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Honka H, Bhattacharjee J, Zadeh M, Kohli R, Gastaldelli A, Salehi M. Vagal activation alters prandial bile acid composition and glycemia in patients with hypoglycemia after Roux-en-Y gastric bypass surgery. Neurogastroenterol Motil 2024; 36:e14763. [PMID: 38342974 DOI: 10.1111/nmo.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/07/2023] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Altered prandial glycemic response after Roux-en-Y gastric bypass (RYGB) is exaggerated in patients with post-RYGB hypoglycemia. Increased contribution of glucagon-like peptide 1 (GLP-1) to prandial insulin secretion plays a key role in developing hypoglycemia after RYGB, but the role of nonhormonal gut factors remains unknown. Here, the effect of vagal activation on prandial bile acid (BA) composition in relation to glucose, insulin and gut hormone responses was examined in a small size group of nondiabetic subjects after RYGB with intact gallbladder compared to nonoperated controls. METHODS Concentrations of blood glucose, hormones, and BAs were measured in two RYGB subjects with documented hypoglycemia (HGB), three asymptomatic RYGB-treated subjects (AGB), and four nonoperated controls with intact gallbladders during a meal-tolerance test with (MTT-Sham) and without (MTT) preceding modified sham feeding (chew and spit). KEY RESULTS Meal ingestion raised serum total BAs in RYGB-treated subjects without any effect in nonoperated controls. Modified sham feeding similarly increased meal-induced responses of conjugated BAs (CBAs) in all subjects (p < 0.05 compared to MTT alone), whereas unconjugated BAs (UBAs), mainly deoxycholic and chenodeoxycholic acid, were raised only in the HGB group (p < 0.001 for interaction). Prandial UBAs had an inverse correlation with glucose nadir (r = -0.75, p < 0.05) and were directly associated with ISR and GLP-1 during MTT-Sham. CONCLUSIONS & INFERENCES In this small cohort, vagal activation by modified sham feeding increases prandial CBAs in both operated and nonoperated subjects but enhances UBAs only in patients with documented post-RYGB hypoglycemia. Our findings highlight a potential role for nonhormonal gut factors, such as BA and gut microbiome, in glucose abnormalities after RYGB.
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Affiliation(s)
- Henri Honka
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jashdeep Bhattacharjee
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mansour Zadeh
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Rohit Kohli
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology-National Research Council, Pisa, Italy
| | - Marzieh Salehi
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- South Texas Veterans Health Care System, Audie Murphy Hospital, San Antonio, Texas, USA
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Honka H, Gastaldelli A, Pezzica S, Peterson R, DeFronzo R, Salehi M. Differential effect of endogenous glucagon-like peptide-1 on prandial glucose counterregulatory response to hypoglycaemia in humans with and without bariatric surgery. Diabetes Obes Metab 2024. [PMID: 38558527 DOI: 10.1111/dom.15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/25/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
AIM To determine the effect of endogenous glucagon-like peptide 1 (GLP-1) on prandial counterregulatory response to hypoglycaemia after gastric bypass (GB). MATERIALS AND METHODS Glucose fluxes, and islet-cell and gut hormone responses before and after mixed-meal ingestion, were compared during a hyperinsulinaemic-hypoglycaemic (~3.2 mmol/L) clamp with and without a GLP-1 receptor (GLP-1R) antagonist exendin-(9-39) infusion in non-diabetic patients who had previously undergone GB compared to matched participants who had previously undergone sleeve gastrectomy (SG) and non-surgical controls. RESULTS Exendin-(9-39) infusion raised prandial endogenous glucose production (EGP) response to insulin-induced hypoglycaemia in the GB group but had no consistent effect on EGP response among the SG group or non-surgical controls (p < 0.05 for interaction). The rates of systemic appearance of ingested glucose or prandial glucose utilization did not differ among the three groups or between studies with and without exendin-(9-39) infusion. Blockade of GLP-1R had no effect on insulin secretion or insulin action but enhanced prandial glucagon in all three groups. CONCLUSIONS These results indicate that impaired post-meal glucose counterregulatory response to hypoglycaemia after GB is partly mediated by endogenous GLP-1, highlighting a novel pathogenic mechanism of GLP-1 in developing hypoglycaemia in this population.
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Affiliation(s)
- Henri Honka
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology-National Research Council, Pisa, Italy
| | - Samantha Pezzica
- Cardiometabolic Risk Unit, Institute of Clinical Physiology-National Research Council, Pisa, Italy
| | - Richard Peterson
- Department of Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Marzieh Salehi
- Division of Diabetes, University of Texas Health Science Center, San Antonio, Texas, USA
- South Texas Veteran Health Care System, Audie Murphy Hospital, San Antonio, Texas, USA
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Miskelly MG, Berggren J, Svensson M, Koffert J, Honka H, Kauhanen S, Nuutila P, Hedenbro J, Lindqvist A, Melander O, Wierup N. The effects of Calorie restriction and Bariatric surgery on Circulating Proneurotensin levels. J Clin Endocrinol Metab 2024:dgae147. [PMID: 38477483 DOI: 10.1210/clinem/dgae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
CONTEXT Proneurotensin (pNT) is associated with obesity and T2D, but the effects of Roux-en-Y gastric bypass (RYGB) on postprandial pNT levels are not well studied. OBJECTIVE Assess effects of RYGB versus very low-energy diet (VLED) on pNT levels in response to mixed-meal tests (MMT), and long-term effects of RYGB on fasting pNT.Study participants: Cohort 1: Nine normoglycemic (NG) and ten T2D patients underwent MMT before and after VLED, immediately post-RYGB and six weeks post-RYGB. Cohort 2: Ten controls with normal weight and ten patients with obesity and T2D, who underwent RYGB or vertical sleeve gastrectomy (VSG), were subjected to MMTs and GIP infusions pre-surgery and three months post-surgery. GLP-1 infusions were performed in normal weight participants. Cohort 3: Fasting pNT was assessed pre-RYGB (n=161), two months post-RYGB (n=92) and 1-year post-RYGB (n=118) in NG and T2D patients. pNT levels were measured using ELISA. RESULTS Reduced fasting and postprandial pNT were evident after VLED and immediately following RYGB. Reintroduction of solid food post-RYGB increased fasting and postprandial pNT. Prior to RYGB, all patients lacked a meal response in pNT, but this was evident post-RYGB/VSG. GIP- or GLP-1 infusion had no effect on pNT levels. Fasting pNT were higher 1-year post-RYGB regardless of glycemic status. CONCLUSION RYGB causes a transient reduction in pNT as a consequence of caloric restriction. The RYGB/VSG-induced rise in postprandial pNT is independent of GIP and GLP-1 and higher fasting pNT are maintained one year post-surgically.
