Entero-endocrine changes after gastric bypass in diabetic and nondiabetic patients: a preliminary study.
BACKGROUND
Alterations in entero-endocrine signaling may play a role in improvements in satiety and glucose tolerance after Roux-en-Y gastric bypass (RYGB). We report our findings of gut hormone secretion in a cohort of diabetic and nondiabetic morbidly obese patients.


METHODS
Ten morbidly obese subjects who underwent uncomplicated RYGB were studied: 5 were diabetic and 9 were female. Nonfasting plasma levels of glucagon-like peptide-1 (GLP-1), insulin, desacyl ghrelin, active ghrelin, neuropeptide Y (NPY), and gastric inhibitory polypeptide (GIP) were determined preoperatively and 6 months postoperatively.


RESULTS
Mean patient age was 42 +/- 11 years, and the mean preoperative body mass index was 50 +/- 6 kg/m(2). At 6 months mean BMI fell to 33 +/- 5 kg/m(2) (P < 0.0001), and there were no differences between diabetics and nondiabetics with respect to amount of weight loss. In non-diabetics, compared to preoperative levels, there were significant increases in GLP-1 and desacyl-ghrelin in the nondiabetic patients (P = 0.046 and P = 0.016, respectively); no change in plasma insulin, active ghrelin, NPY, or GIP was demonstrated. In contrast, when compared to preoperative levels, there were no significant changes in entero-endocrine hormone levels in the diabetic cohort postoperatively.


CONCLUSIONS
At 6 months postoperation, RYGB significantly alters the hormone levels for GLP-1 and desacyl-ghrelin in morbidly obese nondiabetic patients. No significant change was noted in a matched cohort of diabetic patients. Weight loss was similar in diabetics and nondiabetics, suggesting that GLP-1 and ghrelin are not the only mechanisms producing weight loss after RYGB.
Whitson
Bryan A
BA
Department of Surgery, Division of Gastrointestinal Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Leslie
Daniel B
DB
Kellogg
Todd A
TA
Maddaus
Michael A
MA
Buchwald
Henry
H
Billington
Charles J
CJ
Ikramuddin
Sayeed
S
D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D005260:Female; D015390:Gastric Bypass; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D005768:Gastrointestinal Hormones / Q000378:metabolism*; D041981:Gastrointestinal Tract / Q000378:metabolism; D054439:Ghrelin; D052216:Glucagon-Like Peptide 1 / Q000097:blood / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009478:Neuropeptide Y / Q000097:blood / Q000378:metabolism; D009767:Obesity, Morbid / Q000378:metabolism* / Q000601:surgery*; D036361:Peptide Hormones / Q000097:blood / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology
D005768:Gastrointestinal Hormones; D054439:Ghrelin; D007328:Insulin; D009478:Neuropeptide Y; D036361:Peptide Hormones; C422650:ghrelin, des-n-octanoyl; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1