Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with elevated ghrelin.
OBJECTIVE
We sought to determine: (1) if early weight regain between 1 and 2 years after Roux-en-Y gastric bypass (RYGB) is associated with worsened hepatic and peripheral insulin sensitivity, and (2) if preoperative levels of ghrelin and leptin are associated with early weight regain after RYGB.


METHODS
Hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels were assessed longitudinally in 45 subjects before RYGB and at 1 month, 6 months, 1 year, and 2 years postoperatively. Weight regain was defined as ≥5% increase in body weight between 1 and 2 years after RYGB.


RESULTS
Weight regain occurred in 33% of subjects, with an average increase in body weight of 10 ± 5% (8.5 ± 3.3 kg). Weight regain was not associated with worsening of peripheral or hepatic insulin sensitivity. Subjects with weight regain after RYGB had higher preoperative and postoperative levels of ghrelin compared to those who maintained or lost weight during this time. Conversely, the trajectories of leptin levels corresponded with the trajectories of fat mass in both groups.


CONCLUSIONS
Early weight regain after RYGB is not associated with a reversal of improvements in insulin sensitivity. Higher preoperative ghrelin levels might identify patients that are more susceptible to weight regain after RYGB.
Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
Robyn A
RA
Tamboli
Igal
I
Breitman
Pam A
PA
Marks-Shulman
Kareem
K
Jabbour
Willie
W
Melvin
Brandon
B
Williams
Ronald H
RH
Clements
Irene D
ID
Feurer
Naji N
NN
Abumrad
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005260:Female; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism* / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D015430:Weight Gain
D054439:Ghrelin; D020738:Leptin
gastric bypass surgery; ghrelin; insulin sensitivity; weight regain