Alina I Tsouristakis1, Gerardo Febres1, Donald J McMahon1, Beverly Tchang1, Irene M Conwell1, Amanda J Tsang1, Leaque Ahmed2, Marc Bessler3, Judith Korner4. 1. Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA. 2. Department of Surgery, Wyckoff Heights Hospital, Brooklyn, NY, USA. 3. Department of Surgery, Columbia University College of Physicians & Surgeons, New York, NY, USA. 4. Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA. jk181@cumc.columbia.edu.
Abstract
BACKGROUND: Roux-en-Y gastric bypass (RYGB) produces greater weight loss compared with a purely restrictive procedure such as laparoscopic adjustable gastric banding (LAGB). OBJECTIVE: The objective of this study was to quantify changes in hormones that regulate energy homeostasis and appetitive sensations before and after LAGB (n = 18) and RYGB (n = 38) in order to better understand the mechanisms underlying the greater weight loss after RYGB. METHODS: A standardized test meal was administered prior to surgery, at 6 months, and annually thereafter to year 2 after LAGB and year 4 after RYGB. Blood samples were obtained in the fasted state and 30, 60, 90, and 120 min post-meal. RESULTS: Progressive increases in fasting PYY were observed after RYGB together with increases in postprandial area under the curve (AUC) levels that were unchanged after LAGB. GLP-1 AUC increased only after RYGB. There was a weight loss-related increase in fasting ghrelin levels after LAGB that was unchanged 1 year after RYGB despite greater percentage weight loss; ghrelin subsequently increased at years 2-4 post-RYGB. HOMA-IR decreased after both procedures but correlated with weight loss only after LAGB, whereas leptin correlated with weight loss in both groups. Sweet cravings decreased after RYGB. CONCLUSION: A number of weight loss-independent changes in the gut hormonal milieu likely act in concert to promote a decrease in insulin resistance and greater weight loss efficacy after RYGB. A progressive change in hormone levels over time may reflect gut enteroplasticity after RYGB. A decrease in sweet cravings specific to RYGB may further promote superior weight loss outcomes.
BACKGROUND: Roux-en-Y gastric bypass (RYGB) produces greater weight loss compared with a purely restrictive procedure such as laparoscopic adjustable gastric banding (LAGB). OBJECTIVE: The objective of this study was to quantify changes in hormones that regulate energy homeostasis and appetitive sensations before and after LAGB (n = 18) and RYGB (n = 38) in order to better understand the mechanisms underlying the greater weight loss after RYGB. METHODS: A standardized test meal was administered prior to surgery, at 6 months, and annually thereafter to year 2 after LAGB and year 4 after RYGB. Blood samples were obtained in the fasted state and 30, 60, 90, and 120 min post-meal. RESULTS: Progressive increases in fasting PYY were observed after RYGB together with increases in postprandial area under the curve (AUC) levels that were unchanged after LAGB. GLP-1 AUC increased only after RYGB. There was a weight loss-related increase in fasting ghrelin levels after LAGB that was unchanged 1 year after RYGB despite greater percentage weight loss; ghrelin subsequently increased at years 2-4 post-RYGB. HOMA-IR decreased after both procedures but correlated with weight loss only after LAGB, whereas leptin correlated with weight loss in both groups. Sweet cravings decreased after RYGB. CONCLUSION: A number of weight loss-independent changes in the gut hormonal milieu likely act in concert to promote a decrease in insulin resistance and greater weight loss efficacy after RYGB. A progressive change in hormone levels over time may reflect gut enteroplasticity after RYGB. A decrease in sweet cravings specific to RYGB may further promote superior weight loss outcomes.
Authors: A M Wren; L J Seal; M A Cohen; A E Brynes; G S Frost; K G Murphy; W S Dhillo; M A Ghatei; S R Bloom Journal: J Clin Endocrinol Metab Date: 2001-12 Impact factor: 5.958
Authors: M Bueter; A D Miras; H Chichger; W Fenske; M A Ghatei; S R Bloom; R J Unwin; T A Lutz; A C Spector; C W le Roux Journal: Physiol Behav Date: 2011-07-30
Authors: David E Cummings; David S Weigle; R Scott Frayo; Patricia A Breen; Marina K Ma; E Patchen Dellinger; Jonathan Q Purnell Journal: N Engl J Med Date: 2002-05-23 Impact factor: 91.245
Authors: J Korner; W Inabnet; G Febres; I M Conwell; D J McMahon; R Salas; C Taveras; B Schrope; M Bessler Journal: Int J Obes (Lond) Date: 2009-05-05 Impact factor: 5.095