caroline Tran
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Naomi Hotte
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Division of General Surgery, Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Daniel W Birch
- Division of General Surgery, Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Karen Madsen
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Bakbak E, Terenzi DC, Trac JZ, Teoh H, Quan A, Glazer SA, Rotstein OD, Al-Omran M, Verma S, Hess DA. Lessons from bariatric surgery: Can increased GLP-1 enhance vascular repair during cardiometabolic-based chronic disease? Rev Endocr Metab Disord 2021; 22:1171-1188. [PMID: 34228302 DOI: 10.1007/s11154-021-09669-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes (T2D) and obesity represent entangled pandemics that accelerate the development of cardiovascular disease (CVD). Given the immense burden of CVD in society, non-invasive prevention and treatment strategies to promote cardiovascular health are desperately needed. During T2D and obesity, chronic dysglycemia and abnormal adiposity result in systemic oxidative stress and inflammation that deplete the vascular regenerative cell reservoir in the bone marrow that impairs blood vessel repair and exacerbates the penetrance of CVD co-morbidities. This novel translational paradigm, termed 'regenerative cell exhaustion' (RCE), can be detected as the depletion and dysfunction of hematopoietic and endothelial progenitor cell lineages in the peripheral blood of individuals with established T2D and/or obesity. The reversal of vascular RCE has been observed after administration of the sodium-glucose cotransporter-2 inhibitor (SGLT2i), empagliflozin, or after bariatric surgery for severe obesity. In this review, we explore emerging evidence that links improved dysglycemia to a reduction in systemic oxidative stress and recovery of circulating pro-vascular progenitor cell content required for blood vessel repair. Given that bariatric surgery consistently increases systemic glucagon-like-peptide 1 (GLP-1) release, we also focus on evidence that the use of GLP-1 receptor agonists (GLP-1RA) during obesity may act to inhibit the progression of systemic dysglycemia and adiposity, and indirectly reduce inflammation and oxidative stress, thereby limiting the impact of RCE. Therefore, therapeutic intervention with currently-available GLP-1RA may provide a less-invasive modality to reverse RCE, bolster vascular repair mechanisms, and improve cardiometabolic risk in individuals living with T2D and obesity.
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Affiliation(s)
- Ehab Bakbak
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Daniella C Terenzi
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Justin Z Trac
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen A Glazer
- Department of Internal Medicine, Humber River Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Queen's University, Kingston, ON, Canada
| | - Ori D Rotstein
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - David A Hess
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada.
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
- Molecular Medicine Research Laboratories, Robarts Research Institute, London, ON, Canada.
- Department of Physiology and Pharmacology, Western University, London, ON, Canada.
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Hajri T, Ewing D, Talishinskiy T, Amianda E, Eid S, Schmidt H. Depletion of Omega-3 Fatty Acids in RBCs and Changes of Inflammation Markers in Patients With Morbid Obesity Undergoing Gastric Bypass. J Nutr 2021; 151:2689-2696. [PMID: 34113966 DOI: 10.1093/jn/nxab167] [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: 10/25/2019] [Revised: 12/09/2020] [Accepted: 05/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bariatric surgery is considered the most effective treatment for severe obesity. Despite this wide success, bariatric surgery is associated with increased risks of nutritional deficiencies. OBJECTIVES To examine whether Roux-en-Y-gastric bypass (RYGB) alters essential fatty acid (FA) status and inflammation markers. METHODS Subjects with obesity (n = 28; BMI > 40 kg/m2; mean age 48 years) were studied before and 1 year after RYGB. We collected blood samples before and 12 months after RYGB, and analyzed FA in RBCs and peripheral blood mononuclear cells (PBMC), and measured inflammation parameters in plasma. The proportion of total n-3 FAs was the primary outcome, while parameters related to other FAs and inflammation factors were the secondary parameters. In addition, PBMCs from 15 of the participants were cultured alone or with 100 and 200 μM DHA, and the production of IL-6, IL-1β, PGE2, and prostaglandin F2-alpha (PGF2α) was assayed after endotoxin (LPS) stimulation. RESULTS RYGB induced a significant reduction of BMI (-30%) and improvement of insulin resistance (-49%). While the proportion of arachidonic acid was 15% higher after RYGB, the proportions of total and individual n-3 FAs were 50%-75% lower (P < 0.01). Consequently, the RBC omega-3 index and n-3:n-6 fatty acid ratio were 45% and 50% lower after surgery, respectively. In isolated PBMCs, LPS induced the production of IL-6, IL-1β, PGE2, and PGF2α in both pre- and post-RYGB cells, but the effects were 34%-65% higher (P < 0.05) after RYGB. This effect was abrogated by DHA supplementation. CONCLUSIONS This study presents evidence that RBC and PBMC n-3 FAs are severely reduced in patients with obesity after RYGB. DHA supplementation in PBMC moderates the production of inflammation markers, suggesting that n-3 FA supplementation would merit a trial in bariatric patients.
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Affiliation(s)
- Tahar Hajri
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Douglas Ewing
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Erica Amianda
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sebastian Eid
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Hans Schmidt
- Hackensack University Medical Center, Hackensack, NJ, USA
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21
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Nasta AM, Goel R, Goel M, Malek A. Undiagnosed Hyperglycemia Is a Potential Long-term Risk in Metabolic Surgery Patients: 7 Years Follow-up Study. Obes Surg 2021; 31:4251-4256. [PMID: 34273069 DOI: 10.1007/s11695-021-05570-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Diabetes is considered to be a surgically correctable illness. As glycemic control begins soon after surgery, the cessation of anti-diabetic medications is early. Patients believe that their diabetes has been "cured" and the need for blood sugar monitoring is forgotten, leading to undiagnosed hyperglycemia and risk of diabetes-related complications. AIMS To study the effect of bariatric surgery on long-term glycemic control and identify the patients with undiagnosed hyperglycemia. METHODS All patients with type 2 diabetes who underwent bariatric surgery at our center from January 2012 to December 2013 were included in the study. For each patient, demographic, preoperative, and postoperative data were retrospectively reviewed. RESULTS Out of the total 119 patients with diabetes, 91 patients underwent sleeve gastrectomy and 28 underwent Roux-en-Y gastric bypass. Diabetes status at 7 years of follow-up was possible in 53 (44.5%) patients: 44 (48.4%) in SG and 9 (32.2%) in RYGB groups. Overall, complete remission at 7 years was seen in 17 (32.1%) patients and partial remission in 12 (22.6%) patients. Amongst non-remitters (n = 24, 45.3%), 7 (13.2%) patients were on medications with good glycemic control (A1C < 6.5) while 8 (15.1%) patients had poor control (A1C > 6.5) despite ongoing medications. Additionally, 9 (17%) patients had poor glycemic control (A1C > 6.5) and were not receiving any anti-diabetic medications. Patients in whom follow-up A1C was unavailable and their diabetes status remain unknown were 66 (55.5%) at 7 years. CONCLUSION Our study clearly demonstrates high risk of undiagnosed hyperglycemia. Regular long-term follow-up in diabetic patients is even more desirable than amongst patients undergoing bariatric surgery for weight loss alone. Graphical abstract.
