OBJECTIVE: To gain insight into the specific mechanisms by which biliopancreatic diversion (BPD) can improve insulin action. MATERIALS AND METHODS: Nondiabetic severely obese patients (n=20) undergoing BPD were included. Waist-to-hip ratio and serum concentration of glucose, insulin, and leptin were determined before, at 4-day, and at 2 months after the operation. Insulin sensitivity was calculated according to the homeostatic model assessment (HOMA IR). RESULTS: A marked increase of insulin sensitivity was observed by the fourth day after the operation; at the second postoperative month, when body weight was still in the obese range and the food intake was substantially similar to the preoperative one, a further improvement of insulin action towards normality was found. Moreover, before BPD HOMA IR data were independently correlated both to BMI and waist-to-hip ratio values, whereas at 2 months after the operation data were in positive correlation only with the BMI. DISCUSSION: In obese patients, BPD seems to achieve recovery of insulin sensitivity by specific mechanisms independent of weight loss: the main causes of this sharp improvement might be both the intramyocellular fat depletion and the interruption of enteroinsular axis.
OBJECTIVE: To gain insight into the specific mechanisms by which biliopancreatic diversion (BPD) can improve insulin action. MATERIALS AND METHODS: Nondiabetic severely obesepatients (n=20) undergoing BPD were included. Waist-to-hip ratio and serum concentration of glucose, insulin, and leptin were determined before, at 4-day, and at 2 months after the operation. Insulin sensitivity was calculated according to the homeostatic model assessment (HOMA IR). RESULTS: A marked increase of insulin sensitivity was observed by the fourth day after the operation; at the second postoperative month, when body weight was still in the obese range and the food intake was substantially similar to the preoperative one, a further improvement of insulin action towards normality was found. Moreover, before BPD HOMA IR data were independently correlated both to BMI and waist-to-hip ratio values, whereas at 2 months after the operation data were in positive correlation only with the BMI. DISCUSSION: In obesepatients, BPD seems to achieve recovery of insulin sensitivity by specific mechanisms independent of weight loss: the main causes of this sharp improvement might be both the intramyocellular fat depletion and the interruption of enteroinsular axis.
Authors: Tammy L Kindel; Paulo J F Martins; Stephanie M Yoder; Ronald J Jandacek; Randy J Seeley; David A D'Alessio; Silvana Obici; Patrick Tso Journal: Obesity (Silver Spring) Date: 2010-10-28 Impact factor: 5.002
Authors: Villy Våge; Roy M Nilsen; Arnold Berstad; Jan Behme; Nils Sletteskog; Ronny Gåsdal; Camilla Laukeland; Gunnar Mellgren Journal: Obes Surg Date: 2013-01 Impact factor: 4.129
Authors: Katherine E Nori Janosz; Kerstyn C Zalesin; Wendy M Miller; Peter A McCullough; Barry A Franklin Journal: Curr Diab Rep Date: 2009-06 Impact factor: 4.810