| 1. |
- Docherty, Neil G., et al.
(författare)
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Urinary sodium excretion after gastric bypass surgery
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 13:9, s. 1506-1514
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gut-kidney signaling is implicated in sodium homeostasis and thus blood pressure regulation. Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity confers a pronounced and long-lasting blood pressure lowering effect in addition to significant weight loss. Objectives: We set out to establish whether RYGB is associated with an intrinsic change in urinary sodium excretion that may contribute to the reported blood pressure lowering effects of the procedure. Methods: Five female patients (age range: 28-50 yr) without metabolic or hypertensive co-morbidities were included in a study involving four 24-hour residential visits: once before surgery and 10 days, 3 months, and 20 months after surgery. Creatinine and sodium were measured in fasting plasma samples and 24-hour urine samples and creatinine clearance, estimated glomerular filtration rate, and indices of urinary sodium excretion were calculated. Fasting and 60-minute postprandial blood samples from each study day were assayed for pro-B-type natriuretic peptide (NT-proBNP). Results: Increases in weight-normalized urinary sodium excretion of up to 2.3-fold in magnitude occurred at 20 months after surgery. Median fractional excretion of sodium at 20 months was double that seen before surgery. Fasting NT-proBNP levels were stable or increased (1.5- to 5-fold). Moreover, a small postprandial increase in NT-proBNP was observed after surgery. Conclusions: Renal fractional excretion of sodium is increased after RYGB. A shift toward increased postoperative basal and meal associated levels of NT-proBNP coincides with increased urinary sodium excretion. The data support a working hypothesis that an enhanced natriuretic gut kidney signal after RYGB may be of mechanistic importance in the blood pressure lowering effects of this procedure. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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| 2. |
- Docherty, N. G., et al.
(författare)
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Weight Loss Interventions and Progression of Diabetic Kidney Disease
- 2015
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Ingår i: Current Diabetes Reports. - : Springer Science and Business Media LLC. - 1534-4827 .- 1539-0829. ; 15:8
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Tidskriftsartikel (refereegranskat)abstract
- Progressive renal impairment (diabetic kidney disease (DKD)) occurs in upwards of 40 % of patients with obesity and type 2 diabetes mellitus (T2DM) and is a cause of significant morbidity and mortality. Means of attenuating the progression of DKD focus on amelioration of risk factors. Visceral obesity is implicated as a causative agent in impaired metabolic and cardiovascular control in T2DM, and various approaches primarily targeting weight have been examined for their impact on markers of renal injury and dysfunction in DKD. The current report summarises the evidence base for the impact of surgical, lifestyle and pharmacological approaches to weight loss on renal end points in DKD. The potential for a threshold of weight loss more readily achievable by surgical intervention to be a prerequisite for renal improvement is highlighted. Comparing efficacious nonsurgical weight loss strategies with surgical strategies in appropriately powered and controlled prospective studies is a priority for the field.
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| 3. |
- Wallenius, Ville, 1970, et al.
(författare)
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Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus
- 2018
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:6, s. 1461-1472
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Tidskriftsartikel (refereegranskat)abstract
- Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG. Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery. Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline-8.1 +/- 0.6 vs. 8.2 +/- 0.4 mmol/l, 2 days-7.8 +/- 0.5 vs. 7.4 +/- 0.3 mmol/l, 3 weeks-6.6 +/- 0.4 vs. 6.6 +/- 0.3 mmol/l, respectively, P < 0.01 vs. baseline for both groups; 12 months-6.6 +/- 0.4 vs. 5.9 +/- 0.4, respectively, P < 0.05 for LRYGB and P < 0.001 for LSG vs. baseline, P = ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean +/- SEM; LSG + 58 +/- 14%, P < 0.01; LRYGB - 8 +/- 17%, P = ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525 +/- 1258 vs. 4779 +/- 712 pmol x min, respectively, P < 0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (- 10.1 +/- 0.9 vs. - 7.9 +/- 0.5 kg/m(2), respectively, P < 0.05). LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.
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| 4. |
- Arora, Tulika, et al.
