Abstract
IntroductionAbout 20% of patients operated with Roux-en-Y gastric bypass (RYGBP) experience poor long-term weight result. This study compared levels of leptin and gut hormones in long-term weight responders with non-responders after RYGBP. In a subgroup analysis, hormone levels were assessed in T2DM (type 2 diabetes mellitus) and normoglycemic participants.MethodsInsulin, glucose, leptin, acyl-ghrelin, total PYY, active GLP-1, and GIP were measured during an oral glucose tolerance test (OGTT) in post-RYGBP subjects: 22 non-responders (BMI 40.6 ± 6.0 kg/m2 after an excess BMI loss [EBMIL] of 26.0 ± 15.9%) and 18 responders (BMI 29.5 ± 3.5 kg/m2 after an EBMIL of 74.9 ± 18.2%). Subjects were matched for preoperative age, BMI, and years of follow-up. Measures of glucose homeostasis were calculated, and body composition was measured.ResultsFat mass–adjusted fasting leptin correlated negatively with %EBMIL (r = − 0.57, p < 0.01). Non-responders presented higher levels of leptin during the OGTT. Leptin decreased and ghrelin returned to baseline levels earlier in non-responders. Despite having higher insulin resistance than responders, non-responders demonstrated similar OGTT responses of GLP-1, GIP, and PYY. T2DM participants demonstrated lower GLP-1 levels than normoglycemic participants of similar weight.ConclusionFasting leptin is associated with weight result after RYGBP, and hormonal responses to a glucose oral load might work towards promoting obesity in long-term non-responders after RYGBP. Poor long-term weight result and glycemic status after RYGBP are each associated with differences in peptide hormone levels.
Highlights
About 20% of patients operated with Roux-en-Y gastric bypass (RYGBP) experience poor long-term weight result
There was a tendency for a positive correlation between %EBMIL and fasting plasma ghrelin (r = 0.30, p = 0.06, Fig. 1), but this correlation was not found in the normoglycemic subgroup
Diurnal and postprandial variations of ghrelin are otherwise known to disappear in obese subjects, and postprandial levels of ghrelin to be suppressed up to 2 years after RYGBP [29, 31]. These findings suggest that, early postoperative changes notwithstanding, leptin and ghrelin levels in non-responders many years after surgically induced weight loss resemble those of non-operated obese individuals, probably due to preserved or regained adiposity
Summary
About 20% of patients operated with Roux-en-Y gastric bypass (RYGBP) experience poor long-term weight result. This study compared levels of leptin and gut hormones in long-term weight responders with non-responders after RYGBP. Methods Insulin, glucose, leptin, acyl-ghrelin, total PYY, active GLP-1, and GIP were measured during an oral glucose tolerance test (OGTT) in post-RYGBP subjects: 22 non-responders (BMI 40.6 ± 6.0 kg/m2 after an excess BMI loss [EBMIL] of 26.0 ± 15.9%) and 18 responders (BMI 29.5 ± 3.5 kg/m2 after an EBMIL of 74.9 ± 18.2%). Roux-en-Y gastric bypass (RYGBP) [3] results in durable weight loss for most patients [4], with marked hormonal changes occurring promptly after surgery, even before tangible weight loss ensues [5]. After increasing during diet-induced weight loss, ghrelin and GIP both return to baseline levels during weight maintenance [14, 15]. These changes speak in favor of a transient regulatory role of ghrelin and GIP in diet-induced shortterm weight loss
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