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Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with elevated ghrelin

Published on Jul 1, 2014in Obesity3.969
· DOI :10.1002/oby.20776
Robyn A. Tamboli12
Estimated H-index: 12
(Vandy: Vanderbilt University),
Igal Breitman5
Estimated H-index: 5
(Vandy: Vanderbilt University)
+ 6 AuthorsNaji N. Abumrad50
Estimated H-index: 50
(Vandy: Vanderbilt University)
Abstract
Objectives We sought to determine: (1) if early weight regain between 1 and 2 years after Roux-en-Y gastric bypass (RYGB) is associated with worsened hepatic and peripheral insulin sensitivity, and (2) if preoperative levels of ghrelin and leptin are associated with early weight regain after RYGB. Methods Hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels were assessed longitudinally in 45 subjects before RYGB and at 1 month, 6 months, 1 year, and 2 years postoperatively. Weight regain was defined as ≥5% increase in body weight between 1 and 2 years after RYGB. Results Weight regain occurred in 33% of subjects, with an average increase in body weight of 10 ± 5% (8.5 ± 3.3 kg). Weight regain was not associated with worsening of peripheral or hepatic insulin sensitivity. Subjects with weight regain after RYGB had higher preoperative and postoperative levels of ghrelin compared to those who maintained or lost weight during this time. Conversely, the trajectories of leptin levels corresponded with the trajectories of fat mass in both groups. Conclusions Early weight regain after RYGB is not associated with a reversal of improvements in insulin sensitivity. Higher preoperative ghrelin levels might identify patients that are more susceptible to weight regain after RYGB.
  • References (40)
  • Citations (17)
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References40
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#1Kristy M. Heppner (UC: University of Cincinnati)H-Index: 22
#2Carolin L. Piechowski (Charité)H-Index: 6
Last. Diego Perez-Tilve (UC: University of Cincinnati)H-Index: 39
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Growth hormone secretagogue receptors (GHSRs) in the central nervous system (CNS) mediate hyperphagia and adiposity induced by acyl ghrelin (AG). Evidence suggests that des-AG (dAG) has biological activity through GHSR-independent mechanisms. We combined in vitro and in vivo approaches to test possible GHSR-mediated biological activity of dAG. Both AG (100 nmol/L) and dAG (100 nmol/L) significantly increased inositol triphosphate formation in human embryonic kidney-293 cells transfected with hum...
64 CitationsSource
#1Carlene Johnson Stoklossa (AHS: Alberta Health Services)H-Index: 6
#2Suneet Atwal (AHS: Alberta Health Services)H-Index: 1
Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews sev...
29 CitationsSource
#1Ida J. Hatoum (Harvard University)H-Index: 12
#2Lee M. Kaplan (Harvard University)H-Index: 53
Objective Although Roux-en-Y gastric bypass (RYGB) is a generally effective treatment for severe obesity, weight loss (WL) after this operation is highly variable. Accurate predictors of outcome would thus be useful in identifying those patients who would most benefit from this invasive therapy. WL has been characterized using several different metrics, including the number of BMI units lost (ΔBMI), percent baseline WL (%WL), and percent excess body WL (%EBWL). To identify clinically relevant pr...
56 CitationsSource
#1Stefan G. J. A. Camps (UM: Maastricht University)H-Index: 7
#2Sanne P.M. Verhoef (UM: Maastricht University)H-Index: 10
Last. Klaas R. Westerterp (UM: Maastricht University)H-Index: 77
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Background: Diet-induced weight loss is accompanied by adaptive thermogenesis, ie, a disproportional or greater than expected reduction of resting metabolic rate (RMR). Objective: The aim of this study was to investigate whether adaptive thermogenesis is sustained during weight maintenance after weight loss. Design: Subjects were 22 men and 69 women [mean 6 SD age: 40 6 9 y; body mass index (BMI; in kg/m 2 ): 31.9 6 3.0]. They followed a very-low-energy diet for 8 wk, followed by a 44-wk period ...
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#2Andy Bogart (Group Health Research Institute)H-Index: 18
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Background Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass.
