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O'Neill KN, Finucane FM, le Roux CW, et al., 2016, Unmet need for bariatric surgery., Surg Obes Relat Dis, Vol: 13, Pages: 1052-1056
INTRODUCTION: With the rising prevalence of severe obesity and type 2 diabetes (T2D), bariatric surgery offers a clinical and cost-effective treatment for carefully selected patients. Despite this, the provision of surgical services varies significantly between countries. OBJECTIVE: To inform health service planning by estimating the number of people who would potentially benefit from bariatric surgery. SETTING: Nationally representative sample of community-dwelling older adults. METHODS: We applied two separate evidence-based criteria sets for eligibility for bariatric surgery. For the first set of criteria, we considered those with body mass index≥40 kg/m(2) or≥35 kg/m(2) and one or more of the following: T2D, hypertension, previous myocardial infarction, or sleep apnea. For the second set of criteria, we considered patients with T2D and body mass index≥35 kg/m(2), with one or more of the following: previous myocardial infarction, elevated urine albumin-creatinine ratio, retinopathy, neuropathy, or peripheral vascular disease. Prevalence estimates were applied to census figures for 2011, estimating absolute numbers meeting the criteria. RESULTS: Among adults aged≥50 years, 7.97% (95% confidence interval [CI]: 7.23, 8.78), representing 92,573 people (95% CI: 83,978, 101,981), met criteria one and 0.97% (95% CI: 0.73, 1.28), representing 11,231 people (95% CI: 8471, 14,890), met criteria two. With fewer than 1/100,000 population publicly funded surgeries taking place annually, current service provision meets much less than 0.1% of the need. CONCLUSIONS: While many adults who fulfill the eligibility criteria for bariatric surgery may not want or require it, the current level of need for bariatric surgical services is not being met. A strategy to develop and expand the provision of bariatric care is urgently needed.
Pournaras DJ, le Roux CW, Hardwick RH, 2016, Gastrointestinal surgery for obesity and cancer: 2 sides of the same coin, SURGERY FOR OBESITY AND RELATED DISEASES, Vol: 13, Pages: 720-721, ISSN: 1550-7289
Giblin L, McGrath BA, Murray BA, et al., 2016, Letter to the Editor Regarding Equivalent Increases in Circulating GLP-1 Following Jejunal Delivery of Intact and Hydrolysed Casein: Relevance to Satiety Induction following Bariatric Surgery, OBESITY SURGERY, Vol: 27, Pages: 816-817, ISSN: 0960-8923
Elliott JA, Reynolds JV, le Roux CW, et al., 2016, Physiology, pathophysiology and therapeutic implications of enteroendocrine control of food intake, Expert Review of Endocrinology and Metabolism, Vol: 11, Pages: 475-499, ISSN: 1744-6651
Introduction: With the increasing prevalence of obesity and its associated comorbidities, strides to improve treatment strategies have enhanced our understanding of the function of the gut in the regulation of food intake. The most successful intervention for obesity to date, bariatric surgery effectively manipulates enteroendocrine physiology to enhance satiety and reduce hunger.Areas covered: In the present article, we provide a detailed overview of the physiology of enteroendocrine control of food intake, and discuss its pathophysiologic correlates and therapeutic implications in both obesity and gastrointestinal disease.Expert commentary: Ongoing research in the field of nutrient sensing by L-cells, as well as understanding the role of the microbiome and bile acid signaling may facilitate the development of novel strategies to combat the rising population health threat associated with obesity. Further refinement of post-prandial satiety gut hormone based therapies, including the development of chimeric peptides exploiting the pleiotropic nature of the gut hormone response, and identification of novel methods of delivery may hold the key to optimization of therapeutic modulation of gut hormone physiology in obesity.
Zanchi D, Meyer-Gerspach AC, Suenderhauf C, et al., 2016, Differential effects of L-tryptophan and L-leucine administration on brain resting state functional networks and plasma hormone levels, Scientific Reports, Vol: 6, ISSN: 2045-2322
Depending on their protein content, single meals can rapidly influence the uptake of amino acids into the brain and thereby modify brain functions. The current study investigates the effects of two different amino acids on the human gut-brain system, using a multimodal approach, integrating physiological and neuroimaging data. In a randomized, placebo-controlled trial, L-tryptophan, L-leucine, glucose and water were administered directly into the gut of 20 healthy subjects. Functional MRI (fMRI) in a resting state paradigm (RS), combined with the assessment of insulin and glucose blood concentration, was performed before and after treatment. Independent component analysis with dual regression technique was applied to RS-fMRI data. Results were corrected for multiple comparisons. In comparison to glucose and water, L-tryptophan consistently modifies the connectivity of the cingulate cortex in the default mode network, of the insula in the saliency network and of the sensory cortex in the somatosensory network. L-leucine has lesser effects on these functional networks. L-tryptophan and L-leucine also modified plasma insulin concentration. Finally, significant correlations were found between brain modifications after L-tryptophan administration and insulin plasma levels. This study shows that acute L-tryptophan and L-leucine intake directly influence the brain networks underpinning the food-reward system and appetite regulation.