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Affiliation(s)
- Michael G Miskelly
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Johan Berggren
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Malin Svensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jukka Koffert
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Gastroenterology, Turku University Hospital, Turku, Finland
| | - Henri Honka
- Turku PET Centre, University of Turku, Turku, Finland
| | - Saila Kauhanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Jan Hedenbro
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Andreas Lindqvist
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nils Wierup
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
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Rayas M, Gastaldelli A, Honka H, Pezzica S, Carli F, Peterson R, DeFronzo R, Salehi MS. GLP-1 enhances beta-cell response to protein ingestion and bariatric surgery amplifies it. medRxiv 2024:2023.10.22.23297377. [PMID: 37961500 PMCID: PMC10635165 DOI: 10.1101/2023.10.22.23297377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Protein ingestion stimulates β-cell secretion and alters glucose flux. Enhanced action of glucagon-like peptide 1 (GLP-1) and increased plasma glucose excursion contribute to prandial hyperinsulinemia after gastric bypass surgery (GB) and sleeve gastrectomy (SG). We examined the contribution of endogenous GLP-1 to glucose kinetics and β-cell response to protein ingestion under basal glucose concentrations in humans, and whether these responses are affected by rerouted gut after GB or SG. DESIGN Glucose fluxes, insulin secretion rate (ISR), and incretin responses to a 50-gram oral protein load were compared between 10 non-diabetic individuals with GB, 9 matched subjects with SG and 7 non-operated controls (CN) with and without intravenous infusion of exendin-(9- 39) [Ex-9), a specific GLP-1 receptor (GLP-1R) antagonist. RESULTS Blocking GLP-1R increased the plasma glucose concentration before and after protein ingestion in all 3 groups (p<0.05) and decreased β-cell sensitivity to glucose in the first 30 minutes of protein ingestion (p<0.05). Reduction in the prandial ISR3h by Ex-9 infusion, however, only was observed in GB and SG (p<0.05 for interaction) and not in controls. Also, GLP-1R blockade increased post-protein insulin action in GB and SG, but not CN (p=0.09 for interaction). Endogenous glucose production (EGP) during the first 60 minutes after protein ingestion was increased in all 3 groups but EGP3h only was accentuated in GB by Ex-9 infusion (p<0.05 for interaction). CONCLUSION These findings are consistent with both a pancreatic and extrapancreatic role for GLP-1 during protein ingestion in humans, and GLP-1 actions are exaggerated by bariatric surgery.
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Honka H, Gastaldelli A, Pezzica S, Peterson R, DeFronzo R, Salehi M. Endogenous glucagon-like peptide 1 diminishes prandial glucose counterregulatory response to hypoglycemia after gastric bypass surgery. medRxiv 2023:2023.09.20.23295840. [PMID: 37790563 PMCID: PMC10543055 DOI: 10.1101/2023.09.20.23295840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We have previously shown that prandial endogenous glucose production (EGP) during insulin-induced hypoglycemia is smaller in non-diabetic subjects with gastric bypass (GB), where prandial glucagon-like peptide 1 (GLP-1) concentrations are 5-10 times higher than those in non-operated controls. Here, we sought to determine the effect of endogenous GLP-1 on prandial counterregulatory response to hypoglycemia after GB. Glucose fluxes, and islet-cell and gut hormone responses before and after mixed-meal ingestion were compared during a hyperinsulinemic hypoglycemic (~3.2 mmol/l) clamp with and without a GLP-1 receptor (GLP-1R) antagonist exendin-(9-39) (Ex-9) in non-diabetic subjects with prior GB compared to matched subjects with SG and non-surgical controls. In this setting, GLP-1R blockade had no effect on insulin secretion or insulin action, whereas prandial glucagon was enhanced in all 3 groups. Ex-9 infusion raised prandial EGP response to hypoglycemia in every GB subject but had no consistent effects on EGP among subjects with SG or non-operated controls (P < 0.05 for interaction). These results indicate that impaired post-meal glucose counterregulatory response to hypoglycemia after GB is partly mediated by endogenous GLP-1, highlighting a novel mechanism of action of GLP-1R antagonists for the treatment of prandial hypoglycemia in this population.
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Salehi M, Tripathy D, Peterson R, Honka H, Pezzica S, DeFronzo R, Gastaldelli A. Bariatric Surgery Alters the Postprandial Recovery From Hypoglycemia, Mediated by Cholinergic Signal. Diabetes 2023; 72:1374-1383. [PMID: 37467435 PMCID: PMC10545558 DOI: 10.2337/db23-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
Roux-en-Y gastric bypass (GB) and sleeve gastrectomy (SG) surgeries increase prandial insulin and glucagon secretion but reduce the endogenous glucose production (EGP) response to hypoglycemia in comparison with control subjects who had not undergone gastric surgery (CN), suggesting that parasympathetic nervous system (PNS) plays a role. Here, we investigated the effect of acute PNS blockade on the post-meal counterregulatory response to insulin-induced hypoglycemia in GB and SG compared with CN. Glucose kinetics and islet cell secretion were measured in nine subjects without diabetes with GB and seven with SG and five CN during hyperinsulinemic-hypoglycemic clamp (∼3.2 mmol/L) combined with meal ingestion on two separate days with and without intravenous atropine infusion. Glucose and hormonal levels were similar at baseline and during steady-state hypoglycemia before meal ingestion in three groups and unaffected by atropine. Atropine infusion diminished prandial systemic appearance of ingested glucose (RaO) by 30%, EGP by 40%, and glucagon response to hypoglycemia by 90% in CN. In GB or SG, blocking PNS had no effect on the RaO or meal-induced hyperglucagonemia but increased EGP in SG without any effect in GB (P < 0.05 interaction). These findings indicate that cholinergic signal contributes to the recovery from hypoglycemia by meal consumption in humans. However, bariatric surgery dissipates PNS-mediated physiologic responses to hypoglycemia in the fed state. ARTICLE HIGHLIGHTS Rerouted gut after Roux-en-Y gastric bypass (GB) and, to a lesser degree, after sleeve gastrectomy (SG) leads to larger glucose excursion and lower nadir glucose, predisposing individuals to hypoglycemia. Despite prandial hyperglucagonemia, endogenous glucose production response to hypoglycemia is reduced after GB or SG. Parasympathetic nervous system (PNS) activity plays a key role in regulation of glucose kinetics and islet cell function. We examined the effect of acute PNS blockade on counterregulatory glucose and islet cell response to meal ingestion during insulin-induced hypoglycemia among GB, SG, and control subjects who had not had gastric surgery. Our findings demonstrate that cholinergic signal is critical in the recovery from hypoglycemia by meal ingestion in humans who have not had gastric surgery, although prandial PNS-mediated physiologic responses to hypoglycemia are differentially changed by GB and SG.
