title: Changes in Fasting and Prandial Gut and Adiposity Hormones Following Vertical Sleeve Gastrectomy or Roux-en-Y-Gastric Bypass: an 18-Month Prospective Study.
abstract: Vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) produce substantial weight loss, both primarily through gastric restriction but with potentially different hormonal signaling. This prospective, observational study compared changes in gut-derived hormones in VSG, RYGB, and weight-stable participants at 6 and 18 months post-surgery.
  
  
  
  Sixty-four obese, non-diabetic women, including 18 VSG, 23 RYGB, and 23 weight-stable controls completed assessments at baseline and 6 months, before and after consuming a mixed-nutrient meal; blood sampling occurred for 180 min post-meal. Fifty-one participants completed the 18-month outcome. Change from baseline in post-prandial area under the curve (over 180 min) for GLP-1, PYY3-36, ghrelin, and leptin was measured at 6 and 18 months post-surgery.
  
  
  
  At 18 months, VSG and RYGB participants lost a mean (±SEM) of 25.5 ± 2.3% and 34.2 ± 4.2% of initial weight, respectively (p < 0.156), which both differed (p < 0.001) from the +1.7 ± 1.0% gain in the control group. Fasting ghrelin declined significantly more in VSG than RYGB participants at both months 6 (p = 0.0199) and 18 (p = 0.0003). In response to the mixed-nutrient meal, GLP-1 and PYY3-36demonstrated an exaggerated post-prandial response that was significantly greater in RYGB than VSG at 6 months (p < 0.0001 and p = 0.0062, respectively) but not 18 months (p = 0.0296 and p = 0.1210).
  
  
  
  VSG and RYGB both produced substantial weight losses at 18 months. The data suggest a role of gastrointestinal hormones as mediators of weight loss.
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, and the Institute for Diabetes, Obesity and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA. naji.alamuddin@uphs.upenn.edu.|Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA. naji.alamuddin@uphs.upenn.edu.
authors.forename: Naji
authors.initials: N
authors.lastname: Alamuddin
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, and the Institute for Diabetes, Obesity and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Marion L
authors.initials: ML
authors.lastname: Vetter
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Rexford S
authors.initials: RS
authors.lastname: Ahima
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Hesson
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Ritter
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Minnick
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Lucy F
authors.initials: LF
authors.lastname: Faulconbridge
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Allison
authors.affiliation: Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Sarwer
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Chittams
authors.affiliation: Metabolic and Bariatric Surgery Program, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.affiliation: Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hayes
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Loughead
authors.affiliation: Center for Neuroimaging, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Ruben
authors.initials: R
authors.lastname: Gur
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
mesh_terms: D000328:Adult; D005215:Fasting / Q000502:physiology*; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000379:methods / Q000706:statistics & numerical data; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies
chemical_list: D054439:Ghrelin
keywords: Bariatric surgery; Hormone; Obesity; Roux-en-Y gastric bypass; Weight loss, vertical sleeve gastrectomy