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Affiliation(s)
- Amrit Manik Nasta
- Bariatric Surgery, Wockhardt Hospitals, Mumbai Central, Mumbai, India.
| | - Ramen Goel
- Bariatric and Metabolic Surgery, Wockhardt Hospitals, Mumbai, India
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Ji G, Li W, Li P, Tang H, Yu Z, Sun X, Li R, Zhu L, Zhu S. Effect of Roux-en-Y Gastric Bypass for Patients with Type 2 Diabetes Mellitus and a BMI < 32.5 kg/m2: a 6-Year Study in Chinese Patients. Obes Surg 2021; 30:2631-2636. [PMID: 32157520 DOI: 10.1007/s11695-020-04534-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbidly obese patients to improve type 2 diabetes mellitus (T2DM). Recently, T2DM patients with a lower body mass index (BMI) have been receiving more attention, and these patients could benefit from RYGB. METHODS Fifty-two patients with T2DM underwent RYGB between October 2008 and December 2012 in our hospital. Weight, BMI, oral glucose tolerance test (OGTT), insulin release test (IRT), C-peptide release test (CRT), glycosylated hemoglobin (HbA1c), and lipid metabolic parameters were measured at baseline and at 3 and 6 months and 1, 2, 3, 4, 5, and 6 years after surgery. RESULTS The mean age of the 52 patients was 46.8 ± 9.5 years, and 57.7% were male. The mean duration of T2DM was 6.5 ± 4.6 years. Compared with the baseline values, weight and BMI were significantly decreased at several time points after surgery. HbA1c decreased from 8.2 ± 1.7% at baseline to 6.5 ± 1.4% at 3 months, 6.5 ± 1.4% at 6 months, 7.2 ± 1.3% at 4 years, and 7.5 ± 1.2% at 6 years. OGTT, OGTT-IRT, and OGTT-CRT improved after surgery. There was a decrease in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein (LDL) and an increase in high-density lipoprotein (HDL). At 6 years after surgery, 16.7% of patients achieved complete remission of T2DM, and 66.7% achieved improvement in T2DM. CONCLUSION RYGB may be a safe and effective treatment for T2DM patients with a BMI < 32.5 kg/m2 in China. However, a long-term study without loss to follow-up is necessary for better evaluation.
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Affiliation(s)
- Guangnian Ji
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Zhaomei Yu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Rao Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
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Bernard A, Le Beyec-Le Bihan J, Radoi L, Coupaye M, Sami O, Casanova N, Le May C, Collet X, Delaby P, Le Bourgot C, Besnard P, Ledoux S. Orosensory Perception of Fat/Sweet Stimuli and Appetite-Regulating Peptides before and after Sleeve Gastrectomy or Gastric Bypass in Adult Women with Obesity. Nutrients 2021; 13:878. [PMID: 33800516 PMCID: PMC8000537 DOI: 10.3390/nu13030878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to explore the impact of bariatric surgery on fat and sweet taste perceptions and to determine the possible correlations with gut appetite-regulating peptides and subjective food sensations. Women suffering from severe obesity (BMI > 35 kg/m2) were studied 2 weeks before and 6 months after a vertical sleeve gastrectomy (VSG, n = 32) or a Roux-en-Y gastric bypass (RYGB, n = 12). Linoleic acid (LA) and sucrose perception thresholds were determined using the three-alternative forced-choice procedure, gut hormones were assayed before and after a test meal and subjective changes in oral food sensations were self-reported using a standardized questionnaire. Despite a global positive effect of both surgeries on the reported gustatory sensations, a change in the taste sensitivity was only found after RYGB for LA. However, the fat and sweet taste perceptions were not homogenous between patients who underwent the same surgery procedure, suggesting the existence of two subgroups: patients with and without taste improvement. These gustatory changes were not correlated to the surgery-mediated modifications of the main gut appetite-regulating hormones. Collectively these data highlight the complexity of relationships between bariatric surgery and taste sensitivity and suggest that VSG and RYGB might impact the fatty taste perception differently.
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Affiliation(s)
- Arnaud Bernard
- UMR Lipides/Nutrition/Cancer 1231 INSERM/AgroSup Dijon/Univ. Bourgogne-Franche Comté, 21000 Dijon, France;
| | - Johanne Le Beyec-Le Bihan
- UF de Génétique de l’Obésité et des Dyslipidémies, Service de Biochimie Endocrinienne et Oncologique, Centre de Génétique Moléculaire et Chromosomique, Groupe Hospitalier Pitié-Salpêtrière (APHP), 75013 Paris, France;
- Fonctions Gastro-Intestinales, Métaboliques et Physiopathologies Nutritionnelles Inserm UMR1149, Centre de Recherche sur l’Inflammation Paris Montmartre, 75018 Paris, France
| | - Loredana Radoi
- Service d’odontologie, Hôpital Louis Mourier (APHP), 92700 Colombes, France;
| | - Muriel Coupaye
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
| | - Ouidad Sami
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
| | - Nathalie Casanova
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
| | | | - Xavier Collet
- UMR 1048 INSERM/Toulouse III, 31400 Toulouse, France;
| | | | | | - Philippe Besnard
- UMR Lipides/Nutrition/Cancer 1231 INSERM/AgroSup Dijon/Univ. Bourgogne-Franche Comté, 21000 Dijon, France;
- Physiologie de la Nutrition, Agrosup Dijon, 26, Bd Dr Petitjean, 21000 Dijon, France
| | - Séverine Ledoux
- Fonctions Gastro-Intestinales, Métaboliques et Physiopathologies Nutritionnelles Inserm UMR1149, Centre de Recherche sur l’Inflammation Paris Montmartre, 75018 Paris, France
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
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24
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Wilson R, Aminian A, Tahrani AA. Metabolic surgery: A clinical update. Diabetes Obes Metab 2021; 23 Suppl 1:63-83. [PMID: 33621412 DOI: 10.1111/dom.14235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
Metabolic and bariatric surgery has grown beyond 'experimental' weight-loss surgery. As techniques have advanced over the last few decades, so has the growing body of research and evidence, proving that both weight-loss and metabolic health improvement are induced. Metabolic surgery has become the more appropriate term for weight-loss surgery because of the altered gastrointestinal anatomy and subsequent beneficial metabolic effects. Although the tool of metabolic surgery has been well refined, a large portion of the global population does not have adequate access to it. This clinical update aims to (a) inform healthcare providers from all disciplines about the myriad of benefits of metabolic surgery and (b) equip them with the necessary knowledge to bridge the gap between patients in need of metabolic treatment and the therapies in metabolic surgery available to them.
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Key Words
- adjustable gastric banding, atrial fibrillation, bariatric surgery, cancer, cardiovascular disease, gastric bypass, heart failure, hypertension, mortality, obesity, obstructive sleep apnoea, reflux disease, sleeve gastrectomy, type 2 diabetes
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Affiliation(s)
- Rickesha Wilson
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
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25
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Intestinal Electrical Stimulation Enhances Release of Postprandial Incretin Hormones Via Cholinergic Mechanisms. Obes Surg 2021; 31:1957-1966. [PMID: 33469859 DOI: 10.1007/s11695-021-05228-w] [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: 10/15/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Intestinal electrical stimulation (IES) has been reported to reduce body weight and improve glucose tolerance in obese and diabetic rats. Our study aimed to investigate possible IES mechanisms involving incretin hormones using intraduodenal glucose infusion in rats. We hypothesized that the enhanced release of postprandial glucagon-like peptide-1 (GLP-1) at early phase by IES was mediated through neuro/paracrine mechanisms involving the vagal nerve and glucose-dependent insulinotropic peptide (GIP). METHODS Fifteen normal male Sprague-Dawley rats chronically implanted with duodenal electrodes for IES, and an intra-duodenum catheter for the infusion of glucose were studied in a series of sessions with IES of different parameters with and without atropine and M3 receptor antagonist. Blood samples were collected via the tail vein for the measurement of blood glucose, and plasma GLP-1, and GIP. RESULTS (1) Compared to sham-IES, IES of 0.3 ms reduced blood glucose by 16.5-28.4% between 30 and 120 min (all time points p < 0.05), and IES of 3-ms reduced blood glucose at 60 (12.6%) and 90 min (11.8%). IES of 0.3 ms showed a greater hypoglycemic effect than 3 ms (p = 0.024) at 30 min. (2) IES elevated plasma GLP-1 with 0.3 ms (p = 0.001) and with 3 ms p = 0.03). (3) IES substantially elevated plasma GIP with 0.3 ms (p = 0.002) and with 3 ms (p < 0.001). (4) Pretreatment of atropine and the M3 receptor antagonist 4-DAMP blocked the effects of IES on GLP-1, GIP, and blood glucose. CONCLUSIONS IES reduces postprandial blood glucose by enhancing the release of GLP-1 and GIP mediated via the cholinergic mechanism.