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Affiliation(s)
- Marzieh Salehi
- Division of Diabetes, The University of Texas at San Antonio, San Antonio, TX
- Audie L. Murphy Memorial Veterans’ Hospital, South Texas Veterans Health Care System, San Antonio, TX
| | - Devjit Tripathy
- Division of Diabetes, The University of Texas at San Antonio, San Antonio, TX
| | - Richard Peterson
- Department of Surgery, The University of Texas at San Antonio, San Antonio, TX
| | - Henri Honka
- Division of Diabetes, The University of Texas at San Antonio, San Antonio, TX
| | - Samantha Pezzica
- Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Ralph DeFronzo
- Division of Diabetes, The University of Texas at San Antonio, San Antonio, TX
| | - Amalia Gastaldelli
- Division of Diabetes, The University of Texas at San Antonio, San Antonio, TX
- Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
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Saari T, Koffert J, Honka H, Kauhanen S, U-Din M, Wierup N, Lindqvist A, Groop L, Virtanen KA, Nuutila P. Obesity-associated Blunted Subcutaneous Adipose Tissue Blood Flow After Meal Improves After Bariatric Surgery. J Clin Endocrinol Metab 2022; 107:1930-1938. [PMID: 35363252 PMCID: PMC9202692 DOI: 10.1210/clinem/dgac191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Glucose-dependent insulinotropic peptide (GIP) and meal ingestion increase subcutaneous adipose tissue (SAT) perfusion in healthy individuals. The effects of GIP and a meal on visceral adipose tissue (VAT) perfusion are unclear. OBJECTIVE Our aim was to investigate the effects of meal and GIP on VAT and SAT perfusion in obese individuals with type 2 diabetes mellitus (T2DM) before and after bariatric surgery. METHODS We recruited 10 obese individuals with T2DM scheduled for bariatric surgery and 10 control individuals. Participants were studied under 2 stimulations: meal ingestion and GIP infusion. SAT and VAT perfusion was measured using 15O-H2O positron emission tomography-magnetic resonance imaging at 3 time points: baseline, 20 minutes, and 50 minutes after the start of stimulation. Obese individuals were studied before and after bariatric surgery. RESULTS Before bariatric surgery the responses of SAT perfusion to meal (P = .04) and GIP-infusion (P = .002) were blunted in the obese participants compared to controls. VAT perfusion response did not differ between obese and control individuals after a meal or GIP infusion. After bariatric surgery SAT perfusion response to a meal was similar to that of controls. SAT perfusion response to GIP administration remained lower in the operated-on than control participants. There was no change in VAT perfusion response after bariatric surgery. CONCLUSION The vasodilating effects of GIP and meal are blunted in SAT but not in VAT in obese individuals with T2DM. Bariatric surgery improves the effects of a meal on SAT perfusion, but not the effects of GIP. Postprandial increase in SAT perfusion after bariatric surgery seems to be regulated in a GIP-independent manner.
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Affiliation(s)
- Teemu Saari
- Turku PET Centre, University of Turku, 20520 Turku, Finland
- Turku PET Centre, Turku University Hospital, 20520 Turku, Finland
| | - Jukka Koffert
- Turku PET Centre, University of Turku, 20520 Turku, Finland
- Department of Gastroenterology, Turku University Hospital, 20520 Turku, Finland
| | - Henri Honka
- Turku PET Centre, University of Turku, 20520 Turku, Finland
| | - Saila Kauhanen
- Division of Digestive Surgery and Urology, Turku University Hospital, 20520 Turku, Finland
| | - Mueez U-Din
- Turku PET Centre, University of Turku, 20520 Turku, Finland
- Turku PET Centre, Turku University Hospital, 20520 Turku, Finland
| | - Nils Wierup
- Department of Clinical Sciences, Lund University Diabetes Centre, 20213 Malmö, Sweden
| | - Andreas Lindqvist
- Department of Clinical Sciences, Lund University Diabetes Centre, 20213 Malmö, Sweden
| | - Leif Groop
- Department of Clinical Sciences, Lund University Diabetes Centre, 20213 Malmö, Sweden
| | - Kirsi A Virtanen
- Correspondence: Kirsi A. Virtanen, MD, PhD, Turku PET Centre, University of Turku, Department of Endocrinology, Kiinamyllynkatu 4-8, 2052 Turku, Finland. ,
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, 20520 Turku, Finland
- Turku PET Centre, Turku University Hospital, 20520 Turku, Finland
- Department of Endocrinology, Turku University Hospital, 20520 Turku, Finland
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Honka H, Chuang J, D’Alessio D, Salehi M. Utility of Continuous Glucose Monitoring vs Meal Study in Detecting Hypoglycemia After Gastric Bypass. J Clin Endocrinol Metab 2022; 107:e2095-e2102. [PMID: 34935944 PMCID: PMC9016438 DOI: 10.1210/clinem/dgab913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT Gastric bypass (GB) increases postprandial glucose excursion, which in turn can predispose to the late complication of hypoglycemia. Diagnosis remains challenging and requires documentation of symptoms associated with low glucose and relief of symptom when glucose is normalized (Whipple triad). OBJECTIVE To compare the yield of mixed meal test (MMT) and continuous glucose monitoring system (CGMS) in detecting hypoglycemia after GB. SETTING The study was conducted at General Clinical Research Unit, Cincinnati Children's Hospital (Cincinnati, OH, USA). METHODS Glucose profiles were evaluated in 15 patients with documented recurrent clinical hypoglycemia after GB, 8 matched asymptomatic GB subjects, and 9 healthy weight-matched nonoperated controls using MMT in a control setting and CGMS under free-living conditions. RESULTS Patients with prior GB had larger glucose variability during both MMT and CGMS when compared with nonsurgical controls regardless of their hypoglycemic status. Sensitivity (71 vs 47%) and specificity (100 vs 88%) of MMT in detecting hypoglycemia was superior to CGMS. CONCLUSIONS Our findings indicate that a fixed carbohydrate ingestion during MMT is a more reliable test to diagnose GB-related hypoglycemia compared with CGMS during free-living state.
