title: Beta cell function after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention.
abstract: OBJECTIVE
  The effects of various weight loss strategies on pancreatic beta cell function remain unclear. We aimed to compare the effect of intensive lifestyle intervention (ILI) and Roux-en-Y gastric bypass surgery (RYGB) on beta cell function.
  
  
  METHODS
  One year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104).
  
  
  METHODS
  One hundred and nineteen morbidly obese participants without known diabetes from the MOBIL study (mean (s.d.) age 43.6 (10.8) years, body mass index (BMI) 45.5 (5.6) kg/m², 84 women) were allocated to RYGB (n = 64) or ILI (n = 55). The patients underwent repeated oral glucose tolerance tests (OGTTs) and were categorised as having either normal (NGT) or abnormal glucose tolerance (AGT). Twenty-nine normal-weight subjects with NGT (age 42.6 (8.7) years, BMI 22.6 (1.5) kg/m², 19 women) served as controls. OGTT-based indices of beta cell function were calculated.
  
  
  RESULTS
  One year weight reduction was 30% (8) after RYGB and 9% (10) after ILI (P < 0.001). Disposition index (DI) increased in all treatment groups (all P<0.05), although more in the surgery groups (both P < 0.001). Stimulated proinsulin-to-insulin (PI/I) ratio decreased in both surgery groups (both P < 0.001), but to a greater extent in the surgery group with AGT at baseline (P < 0.001). Post surgery, patients with NGT at baseline had higher DI and lower stimulated PI/I ratio than controls (both P < 0.027).
  
  
  CONCLUSIONS
  Gastric bypass surgery improved beta cell function to a significantly greater extent than ILI. Supra-physiological insulin secretion and proinsulin processing may indicate excessive beta cell function after gastric bypass surgery.
authors.affiliation: Department of Medicine, Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway. dag.hofso@siv.no
authors.forename: D
authors.initials: D
authors.lastname: Hofsø
authors.forename: T
authors.initials: T
authors.lastname: Jenssen
authors.forename: J
authors.initials: J
authors.lastname: Bollerslev
authors.forename: T
authors.initials: T
authors.lastname: Ueland
authors.forename: K
authors.initials: K
authors.lastname: Godang
authors.forename: M
authors.initials: M
authors.lastname: Stumvoll
authors.forename: R
authors.initials: R
authors.lastname: Sandbu
authors.forename: J
authors.initials: J
authors.lastname: Røislien
authors.forename: J
authors.initials: J
authors.lastname: Hjelmesæth
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D002851:Chromatography, High Pressure Liquid; D004038:Diet, Reducing; D005081:Exercise Therapy; D005260:Female; D015390:Gastric Bypass; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin