title: Surgical control of obesity and diabetes: the role of intestinal vs. gastric mechanisms in the regulation of body weight and glucose homeostasis.
abstract: OBJECTIVE
  To elucidate the specific role of gastric vs. intestinal manipulations in the regulation of body weight and glucose homeostasis.
  
  
  METHODS
  The effects of intestinal bypass alone (duodenal-jejunal bypass -DJB) and gastric resection alone (SG) in Zucker Diabetic Fatty (ZDF) rats were compared. Additional animals underwent a combination procedure (SG + DJB). Outcome measures included changes in weight, food intake (FI), oral glucose tolerance (GT) and gut hormones.
  
  
  RESULTS
  DJB did not substantially affect weight and FI, whereas SG significantly reduced weight gain and food consumption. DJB rats showed weight-independent improvement in GT, which improved less after SG. Furthermore, SG significantly suppressed plasma ghrelin and increased insulin, glucagon like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide and peptide YY response to oral glucose whereas DJB had no effects on postprandial levels of these hormones. DJB restored postprandial glucagon suppression in diabetic rats whereas SG did not affect glucagon response. The combination procedure (SG + DJB) induced greater weight loss and better GT than SG alone without reducing food intake further.
  
  
  CONCLUSIONS
  These findings reveal a dominant role of the stomach in the regulation of body weight and incretin response to oral glucose whereas intestinal bypass primarily affects glucose homeostasis by a weight-, insulin- and incretin-independent mechanism.
authors.affiliation: Section of GI Metabolic Surgery, Diabetes Surgery Center, Department of Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
authors.forename: Rajesh T
authors.initials: RT
authors.lastname: Patel
authors.forename: Alpana P
authors.initials: AP
authors.lastname: Shukla
authors.forename: Soo Min
authors.initials: SM
authors.lastname: Ahn
authors.forename: Marlus
authors.initials: M
authors.lastname: Moreira
authors.forename: Francesco
authors.initials: F
authors.lastname: Rubino
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000378:metabolism*; D001835:Body Weight; D003921:Diabetes Mellitus, Experimental / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005743:Gastrectomy; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D054439:Ghrelin / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005951:Glucose Tolerance Test; D006706:Homeostasis; D007328:Insulin / Q000097:blood; D007581:Jejunoileal Bypass; D007583:Jejunum / Q000601:surgery; D008297:Male; D009765:Obesity / Q000097:blood / Q000601:surgery*; D019894:Peptide YY / Q000097:blood; D011182:Postoperative Care; D051381:Rats
chemical_list: D001786:Blood Glucose; D054439:Ghrelin; D007328:Insulin; D019894:Peptide YY; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1