Abstract
The objective of this study was to compare the biochemical changes related to glucose tolerance and lipid metabolism in non-diabetic patients shortly after vertical sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Non-diabetic women and men with morbid obesity were studied the day before and six days after SG (N = 15) or RYGB (N = 16). Patients completed an oral glucose tolerance test (OGTT; 75 g glucose) at both visits. SG and RYGB similarly improved fasting glucose homeostasis six days after surgery, with reduced glucose and insulin concentrations. The OGTT revealed differences between the two surgery groups that were not evident from the fasting serum concentrations. Postprandial (120 min) glucose and insulin concentrations were lower after RYGB but not after SG, whereas concentrations of glucagon-like peptide-1, peptide YY, glucagon and non-esterified fatty acids were elevated after both SG and RYGB. Fasting triacylglycerol concentration did not change after surgery, but concentrations of high density lipoprotein and low density lipoprotein cholesterols were reduced in both surgery groups, with no differences between the groups. To conclude, RYGB induced a more pronounced improvement in postprandial glucose homeostasis relative to SG, possibly due to improved insulin sensitivity rather than augmented insulin concentration.
Highlights
The objective of this study was to compare the biochemical changes related to glucose tolerance and lipid metabolism in non-diabetic patients shortly after vertical sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB)
There were no differences between the groups with respect to fasting concentrations of any of the measured parameters before surgery, including glucose, insulin, glucagon like peptide 1 (GLP-1), non-esterified fatty acids (NEFA), peptide YY (PYY), glucagon (Fig. 1A–F), homeostatic model assessment for insulin resistance (HOMA-IR), insulin-like growth factor-1 (IGF1) and insulin-like growth factor binding protein-3 (IGF-BP3) (Table 2)
Fasting serum IGF1 concentration was not affected six days after SG but was lower after RYGB, whereas the concentration of its binding protein IGF-BP3 was lower after both procedures, with no difference between SG and RYGB (Table 2)
Summary
The objective of this study was to compare the biochemical changes related to glucose tolerance and lipid metabolism in non-diabetic patients shortly after vertical sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). SG and RYGB improved fasting glucose homeostasis six days after surgery, with reduced glucose and insulin concentrations. Glucose concentrations often normalize within a few days after bariatric surgery, i.e. before significant weight loss is achieved[5], and one explanation may be changes in hormone secretion as a result of intestinal/gut rearrangement, such as increased glucagon like peptide 1 (GLP-1). In the present study we compared the short-term (six days) effects of vertical sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) performed in non-diabetic patients with severe obesity. The short-term effects of RYGB and SG have been investigated by others, demonstrating larger increase in GLP-1 and insulin concentrations after RYGB relative to SG, after a liquid meal 8–10 days postoperatively[8] in a mixed group of diabetic and non-diabetic patients. Based on findings in other short-term studies, our hypothesis was that glucose homeostasis would be more strongly affected by RYGB compared to SG six days after surgery
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