Abstract
Duodenal-jejunal bypass liners (DJBLs) prevent absorption in the proximal small intestine, the site of fatty acid absorption. We sought to investigate the effects of a DJBL on blood concentrations of essential fatty acids (EFAs) and bioactive polyunsaturated fatty acids (PUFAs). Sub-study of a multicentre, randomised, controlled trial with two treatment groups. Patients aged 18-65 years with type-2 diabetes mellitus and body mass index 30-50kg/m2 were randomised to receive a DJBL for 12 months or best medical therapy, diet and exercise. Whole plasma PUFA concentrations were determined at baseline, 10 days, 6 and 11.5 months; data were available for n=70 patients per group. Weight loss was significantly greater in the DJBL group compared to controls after 11.5 months: total body weight loss 11.3±5.3% versus 6.0±5.7% (mean difference [95% CI]=5.27% [3.75, 6.80], p<0.001). Absolute concentrations of both EFAs, linoleic acid and α-linolenic acid, and their bioactive derivatives, arachidonic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid, were significantly lower in the DJBL group than in the control group at 6 and 11.5 months follow-up. Total serum cholesterol, LDL-cholesterol and HDL-cholesterol were also significantly lower in the DJBL group. One year of DJBL therapy is associated with superior weight loss and greater reductions in total serum cholesterol and LDL-cholesterol, but also depletion of EFAs and their longer chain derivatives. DJBL therapy may need to be offset by maintaining an adequate dietary intake of PUFAs or by supplementation. ClinicalTrials.gov Identifier NCT02459561.
Highlights
Abbreviations usedAA ALA BMI DHA duodenal-jejunal bypass liners (DJBLs) DPA Endoscopic bariatric therapies (EBTs) essential fatty acids (EFAs) EPA EPIC FFQ arachidonic acid a-linolenic acid body mass index docosahexaenoic acid duodenal jejunal bypass liner docosapentaenoic acid Endoscopic Bariatric Therapy essential fatty acid eicosapentaenoic acid The European Prospective Investigation of Cancer Food Frequency QuestionnaireFA Fatty acid methyl esters (FAMEs) GC HDL-C LA LDL-C PPI polyunsaturated fatty acids (PUFAs) Roux-en-y gastric bypass (RYGB) SD T2DM TBWL TSC fatty acid fatty acid methyl ester gas chromatography high-density lipoprotein cholesterol linoleic acid low-density lipoprotein cholesterol proton pump inhibitor polyunsaturated fatty acid Roux-en-Y gastric bypass standard deviation type 2 diabetes mellitus total body weight loss total serum cholesterol find compliance difficult [4,5]
Treatment with the Endobarrier DJBL alongside intensive medical therapy resulted in significantly greater weight loss than in patients treated with best medical therapy and dietary interventions alone with a %TBWL of 11.3% and 6.0% achieved in each group respectively after 11.5 months
In the food-preference subgroup of patients, we were able to demonstrate that there were no significant differences in caloric intake between study arms and, beyond the baseline visit, food preferences and calorific intake were matched between groups except for a significantly greater intake of fats and oils in the Endobarrier group at 12 months when compared to the control group
Summary
FA FAME GC HDL-C LA LDL-C PPI PUFA RYGB SD T2DM TBWL TSC fatty acid fatty acid methyl ester gas chromatography high-density lipoprotein cholesterol linoleic acid low-density lipoprotein cholesterol proton pump inhibitor polyunsaturated fatty acid Roux-en-Y gastric bypass standard deviation type 2 diabetes mellitus total body weight loss total serum cholesterol find compliance difficult [4,5]. In such cases, especially with morbid obesity, gastrointestinal surgical procedures become necessary with the aim to reduce the ability of individuals to consume food and to digest and absorb macronutrients.
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