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Affiliation(s)
- Henri Honka
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX 78229, USA
- Henri Honka, MD, PhD, Division of Diabetes, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
| | - Janet Chuang
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3026, USA
| | - David D’Alessio
- University of Cincinnati College of Medicine, Department of Medicine, Cincinnati, OH 45267, USA
| | - Marzieh Salehi
- Division of Diabetes, University of Texas Health Science Center, San Antonio, TX 78229, USA
- University of Cincinnati College of Medicine, Department of Medicine, Cincinnati, OH 45267, USA
- Bartter Research Unit, South Texas Veterans Health Care System, Audie Murphy Hospital, San Antonio, TX 78229, USA
- Correspondence: Marzieh Salehi, MD, MS, Bartter Research Unit, Audie Murphy Hospital, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
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Dadson P, Rebelos E, Honka H, Juárez-Orozco LE, Kalliokoski KK, Iozzo P, Teuho J, Salminen P, Pihlajamäki J, Hannukainen JC, Nuutila P. Change in abdominal, but not femoral subcutaneous fat CT-radiodensity is associated with improved metabolic profile after bariatric surgery. Nutr Metab Cardiovasc Dis 2020; 30:2363-2371. [PMID: 32919861 DOI: 10.1016/j.numecd.2020.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Computed tomography (CT)-derived adipose tissue radiodensity represents a potential noninvasive surrogate marker for lipid deposition and obesity-related metabolic disease risk. We studied the effects of bariatric surgery on CT-derived adipose radiodensities in abdominal and femoral areas and their relationships to circulating metabolites in morbidly obese patients. METHODS AND RESULTS We examined 23 morbidly obese women who underwent CT imaging before and 6 months after bariatric surgery. Fifteen healthy non-obese women served as controls. Radiodensities of the abdominal subcutaneous (SAT) and visceral adipose tissue (VAT), and the femoral SAT, adipose tissue masses were measured in all participants. Circulating metabolites were measured by NMR. At baseline, radiodensities of abdominal fat depots were lower in the obese patients as compared to the controls. Surprisingly, radiodensity of femoral SAT was higher in the obese as compared to the controls. In the abdominal SAT depot, radiodensity strongly correlated with SAT mass (r = -0.72, p < 0.001). After surgery, the radiodensities of abdominal fat increased significantly (both p < 0.01), while femoral SAT radiodensity remained unchanged. Circulating ApoB/ApoA-I, leucine, valine, and GlycA decreased, while glycine levels significantly increased as compared to pre-surgical values (all p < 0.05). The increase in abdominal fat radiodensity correlated negatively with the decreased levels of ApoB/ApoA-I ratio, leucine and GlycA (all p < 0.05). The increase in abdominal SAT density was significantly correlated with the decrease in the fat depot mass (r = -0.66, p = 0.002). CONCLUSION Higher lipid content in abdominal fat depots, and lower content in femoral subcutaneous fat, constitute prominent pathophysiological features in morbid obesity. Further studies are needed to clarify the role of non-abdominal subcutaneous fat in the pathogenesis of obesity. CLINICAL TRIAL REGISTRATION NUMBER NCT01373892.
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Affiliation(s)
- Prince Dadson
- Turku PET Centre, University of Turku, Turku, Finland
| | - Eleni Rebelos
- Turku PET Centre, University of Turku, Turku, Finland
| | - Henri Honka
- Turku PET Centre, University of Turku, Turku, Finland
| | | | | | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Jarmo Teuho
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Clinical Nutrition and Obesity Centre, Kuopio University Hospital, Kuopio, Finland
| | - Jarna C Hannukainen
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland; Department of Endocrinology, Turku University Hospital, Turku, Finland.
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Solis-Herrera C, Daniele G, Alatrach M, Agyin C, Triplitt C, Adams J, Patel R, Gastaldelli A, Honka H, Chen X, Abdul-Ghani M, Cersosimo E, Del Prato S, DeFronzo R. Increase in Endogenous Glucose Production With SGLT2 Inhibition Is Unchanged by Renal Denervation and Correlates Strongly With the Increase in Urinary Glucose Excretion. Diabetes Care 2020; 43:1065-1069. [PMID: 32144165 PMCID: PMC7171949 DOI: 10.2337/dc19-2177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 (SGLT2) inhibition causes an increase in endogenous glucose production (EGP). However, the mechanisms are unclear. We studied the effect of SGLT2 inhibitors on EGP in subjects with type 2 diabetes (T2D) and without diabetes (non-DM) in kidney transplant recipients with renal denervation. RESEARCH DESIGN AND METHODS Fourteen subjects who received a renal transplant (six with T2D [A1C 7.2 ± 0.1%] and eight non-DM [A1C 5.6 ± 0.1%) underwent measurement of EGP with [3-3H]glucose infusion following dapagliflozin (DAPA) 10 mg or placebo. Plasma glucose, insulin, C-peptide, glucagon, and titrated glucose-specific activity were measured. RESULTS Following placebo in T2D, fasting plasma glucose (FPG) (143 ± 14 to 124 ± 10 mg/dL; P = 0.02) and fasting plasma insulin (12 ± 2 to 10 ± 1.1 μU/mL; P < 0.05) decreased; plasma glucagon was unchanged, and EGP declined. After DAPA in T2D, FPG (143 ± 15 to 112 ± 9 mg/dL; P = 0.01) and fasting plasma insulin (14 ± 3 to 11 ± 2 μU/mL; P = 0.02) decreased, and plasma glucagon increased (all P < 0.05 vs. placebo). EGP was unchanged from baseline (2.21 ± 0.19 vs. 1.96 ± 0.14 mg/kg/min) in T2D (P < 0.001 vs. placebo). In non-DM following DAPA, FPG and fasting plasma insulin decreased, and plasma glucagon was unchanged. EGP was unchanged from baseline (1.85 ± 0.10 to 1.78 ± 0.10 mg/kg/min) after DAPA, whereas EGP declined significantly with placebo. When the increase in EGP production following DAPA versus placebo was plotted against the difference in urinary glucose excretion (UGE) for all patients, a strong correlation (r = 0.824; P < 0.001) was observed. CONCLUSIONS Renal denervation in patients who received a kidney transplant failed to block the DAPA-mediated stimulation of EGP in both individuals with T2D and non-DM subjects. The DAPA-stimulated rise in EGP is strongly related to the increase in UGE, blunting the decline in FPG.
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Affiliation(s)
- Carolina Solis-Herrera
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Giuseppe Daniele
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX.,Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mariam Alatrach
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Christina Agyin
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Curtis Triplitt
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - John Adams
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Rupal Patel
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Amalia Gastaldelli
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX.,Institute of Clinical Physiology, Pisa, Italy
| | - Henri Honka
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Xi Chen
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Eugenio Cersosimo
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Stephano Del Prato
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Ralph DeFronzo
- Division of Diabetes, The University of Texas Health Science Center at San Antonio, San Antonio, TX
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11
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Abstract
PURPOSE OF REVIEW The Roux-en-Y gastric bypass surgery (RYGB) improves glucose control in majority of patients with type 2 diabetes. However, a minority group of individuals develop a life-threatening complication of hyperinsulinemic hypoglycemia. The goal of this review is to identify underlying mechanisms by which RYGB cause hypoglycemia and describe pathogenesis-driven strategies to diagnose and treat this condition. RECENT FINDINGS Gastric bypass leads to higher and earlier peak levels of glucose and lower nadir glucose after eating along with larger insulin and glucagon-like peptide 1 (GLP-1) secretion, resetting the balance between glucose appearance and clearance after this procedure. These weight-loss independent glycemic effects of RYGB have been attributed to changes in ingested glucose appearance as a result of rapid nutrient emptying from stomach pouch to the intestine and increased glucose clearance as a result of prandial hyperinsulinemia. The exaggerated effect of RYGB on postmeal glucose metabolism is a syndrome of postprandial hyperinsulinemic hypoglycemia manifesting in a group of individuals several years after this surgery. Affected patients have larger systemic appearance of ingested glucose and greater postmeal secretion of insulin and GLP-1 compared to those with history of RYGB without symptomatic hypoglycemia. Current evidence supporting a multifactorial model of glucose dysregulation among patients with hypoglycemia will be highlighted in this review. SUMMARY Hypoglycemia after RYGB is a life-threatening condition and likely represents the extreme glycemic phenotype of this procedure. Diagnosis is challenging and treatment options are limited.