Nair M, le Roux CW, Docherty NG, 2016, Mechanisms underpinning remission of albuminuria following bariatric surgery., Current Opinion in Endocrinology, Diabetes and Obesity, Vol: 23, Pages: 366-372, ISSN: 1080-8205
PURPOSE OF REVIEW: Albuminuria is a biomarker of renal injury commonly used to monitor progression of diabetic kidney disease. The appearance of excess albumin in the urine reflects alterations in the structure and permeability of the glomerular filtration barrier. The present article summarizes the clinical evidence base for remission of albuminuria after bariatric surgery. It furthermore focuses on how beneficial impacts on glomerular podocyte structure and function may explain this phenomenon. RECENT FINDINGS: A coherent clinical evidence base is emerging demonstrating remission of albuminuria following bariatric surgery in patients with obesity and diabetes. The impaired metabolic milieu in diabetic kidney disease drives podocyte dedifferentiation and death through glucotoxic, lipotoxic proinflammatory, and pressure-related stress. Improvements in these parameters after surgery correlate with improvements in albuminuria and preclinical studies provide mechanistic data that support the existence of cause-effect relationship. SUMMARY: The benefits of bariatric surgery extend beyond weight loss in diabetes to encompass beneficial effects on diabetic renal injury. Attenuation of the toxic metabolic milieu that the podocyte is exposed to postbariatric surgery suggests that the restitution of podocyte health is a key cellular event underpinning remission of albuminuria.
Gorman DM, le Roux CW, Docherty NG, 2016, The Effect of Bariatric Surgery on Diabetic Retinopathy: Good, Bad, or Both?, Diabetes and Metabolism Journal, Vol: 40, Pages: 354-364, ISSN: 2233-6087
Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.
Miras AD, Herring R, Vuisrikala A, et al., 2016, Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans, Obesity Science & Practice, Vol: 3, Pages: 95-98, ISSN: 2055-2238
Objective: Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, and the Roux-en-Y gastric bypass (RYGB) in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction independent glucose-lowering properties on hepatic insulin sensitivity. In this first in humans mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno-jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity using the gold standard euglycaemic hyperinsulinaemic clamp methodology. Method: Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, one week after a low-calorie liquid diet and after a further one week following insertion of the DJBL whilst on the same diet.Results: DJBL did not improve the insulin sensitivity of hepatic glucose production (HGP) beyond the improvements achieved with caloric restriction. Conclusions: Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after RYGB and explain, at least in part, the rapid improvements in glycaemia.
Hunt KF, Dunn JT, le Roux CW, et al., 2016, Differences in Regional Brain Responses to Food Ingestion After Roux-en-Y Gastric Bypass and the Role of Gut Peptides: A Neuroimaging Study., Diabetes Care, Vol: 39, Pages: 1787-1795, ISSN: 1935-5548
OBJECTIVE: Improved appetite control, possibly mediated by exaggerated gut peptide responses to eating, may contribute to weight loss after Roux-en-Y gastric bypass (RYGB). This study compared brain responses to food ingestion between post-RYGB (RYGB), normal weight (NW), and obese (Ob) unoperated subjects and explored the role of gut peptide responses in RYGB. RESEARCH DESIGN AND METHODS: Neuroimaging with [(18)F]-fluorodeoxyglucose (FDG) positron emission tomography was performed in 12 NW, 21 Ob, and 9 RYGB (18 ± 13 months postsurgery) subjects after an overnight fast, once FED (400 kcal mixed meal), and once FASTED, in random order. RYGB subjects repeated the studies with somatostatin infusion and basal insulin replacement. Fullness, sickness, and postscan ad libitum meal consumption were measured. Regional brain FDG uptake was compared using statistical parametric mapping. RESULTS: RYGB subjects had higher overall fullness and food-induced sickness and lower ad libitum consumption. Brain responses to eating differed in the hypothalamus and pituitary (exaggerated activation in RYGB), left medial orbital cortex (OC) (activation in RYGB, deactivation in NW), right dorsolateral frontal cortex (deactivation in RYGB and NW, absent in Ob), and regions mapping to the default mode network (exaggerated deactivation in RYGB). Somatostatin in RYGB reduced postprandial gut peptide responses, sickness, and medial OC activation. CONCLUSIONS: RYGB induces weight loss by augmenting normal brain responses to eating in energy balance regions, restoring lost inhibitory control, and altering hedonic responses. Altered postprandial gut peptide responses primarily mediate changes in food-induced sickness and OC responses, likely to associate with food avoidance.