248 CitationsSource
#1Amanda JiménezH-Index: 14
#2Roser CasamitjanaH-Index: 51
Last. Josep Vidal (University of Barcelona)H-Index: 39
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Objective: To identify the rates and the predictors of long-term remission and the recurrence of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP) or sleeve gastrectomy (SG). Background: The durability of the improvement of T2DM after bariatric surgery is not well characterized. Methods: One hundred fifty-three subjects with T2DM (RYGBP: n = 98; SG: n = 55) were evaluated for remission and recurrence of the disease throughout35.4 ±13.5 months’follow-up. The type ofsurgery, d...
162 CitationsSource
#1Rafael M. Laurino Neto (UNIFESP: Federal University of São Paulo)H-Index: 3
#2Fernando A. M. Herbella (UNIFESP: Federal University of São Paulo)H-Index: 19
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35 CitationsSource
#1Philip R. SchauerH-Index: 61
#2Sangeeta R. KashyapH-Index: 29
Last. Deepak L. Bhatt (Harvard University)H-Index: 122
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Of the 150 patients, 93% completed 12 months of follow-up. The proportion of patients with the primary end point was 12% (5 of 41 patients) in the medicaltherapy group versus 42% (21 of 50 patients) in the gastric-bypass group (P = 0.002) and 37% (18 of 49 patients) in the sleeve-gastrectomy group (P = 0.008). Glycemic control improved in all three groups, with a mean glycated hemoglobin level of 7.5±1.8% in the medical-therapy group, 6.4±0.9% in the gastric-bypass group (P<0.001), and 6.6±1.0% ...
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Methods In this single-center, nonblinded, randomized, controlled trial, 60 patients between the ages of 30 and 60 years with a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or more, a history of at least 5 years of diabetes, and a glycated hemoglobin level of 7.0% or more were randomly assigned to receive conventional medical therapy or undergo either gastric bypass or biliopancreatic diversion. The primary end point was the rate of diabetes ...
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#1Julia P. DunnH-Index: 6
#2Naji N. Abumrad (Vandy: Vanderbilt University)H-Index: 50
Last. Robyn A. Tamboli (Vandy: Vanderbilt University)H-Index: 12
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OBJECTIVE Early after Roux-en-Y gastric bypass (RYGB), there is improvement in type 2 diabetes, which is characterized by insulin resistance. We determined the acute effects of RYGB, with and without omentectomy, on hepatic and peripheral insulin sensitivity. We also investigated whether preoperative diabetes or postoperative diabetes remission influenced tissue-specific insulin sensitivity after RYGB. RESEARCH DESIGN AND METHODS We studied 40 obese (BMI 48 ± 8 kg/m 2 ) participants, 17 with dia...
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#1A. Daniel Guerron (Duke University)
#2Ranjan Sudan (Duke University)H-Index: 19
Obesity is a growing worldwide epidemic and an emerging healthcare problem affecting millions of people in the United States. Currently, mortality is less than 1%, and morbidity is under 10%. One significant long-term concern is weight regain. In order to manage weight regain, a multifactorial approach is critical. Options for treatment include behavioral modifications, pharmacological intervention, endoscopic revision, and surgical operations offer additional weight loss and amelioration of com...
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#2Sunil Kumar Sirohi (XULA: Xavier University of Louisiana)H-Index: 15
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Abstract Background Although some early metabolic benefits provided by bariatric surgery are known to occur regardless of weight loss, the impact of mid to long-term weight recidivism after Roux-en-Y gastric bypass (RYGB) on metabolic outcomes is not profoundly understood. Objective To investigate the effect of weight recidivism on insulin resistance among non-diabetic individuals with morbid obesity after RYGB during a three-year follow-up. Setting Public tertiary university hospital. Methods T...
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Bariatric surgery is the most effective and durable treatment for morbid obesity, with an unexplained yet beneficial side effect of restoring insulin sensitivity and improving glycemia, often before weight loss is observed. Among the many contributing mechanisms often cited, the altered handling of intestinal bile acids is of considerable therapeutic interest. Here, we review a growing body of literature examining the metabolic effects of bile acids ranging from their physical roles in dietary f...
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#2Kathrine J. Vinknes (University of Oslo)H-Index: 7
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