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Affiliation(s)
- Henri Honka
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center
| | - Marzieh Salehi
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center
- Bartter Research Unit, Audie Murphy Hospital, STVHCS, San Antonio, Texas, USA
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12
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Shcherbina L, Lindqvist A, Thorén Fischer AH, Ahlqvist E, Zhang E, Falkmer SE, Renström E, Koffert J, Honka H, Wierup N. Intestinal CART is a regulator of GIP and GLP-1 secretion and expression. Mol Cell Endocrinol 2018; 476:8-16. [PMID: 29627317 DOI: 10.1016/j.mce.2018.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/26/2018] [Accepted: 04/05/2018] [Indexed: 12/20/2022]
Abstract
Impaired incretin effect is a culprit in Type 2 Diabetes. Cocaine- and amphetamine-regulated transcript (CART) is a regulatory peptide controlling pancreatic islet hormone secretion and beta-cell survival. Here we studied the potential expression of CART in enteroendocrine cells and examined the role of CART as a regulator of incretin secretion and expression. CART expression was found in glucose-dependent insulinotropic polypeptide (GIP)-producing K-cells and glucagon-like peptide-1 (GLP-1)-producing L-cells in human duodenum and jejunum and circulating CART levels were increased 60 min after a meal in humans. CART expression was increased by fatty acids and GIP, but unaffected by glucose in GLUTag and STC-1 cells. Exogenous CART had no effect on GIP and GLP-1 expression and secretion in GLUTag or STC-1 cells, but siRNA-mediated silencing of CART reduced GLP-1 expression and secretion. Furthermore, acute intravenous administration of CART increased GIP and GLP-1 secretion during an oral glucose-tolerance test in mice. We conclude that CART is a novel constituent of human K- and L-cells with stimulatory actions on incretin secretion and that interfering with the CART system may be a therapeutic avenue for T2D.
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Affiliation(s)
| | - A Lindqvist
- Lund University Diabetes Centre, Malmö, Sweden
| | | | - E Ahlqvist
- Lund University Diabetes Centre, Malmö, Sweden
| | - E Zhang
- Lund University Diabetes Centre, Malmö, Sweden
| | - S E Falkmer
- Department of Clinical Pathology, Ryhov Hospital, Jönköping, Sweden
| | - E Renström
- Lund University Diabetes Centre, Malmö, Sweden
| | - J Koffert
- Turku PET Centre, University of Turku, Turku, Finland
| | - H Honka
- Turku PET Centre, University of Turku, Turku, Finland
| | - N Wierup
- Lund University Diabetes Centre, Malmö, Sweden.
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13
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Honka H, Koffert J, Kauhanen S, Kudomi N, Hurme S, Mari A, Lindqvist A, Wierup N, Parkkola R, Groop L, Nuutila P. Liver blood dynamics after bariatric surgery: the effects of mixed-meal test and incretin infusions. Endocr Connect 2018; 7:888-896. [PMID: 29941634 PMCID: PMC6063878 DOI: 10.1530/ec-18-0234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 01/18/2023]
Abstract
AIMS/HYPOTHESIS The mechanisms for improved glycemic control after bariatric surgery in subjects with type 2 diabetes (T2D) are not fully known. We hypothesized that dynamic hepatic blood responses to a mixed-meal are changed after bariatric surgery in parallel with an improvement in glucose tolerance. METHODS A total of ten morbidly obese subjects with T2D were recruited to receive a mixed-meal and a glucose-dependent insulinotropic polypeptide (GIP) infusion before and early after (within a median of less than three months) bariatric surgery, and hepatic blood flow and volume (HBV) were measured repeatedly with combined positron emission tomography/MRI. Ten lean non-diabetic individuals served as controls. RESULTS Bariatric surgery leads to a significant decrease in weight, accompanied with an improved β-cell function and glucagon-like peptide 1 (GLP-1) secretion, and a reduction in liver volume. Blood flow in portal vein (PV) was increased by 1.65-fold (P = 0.026) in response to a mixed-meal in subjects after surgery, while HBV decreased in all groups (P < 0.001). When the effect of GIP infusion was tested separately, no change in hepatic arterial and PV flow was observed, but HBV decreased as seen during the mixed-meal test. CONCLUSIONS/INTERPRETATION Early after bariatric surgery, PV flow response to a mixed-meal is augmented, improving digestion and nutrient absorption. GIP influences the post-prandial reduction in HBV thereby diverting blood to the extrahepatic sites.