Neff KJ, Baud G, Raverdy V, et al., 2016, Renal Function and Remission of Hypertension After Bariatric Surgery: a 5-Year Prospective Cohort Study, Obesity Surgery, ISSN: 1708-0428
PURPOSE: This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) on renal function for at least 5 years post-operatively in a tertiary referral center for bariatric surgery. MATERIALS AND METHODS: This prospective cohort study of patients undergoing RYGB and LAGB measured renal function, blood pressure, and diabetes status pre-operatively and then 1 and 5 years post-operatively. Renal function was assessed using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault formulae. Hypertension and diabetes were defined by the European Society of Hypertension and European Society of Cardiology joint guidelines and American Diabetes Association guidelines, respectively. A sub-group who had completed 10 years post-operative follow-up was also included. RESULTS: Estimated glomerular filtration rate (eGFR) increased over 5 years after RYGB (N = 190; 94 ± 2 mL/min/1.73 m(2) to 102 ± 22 mL/min/1.73 m(2), p = 0.01) and LAGB (N = 271; 88 ± 1 to 93 ± 22 mL/min/1.73 m(2), p = 0.02). In a sub-group with up to 10 years post-operative date, this trend was maintained. In patients with renal impairment, eGFR improved over 5 years (52 ± 2 to 68 ± 7 mL/min/1.73 m(2), p = 0.01). Remission of hypertension was greater after RYGB than LAGB at 1 year (32 vs. 16 %, p = 0.008) and at 5 years post-operatively (23 vs. 11 %, p = 0.02). CONCLUSIONS: Bariatric surgery stabilizes eGFR post-operatively for at least 5 years. In a sub-group with renal impairment, eGFR is increased in the first post-operative year and this is maintained for up to 5 year
Maghsoodi N, Alaghband-Zadeh J, Cross G, et al., 2016, ANNALS EXPRESS: Elevated Fasting & Post-prandial C-Terminal Telopeptide (CTX) after Roux-en-Y gastric bypass (RYGB), Annals of Clinical Biochemistry, ISSN: 0004-5632
BACKGROUND: Roux-en-Y gastric bypass (RYGB) increases circulating Bile Acids (BAs) concentrations, known mediators of post-prandial suppression of markers of bone resorption. Long-term data however indicate that RYGB confers an increased risk of bone loss on recipients. METHODS: Thirty six obese individuals, median age 44 (26-64) with median BMI at baseline of 42.5 (40.4 - 46) were studied before and 15 months after RYGB. After an overnight fast, patients received a 400 Kcal mixed meal. Blood samples were collected pre-meal then at 30 minute periods for 120 mins. Pre and post-meal samples were analysed for total BAs, Parathyroid Hormone (PTH) and C-terminal Telopeptide (CTX). RESULTS: Body weight loss post-RYGB was associated with a median 4.9-fold increase in peak post-prandial total BA concentration and a median 2.4-fold increase in cumulative food evoked BA response. Median fasting PTH, post-prandial reduction in PTH and total PTH release over 120 minutes remained unchanged after surgery. After surgery, median fasting CTX increased 2.3 fold, peak post-prandial levels increased 3.8 fold and total release was increased 1.9-fold CONCLUSIONS: : Fasting and postprandial total BAs and CTX are increased above normal range after RYGB. These changes occur in spite of improved Vitamin D status with supplementation. These results suggest that post-RYGB increases in total BAs do not effectively oppose an ongoing resorptive signal operative along the gut-bone axis. Serial measurement of CTX may be of value as a risk marker for long-term skeletal pathology in patients post-RYGB.
