Stefano De Vuono1, Maria Anastasia Ricci2, Elisa Nulli Migliola2, Maria Chiara Monti3, Elva Morretta4,3, Marcello Boni5, Stefano Ministrini2, Adriana Carino6, Stefano Fiorucci6, Eleonora Distrutti6, Graziana Lupattelli2. 1. Internal Medicine, "Santa Maria della Misericordia" Hospital, Department of Medicine, University of Perugia, Piazzale Lucio Severi, Sant'Andrea delle Fratte, 06132, Perugia, Italy. insect3@tiscali.it. 2. Internal Medicine, "Santa Maria della Misericordia" Hospital, Department of Medicine, University of Perugia, Piazzale Lucio Severi, Sant'Andrea delle Fratte, 06132, Perugia, Italy. 3. Department of Pharmacy, University of Salerno, Salerno, Italy. 4. PhD Program in Drug Discovery and Development, University of Salerno, Salerno, Italy. 5. Department of Surgery, "San Giovanni Battista" Hospital, Perugia, Italy. bonimarce@tiscali.it. 6. Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
Abstract
BACKGROUND AND AIMS: The rising prevalence of morbid obesity is increasing the demand for bariatric surgery. The benefits observed after bariatric surgery seems to be not fully explained by surgery-induced weight loss or traditional cardiovascular risk factors regression or improvement. Some evidences suggest that bile acid (BA) levels change after bariatric surgery, thus suggesting that BA concentrations could influence some of the metabolic improvement induced by bariatric surgery. In this report, we have characterized circulating BA patterns and compared them to metabolic and vascular parameters before and after sleeve gastrectomy (SG). PATIENTS AND METHODS: Seventy-nine subjects (27 males, 52 females, aged 45 ± 12 years, mean BMI 45 ± 7 kg/m2) SG candidates were included in the study. Before and about 12 months after SG, all subjects underwent a clinical examination, blood tests (including lipid profile, plasma glucose and insulin, both used for calculating HOMA-IR, and glycated hemoglobin), ultrasound visceral fat area estimation, ultrasound flow-mediated dilation evaluation, and determination of plasma BA concentrations. RESULTS: Before SG, both primary and secondary BA levels were higher in insulin-resistant obese subjects than in non-insulin resistant obese, and BA were positively associated with the markers of insulin-resistance. After SG, total (conjugated and unconjugated) cholic acids significantly decreased (p 0.007), and total lithocholic acids significantly increased (p 0.017). SG-induced total cholic and chenodeoxycholic acid changes were directly associated with surgery-induced glycemia (p 0.011 and 0.033 respectively) and HOMA-IR (p 0.016 and 0.012 respectively) changes. CONCLUSIONS: Serum BA are associated with glucose metabolism and particularly with markers of insulin-resistance. SG modifies circulating BA pool size and composition. SG-induced BA changes are associated with insulin-resistance amelioration. In conclusion, an interplay between glucose metabolism and circulating BA exists but further studies are needed.
BACKGROUND AND AIMS: The rising prevalence of morbid obesity is increasing the demand for bariatric surgery. The benefits observed after bariatric surgery seems to be not fully explained by surgery-induced weight loss or traditional cardiovascular risk factors regression or improvement. Some evidences suggest that bile acid (BA) levels change after bariatric surgery, thus suggesting that BA concentrations could influence some of the metabolic improvement induced by bariatric surgery. In this report, we have characterized circulating BA patterns and compared them to metabolic and vascular parameters before and after sleeve gastrectomy (SG). PATIENTS AND METHODS: Seventy-nine subjects (27 males, 52 females, aged 45 ± 12 years, mean BMI 45 ± 7 kg/m2) SG candidates were included in the study. Before and about 12 months after SG, all subjects underwent a clinical examination, blood tests (including lipid profile, plasma glucose and insulin, both used for calculating HOMA-IR, and glycated hemoglobin), ultrasound visceral fat area estimation, ultrasound flow-mediated dilation evaluation, and determination of plasma BA concentrations. RESULTS: Before SG, both primary and secondary BA levels were higher in insulin-resistant obese subjects than in non-insulin resistant obese, and BA were positively associated with the markers of insulin-resistance. After SG, total (conjugated and unconjugated) cholic acids significantly decreased (p 0.007), and total lithocholic acids significantly increased (p 0.017). SG-induced total cholic and chenodeoxycholic acid changes were directly associated with surgery-induced glycemia (p 0.011 and 0.033 respectively) and HOMA-IR (p 0.016 and 0.012 respectively) changes. CONCLUSIONS: Serum BA are associated with glucose metabolism and particularly with markers of insulin-resistance. SG modifies circulating BA pool size and composition. SG-induced BA changes are associated with insulin-resistance amelioration. In conclusion, an interplay between glucose metabolism and circulating BA exists but further studies are needed.
Entities:
Keywords:
Bariatric surgery; Bile acids; Metabolism; Morbid obesity; Sleeve gastrectomy
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