Alterations in proinsulin and insulin dynamics, HDL Cholesterol and ALT after gastric bypass surgery. A 42-months follow-up study.
BACKGROUND
Roux-en-Y gastric bypass (RYGBP) powerfully reduces type 2 diabetes (T2DM) incidence. Proinsulin predicts development of T2DM. Adjustable gastric banding is associated with lowered proinsulin but after RYGBP information is scant.


METHODS
Twenty-one non-diabetic morbidly obese patients who underwent RYGBP surgery were evaluated before (baseline), at 12 months (first follow-up), and at 42 months, range 36-50 (second follow-up), after surgery and compared to a control group, matched at baseline regarding fasting glucose, insulin, proinsulin, alanine aminotransferase (ALT), high-density lipoprotein (HDL) cholesterol, and body mass index (BMI).


RESULTS
In the RYGBP group, fasting serum proinsulin concentrations were markedly lowered from 13.5 to 3.5 pmol/l at first follow-up and to 4.9 pmol/l at second follow-up (p < 0.001, respectively). Fasting insulin concentrations were reduced from 83.4 to 24.6 pmol/l at first follow-up (p < 0.001) and to 36.4 pmol/l at second follow-up (p < 0.01). ALT was lowered from 0.62 to 0.34 mukatal/l at first follow-up and continued to lower to 0.24 mukatal/l at second follow-up (p < 0.001, respectively). The further decrease between first and second follow-up was also significant (p = 0.002). HDL cholesterol increased from 1.16 to 1.45 mmol/l at the first follow-up and continued to increase at second follow-up to 1.58 mmol/l (p < 0.001, respectively). The further increase between first and second follow-up was also significant (p = 0.006). The differences between groups at first follow-up were significant for BMI, proinsulin, insulin, ALT, and HDL cholesterol (p = 0.04-0.001).


CONCLUSIONS
RYGBP surgery in morbidly obese patients is not only characterized by markedly and sustained lowered BMI but also lowered concentrations of proinsulin, insulin, and ALT and increased HDL cholesterol.
Johansson
Hans-Erik
HE
Department of Public Health and Caring Sciences/Geriatrics, Uppsala University Hospital, Uppsala Science Park, 75185, Uppsala, Sweden. hans-erik.johansson@pubcare.uu.se
Haenni
Arvo
A
Ohrvall
Margareta
M
Sundbom
Magnus
M
Zethelius
Björn
B
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism* / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D008076:Cholesterol, HDL; D007328:Insulin; D000410:Alanine Transaminase