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Magouliotis DE, Fergadi MP, Zacharoulis D. The Significant Hormonal Traits of Laparoscopic Sleeve Gastrectomy Are Further Supported Using Three-Dimensional MDCT Gastrography. Obes Surg 2021; 31:2291-2292. [PMID: 33393000 DOI: 10.1007/s11695-020-05140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/08/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Sciences, UCL, London, UK.,Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | - Maria P Fergadi
- Department of Radiology, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
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27
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Nedeljkovic-Arsenovic O, Banovic M, Radenkovic D, Rancic N, Polovina S, Micic D, Nedeljkovic I. Five-Year Outcomes in Bariatric Surgery Patients. ACTA ACUST UNITED AC 2020; 56:medicina56120669. [PMID: 33287109 PMCID: PMC7761683 DOI: 10.3390/medicina56120669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 12/25/2022]
Abstract
Background and objectives: Obesity presents as a multifactorial, pandemic disease that arises as a consequence of unequal energy intake and energy consumption. Obesity adversely affects the quality of life, leading not only to disability, but also to various other disorders. Bariatric surgery is the most effective method for achieving significant and sustained weight loss in individuals with extreme obesity. The aim of this study was to examine how well surgically induced weight loss is maintained after five years of follow-up and its effects on cardiovascular risk factors and outcome. Materials and Methods: This is a retrospective cross-sectional study of 66 patients with morbid obesity, with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 and obesity-related health conditions, aged 20 to 61 years, mostly women (77.3%) who underwent laparoscopic Roux-en-Y gastric bypass surgery. Results: Average follow-up was 6.42 years (95% CI 6.30–6.54 years) after surgery, with survival rate of 97% in operated individuals. There was a statistically significant reduction of weight and body mass index 6 months and 5 years after surgery in comparison to the initial values (p < 0.001). Of 62 patients who presented weight loss at the end of the follow-up period, 38 were able to maintain the amount of weight loss that was attained 6 months after surgery, while 24 patients regained weight compared to their postoperative weight at 6 months. Two patients reported no weight loss after treatment. Significant weight reduction was associated with better control of diabetes and increased self-reported physical activity at 6 months and 5 years after surgery, as well as with a reduction of the use of anti-diabetic and anti-hypertensive medications. Conclusions: Our research demonstrates a positive long-term impact of bariatric surgery on patients’ health conditions, significant and sustained weight loss, and decrease in BMI, which were associated with a reduction of co-morbidities and risk factors for cardiovascular diseases.
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Affiliation(s)
- Olga Nedeljkovic-Arsenovic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Correspondence: (O.N.-A.); (N.R.)
| | - Marko Banovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
| | - Dejan Radenkovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
- Correspondence: (O.N.-A.); (N.R.)
| | - Snezana Polovina
- Department of Endocrinology, Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Faculty of Pharmacy, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Dragan Micic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
| | - Ivana Nedeljkovic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
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28
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Farha J, Abbarh S, Haq Z, Itani MI, Oberbach A, Kumbhari V, Badurdeen D. Endobariatrics and Metabolic Endoscopy: Can We Solve the Obesity Epidemic with Our Scope? Curr Gastroenterol Rep 2020; 22:60. [PMID: 33205261 DOI: 10.1007/s11894-020-00798-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Obesity is a chronic relapsing disease that results in cardiovascular disease, diabetes mellitus, and non-alcoholic fatty liver disease. Currently, surgery represents the most effective treatment. However, the advent of minimally invasive endoscopic bariatric therapy (EBT) has shifted the treatment paradigm to less invasive, cost-effective procedures with minimal complications and recovery time that are preferred by patients. In this review, we will describe current and future EBTs, focusing on outcomes and safety. RECENT FINDINGS The endoscope has provided an incisionless portal into the gastrointestinal tract for placement of space-occupying devices and intraluminal procedures. EBTs are no longer solely manipulating anatomic alterations; instead, they aim to improve metabolic parameters such as glycated hemoglobin, low-density lipoprotein, cholesterol, and hepatic indices by targeting the mucosal layer of the gastrointestinal tract. The endoscope has succeeded in facilitating clinically meaningful weight loss and improvement of metabolic parameters. Future, solutions to the obesity epidemic will likely entail genetic testing, evaluation of the microbiome, and delivery of personalized therapy, utilizing combination endoscopic modalities that change the anatomy and physiology of individual patients, with new targets such as the abnormal metabolic signal.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Zadid Haq
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Validation of Individualized Metabolic Surgery Score in Indian Diabetics Undergoing Metabolic Surgery—a Retrospective Study of 100 Patients. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Soong TC, Lee MH, Lee WJ, Chen JC, Wu CC, Chun SC. One Anastomosis Gastric Bypass for the Treatment of Type 2 Diabetes: Long-Term Results and Recurrence. Obes Surg 2020; 31:935-941. [PMID: 33145718 DOI: 10.1007/s11695-020-05093-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bariatric/metabolic surgery has been incorporated into the therapeutic treatment of type 2 diabetes mellitus (T2DM). Among many bariatric/metabolic procedures, one anastomosis gastric bypass (OAGB) is one of the most effective procedures but long-term data about T2DM recurrence after OAGB are lacking. METHODS Outcomes of 134 patients who had undergone OAGB for the treatment of T2DM with long-term (5 years) follow-up were assessed in a retrospective cohort study. The remission of T2DM after OAGB surgery was evaluated in different groups using a scoring system composed of the age, BMI, C-peptide level, duration of T2DM (ABCD score), and percent of total weight loss (%TWL). RESULTS The %TWL and percent of excess weight loss (%EWL) of the OAGB patients at 5 years after surgery were 29.2 (10.6) and 72.1(27.5), respectively. The mean BMI decreased from 39.5(7.9) to 27.6(5.3) kg/m2 and mean glycated hemoglobin A1C (HbA1c) decreased from 8.9 to 5.9% in OAGB patients at 5 years after OAGB. The complete T2DM remission rate of OAGB was 76.1% at 1 year and 64.2% at 5 years after surgery. Forty-one (57.8%) out of 71 patients who completed a 10-year follow-up remained in complete T2DM remission. The T2DM recurrence rate of OAGB patients was 15.7% at 5 years after surgery. CONCLUSIONS OAGB is highly effective in inducing T2DM remission but a significant number of patients will still have T2DM recurrence. To select patient with an ABCD score > 5 and maintaining a weight loss greater than 30% is important for durable T2DM remission after OAGB.