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Affiliation(s)
- Henri Honka
- Turku PET CentreUniversity of Turku, Turku, Finland
| | - Jukka Koffert
- Turku PET CentreUniversity of Turku, Turku, Finland
- Department of GastroenterologyTurku University Hospital, Turku, Finland
| | - Saila Kauhanen
- Division of Digestive Surgery and UrologyTurku University Hospital, Turku, Finland
| | | | - Saija Hurme
- Department of BiostatisticsUniversity of Turku, Turku, Finland
| | - Andrea Mari
- Institute of NeuroscienceNational Research Council, Padua, Italy
| | - Andreas Lindqvist
- Department of Clinical SciencesLund University Diabetes Centre, Malmö, Sweden
| | - Nils Wierup
- Department of Clinical SciencesLund University Diabetes Centre, Malmö, Sweden
| | - Riitta Parkkola
- Department of RadiologyUniversity of Turku and Turku University Hospital, Turku, Finland
| | - Leif Groop
- Department of Clinical SciencesLund University Diabetes Centre, Malmö, Sweden
| | - Pirjo Nuutila
- Turku PET CentreUniversity of Turku, Turku, Finland
- Department of EndocrinologyTurku University Hospital, Turku, Finland
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14
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Dadson P, Ferrannini E, Landini L, Hannukainen JC, Kalliokoski KK, Vaittinen M, Honka H, Karlsson HK, Tuulari JJ, Soinio M, Salminen P, Parkkola R, Pihlajamäki J, Iozzo P, Nuutila P. Fatty acid uptake and blood flow in adipose tissue compartments of morbidly obese subjects with or without type 2 diabetes: effects of bariatric surgery. Am J Physiol Endocrinol Metab 2017; 313:E175-E182. [PMID: 28400411 DOI: 10.1152/ajpendo.00044.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/21/2017] [Accepted: 04/06/2017] [Indexed: 11/22/2022]
Abstract
Body fat accumulation, distribution, and metabolic activity are factors in the pathophysiology of obesity and type 2 diabetes (T2D). We investigated adipose blood flow, fatty acid uptake (FAU), and subcutaneous and visceral fat cellularity in obese patients with or without T2D. A total of 23 morbidly obese (mean body mass index = 42 kg/m2) patients were studied before and 6 mo after bariatric surgery; 15 nonobese subjects served as controls. Positron emission tomography was used to measure tissue FAU (with 18F-FTHA) and blood flow (with H215O); MRI was used for fat distribution and fat biopsy for adipocyte size. Obese subjects had subcutaneous hyperplasia and hypertrophy and lower blood flow; when expressed per cell, flow was similar to controls. FAU into subcutaneous and visceral depots was increased in the obese; per unit tissue mass, however, FAU was similar to controls but reduced in skeletal muscle. Fatty acid fractional extraction in subcutaneous fat and muscle was only increased in obese patients with T2D. We conclude that surgery reduces subcutaneous fat hyperplasia and hypertrophy; subcutaneous blood flow and FAU decrease in absolute terms and per cell while fractional FAU remains unchanged in T2D. In the obese, subcutaneous blood flow is a determinant of FAU and is coupled with cellularity; efficiency of FAU is enhanced in subcutaneous fat and muscle in T2D.
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Affiliation(s)
- Prince Dadson
- Turku PET Centre, University of Turku, Turku, Finland
| | - Ele Ferrannini
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Linda Landini
- Turku PET Centre, University of Turku, Turku, Finland
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | | | | | - Maija Vaittinen
- Turku PET Centre, University of Turku, Turku, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Henri Honka
- Turku PET Centre, University of Turku, Turku, Finland
| | | | | | - Minna Soinio
- Department of Endocrinology, Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Medical Imaging Center, Turku University Hospital, Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland; and
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, Department of Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Patricia Iozzo
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland;
- Department of Endocrinology, Turku University Hospital, Turku, Finland
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15
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Honka H, Koffert J, Kauhanen S, Teuho J, Hurme S, Mari A, Lindqvist A, Wierup N, Groop L, Nuutila P. Bariatric Surgery Enhances Splanchnic Vascular Responses in Patients With Type 2 Diabetes. Diabetes 2017; 66:880-885. [PMID: 28096259 DOI: 10.2337/db16-0762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/11/2017] [Indexed: 11/13/2022]
Abstract
Bariatric surgery results in notable weight loss and alleviates hyperglycemia in patients with type 2 diabetes (T2D). We aimed to characterize the vascular effects of a mixed meal and infusion of exogenous glucose-dependent insulinotropic polypeptide (GIP) in the splanchnic region in 10 obese patients with T2D before and after bariatric surgery and in 10 lean control subjects. The experiments were carried out on two separate days. Pancreatic and intestinal blood flow (BF) were measured at baseline, 20 min, and 50 min with 15O-water by using positron emission tomography and MRI. Before surgery, pancreatic and intestinal BF responses to a mixed meal did not differ between obese and lean control subjects. Compared with presurgery, the mixed meal induced a greater increase in plasma glucose, insulin, and GIP concentrations after surgery, which was accompanied by a marked augmentation of pancreatic and intestinal BF responses. GIP infusion decreased pancreatic but increased small intestinal BF similarly in all groups both before and after surgery. Taken together, these results demonstrate that bariatric surgery leads to enhanced splanchnic vascular responses as a likely consequence of rapid glucose appearance and GIP hypersecretion.
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Affiliation(s)
- Henri Honka
- Turku PET Centre, University of Turku, Turku, Finland
| | - Jukka Koffert
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Gastroenterology, Turunmaa Hospital, Turku, Finland
| | - Saila Kauhanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, University of Turku, Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Andreas Lindqvist
- Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
| | - Nils Wierup
- Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
| | - Leif Groop
- Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
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16
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Koffert J, Honka H, Teuho J, Kauhanen S, Hurme S, Parkkola R, Oikonen V, Mari A, Lindqvist A, Wierup N, Groop L, Nuutila P. Effects of meal and incretins in the regulation of splanchnic blood flow. Endocr Connect 2017; 6:179-187. [PMID: 28258126 PMCID: PMC5428912 DOI: 10.1530/ec-17-0015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/03/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Meal ingestion is followed by a redistribution of blood flow (BF) within the splanchnic region contributing to nutrient absorption, insulin secretion and glucose disposal, but factors regulating this phenomenon in humans are poorly known. The aim of the present study was to evaluate the organ-specific changes in BF during a mixed-meal and incretin infusions. DESIGN A non-randomized intervention study of 10 healthy adults to study splanchnic BF regulation was performed. METHODS Effects of glucose-dependent insulinotrophic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) infusions and mixed-meal were tested in 10 healthy, glucose tolerant subjects using PET-MRI multimodal imaging technology. Intestinal and pancreatic BF and blood volume (BV) were measured with 15O-water and 15O-carbon monoxide, respectively. RESULTS Ingestion of a mixed-meal led to an increase in pancreatic and jejunal BF, whereas duodenal BF was unchanged. Infusion of GIP and GLP-1 reduced BF in the pancreas. However, GIP infusion doubled blood flow in the jejunum with no effect of GLP-1. CONCLUSION Together, our data suggest that meal ingestion leads to increases in pancreatic BF accompanied by a GIP-mediated increase in jejunal but not duodenal blood flow.