Neff KJ, Elliott JA, Corteville C, et al., 2016, Effect of Roux-en-Y gastric bypass and diet-induced weight loss on diabetic kidney disease in the Zucker diabetic fatty rat., Surgery for Obesity and Related Diseases, ISSN: 1878-7533
BACKGROUND: Reductions in urinary protein excretion after Roux-en-Y gastric bypass (RYGB) surgery in patients with diabetic kidney disease have been reported in multiple studies. OBJECTIVES: To determine the weight loss dependence of the effect of RYGB on urinary protein excretion by comparing renal outcomes in Zucker diabetic fatty rats undergoing either gastric bypass surgery or a sham operation with or without weight matching. SETTING: University laboratories. METHODS: Zucker diabetic fatty rats underwent surgery at 18 weeks of age. A subgroup of sham operated rats were weight matched to RYGB operated rats by restricting food intake. Urinary protein excretion was assessed at baseline and at postoperative weeks 4 and 12. Renal histology and macrophage-associated inflammation were assessed at postoperative week 12. RESULTS: Progressive urinary protein excretion was attenuated by both RYGB and diet-induced weight loss, albeit to a lesser extent by the latter. Both weight loss interventions produced equivalent reductions in glomerulomegaly, glomerulosclerosis, and evidence of renal macrophage infiltration. CONCLUSION: Weight loss per se improves renal structure and attenuates renal inflammatory responses in an experimental animal model of diabetic kidney disease. Better glycemic control post-RYGB may in part explain the greater reductions in urinary protein excretion after gastric bypass surgery.
Melvin A, le Roux CW, Docherty NG, 2016, The Gut as an Endocrine Organ: Role in the Regulation of Food Intake and Body Weight., Current Atherosclerosis Reports, Vol: 18, ISSN: 1534-6242
Obesity and its related complications remain a major threat to public health. Efforts to reduce the prevalence of obesity are of paramount importance in improving population health. Through these efforts, our appreciation of the role of gut-derived hormones in the management of body weight has evolved and manipulation of this system serves as the basis for our most effective obesity interventions. PURPOSE OF THE REVIEW: We review current understanding of the enteroendocrine regulation of food intake and body weight, focusing on therapies that have successfully embraced the physiology of this system to enable weight loss. RECENT FINDINGS: In addition to the role of gut hormones in the regulation of energy homeostasis, our understanding of the potential influence of enteroendocrine peptides in food reward pathways is evolving. So too is the role of gut derived hormones on energy expenditure. Gut-derived hormones have the ability to alter feeding behavior. Certain obesity therapies already manipulate this system; however, our evolving understanding of the effects of enteroendocrine signals on hedonic aspects of feeding and energy expenditure may be crucial in identifying future obesity therapies.
Elliott JA, le Roux CW, 2016, Type 2 diabetes with BMI <30 kg/m<SUP>2</SUP>: Can we predict success of metabolic surgery?, SURGERY FOR OBESITY AND RELATED DISEASES, Vol: 12, Pages: 1363-1365, ISSN: 1550-7289
Bächler T, le Roux CW, Bueter M, 2016, How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?, Clinical and Experimental Gastroenterology, Vol: 2016, Pages: 181-189, ISSN: 1178-7023
Bariatric surgery is currently the most effective option for the treatment of morbid obesity and its associated comorbidities. Recent clinical and experimental findings have challenged the role of mechanical restriction and caloric malabsorption as the main mechanisms for weight loss and health benefits. Instead, other mechanisms including increased levels of satiety gut hormones, altered gut microbiota, changes in bile acid metabolism, and/or energy expenditure have been proposed as explanations for benefits of bariatric surgery. Beside the standard proximal Roux-en-Y gastric bypass and the biliopancreatic diversion with or without duodenal switch, where parts of the small intestine are excluded from contact with nutrients, resectional techniques like the sleeve gastrectomy (SG) have recently been added to the armory of bariatric surgeons. The variation of weight loss and glycemic control is vast between but also within different bariatric operations. We surveyed members of the Swiss Society for the Study of Morbid Obesity and Metabolic Disorders to assess the extent to which the phenotype of patients influences the choice of bariatric procedure. Swiss bariatric surgeons preferred Roux-en-Y gastric bypass and SG for patients with type 2 diabetes mellitus and patients with a body mass index >50 kg/m(2), which is consistent with the literature. An SG was preferred in patients with a high anesthetic risk or previous laparotomy. The surgeons' own experience was a major determinant as there is little evidence in the literature for this approach. Although trends will come and go, evidence-based medicine requires a rigorous examination of the proof to inform clinical practice.