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Affiliation(s)
- Tien-Chou Soong
- Center of Weight Loss and Health Management, E-DA Dachang Hospital, Kaohsiung, Taiwan.,Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan.,College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Hsien Lee
- Metabolic & Bariatric Surgical Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Wei-Jei Lee
- Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan. .,Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Chun-Chi Wu
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Shu-Chun Chun
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
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31
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Short versus long biliopancreatic limb in Roux-en-Y gastric bypass surgery for treatment of type 2 diabetes mellitus. Wideochir Inne Tech Maloinwazyjne 2020; 16:129-138. [PMID: 33786126 PMCID: PMC7991953 DOI: 10.5114/wiitm.2020.99997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Although laparoscopic Roux-en-Y gastric bypass (RYGB) is still widely accepted as a valid procedure in the treatment of obesity and type 2 diabetes mellitus (T2DM), there continues to be a significant controversy about how long the Roux and biliopancreatic limb should be bypassed for optimum results. Aim To assess the effect of a longer biliopancreatic limb (BPL) length on glycemic control after RYGB in T2DM patients. Material and methods Eighty-four patients with uncontrolled T2DM who underwent RYGB between May 2010 and April 2017 were collected from the prospectively designed database. Forty patients (S-BPL group) received BPL lengths ≤ 50 cm, including 30 cm (n = 1), 40 cm (n = 1), and 50 cm (n = 38). Forty-four patients (L-BPL group) received 100 cm BPL. Anthropometry, serum glucose and lipid metabolic parameters were measured at baseline and 1, 3, 6, 12, 24 and 36 months after surgery. Results Comparing the two groups, there were no significant differences in anthropometric and biochemical measures, except the weight and body mass index, which were higher in the S-BPL group (85.91 ±20.32 vs. 76.25 ±16.99, p = 0.038; 31.87 ±6.61 vs. 28.7 ±4.29, p = 0.005) compared to the L-BPL group. The body weight, glucose and lipid metabolic parameters decreased over time and then remained essentially stable from the first year in both groups. Two years after surgery, the remission (HbA1c% ≤ 6%) of T2DM was 31.2% in the S-BPL group and 37.5% in the L-BPL group (p = 0.685). Conclusions With consistent total small bowel bypass (AL + BPL) lengths, lengthening of the BPL from 30 to 100 cm did not affect the post-RYGB glycemic control and weight loss.
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32
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Almalki OM, Soong TC, Lee WJ, Chen JC, Wu CC, Lee YC. Variation in Small Bowel Length and Its Influence on the Outcomes of Sleeve Gastrectomy. Obes Surg 2020; 31:36-42. [PMID: 32914323 DOI: 10.1007/s11695-020-04958-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Small bowel length is drawing attention in the development of gastrointestinal bariatric/metabolic surgery, but the importance of the length of the small bowel in bariatric/metabolic is not clear. The present study was conducted to investigate variations in small bowel length and their clinical significance in patients undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS Small bowel length was measured in 620 patients diagnosed with obesity who underwent LSG between March 2014 and August 2018. Prospectively obtained demographic and clinical data were investigated, focusing on the association between small bowel length and weight loss. RESULTS Small bowel length varied widely among patients (mean 739.8 + 115.7 cm, range 380-1050 cm). Linear regression analysis revealed a significant association between small bowel length and body height, body weight, waist circumference, and serum levels of low-density lipoprotein cholesterol, hemoglobin, C-peptide, glycated hemoglobin (A1C), and gamma-glutamyl transferase (r-GT). Multivariate analysis confirmed that body height and serum A1C% levels independently predicted small bowel length in bariatric patients, strongly with body height (p < 0.001) but weakly with A1C%(p = 0.021). One-year follow-up rate was 75.3% (467/620), and small bowel length did not influence weight loss or the reduction of obesity related cardiovascular risk factors after LSG. CONCLUSION In this study, small bowel length varied widely among bariatric patients and was strongly associated with body height and weakly with serum A1C levels. Small bowel length has no significant role in weight loss or the resolution of cardiovascular risk factors after LSG.
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Affiliation(s)
- Owaid M Almalki
- Department of Surgery, College of Medicine, Taif University, Ta'if, Saudi Arabia.,Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Tien-Chou Soong
- Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan.,Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan.,College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Chun-Chi Wu
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University, Taoyuan, Taiwan
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33
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Kraemer MDS, Moehlecke M, Rheinheimer J, Canani LH, Leitão CB, Nicoletto BB. Plasma progranulin levels in obese patients before and after Roux-en-Y gastric bariatric surgery: a longitudinal study. Surg Obes Relat Dis 2020; 16:1655-1660. [PMID: 32839122 DOI: 10.1016/j.soard.2020.06.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/10/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery stands out as the most effective long-term intervention for sustainable weight loss and metabolic improvement in patients with severe obesity. Progranulin was recently identified as an adipokine related to obesity and inflammation, revealing a metabolic function and proinflammatory properties. OBJECTIVE To evaluate plasma progranulin levels before and after 6 months of bariatric surgery in Roux-en-Y gastric bypass (RYGB). SETTING Tertiary referral hospital, southern Brazil. METHODS This was a prospective longitudinal study, including 23 obese patients who underwent RYGB. Demographic and clinical characteristics, body composition, and resting energy expenditure were evaluated. Plasma progranulin was determined with enzyme-linked immunosorbent assays in a peripheral blood sample collected before and 6 months after the surgical procedure. RESULTS The participants were mostly women (78.3%), with a mean age of 42.3 ± 10.8 years and baseline body mass index of 48.8 ± 10.4 kg/m2. Regarding the anthropometric parameters, there were differences in the pre- and post-RYGB values, with reduction of weight, body mass index, body fat percentage, and cervical and abdominal circumferences. All laboratory parameters improved, such as lipid profile and fasting glycemia, and resting energy expenditure values decreased significantly. Plasma progranulin levels decreased from 47.6 ± 13.5 ng/mL before RYGB to 40.4 ± 9.9 ng/mL after 6 months of surgery (P = .005). The reduction of progranulin did not correlate with body composition or laboratory data. CONCLUSIONS Plasma progranulin levels significantly reduced 6 months after RYGB, but it could not be explained by changes in anthropometry, body composition, or glycemic or lipid profile.
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Affiliation(s)
| | - Milene Moehlecke
- Programa de Pós Graduação em Ciências Médicas, Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Jakeline Rheinheimer
- Programa de Pós Graduação em Ciências Médicas, Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Luis Henrique Canani
- Programa de Pós Graduação em Ciências Médicas, Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Cristiane Bauermann Leitão
- Programa de Pós Graduação em Ciências Médicas, Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Bruna Bellincanta Nicoletto
- Programa de Pós Graduação em Ciências Médicas, Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Área do Conhecimento de Ciências da Vida, Universidade de Caxias do Sul, Caxias do Sul, Brasil.
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34
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Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12 Years Follow-up Study. Obes Surg 2020; 30:4834-4839. [PMID: 32578178 DOI: 10.1007/s11695-020-04782-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a recommended treatment for type 2 diabetes mellitus (T2DM) in patients with obesity, with superiority over medical therapy. While diabetes remission is achieved initially in 60-90% of patients following surgery, many may experience relapse of diabetes on the long-term. Data on long-term follow-up of bariatric surgery is scarce. We report this 12-year follow-up study of glycaemic control following RYGB. METHODS Two hundred seventeen patients with obesity (109 diabetic, 108 matched nondiabetic) who underwent RYGB between 2000 and 2008 were identified. Data was recorded prospectively for these patients at baseline and 2 years postoperatively. The long-term data was obtained via direct contact with the patients cross-checked with our hospital/national patients' electronic databases. RESULTS The follow-up rate was 88% (initial age 44 ± 9 years, female 79%). The mean (± SD) percentage total weight loss was 28% (± 15%) and 27% (± 17%) at 2 years and 12 years, respectively. Diabetes remission rate was 69% at 2 years, but decreased to 36% at 12 years following surgery. The 12-year incidence of new-onset T2DM in the control group was 4.3%. On univariate analysis, age, preoperative duration of diabetes and use of insulin were associated with less chance of diabetes remission at long-term (p value 0.06, 0.01 and 0.03, respectively). However, on multivariate regression analysis, only the duration of diabetes preoperatively remained significant (p = 0.025). CONCLUSION This study shows a high relapse of diabetes 12-year post-RYGB despite the durability of weight loss. This affects preoperative counselling and indicates a need for a longer follow-up to detect relapse.