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Affiliation(s)
- Jukka Koffert
- Department of GastroenterologyTurunmaa Hospital, Turku, Finland
- Turku PET CentreUniversity of Turku, Turku, Finland
| | - Henri Honka
- Turku PET CentreUniversity of Turku, Turku, Finland
| | - Jarmo Teuho
- Department of GastroenterologyTurunmaa Hospital, Turku, Finland
| | - Saila Kauhanen
- Division of Digestive Surgery and UrologyTurku University Hospital, Turku, Finland
| | - Saija Hurme
- Institute of BiostatisticsUniversity of Turku, Turku, Finland
| | - Riitta Parkkola
- Turku PET CentreUniversity of Turku, Turku, Finland
- Department of RadiologyUniversity of Turku and Turku University Hospital, Turku, Finland
| | - Vesa Oikonen
- Turku PET CentreUniversity of Turku, Turku, Finland
| | - Andrea Mari
- Institute of NeuroscienceNational Research Council, Padua, Italy
| | - Andreas Lindqvist
- Department of Clinical SciencesLund University Diabetes Centre, Malmö, Sweden
| | - Nils Wierup
- Department of Clinical SciencesLund University Diabetes Centre, Malmö, Sweden
| | - Leif Groop
- Department of Clinical SciencesLund University Diabetes Centre, Malmö, Sweden
| | - Pirjo Nuutila
- Turku PET CentreUniversity of Turku, Turku, Finland
- Department of EndocrinologyTurku University Hospital, Turku, Finland
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17
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Karlsson HK, Tuulari JJ, Tuominen L, Hirvonen J, Honka H, Parkkola R, Helin S, Salminen P, Nuutila P, Nummenmaa L. Weight loss after bariatric surgery normalizes brain opioid receptors in morbid obesity. Mol Psychiatry 2016; 21:1057-62. [PMID: 26460230 DOI: 10.1038/mp.2015.153] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 12/13/2022]
Abstract
Positron emission tomography (PET) studies suggest opioidergic system dysfunction in morbid obesity, while evidence for the role of the dopaminergic system is less consistent. Whether opioid dysfunction represents a state or trait in obesity remains unresolved, but could be assessed in obese subjects undergoing weight loss. Here we measured brain μ-opioid receptor (MOR) and dopamine D2 receptor (D2R) availability in 16 morbidly obese women twice-before and 6 months after bariatric surgery-using PET with [(11)C]carfentanil and [(11)C]raclopride. Data were compared with those from 14 lean control subjects. Receptor-binding potentials (BPND) were compared between the groups and between the pre- and postoperative scans among the obese subjects. Brain MOR availability was initially lower among obese subjects, but weight loss (mean=26.1 kg, s.d.=7.6 kg) reversed this and resulted in ~23% higher MOR availability in the postoperative versus preoperative scan. Changes were observed in areas implicated in reward processing, including ventral striatum, insula, amygdala and thalamus (P's<0.005). Weight loss did not influence D2R availability in any brain region. Taken together, the endogenous opioid system plays an important role in the pathophysiology of human obesity. Because bariatric surgery and concomitant weight loss recover downregulated MOR availability, lowered MOR availability is associated with an obese phenotype and may mediate excessive energy uptake. Our results highlight that understanding the opioidergic contribution to overeating is critical for developing new treatments for obesity.
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Affiliation(s)
- H K Karlsson
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - J J Tuulari
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - L Tuominen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - J Hirvonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku, Finland.,Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - H Honka
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - R Parkkola
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - S Helin
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - P Salminen
- Department of Digestive Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - P Nuutila
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Department of Endocrinology, Turku University Hospital, Turku, Finland
| | - L Nummenmaa
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland.,Department of Psychology, University of Turku, Turku, Finland
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18
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Honka H, Koffert J, Hannukainen JC, Tuulari JJ, Karlsson HK, Immonen H, Oikonen V, Tolvanen T, Soinio M, Salminen P, Kudomi N, Mari A, Iozzo P, Nuutila P. The effects of bariatric surgery on pancreatic lipid metabolism and blood flow. J Clin Endocrinol Metab 2015; 100:2015-23. [PMID: 25734253 DOI: 10.1210/jc.2014-4236] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Bariatric surgery leads to a rapid and sustained weight loss often accompanied with improvement in glucose homeostasis. OBJECTIVE The objective of this study was to investigate the effects of bariatric surgery on pancreatic lipid metabolism, blood flow, and glycemic control. DESIGN This was a longitudinal study. SETTING The study was conducted in a clinical research center. PARTICIPANTS This study included 27 morbidly obese and 15 healthy control subjects. INTERVENTIONS Measurements were performed using positron emission tomography with the palmitate analog 14(R,S)-[(18)F]fluoro-6-thia-heptadecanoic acid and radiowater ([(15)O]H2O) and computed tomography. In morbidly obese subjects, positron emission tomography/computed tomography imaging studies were performed before and 6 months after bariatric surgery (either Roux-en-Y gastric bypass or sleeve gastrectomy). MAIN OUTCOME MEASURES Pancreatic fat and fat-free volume, fatty acid uptake and blood flow were measured as well as parameters of β-cell function, glucose tolerance, and insulin sensitivity. RESULTS Six months after bariatric surgery, 23% excess weight loss was observed (P < .0001), and diabetes remission was seen in 7 of 10 patients. When compared with preoperative values, after surgery, notable decreases in pancreatic fat volume (P < .01), fatty acid uptake, and blood flow (both P < .05) were seen, whereas no change was seen in pancreatic fat-free volume. The decrease in pancreatic fat volume and the preservation of blood flow were associated with favorable glucose homeostasis and β-cell function. CONCLUSIONS Bariatric surgery elicits marked alterations in pancreatic lipid metabolism and blood flow, which may contribute to the observed improvement in glucose homeostasis and remission of type 2 diabetes.
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Affiliation(s)
- Henri Honka
- Turku PET Centre (H.H., J.K., J.C.H., J.J.T., H.K.K., H.I., V.O., T.T., P.N.), University of Turku, 20520 Turku, Finland; Department of Endocrinology (M.S., P.N.) and Division of Digestive Surgery and Urology (P.S.), Turku University Hospital, 20520 Turku, Finland; Faculty of Medicine (N.K.), Kagawa University, Kagawa 760-0016, Japan; Institute of Biomedical Engineering (A.M.), National Research Council, 35127 Padua, Italy; and Institute of Clinical Physiology (P.I.), National Research Council, 56124 Pisa, Italy
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Honka H, Hannukainen JC, Tarkia M, Karlsson H, Saunavaara V, Salminen P, Soinio M, Mikkola K, Kudomi N, Oikonen V, Haaparanta-Solin M, Roivainen A, Parkkola R, Iozzo P, Nuutila P. Pancreatic metabolism, blood flow, and β-cell function in obese humans. J Clin Endocrinol Metab 2014; 99:E981-90. [PMID: 24527718 DOI: 10.1210/jc.2013-4369] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Glucolipotoxicity is believed to induce pancreatic β-cell dysfunction in obesity. Previously, it has not been possible to study pancreatic metabolism and blood flow in humans. OBJECTIVE The objective of the study was to investigate whether pancreatic metabolism and blood flow are altered in obesity using positron emission tomography (PET). In the preclinical part, the method was validated in animals. DESIGN This was a cross-sectional study. SETTING The study was conducted in a clinical research center. PARTICIPANTS Human studies consisted of 52 morbidly obese and 25 healthy age-matched control subjects. Validation experiments were done with rodents and pigs. INTERVENTIONS PET and magnetic resonance imaging studies using a glucose analog ([(18)F]fluoro-2-deoxy-d-glucose), a palmitate analog [14(R,S)-[(18)F]fluoro-6-thia-heptadecanoic acid], and radiowater ([(15)O]H2O) were performed. In animals, a comparison between ex vivo and in vivo data was performed. MAIN OUTCOME MEASURES Pancreatic glucose/fatty acid (FA) uptake, fat accumulation, and blood flow parameters of β-cell function were measured. RESULTS PET proved to be a feasible method to measure pancreatic metabolism. Compared with healthy participants, obese participants had elevated pancreatic FA uptake (P < .0001), more fat accumulation (P = .0001), lowered glucose uptake both during fasting and euglycemic hyperinsulinemia, and blunted blood flow (P < .01) in the pancreas. Blood flow, FA uptake, and fat accumulation were negatively associated with multiple markers of β-cell function. CONCLUSIONS Obesity leads to changes in pancreatic energy metabolism with a substrate shift from glucose to FAs. In morbidly obese humans, impaired pancreatic blood flow may contribute to β-cell dysfunction and in the pathogenesis of type 2 diabetes.