Cohen RV, Shikora S, Petry T, et al., 2016, The Diabetes Surgery Summit II Guidelines: a Disease-Based Clinical Recommendation., Obesity Surgery, Vol: 26, Pages: 1989-1991, ISSN: 1708-0428
There is mounting evidence, derived from mechanistic studies, RCTs, and other high-quality studies that there are weight loss independent antidiabetic effects of gastrointestinal surgery. Additionally, there appears to be no relation between the positive metabolic outcomes to baseline BMI. The outdated US National Health Institutes guidelines from 1991 were centered on BMI only criterion and often misleading. The Second Diabetes Surgery Summit held in collaboration with leading diabetes organizations and endorsed by a large group of international Professional Societies developed guidelines that defined eligibility based on the severity and degree of T2D medical control while referring to obesity as a qualifier and not the sole criterion. That is the first time that guidelines are provided to put metabolic surgery into the T2D treatment algorithms.
Mathes CM, Letourneau C, Blonde GD, et al., 2016, Roux-en-Y gastric bypass in rats progressively decreases the proportion of fat calories selected from a palatable cafeteria diet, American Journal of Physiology-Regulatory Integrative and Comparative Physiology, Vol: 310, Pages: R952-R959, ISSN: 1522-1490
Roux-en-Y gastric bypass surgery (RYGB) decreases caloric intake in both human patients and rodent models. In long-term intake tests, rats decrease their preference for fat and/or sugar after RYGB, and patients may have similar changes in food selection. Here we evaluated the impact of RYGB on intake during a “cafeteria”-style presentation of foods to assess if rats would lower the percentage of calories taken from fat and/or sugar after RYGB in a more complex dietary context. Male Sprague-Dawley rats that underwent either RYGB or sham surgery (Sham) were presurgically and postsurgically given 8-days free access to four semisolid foods representative of different fat and sugar levels along with standard chow and water. Compared with Sham rats, RYGB rats took proportionally fewer calories from fat and more calories from carbohydrates; the latter was not attributable to an increase in sugar intake. The proportion of calories taken from protein after RYGB also increased slightly. Importantly, these postsurgical macronutrient caloric intake changes in the RYGB rats were progressive, making it unlikely that the surgery had an immediate impact on the hedonic evaluation of the foods and strongly suggesting that learning is influencing the food choices. Indeed, despite these dietary shifts, RYGB, as well as Sham, rats continued to select the majority of their calories from the high-fat/high-sugar option. Apparently after RYGB, rats can progressively regulate their intake and selection of complex foods to achieve a seemingly healthier macronutrient dietary composition.
Hansen TT, Jakobsen TA, Nielsen MS, et al., 2016, Hedonic Changes in Food Choices Following Roux-en-Y Gastric Bypass, Obesity Surgery, Vol: 26, Pages: 1946-1955, ISSN: 1708-0428
It has been suggested that a shift in food choices leading to a diet with a lower energy density plays an important role in successful weight loss after Roux-en-Y gastric bypass (RYGB) surgery. A decreased hedonic drive to consume highly palatable foods may explain these changes in eating behavior. Here, we review the literature examining postoperative changes in mechanisms contributing to hedonic drive (food preferences, reinforcing value of food, dopamine signaling, and activity reward-related brain regions). The majority of studies reviewed support that RYGB decrease the hedonic drive to consume highly palatable foods. Still, in order to fully understand the complexity of these changes, we need studies combining sociological and psychological approaches with objective measures of actual food choices examining different measures of hedonic drive.
Welbourn R, le Roux CW, Owen-Smith A, et al., 2016, Why the NHS should do more bariatric surgery; how much should we do?, BMJ, Vol: 353, ISSN: 0959-8138
Jung J, Ha TK, Lee J, et al., 2016, Changes in one-carbon metabolism after duodenal-jejunal bypass surgery, AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM, Vol: 310, Pages: E624-E632, ISSN: 0193-1849
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Melvin A, Le Roux CW, Docherty NG, 2016, Which Organ is Responsible for the Pathogenesis of Obesity?, Ir Med J, Vol: 109, ISSN: 0332-3102
Obesity is associated with significant complications and healthcare costs, but our ability to treat obesity has been limited by our understanding of its pathogenesis. We surveyed diabetologists and obesity related health care professionals asking them which organ they believed to be responsible for the pathogenesis of obesity. Participants favoured a central nervous system (CNS) aetiology. The response echoes evidence from genome wide association studies identifying a link between obesity and CNS loci. Our most successful obesity therapies involve the manipulation of subcortical area of the brain involved in energy balance. Future success in the management of obesity will be determined by our ability to define the pathogenesis of the disease in individual cases, moving from a one-size-fits-all, to more focused interventions.