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35
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Khanal P, D. Axel AM, Safayi S, Elbrønd VS, Nielsen MO. Prenatal over- and undernutrition differentially program small intestinal growth, angiogenesis, absorptive capacity, and endocrine function in sheep. Physiol Rep 2020; 8:e14498. [PMID: 32597039 PMCID: PMC7322502 DOI: 10.14814/phy2.14498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
The aim was to test the hypothesis that prenatal under- and overnutrition in late gestation can program small intestinal (SI) growth, angiogenesis, and endocrine function to predispose for a hyperabsorptive state, thereby increasing the susceptibility to the adverse effects of an early postnatal obesogenic diet. Twin-pregnant ewes were exposed to adequate (NORM), LOW (50% of NORM), or HIGH (150% energy and 110% protein of NORM) diets through the last trimester (term ~147 days). From 3 days to 6 months of age, their lambs were fed either a moderate (CONV) or a high-carbohydrate high-fat (HCHF) diet. At 6 months of age, responses in plasma metabolites and insulin to refeeding after fasting were determined and then different segments of the SI were sampled at autopsy. Prenatal overnutrition impacts were most abundant in the duodenum where HIGH had increased villus amplification factor and lowered villi thickness with increased IRS-1 and reduced GH-R expressions. In jejunum, HIGH lambs had an increased expression of Lactate gene and amplified when exposed to HCHF postnatally. Specifically, in LOW, sensitivity to HCHF was affected in ileum. Thus, the mismatching LOW-HCHF nutrition increased expressions of angiogenic genes (VEGF, VEGF-R1, ANGPT1, RTK) and increased mucosa layer (tunica mucosa) thickness but reduced muscle layer (Tunica muscularis) thickness. The SI is a target of prenatal nutritional programming, where late gestation overnutrition increased and shifted digestive capacity for carbohydrates toward the jejunum, whereas late gestation undernutrition predisposed for ileal angiogenesis and carbohydrate and fat hyperabsorptive capacity upon subsequent exposure to postnatal obesogenic diet.
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Affiliation(s)
- Prabhat Khanal
- Faculty of Biosciences and AquacultureAnimal Science, Production and Welfare DivisionNord UniversitySteinkjerNorway
| | - Anne Marie D. Axel
- Department of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksbergDenmark
| | | | - Vibeke S. Elbrønd
- Department of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksbergDenmark
| | - Mette O. Nielsen
- Department of Animal ScienceFaculty of Technical SciencesAarhus UniversityTjeleDenmark
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36
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Lee MH, Almalki OM, Lee WJ, Chen SC, Chen JC, Wu CC. Laparoscopic Sleeve Gastrectomy for Type 2 Diabetes Mellitus: Long-Term Result and Recurrence of Diabetes. Obes Surg 2020; 30:3669-3674. [DOI: 10.1007/s11695-020-04737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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37
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Colás A, Varela M, Mraz M, Novak D, Cuesta-Frau D, Vigil L, Benes M, Pelikanova T, Haluzik M, Burda V, Vargas B. Influence of glucometric 'dynamical' variables on duodenal-jejunal bypass liner (DJBL) anthropometric and metabolic outcomes. Diabetes Metab Res Rev 2020; 36:e3287. [PMID: 31916665 DOI: 10.1002/dmrr.3287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 11/19/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects. METHODS Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes. RESULTS There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control (∆BMI-∆TU6.1: rho = - 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control (∆FBG-∆AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02). CONCLUSIONS In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation.
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Affiliation(s)
- Ana Colás
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Varela
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
| | - Milos Mraz
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Daniel Novak
- Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - David Cuesta-Frau
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi, Spain
| | - Luis Vigil
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
| | - Marek Benes
- Hepatogastroenterology Department, Transplantation Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Terezie Pelikanova
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Martin Haluzik
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
- Laboratory of Experimental Diabetology, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vaclav Burda
- Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Borja Vargas
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
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38
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Guan W, Cui Y, Bu H, Liu J, Zhao S, Zhao Q, Ma X. Duodenal-Jejunal Exclusion Surgery Improves Type 2 Diabetes in a Rat Model Through Regulation of Early Glucose Metabolism. Can J Diabetes 2020; 44:401-406.e1. [PMID: 32279935 DOI: 10.1016/j.jcjd.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/25/2018] [Accepted: 12/07/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Metabolic surgery has been proven to be widely effective for the control of glucose and weight in patients with type 2 diabetes and obesity. However, the effects of bariatric surgery on nonobesity type 2 diabetes and its metabolism are still unclear. This study aimed to measure the effects of duodenal-jejunal exclusion on glycometabolism in nonobese rats with type 2 diabetes and to investigate its mechanisms. METHODS Goto-Kakizaki rats and Sprague-Dawley rats were divided into duodenal-jejunal exclusion operation groups and sham operation groups, respectively. The glucose-relative parameters were measured before and after operation. Eight weeks postoperation, the levels of the key regulators of intestinal gluconeogenesis and the crucial proteins of hepatic insulin signalling were evaluated. RESULTS Postoperatively, the concentrations of blood glucose declined, and the insulin sensitivity increased significantly in rats with diabetes. However, there was no obvious reduction in weight. Eight weeks postoperatively, the mRNA levels of glucose-6-phosphatase and phosphoenolpyruvate pyruvate kinase in the jejunum and the levels of insulin receptor substrate-2 and glucose transporter-2 in the liver were significantly increased compared with the rats that had undergone the sham operation. CONCLUSIONS Duodenal-jejunal exclusion surgery is an effective procedure for improving glucose metabolism independent of weight loss in nonobese rats with diabetes. The molecular mechanisms might be associated with a series of processes, including intestinal gluconeogenesis and the hepatic insulin signaling pathway.
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Affiliation(s)
- Wei Guan
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuliang Cui
- Department of Endocrinology, the Dezhou People's Hospital, Dezhou, China
| | - Hemei Bu
- Department of Nutriology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Liu
- Department of Endocrinology, the Dezhou People's Hospital, Dezhou, China
| | - Sha Zhao
- Department of Nutriology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Zhao
- Department of Endocrinology, the Dezhou People's Hospital, Dezhou, China
| | - Xianghua Ma
- Department of Nutriology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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de La Harpe R, Rüeger S, Kutalik Z, Ballabeni P, Suter M, Vionnet N, Laferrère B, Pralong F. Weight Loss Directly Influences Intermediate-Term Remission of Diabetes Mellitus After Bariatric Surgery: A Retrospective Case-Control Study. Obes Surg 2020; 30:1332-1338. [PMID: 31754925 PMCID: PMC10015445 DOI: 10.1007/s11695-019-04283-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Roux en Y gastric bypass surgery (RYGB) is an effective therapy for patients with severe obesity. It induces both significant weight loss and rapid improvements of metabolic complications. This study was undertaken to better define the direct role of weight loss in the metabolic improvements. METHODS A retrospective, case-control study of a cohort of 649 patients with obesity who underwent RYGB, comparing higher and lower responders at 2 years after surgery (n = 100 pairs). Pairs of patients were matched for age, gender, and initial BMI. The rates of remission of diabetes, hypertension, dyslipidemia, and hyperuricemia were compared using a mixed effects logistic regression analysis. RESULTS Diabetes before surgery was present in 12/100 lower responders and 17/100 higher responders. Remission at 2 years was observed in 4/12 (33%) of lower responders, compared to 15/17 (88%) of higher responders. Thus, the odds of diabetes remission was significantly smaller in lower responders (OR = 0.067, 95% CI 0.01-0.447). A mixed model regression analysis of all the parameters for each patient showed that the odds of achieving remission of any comorbidity was significantly lower in lower responders (OR = 0.62, 95% CI = 0.39-0.97). CONCLUSION We could demonstrate that weight loss is a significant determinant of the remission of diabetes 2 years after RYGB. These data underline the importance of weight loss in the benefits of this procedure.
