Journal Article

Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass

Dirksen, C, Rehfeld, J F, Hartmann, B, Hansen, D L, Madsen, J L, Kielgast, U, Jacobsen, S H, Clausen, T R, Jørgensen, N B, Damgaard, M, Bojsen-Møller, K N, Holst, J J, Madsbad, S, Worm, D

2013

Overview

Objective: To identify factors contributing to the variation in weight loss after Roux-en-Y gastric bypass (RYGB). Design: 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. Materials and 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 YY 3–36 (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. Conclusion: 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.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/45/776/198 / 692/699/2743/393 / 692/700/565/545/2098 / Absorptiometry, Photon / Appetite / Appetite Regulation / Bile Acids and Salts - metabolism / Bioenergetics / Biological and medical sciences / Blood Glucose - metabolism / Body Mass Index / Calorimetry / Cholecystokinin - metabolism / Cross-Sectional Studies / Dumping Syndrome - etiology / Dumping Syndrome - metabolism / Endocrinology / Energy / Energy Metabolism / Epidemiology / Female / Follow-Up Studies / Fundamental and applied biological sciences. Psychology / Gastric bypass / Gastric Bypass - adverse effects / Gastrointestinal hormones / Gastrointestinal surgery / Ghrelin - metabolism / Glucagon / Glucagon-Like Peptide 1 - metabolism / Health Promotion and Disease Prevention / Hormones / Humans / Hunger / Insulin / Internal Medicine / Male / Medical sciences / Medicine / Medicine & Public Health / Metabolic Diseases / Metabolism / Middle Aged / Neurotensin - metabolism / Obesity / Obesity, Morbid - metabolism / Obesity, Morbid - surgery / original-article / Peptide YY - metabolism / Peptides / Physiological aspects / Public Health / Treatment Outcome / Vertebrates: endocrinology / Weight control / Weight Loss