Nair M, le Roux CW, Docherty NG, 2016, Measuring changes in renal function after bariatric surgery: Why estimated glomerular filtration rate is not good enough, SURGERY FOR OBESITY AND RELATED DISEASES, Vol: 12, Pages: 1897-1898, ISSN: 1550-7289
Pournaras DJ, Nygren J, Hagstrom-Toft E, et al., 2016, Improved glucose metabolism after gastric bypass: evolution of the paradigm, SURGERY FOR OBESITY AND RELATED DISEASES, Vol: 12, Pages: 1457-1465, ISSN: 1550-7289
Neff KJ, le Roux CW, 2016, Bariatric surgery: traversing the CROSSROADS into mainstream diabetes care, Diabetologia, Vol: 59, Pages: 942-944, ISSN: 1432-0428
Mossberg KE, Pournaras DJ, Welbourn R, et al., 2016, Differential response of plasma plasminogen activator inhibitor 1 after weight loss surgery in patients with or without type 2 diabetes, SURGERY FOR OBESITY AND RELATED DISEASES, Vol: 13, Pages: 53-57, ISSN: 1550-7289
de Jonge C, Rensen SS, Verdam FJ, et al., 2016, Impact of Duodenal-Jejunal Exclusion on Satiety Hormones, Obesity Surgery, Vol: 26, Pages: 672-678, ISSN: 1708-0428
Objective Bariatric procedures that exclude the proximalsmall intestine lead to significant weight loss which is probablymediated by changes in hormones that alter appetite, suchas peptide YY (PYY), ghrelin, cholecystokinin (CCK), andleptin. Here, the effect of the non-surgical duodenal-jejunalbypass liner (DJBL) on concentrations of hormones implicatedin appetite control was investigated.Subjects A two-center prospective study was conducted betweenJanuary and December 2010. Seventeen obese subjectswith type 2 diabetes were treated with the DJBL for 24 weeks.Fasting concentrations of leptin and meal responses of plasmaPYY, CCK, and ghrelin were determined prior to and afterimplantation of the DJBL.Results At baseline, subjects had an average body weight of116.0±5.8 kg. One week after implantation, subjects had lost4.3±0.6 kg (p<0.01), which progressed to 12.7±1.3 kg atweek 24 (p<0.01). Postprandial concentrations of PYY andghrelin increased (baseline vs. week 1 vs. week 24 PYY: 2.6±0.2 vs. 4.1±0.4 vs. 4.1±0.7 nmol/L/min and ghrelin: 7.8±1.8vs. 11.0±1.8 vs. 10.6±1.8 ng/mL/min, all p<0.05). In parallel,the CCK response decreased (baseline vs. week 1 vs. week24: 434±51 vs. 229±52 vs. 256±51pmol/L/min, p<0.01).Fasting leptin concentrations also decreased (baseline vs.week 24: 98±17 vs. 53±10 ng/mL, p<0.01).Conclusions DJBL treatment induces weight loss paralleledby changes in concentrations of hormones involved in appetitecontrol.
Wilding JPH, Overgaard RV, Jacobsen LV, et al., 2016, Exposure-response analyses of liraglutide 3.0 mg for weight management, Diabetes Obesity & Metabolism, Vol: 18, Pages: 491-499, ISSN: 1463-1326
Welbourn R, Dixon J, Barth JH, et al., 2016, NICE-Accredited Commissioning Guidance for Weight Assessment and Management Clinics: a Model for a Specialist Multidisciplinary Team Approach for People with Severe Obesity, OBESITY SURGERY, Vol: 26, Pages: 649-659, ISSN: 0960-8923
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Dutia R, Embrey M, O'Brien S, et al., 2016, Temporal changes in bile acid levels and 12α-hydroxylation after Roux-en-Y gastric bypass surgery in type 2 diabetes (vol 39, pg 806, 2015), INTERNATIONAL JOURNAL OF OBESITY, Vol: 40, Pages: 554-554, ISSN: 0307-0565
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Docherty NG, le Roux CW, 2016, Reconfiguration of the small intestine and diabetes remitting effects of Roux-en-Y gastric bypass surgery, CURRENT OPINION IN GASTROENTEROLOGY, Vol: 32, Pages: 61-66, ISSN: 0267-1379
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