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Affiliation(s)
- R de La Harpe
- Service of Internal Medicine, Morges, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
| | - S Rüeger
- School of Life Sciences, EPFL, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Z Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne (UNIL), Lausanne, Switzerland
| | - P Ballabeni
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne (UNIL), Lausanne, Switzerland.,Clinical Research Center (CRC), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - M Suter
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland
| | - N Vionnet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - B Laferrère
- New York Obesity Nutrition Research Center, Divison of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - F Pralong
- Center for Endocrinology, Diabetology and Obesity, La Tour Private Hospital, Meyrin, Switzerland
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40
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Umemura A, Sasaki A, Nitta H, Nikai H, Baba S, Takahara T, Hasegawa Y, Katagiri H, Kanno S, Ishigaki Y. Prognostic factors and a new preliminary scoring system for remission of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy. Surg Today 2020; 50:1056-1064. [PMID: 32170427 DOI: 10.1007/s00595-020-01990-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/11/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the early remission rate of type 2 diabetes mellitus (T2DM) after laparoscopic sleeve gastrectomy (LSG) and establish a preliminary scoring system that predicts T2DM remission. METHODS We assessed the outcomes of 49 morbidly obese patients with T2DM who underwent LSG between 2008 and 2018. The prognostic factors for T2DM remission 1 year post-LSG were identified and an original scoring system was established. We validated our scoring system by comparing it with the individualized metabolic surgery score and the ABCD score. RESULTS The patients' mean body weight loss and percentage of excess weight loss were 34.4 kg and 59.4%, respectively, while the T2DM remission rate was 77.5%. The serum insulin level and the T2DM duration were independent predictive factors, the receiver-operating characteristic (ROC) curves for which revealed cutoff values of 12.7 ng/mL and 72 months, respectively. We set our system's score range at 0-2, whereby patients with higher scores have a good T2DM remission prognosis, as higher insulin levels, and/or shorter T2DM duration. Our scoring system had accuracy levels similar to those of the ABCD score with a simple stratification. CONCLUSION Our preliminary scoring system attains a good level of accuracy for predicting T2DM remission.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shigeaki Baba
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, 020-8505, Japan
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Chen G, Zhuang J, Cui Q, Jiang S, Tao W, Chen W, Yu S, Wu L, Yang W, Liu F, Yang J, Wang C, Jia S. Two Bariatric Surgical Procedures Differentially Alter the Intestinal Microbiota in Obesity Patients. Obes Surg 2020; 30:2345-2361. [PMID: 32152837 DOI: 10.1007/s11695-020-04494-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Haange SB, Jehmlich N, Krügel U, Hintschich C, Wehrmann D, Hankir M, Seyfried F, Froment J, Hübschmann T, Müller S, Wissenbach DK, Kang K, Buettner C, Panagiotou G, Noll M, Rolle-Kampczyk U, Fenske W, von Bergen M. Gastric bypass surgery in a rat model alters the community structure and functional composition of the intestinal microbiota independently of weight loss. MICROBIOME 2020; 8:13. [PMID: 32033593 PMCID: PMC7007695 DOI: 10.1186/s40168-020-0788-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/13/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) surgery is a last-resort treatment to induce substantial and sustained weight loss in cases of severe obesity. This anatomical rearrangement affects the intestinal microbiota, but so far, little information is available on how it interferes with microbial functionality and microbial-host interactions independently of weight loss. METHODS A rat model was employed where the RYGB-surgery cohort is compared to sham-operated controls which were kept at a matched body weight by food restriction. We investigated the microbial taxonomy and functional activity using 16S rRNA amplicon gene sequencing, metaproteomics, and metabolomics on samples collected from theileum, the cecum, and the colon, and separately analysed the lumen and mucus-associated microbiota. RESULTS Altered gut architecture in RYGB increased the relative occurrence of Actinobacteria, especially Bifidobacteriaceae and Proteobacteria, while in general, Firmicutes were decreased although Streptococcaceae and Clostridium perfringens were observed at relative higher abundances independent of weight loss. A decrease of conjugated and secondary bile acids was observed in the RYGB-gut lumen. The arginine biosynthesis pathway in the microbiota was altered, as indicated by the changes in the abundance of upstream metabolites and enzymes, resulting in lower levels of arginine and higher levels of aspartate in the colon after RYGB. CONCLUSION The anatomical rearrangement in RYGB affects microbiota composition and functionality as well as changes in amino acid and bile acid metabolism independently of weight loss. The shift in the taxonomic structure of the microbiota after RYGB may be mediated by the resulting change in the composition of the bile acid pool in the gut and by changes in the composition of nutrients in the gut. Video abstract.
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Affiliation(s)
- Sven-Bastiaan Haange
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
- Institute of Biochemistry, Faculty of Life Sciences, University of Leipzig, Leipzig, Germany
| | - Nico Jehmlich
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Ute Krügel
- Rudolf Boehm Institute of Pharmacology and Toxicology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Constantin Hintschich
- Neuroendocrine Regulation of Energy Homeostasis Group, IFB Adiposity Diseases, Leipzig, Germany
| | - Dorothee Wehrmann
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Mohammed Hankir
- Neuroendocrine Regulation of Energy Homeostasis Group, IFB Adiposity Diseases, Leipzig, Germany
- Current address: Department of Experimental Surgery, Wuerzburg University Hospital, Wuerzburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Vascular and Pediatric Surgery, Wuerzburg University Hospital, Wuerzburg, Germany
| | - Jean Froment
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Thomas Hübschmann
- Department of Environmental Microbiology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Susann Müller
- Department of Environmental Microbiology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Dirk K. Wissenbach
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
- Current address: Institute of Forensic Medicine, Jena University Hospital, Jena, Germany
| | - Kang Kang
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoll Institute, Jena, Germany
| | - Christian Buettner
- Institute for Bioanalysis, Faculty of Applied Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
| | - Gianni Panagiotou
- Systems Biology and Bioinformatics Group, School of Biological Sciences, The University of Hong Kong, Hong Kong SAR, China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Matthias Noll
- Institute for Bioanalysis, Faculty of Applied Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
| | - Ulrike Rolle-Kampczyk
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Wiebke Fenske
- Neuroendocrine Regulation of Energy Homeostasis Group, IFB Adiposity Diseases, Leipzig, Germany
| | - Martin von Bergen
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
- Institute of Biochemistry, Faculty of Life Sciences, University of Leipzig, Leipzig, Germany
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Mochida T, Take K, Maki T, Nakakariya M, Adachi R, Sato K, Kitazaki T, Takekawa S. Inhibition of MGAT2 modulates fat-induced gut peptide release and fat intake in normal mice and ameliorates obesity and diabetes in ob/ob mice fed on a high-fat diet. FEBS Open Bio 2019; 10:316-326. [PMID: 31837122 PMCID: PMC7050258 DOI: 10.1002/2211-5463.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/12/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022] Open
Abstract
Monoacylglycerol O‐acyltransferase 2 (MGAT2) is one of the key enzymes responsible for triglyceride (TG) re‐synthesis in the small intestine. We have previously demonstrated that pharmacological inhibition of MGAT2 has beneficial effects on obesity and metabolic disorders in mice. Here, we further investigate the effects of MGAT2 inhibition on (a) fat‐induced gut peptide release and fat intake in normal mice and (b) metabolic disorders in high‐fat diet (HFD)‐fed ob/ob mice, a model of severe obesity and type 2 diabetes mellitus, using an orally bioavailable MGAT2 inhibitor Compound B (CpdB). CpdB inhibited elevation of plasma TG in mice challenged with an oil‐supplemented liquid meal. Oil challenge stimulated the secretion of two gut anorectic hormones (peptide tyrosine–tyrosine and glucagon‐like peptide‐1) into the bloodstream, and these responses were augmented in mice pretreated with CpdB. In a two‐choice test using an HFD and a low‐fat diet, CpdB selectively inhibited intake of the HFD in normal mice. Administration of CpdB to HFD‐fed ob/ob mice for 5 weeks suppressed food intake and body weight gain and inhibited elevation of glycated hemoglobin. These results indicate that pharmacological MGAT2 inhibition modulates fat‐induced gut peptide release and fat intake in normal mice and improves obesity and diabetes in HFD‐fed ob/ob mice and thus may have potential for development into a treatment of obesity and its related metabolic diseases.
