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Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass.

Korner J, Inabnet W, Febres G, Conwell IM, McMahon DJ, Salas R, Taveras C, Schrope B, Bessler M - Int J Obes (Lond) (2009)

Bottom Line: At 1 year there was greater weight loss in RYGB compared with LAGB patients (30 vs 15%), but final body mass index was similar (34 vs 33 kg m(-2)).GLP-1 levels at 30 min after meal were threefold greater after RYGB compared with LAGB (P<0.001).There was a significant decrease in free T(3) (P<0.01) after RYGB.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jk181@columbia.edu

ABSTRACT

Objective: The objective of this study was to quantify hormones that regulate energy and glucose homeostasis to establish possible mechanisms for the greater efficacy of Roux-en-Y gastric bypass (RYGB) compared with laparoscopic adjustable gastric banding (LAGB) in achieving weight loss and improved insulin sensitivity.

Design: Longitudinal study of patients undergoing LAGB (n=15) and RYGB (n=28) who were studied before surgery and at 2, 12, 26 and 52 weeks afterwards.

Measurements: Fasting blood samples were drawn at each visit. Postprandial blood samples were also obtained before surgery and at 26 and 52 weeks. Samples were assayed for peptide YY (PYY), ghrelin, glucagon-like peptide-1 (GLP-1), glucose, insulin, leptin, thyrotropic hormone, free T(4) and free T(3).

Results: At 1 year there was greater weight loss in RYGB compared with LAGB patients (30 vs 15%), but final body mass index was similar (34 vs 33 kg m(-2)). At week 52, area under the curve (AUC) for PYY in RYGB subjects was greater than LAGB (P<0.01). GLP-1 levels at 30 min after meal were threefold greater after RYGB compared with LAGB (P<0.001). Conversely, ghrelin AUC increased after LAGB at week 52 (P<0.05) but tended to decrease after RYGB. Fasting glucose, insulin, and leptin and homeostasis model of assessment (HOMA-IR) decreased in both groups over time but were significantly lower at week 52 after RYGB compared with LAGB. The change in leptin correlated significantly with weight loss in LAGB (r=0.86) and RYGB (r=0.77), however, HOMA-IR correlated significantly with weight loss only in LAGB (r=0.78), and not RYGB (r=0.15). There was a significant decrease in free T(3) (P<0.01) after RYGB.

Conclusions: Differences in levels of gut hormones may play a role in promoting greater weight loss and insulin sensitivity after RYGB compared with LAGB, however, weight loss may be limited by decreases in free T(3) and leptin.

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Plasma PYY and ghrelin levels in response to a test meal before surgery and at weeks 26 and 52 after LAGB (left panel) and RYGB (right panel). Fasting and postprandial levels of PYY (A,B) and ghrelin (E,F): *P < 0.05, **P < 0.01, ***P < 0.001, week 52 compared with week 0. Area under the curve of PYY (C,D) and ghrelin (G,H): *P < 0.05, **P < 0.01, ***P < 0.001, compared with week 0; φP < 0.05, compared with week 26.
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Figure 2: Plasma PYY and ghrelin levels in response to a test meal before surgery and at weeks 26 and 52 after LAGB (left panel) and RYGB (right panel). Fasting and postprandial levels of PYY (A,B) and ghrelin (E,F): *P < 0.05, **P < 0.01, ***P < 0.001, week 52 compared with week 0. Area under the curve of PYY (C,D) and ghrelin (G,H): *P < 0.05, **P < 0.01, ***P < 0.001, compared with week 0; φP < 0.05, compared with week 26.

Mentions: Fasting levels of PYY were not significantly different between groups at any time point (Table 1). There was a progressive increase in fasting PYY in the RYGB group such that at wk 52 levels were significantly greater than baseline (P = 0.014). The most striking differences in PYY levels were noted post-meal in RYGB subjects. At 26 and 52 wks, PYY levels at 30 minutes were approximately 3.5-fold greater than levels prior to surgery and were significantly greater than in LAGB subjects at the same time points (Fig. 2, P < 0.001). There was a corresponding 3-fold increase in AUC for PYY in the RYGB group at wk 26 (P < 0.001) and a continued increase in PYY levels such that AUC at wk 52 was significantly greater than at wk 26 (P = 0.025). AUC in the LAGB subjects was also increased after surgery but the difference was statistically significant only at wk 26 (P = 0.003). The non-significant increase in AUC for PYY at wk 52 may be due to a change in assay (see Methods). PYY did not correlate with percent weight loss in either group.


Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass.

