Influences of fat restriction and lipase inhibition on gastric emptying in obesity.
OBJECTIVE
Accelerated gastric emptying of solids may play a role in the pathogenesis of obesity. Orlistat, a potent lipase inhibitor, induces fat malabsorption and body weight loss but might accelerate gastric emptying as a result of suppressed CCK release. The aim was to investigate the role of fat restriction and lipase inhibition in CCK release and gastric emptying.


METHODS
A total of 28 patients (three male (M)/25 female (F); mean (s.d.) BMI 37.4(3.9) kg/m2) entering a randomized, double-blind, placebo-controlled study.


METHODS
CCK release and gastric emptying by scintigraphy at the start (T0), after 1 month of an energy- and fat-restricted diet and placebo (T1), and after 1 month (T2) and 1 year (T3) of randomization to placebo or 120 mg orlistat three times a day.


RESULTS
One month of dieting and a weight loss of 2.3 kg (2.1% of initial weight) did not affect gastric emptying of liquids and solids. Basal and meal-stimulated CCK levels remained unaltered. Placebo-treated subjects who continued the diet for 1 month demonstrated a borderline significant suppressed CCK secretion and a weight loss of 1.2 kg (1.0%) without an effect on gastric emptying. After 1 year, the CCK secretion recovered to or beyond values at the start. A significantly slower emptying of solids (17.6 (T3) versus 25.9 (T1)%/h) and a weight loss of 10.4 kg (9.9%) was observed. Subjects on 120 mg orlistat lost 2.5 kg (2.5%) after 1 month, and 9.8 kg (9.9%) after 1 year. Basal and postprandial CCK release decreased significantly after the first month of orlistat treatment but normalized after 1 year. Diet and lipase inhibition did not have any influence on gastric emptying.


CONCLUSIONS
Energy and fat restriction of 1 month did not alter gastric emptying in the whole group. Continuation of the diet for 1 year resulted in a delayed gastric emptying of solids. Lipase inhibition did not result in a sustained depressed CCK release and the anticipated acceleration of gastric emptying did not occur.
Mathus-Vliegen
E M H
EM
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. e.mathus-vliegen@amc.uva.nl
van Ierland-van Leeuwen
M L
ML
Bennink
R J
RJ
D019440:Anti-Obesity Agents / Q000627:therapeutic use; D002766:Cholecystokinin / Q000378:metabolism*; D018752:Diet, Fat-Restricted; D004038:Diet, Reducing; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008049:Lipase / Q000037:antagonists & inhibitors*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy / Q000188:drug therapy / Q000378:metabolism*; D000077403:Orlistat; D012528:Satiety Response; D015431:Weight Loss / Q000502:physiology
D019440:Anti-Obesity Agents; D004791:Enzyme Inhibitors; D007783:Lactones; D002766:Cholecystokinin; D000077403:Orlistat; D008049:Lipase