title: Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass.
abstract: OBJECTIVE
  To identify factors contributing to the variation in weight loss after Roux-en-Y gastric bypass (RYGB).
  
  
  METHODS
  Cross-sectional study of patients with good (excess body mass index lost (EBL) >60%) and poor weight loss response (EBL <50%) >12 months after RYGB and a lean control group matched for age and gender.
  
  
  METHODS
  Sixteen patients with good weight loss response, 17 patients with poor weight loss response, and eight control subjects were included in the study. Participants underwent dual energy X-ray absorptiometry scan, indirect calorimetry and a 9 h multiple-meal test with measurements of glucose, insulin, total bile acids (TBA), glucagon-like peptide (GLP)-1, peptide YY3-36 (PYY), cholecystokinin (CCK), ghrelin, neurotensin and pancreatic polypeptide (PP) as well as assessment of early dumping and appetite.
  
  
  RESULTS
  Suppression of hunger was more pronounced in the good than the poor responders in response to the multiple-meal test (P=0.006). In addition, the good responders had a larger release of GLP-1 (P=0.009) and a greater suppression of ghrelin (P=0.037) during the test, whereas the postprandial secretion of CCK was highest in the poor responders (P=0.005). PYY, neurotensin, PP and TBA release did not differ between the RYGB-operated groups. Compared with control subjects, patients had exaggerated release of GLP-1 (P<0.001), PYY (P=0.008), CCK (P=0.010) and neurotensin (P<0.001). Early dumping was comparable in the good and poor responders, but more pronounced than in controlled subjects. Differences in resting energy expenditure between the three groups were entirely explained by differences in body composition.
  
  
  CONCLUSIONS
  Favorable meal-induced changes in hunger and gut hormone release in patients with good compared with poor weight loss response support the role of gut hormones in the weight loss after RYGB.
authors: 1] Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark [2] Novo Nordisk Foundation Centre for Basic Metabolic Research, the Panum Institute, University of Copenhagen, Copenhagen N, Denmark.
authors: C
authors: C
authors: Dirksen
authors: N B
authors: NB
authors: Jørgensen
authors: K N
authors: KN
authors: Bojsen-Møller
authors: U
authors: U
authors: Kielgast
authors: S H
authors: SH
authors: Jacobsen
authors: T R
authors: TR
authors: Clausen
authors: D
authors: D
authors: Worm
authors: B
authors: B
authors: Hartmann
authors: J F
authors: JF
authors: Rehfeld
authors: M
authors: M
authors: Damgaard
authors: J L
authors: JL
authors: Madsen
authors: S
authors: S
authors: Madsbad
authors: J J
authors: JJ
authors: Holst
authors: D L
authors: DL
authors: Hansen
mesh_terms: D015502:Absorptiometry, Photon; D001069:Appetite Regulation; D001647:Bile Acids and Salts / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002766:Cholecystokinin / Q000378:metabolism; D003430:Cross-Sectional Studies; D004377:Dumping Syndrome / Q000209:etiology / Q000378:metabolism*; D004734:Energy Metabolism; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects; D054439:Ghrelin / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009496:Neurotensin / Q000378:metabolism; D009767:Obesity, Morbid / Q000378:metabolism* / Q000601:surgery; D019894:Peptide YY / Q000378:metabolism; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001647:Bile Acids and Salts; D001786:Blood Glucose; D054439:Ghrelin; D019894:Peptide YY; D009496:Neurotensin; D052216:Glucagon-Like Peptide 1; D002766:Cholecystokinin