Abstract
BackgroundRoux-en-Y gastric bypass (RYGB) is considered effective for weight loss and for treatment of many obesity-related metabolic diseases. Ghrelin is an essential orexigenic peptide that plays an indispensable role in controlling body weight and energy homeostasis of post-operative patients. This systematic review and meta-analysis aimed to investigate changes in the level of fasting total ghrelin following RYGB.MethodsA systematic literature search of PubMed, EMBASE, and the Cochrane Library until April 2018 with keywords “ghrelin” and “gastric bypass” was performed in accordance with the MOOSE guidelines and PRISMA statement. Three reviewers independently selected the studies and extracted data. Quality assessment of the included studies was undergone. A random effects model was employed to calculate overall effect sizes. Subgroup analyses and meta-regression were subsequently performed.ResultsSixteen studies with 325 patients were included. We found ghrelin levels had an increasing tendency (SMD = 0.30; 95% CI = 0.04 to 0.57) despite moderate heterogeneity (I2 = 58%). Subsequent subgroup analysis indicated that ghrelin levels decreased (SMD = − 0.49; 95% CI = − 0.98 to 0.00) in the short term (≤ 3 months) and increased (SMD = 0.46; 95% CI = 0.22 to 0.69) in the long term (> 3 months) after RYGB. Meta-regression showed that gastric pouch volume, alimentary limb length and biliopancreatic limb length were not associated with changes in ghrelin levels.ConclusionFasting total ghrelin levels decreased in the short term (≤ 3 months) and increased in the long term (> 3 months) after RYGB.
Highlights
With the improvement in human living standards, overweight [body mass index (BMI) ≥ 25 kg/m2] and obesity (BMI ≥ 30 kg/m2) have become a worldwide problem for decades, beginning in the last century [1]
The short-term subgroup consisted of three studies [27, 30, 37] and the analysis showed that fasting total ghrelin levels after Roux-en-Y gastric bypass (RYGB) were significantly lower than pre-surgery levels [standard mean difference (SMD) = − 0.49; 95% confidence intervals (CIs) (− 0.98 and 0.00), P = 0.05, I2 = 0%]
In our meta-analysis, we found that fasting total ghrelin levels changed after RYGB and this change was associated with time course of the surgery
Summary
With the improvement in human living standards, overweight [body mass index (BMI) ≥ 25 kg/m2] and obesity (BMI ≥ 30 kg/m2) have become a worldwide problem for decades, beginning in the last century [1]. Several weight loss treatments have emerged, including lifestyle modification, medication, and surgery. Among these treatments, bariatric surgery is considered the most effective for long-term treatment of morbid obesity [2]. Roux-en-Y gastric bypass (RYGB), as one of many described surgerical procedures, was shown to be effective for long-term weight loss and improvement in obesity-related comorbidities and quality of life [3]. RYGB creates a small gastric pouch and attaches it to the mid-jejunum, bypassing most of the stomach and the proximal jejunum [4]. Roux-en-Y gastric bypass (RYGB) is considered effective for weight loss and for treatment of many obesity-related metabolic diseases. This systematic review and meta-analysis aimed to investigate changes in the level of fasting total ghrelin following RYGB.
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