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Affiliation(s)
- Taisuke Mochida
- Cardiovascular and Metabolic Drug Discovery Unit, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Kazumi Take
- Cardiovascular and Metabolic Drug Discovery Unit, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Toshiyuki Maki
- Cardiovascular and Metabolic Drug Discovery Unit, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Masanori Nakakariya
- Drug Metabolism and Pharmacokinetics Research Laboratories, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Ryutaro Adachi
- Biomolecular Research Laboratories, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Kenjiro Sato
- Cardiovascular and Metabolic Drug Discovery Unit, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Tomoyuki Kitazaki
- Cardiovascular and Metabolic Drug Discovery Unit, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Shiro Takekawa
- Cardiovascular and Metabolic Drug Discovery Unit, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
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Abstract
PURPOSE OF REVIEW We seek to characterize the impact of bariatric surgery on diabetes mellitus by recalling its history, examining the clinical data, exploring the putative mechanisms of action, and anticipating its future. RECENT FINDINGS Results of clinical trials reveal that bariatric surgery induces remission of diabetes in 33-90% of individuals at 1-year post-treatment versus 0-39% of medically managed. Remission rates decrease over time but remain higher in surgically treated individuals. Investigations have revealed numerous actions of surgery including effects on intestinal physiology, neuronal signaling, incretin hormone secretion, bile acid metabolism, and microbiome changes. Bariatric surgery improves control of diabetes through both weight-dependent and weight-independent actions. These various mechanisms help explain the difference between individuals treated surgically vs. medically. They also explain differing effects of various bariatric surgery procedure types. Understanding how surgery affects diabetes will help optimize utilization of the therapy for both disease prevention and treatment.
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Affiliation(s)
- Alison H Affinati
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA
| | - Andrew T Kraftson
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA.
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Cӑtoi AF, Pârvu AE, Mironiuc A, Silaghi H, Pop ID, Andreicuț AD. Ultra-Early and Early Changes in Bile Acids and Insulin After Sleeve Gastrectomy Among Obese Patients. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E757. [PMID: 31766784 PMCID: PMC6955910 DOI: 10.3390/medicina55120757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE In obese patients, sleeve gastrectomy (SG) has shown mixed results on bile acid (BA) values. The aim of our study was to examine the potential ultra-early and early changes of the circulating total BA in relation with the changes of insulin resistance (IR) in obese patients submitted to laparoscopic SG. Materials and Methods: Twenty-four obese subjects were investigated for body mass index (BMI), total fasting BA, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and leptin before and at 7 and 30 d after SG. Results: After surgery, mean BMI decreased at the first (p < 0.001) and at the second time point (p < 0.001) relative to baseline. Total fasting BA values did not change significantly at 7 d (p = 0.938) and at 30 d (p = 0.289) after SG. No significant changes were found at 7 d (p = 0.194, p = 0.34) and 30 d (p = 0.329, p = 0.151) after surgery regarding fasting insulin and HOMA-IR, respectively. However, a trend of increased total fasting BA and decreased fasting insulin and HOMA- after laparoscopic SG has been found. Negative correlations between total fasting BA and insulin (r = -0.807, p = 0.009), HOMA-IR (r = -0.855, p = 0.014), and blood glucose (r = -0.761, p = 0.047), respectively, were observed at one month after SG. Conclusion: In conclusion, here, we found a lack of significant changes in total fasting BA, insulin, and HOMA-IR ultra-early and early after SG, which precluded us to consider a possible relation between the variations of BA and IR. However, the presence of the tendency for total fasting BA to increase and for insulin and HOMA-IR to decrease, as well as of the negative correlations one month after laparoscopic SG, suggest that this surgery brings about some changes that point towards the existence, and possibly towards the restoration, at least to some extent, of the link between BA and glucose metabolism.
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Affiliation(s)
- Adriana Florinela Cӑtoi
- Department of Pathophysiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.E.P.); (A.D.A.)
| | - Alina Elena Pârvu
- Department of Pathophysiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.E.P.); (A.D.A.)
| | - Aurel Mironiuc
- 2nd Surgical Clinic, Department of Surgery, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Horațiu Silaghi
- 5th Surgical Clinic, Department of Surgery, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Ioana Delia Pop
- Department of Exact Sciences, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania;
| | - Andra Diana Andreicuț
- Department of Pathophysiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.E.P.); (A.D.A.)
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An Overview of Disease Burden, Mechanism, Traditional and Non-traditional Management of Type 2 Diabetes. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Diabetes is a major global health problem leading to high morbidity, mortality, and economic burden. Diabetes is connected to complex social, environmental, and behavioral factors and requires multisectoral evidence-based strategies to reduce its incidence and prevalence. Here we attempt to connect existing diabetes data with the underlying mechanism of the disease, while touching disease processes and traditional management approaches for diabetes and its complications. The major objective of this manuscript is to examine the effect of nontraditional treatment modalities, e.g. non-pharmaceutical interventions, supplements, alternative and integrative therapies etc., on diabetes. We performed an extensive literature search and review using electronic databases (PubMed and Google Scholar) to examine recent and historical diabetes statistics, the underlying mechanism of the disease, traditional treatments, remission possibility, and finally, the role of alternative therapies and supplements in its management. We found that there is no sufficient evidence to make most of the alternative therapies the first line of management and prevention approach for diabetes. Long-term and large-scale studies are needed to evaluate the safety and efficacy of alternative medicine. We feel that this review could urge other health researchers to plan comprehensive studies to examine the role of alternative or newly-identified therapies in diabetes. Also, this information can be useful for diverse health professionals and policymakers in developing and implementing evidence-based strategies.
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The Impact of Preoperative BMI (Obesity Class I, II, and III) on the 12-Month Evolution of Patients Undergoing Laparoscopic Gastric Bypass. Obes Surg 2019; 28:3095-3101. [PMID: 29725974 DOI: 10.1007/s11695-018-3281-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Whether or not the initial body mass index (BMI) influences weight loss and comorbidities improvement after bariatric surgery continues to be a matter of debate. The main reason for this is a lack of studies including obesity class I. METHODS Retrospective study with patients submitted to gastric bypass at a single institution. They were classified based on initial BMI (obesity class I, II, and III), and a comparative analysis of their metabolic profile (glucose, HbA1c%, C-peptide, insulin and diabetes medication), lipid profile (triglycerides, total cholesterol, HDL, LDL), and clinical data (systolic/diastolic blood pressure and cardiovascular risk) was performed at 0 and 12 months. Diabetes remission and weight loss were also analyzed. RESULTS Two-hundred and twenty patients were included (23 in group 1, 113 in group 2, and 84 in group 3). Initial weight, BMI, and number of patients with T2DM were statistically different in group 1; other parameters were homogenous. At 12 months, every group had similar improvement of the metabolic profile, excepting serum insulin. Diabetes remission was 57.9, 61.1, and 60% for group 1, 2, and 3. For weight loss, there were differences between groups when using BMI and percentage of excess weight loss, but not with percentage of total weight loss. The non-metabolic and clinical data improved without differences, except for total cholesterol and LDL. CONCLUSIONS The metabolic, lipid, and clinical profiles associated with obesity present similar improvement 1 year after laparoscopic gastric bypass, despite different baseline BMI. Diabetes remission and percentage of total weight loss were also similar.
