The Effect of One Anastomosis Gastric Bypass on Branched-Chain Fatty Acid and Branched-Chain Amino Acid Metabolism in Subjects with Morbid Obesity

Alicja Pakiet,Piotr Stepnowski,Tomasz Sledzinski,Faidon Magkos,Justyna Korczynska,Adriana Mika,Olga Rostkowska,Ewa Sobczak,Monika Proczko-Stepaniak,Patrycja Jabłonska,Lukasz Kaska,Maciej Wilczynski

doi:10.1007/s11695-019-04157-z

Abstract

BackgroundSubjects with morbid obesity have low levels of serum branched-chain fatty acids (BCFAs), which correlate inversely with insulin resistance, hypertriglyceridemia, and inflammation. Recent evidence suggests BCFAs are produced during branched-chain amino acid (BCAA) catabolism in human adipose tissue. Elevated concentrations of BCAAs are associated with insulin resistance.ObjectivesIn this single-center study, we evaluated the effect of one anastomosis gastric bypass (OAGB) on circulating BCFA and BCAA. Moreover, we determined the expression of genes involved in BCAA catabolism in adipose tissue of patients with obesity and lean controls.MethodsFasting levels of BCFAs and BCAAs were determined by gas and liquid chromatography, respectively, coupled with mass spectrometry, in 50 patients with morbid obesity before and 6–9 months after surgery, and in 32 lean controls. Visceral and subcutaneous adipose tissue (VAT and SAT, respectively) biopsies were collected at baseline to determine mRNA levels for enzymes involved in BCAA catabolism.ResultsBefore surgery, patients with obesity had lower BCFAs and greater BCAAs than control subjects. OAGB increased BCFA and decreased BCAA levels. Insulin resistance (assessed by HOMA) correlated inversely with BCFAs and positively with BCAAs. Expression of genes involved in BCAA catabolism in VAT (but not SAT) was lower in patients with obesity than in lean controls.ConclusionsOAGB-induced weight loss increases circulating BCFAs and decreases circulating BCAAs in patients with morbid obesity, perhaps by altering BCAA catabolism in VAT. We speculate that this shift may be related to the improvement in insulin sensitivity after surgery.

Highlights

Bariatric surgery is a treatment option for morbid obesity and is more effective than diet and pharmacotherapy [1, 2]
The one anastomosis gastric bypass (OAGB)-induced increase in circulating branched-chain fatty acids (BCFAs) was similar in patients with morbid obesity with and without T2DM (Supplementary Fig. 1A, B)
We found that branched-chain amino acid (BCAA) correlated directly with the homeostasis model assessment (HOMA) index of insulin resistance (r = 0.30, p = 0.007) and triglyceride concentration (r = 0.33, p = 0.003), whereas BCFAs correlated inversely with these two parameters (HOMA: r = − 0.28, p = 0.012; triglycerides: r = − 0.37, p = 0.001)

Summary

Introduction

Bariatric surgery is a treatment option for morbid obesity and is more effective than diet and pharmacotherapy [1, 2]. One anastomosis gastric bypass (OAGB) is a promising type of bariatric surgery that improves metabolic parameters (reduction in serum concentrations of triglycerides, total and LDL cholesterol, and C-reactive protein; and increase in HDL cholesterol concentration) [4], causes remission of type 2 diabetes mellitus, and is associated with relatively low morbidity [5, 6]. Subjects with morbid obesity have low levels of serum branched-chain fatty acids (BCFAs), which correlate inversely with insulin resistance, hypertriglyceridemia, and inflammation. Recent evidence suggests BCFAs are produced during branched-chain amino acid (BCAA) catabolism in human adipose tissue. Objectives In this single-center study, we evaluated the effect of one anastomosis gastric bypass (OAGB) on circulating BCFA and BCAA. We determined the expression of genes involved in BCAA catabolism in adipose tissue of patients with obesity and lean controls

Objectives

Methods

Results

Conclusion