Journal Article

Increased Postprandial Energy Expenditure May Explain Superior Long Term Weight Loss after Roux-en-Y Gastric Bypass Compared to Vertical Banded Gastroplasty

Bueter, Marco, Fändriks, Lars, le Roux, Carel W., Olbers, Torsten, Lönroth, Hans, Stenlöf, Kaj, Werling, Malin

2013

Overview

Gastric bypass results in greater weight loss than Vertical banded gastroplasty (VBG), but the underlying mechanisms remain unclear. In addition to effects on energy intake the two bariatric techniques may differentially influence energy expenditure (EE). Gastric bypass in rats increases postprandial EE enough to result in elevated EE over 24 hours. This study aimed to investigate alterations in postprandial EE after gastric bypass and VBG in humans. Fourteen women from a randomized clinical trial between gastric bypass (n = 7) and VBG (n = 7) were included. Nine years postoperatively and at weight stability patients were assessed for body composition and calorie intake. EE was measured using indirect calorimetry in a respiratory chamber over 24 hours and focused on the periods surrounding meals and sleep. Blood samples were analysed for postprandial gut hormone responses. Groups did not differ regarding body composition or food intake either preoperatively or at study visit. Gastric bypass patients had higher EE postprandially (p = 0.018) and over 24 hours (p = 0.048) compared to VBG patients. Postprandial peptide YY (PYY) and glucagon like peptide 1 (GLP-1) levels were higher after gastric bypass (both p<0.001). Gastric bypass patients have greater meal induced EE and total 24 hours EE compared to VBG patients when assessed 9 years postoperatively. Postprandial satiety gut hormone responses were exaggerated after gastric bypass compared to VBG. Long-term weight loss maintenance may require significant changes in several physiological mechanisms which will be important to understand if non-surgical approaches are to mimic the effects of bariatric surgery.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adiposity / Adult / Biology / Body composition / Body Mass Index / Body weight loss / Bypasses / Calorimetry / Clinical trials / Comparative analysis / Diet / Education / Energy / Energy expenditure / Energy intake / Energy Metabolism / Ethics / Female / Follow-Up Studies / Food / Food composition / Food intake / Gastric Bypass / Gastroenterologi och hepatologi / Gastroenterology and Hepatology / Gastrointestinal surgery / Gastroplasty / Glucagon / Health aspects / Heart surgery / Hospitals / Humans / Hunger / Kirurgi / Laparoscopy / Meals / Medicine / Metabolism / Middle Aged / Mortality / Motor Activity / Obesity / Obesity - metabolism / Obesity - surgery / Patients / Peptides / Physiology / Postprandial Period / Randomized Controlled Trials as Topic / Rats / Respiratory Rate / Rodents / Satiety / Sleep / Stability analysis / Surgery / Treatment Outcome / Weight control / Weight Loss