Limits...
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.

Show MeSH

Related in: MedlinePlus

Percent change in leptin over time (A). *P < 0.01,**P < 0.001; change from baseline within group; φP < 0.001; compared with LAGB at same time-point. Relationship between percent change in leptin levels and percent weight loss at wk 52 (B). LAGB (dotted line) and RYGB (solid line) subjects.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2710396&req=5

Figure 5: Percent change in leptin over time (A). *P < 0.01,**P < 0.001; change from baseline within group; φP < 0.001; compared with LAGB at same time-point. Relationship between percent change in leptin levels and percent weight loss at wk 52 (B). LAGB (dotted line) and RYGB (solid line) subjects.

Mentions: Fasting leptin levels did not differ at baseline between groups (Table 1). There was a significant decrease at wk 2 in LAGB subjects (P < 0.001), but levels did not decrease further despite continued weight loss. Leptin levels at wk 2 were also significantly decreased in RYGB subjects (P < 0.001). The percent change from baseline after RYGB (Fig. 5) continued to decrease from wk 2 to 12 (P < 0.001) and wk 12 to 26 (P = 0.019), showing stabilization from wk 26 to 52 (P = 0.294). The percent change in leptin correlated with percent weight loss at wk 52 in LAGB (r = 0.86, P < 0.001) and RYGB (r=0.77, P < 0.001) (Fig. 5).


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)

Percent change in leptin over time (A). *P < 0.01,**P < 0.001; change from baseline within group; φP < 0.001; compared with LAGB at same time-point. Relationship between percent change in leptin levels and percent weight loss at wk 52 (B). LAGB (dotted line) and RYGB (solid line) subjects.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710396&req=5

Figure 5: Percent change in leptin over time (A). *P < 0.01,**P < 0.001; change from baseline within group; φP < 0.001; compared with LAGB at same time-point. Relationship between percent change in leptin levels and percent weight loss at wk 52 (B). LAGB (dotted line) and RYGB (solid line) subjects.
Mentions: Fasting leptin levels did not differ at baseline between groups (Table 1). There was a significant decrease at wk 2 in LAGB subjects (P < 0.001), but levels did not decrease further despite continued weight loss. Leptin levels at wk 2 were also significantly decreased in RYGB subjects (P < 0.001). The percent change from baseline after RYGB (Fig. 5) continued to decrease from wk 2 to 12 (P < 0.001) and wk 12 to 26 (P = 0.019), showing stabilization from wk 26 to 52 (P = 0.294). The percent change in leptin correlated with percent weight loss at wk 52 in LAGB (r = 0.86, P < 0.001) and RYGB (r=0.77, P < 0.001) (Fig. 5).

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