Korner J, Inabnet W, Febres G, Conwell IM, McMahon DJ, Salas R, Taveras C, Schrope B, Bessler M - Int J Obes (Lond) (2009)

Plasma PYY and ghrelin levels in response to a test meal before surgery and at weeks 26 and 52 after LAGB (left panel) and RYGB (right panel). Fasting and postprandial levels of PYY (A,B) and ghrelin (E,F): *P < 0.05, **P < 0.01, ***P < 0.001, week 52 compared with week 0. Area under the curve of PYY (C,D) and ghrelin (G,H): *P < 0.05, **P < 0.01, ***P < 0.001, compared with week 0; φP < 0.05, compared with week 26.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2710396&req=5

Figure 2: Plasma PYY and ghrelin levels in response to a test meal before surgery and at weeks 26 and 52 after LAGB (left panel) and RYGB (right panel). Fasting and postprandial levels of PYY (A,B) and ghrelin (E,F): *P < 0.05, **P < 0.01, ***P < 0.001, week 52 compared with week 0. Area under the curve of PYY (C,D) and ghrelin (G,H): *P < 0.05, **P < 0.01, ***P < 0.001, compared with week 0; φP < 0.05, compared with week 26.
Mentions: Fasting levels of PYY were not significantly different between groups at any time point (Table 1). There was a progressive increase in fasting PYY in the RYGB group such that at wk 52 levels were significantly greater than baseline (P = 0.014). The most striking differences in PYY levels were noted post-meal in RYGB subjects. At 26 and 52 wks, PYY levels at 30 minutes were approximately 3.5-fold greater than levels prior to surgery and were significantly greater than in LAGB subjects at the same time points (Fig. 2, P < 0.001). There was a corresponding 3-fold increase in AUC for PYY in the RYGB group at wk 26 (P < 0.001) and a continued increase in PYY levels such that AUC at wk 52 was significantly greater than at wk 26 (P = 0.025). AUC in the LAGB subjects was also increased after surgery but the difference was statistically significant only at wk 26 (P = 0.003). The non-significant increase in AUC for PYY at wk 52 may be due to a change in assay (see Methods). PYY did not correlate with percent weight loss in either group.

Bottom Line: At 1 year there was greater weight loss in RYGB compared with LAGB patients (30 vs 15%), but final body mass index was similar (34 vs 33 kg m(-2)).GLP-1 levels at 30 min after meal were threefold greater after RYGB compared with LAGB (P<0.001).There was a significant decrease in free T(3) (P<0.01) after RYGB.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jk181@columbia.edu

ABSTRACT

Objective: The objective of this study was to quantify hormones that regulate energy and glucose homeostasis to establish possible mechanisms for the greater efficacy of Roux-en-Y gastric bypass (RYGB) compared with laparoscopic adjustable gastric banding (LAGB) in achieving weight loss and improved insulin sensitivity.

Design: Longitudinal study of patients undergoing LAGB (n=15) and RYGB (n=28) who were studied before surgery and at 2, 12, 26 and 52 weeks afterwards.

Measurements: Fasting blood samples were drawn at each visit. Postprandial blood samples were also obtained before surgery and at 26 and 52 weeks. Samples were assayed for peptide YY (PYY), ghrelin, glucagon-like peptide-1 (GLP-1), glucose, insulin, leptin, thyrotropic hormone, free T(4) and free T(3).

Results: At 1 year there was greater weight loss in RYGB compared with LAGB patients (30 vs 15%), but final body mass index was similar (34 vs 33 kg m(-2)). At week 52, area under the curve (AUC) for PYY in RYGB subjects was greater than LAGB (P<0.01). GLP-1 levels at 30 min after meal were threefold greater after RYGB compared with LAGB (P<0.001). Conversely, ghrelin AUC increased after LAGB at week 52 (P<0.05) but tended to decrease after RYGB. Fasting glucose, insulin, and leptin and homeostasis model of assessment (HOMA-IR) decreased in both groups over time but were significantly lower at week 52 after RYGB compared with LAGB. The change in leptin correlated significantly with weight loss in LAGB (r=0.86) and RYGB (r=0.77), however, HOMA-IR correlated significantly with weight loss only in LAGB (r=0.78), and not RYGB (r=0.15). There was a significant decrease in free T(3) (P<0.01) after RYGB.

Conclusions: Differences in levels of gut hormones may play a role in promoting greater weight loss and insulin sensitivity after RYGB compared with LAGB, however, weight loss may be limited by decreases in free T(3) and leptin.

Show MeSH
Related in: MedlinePlus