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Affiliation(s)
- Henri Honka
- Turku PET Centre (H.H., J.C.H., M.T., H.K., V.S., K.M., V.O., M.H.-S., A.R., R.P., P.N.), University of Turku, Turku 20520, Finland; Division of Digestive Surgery and Urology (P.S.) and Department of Endocrinology (P.N., M.S.), Turku University Hospital, Turku 20520, Finland; Faculty of Medicine (N.K.), University of Kagawa, Kagawa 760-0016, Japan; Department of Radiology (R.P.), University of Tampere, Tampere 33014, Finland; Institute of Biomedical Engineering (P.I.), National Research Council, 35128 Padua, Italy; and Institute of Clinical Physiology (P.I.), National Research Council, 56124 Pisa, Italy
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Huovinen V, Saunavaara V, Kiviranta R, Tarkia M, Honka H, Stark C, Laine J, Linderborg K, Tuomikoski P, Badeau RM, Knuuti J, Nuutila P, Parkkola R. Vertebral bone marrow glucose uptake is inversely associated with bone marrow fat in diabetic and healthy pigs: [(18)F]FDG-PET and MRI study. Bone 2014; 61:33-8. [PMID: 24389418 DOI: 10.1016/j.bone.2013.12.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 12/11/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Diabetes induces osteoporosis and during osteoporosis, vertebral bone marrow (VBM) adipose tissue amount increases. The association between this adiposity and bone marrow metabolism is unclear. Here, we compared VBM glucose metabolism and fat content in healthy and diabetic pigs, in vivo, using positron emission tomography (PET), in-phase and out-of-phase magnetic resonance imaging and magnetic resonance proton spectroscopy ((1)H MR spectroscopy). MATERIALS/METHODS Eleven pigs (n=11) were used. The intervention group had five diabetic and the control group had six healthy pigs. To measure metabolism, PET-imaging with [(18)F]fluoro-deoxy-glucose ([(18)F]FDG) intravenous tracer was used. 1.5-T MRI with (1)H spectroscopy, in-phase and out-of-phase imaging and chemical TAG analysis of the VBM were performed. RESULTS We found a significant inverse correlation between VBM glucose uptake (GU) and VBM fat content (R=-0.800, p<0.01) and TAG concentration assay (R=-0.846, p<0.05). There was a trend, although non-significant, of a linear correlation between VBM (1)H MR spectroscopy and TAG concentration (R=0.661) and (1)H MR spectroscopy and in-phase and out-of-phase MR imaging (R=0.635). CONCLUSIONS VBM glucose metabolism coupled with VBM fat content may impact diabetic induced osteoporosis.
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Affiliation(s)
- Ville Huovinen
- Turku PET Centre, University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Radiology, University of Turku, Medical Imaging Centre of Southwest Finland and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Riku Kiviranta
- Turku PET Centre, University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Endocrinology, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Miikka Tarkia
- Turku PET Centre, University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Henri Honka
- Turku PET Centre, University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Christoffer Stark
- Department of Surgery, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Julius Laine
- Department of Surgery, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Kaisa Linderborg
- Food Chemistry and Food Development, Department of Biochemistry, University of Turku, 20014 Turku, Finland
| | - Pasi Tuomikoski
- Food Chemistry and Food Development, Department of Biochemistry, University of Turku, 20014 Turku, Finland
| | | | - Juhani Knuuti
- Turku PET Centre, University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Endocrinology, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, Tampere University and Tampere University Hospital, PL 2000, 33521 Tampere, Finland; Department of Radiology, University of Turku, Medical Imaging Centre of Southwest Finland and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland.
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Honka H, Mäkinen J, Hannukainen JC, Tarkia M, Oikonen V, Teräs M, Fagerholm V, Ishizu T, Saraste A, Stark C, Vähäsilta T, Salminen P, Kirjavainen A, Soinio M, Gastaldelli A, Knuuti J, Iozzo P, Nuutila P. Validation of [18F]fluorodeoxyglucose and positron emission tomography (PET) for the measurement of intestinal metabolism in pigs, and evidence of intestinal insulin resistance in patients with morbid obesity. Diabetologia 2013; 56:893-900. [PMID: 23334481 DOI: 10.1007/s00125-012-2825-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/17/2012] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS The role of the intestine in the pathogenesis of metabolic diseases is gaining much attention. We therefore sought to validate, using an animal model, the use of positron emission tomography (PET) in the estimation of intestinal glucose uptake (GU), and thereafter to test whether intestinal insulin-stimulated GU is altered in morbidly obese compared with healthy human participants. METHODS In the validation study, pigs were imaged using [(18)F]fluorodeoxyglucose ([(18)F]FDG) and the image-derived data were compared with corresponding ex vivo measurements in tissue samples and with arterial-venous differences in glucose and [(18)F]FDG levels. In the clinical study, GU was measured in different regions of the intestine in lean (n = 8) and morbidly obese (n = 8) humans at baseline and during euglycaemic hyperinsulinaemia. RESULTS PET- and ex vivo-derived intestinal values were strongly correlated and most of the fluorine-18-derived radioactivity was accumulated in the mucosal layer of the gut wall. In the gut wall of pigs, insulin promoted GU as determined by PET, the arterial-venous balance or autoradiography. In lean human participants, insulin increased GU from the circulation in the duodenum (from 1.3 ± 0.6 to 3.1 ± 1.1 μmol [100 g](-1) min(-1), p < 0.05) and in the jejunum (from 1.1 ± 0.7 to 3.0 ± 1.5 μmol [100 g](-1) min(-1), p < 0.05). Obese participants failed to show any increase in insulin-stimulated GU compared with fasting values (NS). CONCLUSIONS/INTERPRETATION Intestinal GU can be quantified in vivo by [(18)F]FDG PET. Intestinal insulin resistance occurs in obesity before the deterioration of systemic glucose tolerance.
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Affiliation(s)
- H Honka
- Turku PET Centre, University of Turku, PL 52, FIN-20520 Turku, Finland
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