Gastrointestinal Hormones and Weight Loss Maintenance Following Roux-en-Y Gastric Bypass.
BACKGROUND
Factors underlying variable weight loss (WL) after Roux-en-Y gastric bypass (RYGB) are poorly understood.


OBJECTIVE
Our objective was to gain insight on the role of gastrointestinal hormones on poor WL maintenance (P-WLM) following RYGB.


METHODS
First, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and ghrelin responses to a standardized mixed liquid meal (SMLM) were compared between subjects with good WL (G-WL, n = 32) or P-WLM (n = 22). Second, we evaluated food intake (FI) following blockade of gut hormonal secretion in G-WL (n = 23) or P-WLM (n = 19) subjects. Finally, the impact of dietary-induced WL on the hormonal response in subjects with P-WLM (n = 14) was assessed.


METHODS
This study was undertaken in a tertiary hospital.


METHODS
In studies 1 and 3, the outcomes measures were the areas under the curve of gut hormones following a SMLM; in study 2, FI following subcutaneous injection of saline or octreotide were evaluated.


RESULTS
P-WLM associated a blunted GLP-1 (P = .044) and PYY (P = .001) responses and lesser suppression of ghrelin (P = .032) following the SMLM challenge. On saline day, FI in the G-WL (393 ± 143 kcal) group was less than in the P-WLM (519 ± 143 Kcal; P = .014) group. Octreotide injection resulted in enlarged FI in both groups (G-WL: 579 ± 248 kcal, P = .014; P-WLM: 798 ± 284 Kcal, P = .036), but the difference in FI between groups remained (P < .001). In subjects with P-WLM, dietary-induced WL resulted in larger ghrelin suppression (P = .046), but no change in the GLP-1 or PYY responses.


CONCLUSIONS
Our data show gastrointestinal hormones play a role in the control of FI following RYGB, but do not support that changes in GLP-1, PYY, or ghrelin play a major role as determinants of P-WLM after this type of surgery.
Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036.
Ana
A
de Hollanda
Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036.
Gregori
G
Casals
Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036.
Salvadora
S
Delgado
Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036.
Amanda
A
Jiménez
Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036.
Judith
J
Viaplana
Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036.
Antonio M
AM
Lacy
Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036.
Josep
J
Vidal
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004032:Diet; D004038:Diet, Reducing; D004435:Eating; D005260:Female; D015390:Gastric Bypass; D005768:Gastrointestinal Hormones / Q000097:blood*; D054439:Ghrelin / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy / Q000378:metabolism / Q000601:surgery; D015282:Octreotide / Q000494:pharmacology; D019894:Peptide YY / Q000097:blood; D016896:Treatment Outcome; D015431:Weight Loss
D005768:Gastrointestinal Hormones; D054439:Ghrelin; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1; D015282:Octreotide