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Shan CX, Qiu NC, Liu ME, Zha SL, Song X, Du ZP, Rao WS, Jiang DZ, Zhang W, Qiu M. Effects of Diet on Bile Acid Metabolism and Insulin Resistance in Type 2 Diabetic Rats after Roux-en-Y Gastric Bypass. Obes Surg 2019; 28:3044-3053. [PMID: 29721762 DOI: 10.1007/s11695-018-3264-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is effective for the treatment of type 2 diabetes mellitus; however, the mechanism remains unclear. METHODS The effects of RYGB on postprandial responses to three different diets (low carbohydrate (CH)-rich diet, high CH-rich diet, and fat-rich diet) of different nutritional composition in a Goto-Kakizaki (GK) diabetic rat model were assessed by measuring glucose tolerance, insulin resistance, incretin responses, and bile acid (BA) metabolism. RESULTS GK-RYGB group rats lost weight and preferred low CH-rich diet, but there were no significant differences in BW among the different diets. Glucose tolerance and insulin resistance were improved in rats who underwent RYGB, together with higher levels of circulating BAs, plasma GLP-1, and PYY levels. GK-RYGB rats fed high CH-rich or fat-rich diet showed increased glucose level and insulin resistance, together with high plasma BA, GIP, and PYY levels compared to those fed a low CH-rich diet. CONCLUSION RYGB improves glucose tolerance and insulin resistance which may be related to BA metabolism and hormone levels, and the nutrient composition of the diet affects the treatment effect of RYGB on T2DM.
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Affiliation(s)
- Cheng-Xiang Shan
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China
| | - Nian-Cun Qiu
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China.,Department of General Surgery, Hainan Branch of Chinese PLA General Hospital, Sanya, 572000, China
| | - Miao-E Liu
- Key Laboratory of Reproductive Genetics, Women's Hospital, Zhejiang University, Zhejiang, 310000, China
| | - Si-Luo Zha
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China
| | - Xin Song
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China
| | - Zhi-Peng Du
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China
| | - Wen-Sheng Rao
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China
| | - Dao-Zhen Jiang
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China
| | - Wei Zhang
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China.
| | - Ming Qiu
- Department of General Surgery, Chang Zheng Hospital affiliated to Second Military Medical University, 440 Chengdu North Road, Shanghai, 200003, China.
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Selection of Bypass vs Sleeve for the Management of Type-2 Diabetes in Severely Obese: Could Ethnicity Play a Role? Obes Surg 2019; 28:3073-3079. [PMID: 29748734 DOI: 10.1007/s11695-018-3294-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Prospective data was evaluated to see whether bariatric procedure type made any difference to diabetes remission. METHODS One hundred eighty-six consecutive patients of Indian ethnicity (M:F 89:97) with type 2 diabetes mellitus (T2DM) and HbA1c > 6.5 were assessed before and at 1 year following surgery. Age, BMI, C-peptide and duration of diabetes (ABCD - described by WJ Lee), insulin use, baseline HbA1c, and % weight loss were tested as modifiers. We present remission rates (HbA1c ≤ 6.0%) and between group remission odds ratio (OR) and adjusted OR after controlling for key modifiers. RESULTS Patients selecting RYGB (n = 113) vs SG (n = 73) were older (50.7 vs 44.2 years), had a lower BMI (44.1 vs 46.7), lower C-peptide (3.5 vs 4.7 ng/ml), greater duration of diabetes (8 vs 3 years), and higher HbA1c (8.90 and 7.9%) respectively p < 0.05 for all (combined R2 = 0.38). Weight loss at 1 year was 27 and 30% for RYGB and SG respectively (p = 0.01). Remission at 1 year was achieved by 37% of patient selecting RYGB and 74% for the SG (OR = 0.21, 95% CI 0.11-0.41, p < 0.001). After adjusting for ABCD, the adjusted OR (AOR) still favored the SG (AOR = 0.32, 0.14-0.74, p = 0.01), and adjustment for HbA1c and weight loss (AOR 0.4, 0.17-0.95, p = 0.038) attenuated the effect. CONCLUSION The analysis suggests SG may be superior to RYGB in this Indian population. Ethnicity may play a role in predicting the response to bariatric surgery and hence the choice of procedure. A randomized controlled trial is needed to clarify the relative benefit.
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Chang DM, Lee WJ, Chen JC, Ser KH, Tsai PL, Lee YC. Thirteen-Year Experience of Laparoscopic Sleeve Gastrectomy: Surgical Risk, Weight Loss, and Revision Procedures. Obes Surg 2019; 28:2991-2997. [PMID: 29931481 DOI: 10.1007/s11695-018-3344-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been validated as a safe and effective treatment for morbid obesity. However, data of the long-term outcome remains lacking. METHODS A total of 1759 LSG was performed as primary bariatric procedure from 2005 to 2017 with mean age of 35.2 ± 10.3 years old (14-71), female 69.7%, mean body mass index (BMI) 37.9 ± 7.7 kg/m2, and mean waist width 113.7 ± 17.9 cm. All patients were evaluated and managed under a strict multidisciplinary team approach. A retrospective analysis of a prospective bariatric database and telephone interview of patients who defaulted clinic follow-up at 10 years was conducted. RESULTS The mean operating time, intraoperative blood, and hospital stay of LSG were 121.5 ± 36.5 min, 40.8 ± 69.7 ml, and 2.8 ± 2.7 days, respectively. The 30-day postoperative major complication occurred in 25 (1.4%) patients. The major complication rate was 15% at first year and 0% at the last year. The follow-up rate at 1, 5 and 10 years were 89.3%, 52.1 and 64.4%. At postoperative 1, 5, and 10 years, the mean percentage of total weight loss (%TWL) and excess weight loss (EWL%) of LSG patients were 33.4, 28.3, and 26.6% and 92.2, 80.1, and 70.5%, respectively. The mean BMI became 27, 26.2, and 27.1 kg/m2 at postoperative 1, 5, and 10 years. At follow-up, a total 69 patients needed surgical revision due to reflux disease (n = 45), weight regain (n = 19), persistent diabetes (n = 2), and chronic fistula (n = 3). The type of revision procedures were hiatal repair and gastropexy (n = 29), Roux-en Y gastric bypass (RYGB) (n = 23), and single anastomosis bypass (n = 17) with median time to revision 33 months (range 3-62). At 10 years, the overall revision rate was 21.5% (14/65) and 11(16.9%) of 65 patients were converted to RYGB. The other 54 patients remained at LSG anatomy, but 45% of them required proton pump inhibitor for reflux symptoms. CONCLUSIONS Our results showed that primary LSG is a durable primary bariatric procedure with sustained weight loss and a high resolution of comorbidities at 10 years, but about half the patients had de novo GERD. The need for conversion to RYGB was 16.9% at 10 years.
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Affiliation(s)
- Der-Ming Chang
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China.,Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Kong-Han Ser
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Pei-Ling Tsai
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, Tauoyan, Taiwan, Republic of China
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