(författare)
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Roux-en-Y Gastric Bypass Surgery Induces Early Plasma Metabolomic and Lipidomic Alterations in Humans Associated with Diabetes Remission
- 2015
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5
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Tidskriftsartikel (refereegranskat)abstract
- Roux-en-Y gastric bypass (RYGB) is an effective method to attain sustained weight loss and diabetes remission. We aimed to elucidate early changes in the plasma metabolome and lipidome after RYGB. Plasma samples from 16 insulin-resistant morbidly obese subjects, of whom 14 had diabetes, were subjected to global metabolomics and lipidomics analysis at pre-surgery and 4 and 42 days after RYGB. Metabolites and lipid species were compared between time points and between subjects who were in remission and not in remission from diabetes 2 years after surgery. We found that the variables that were most discriminatory between time points were decanoic acid and octanoic acid, which were elevated 42 days after surgery, and sphingomyelins (18:1/21:0 and 18:1/23:3), which were at their lowest level 42 days after surgery. Insulin levels were lower at 4 and 42 days after surgery compared with pre-surgery levels. At 4 days after surgery, insulin levels correlated positively with metabolites of branched chain and aromatic amino acid metabolism and negatively with triglycerides with long-chain fatty acids. Of the 14 subjects with diabetes prior to surgery, 7 were in remission 2 years after surgery. The subjects in remission displayed higher pre-surgery levels of tricarboxylic acid cycle intermediates and triglycerides with long-chain fatty acids compared with subjects not in remission. Thus, metabolic alterations are induced soon after surgery and subjects with diabetes remission differ in the metabolic profiles at pre- and early post-surgery time points compared to patients not in remission.
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| 5. |
- Elliott, J. A., et al.
(författare)
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Gut Hormone Suppression Increases Food Intake After Esophagectomy With Gastric Conduit Reconstruction
- 2015
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Ingår i: Annals of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0003-4932. ; 262:5, s. 824-830
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To characterize the gut hormone profile and determine the effect of satiety gut hormone blockade on food intake in disease-free postesophagectomy patients.Background:Improved oncologic outcomes for esophageal cancer have resulted in increased survivorship and a focus on health-related quality of life. Anorexia and early satiety are common, but putative causative factors, in particular the gut-brain hormonal axis, have not been systematically studied.Methods:In a double-blind, placebo-controlled, randomized crossover study, disease-free patients at least 1 year postresection and gastric conduit reconstruction received either 1mL 0.9% saline or 1mL (100g) octreotide acetate subcutaneously followed by a standardized ad libitum meal on each of two assessments. Fasting and postprandial plasma glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and ghrelin immunoreactivity were measured. Gut hormone responses and calorie intake postsaline versus octreotide were compared between experimental and control groups.Results:Eighteen subjects [esophagectomy (ES), n=10, 2.40.75 years postresection; and unoperated control subjects, n=8] were studied. ES demonstrated significant weight loss at 3, 6, 12, and 24 months postoperatively (all P<0.05). Ghrelin levels were similar (P=0.58) for both groups, but postprandial GLP-1 and PYY responses were significantly (P<0.001) greater among ES as compared with controls. After octreotide, ad libitum calorie intake increased among ES (1.5 +/- 0.2 fold-change, P=0.02) but not controls (1.1 +/- 0.1 fold-change, P=0.30).Conclusions:ES demonstrated an exaggerated postprandial satiety gut hormone response that was attenuated by octreotide, thus identifying a potential therapeutic target to modulate in the ES patient with early satiety.
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| 6. |
- Mathes, C. M., et al.
(författare)
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Roux-en-Y gastric bypass in rats progressively decreases the proportion of fat calories selected from a palatable cafeteria diet
- 2016
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Ingår i: American Journal of Physiology-Regulatory Integrative and Comparative Physiology. - : American Physiological Society. - 0363-6119 .- 1522-1490. ; 310:10
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 7. |
- Abdelhafez, A. H. K., et al.
(författare)
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Impact of Abdominal Subcutaneous Fat Reduction on Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus
- 2018
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Ingår i: Bariatric Surgical Practice and Patient Care. - : Mary Ann Liebert Inc. - 2168-023X .- 2168-0248. ; 13:1, s. 25-32
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Tidskriftsartikel (refereegranskat)abstract
- Background: The effect on type 2 diabetes mellitus (T2DM) when adipose tissue is removed is controversial. This study aimed to evaluate and compare the effect of the abdominoplasty and bariatric surgery on glycemic control in patients with T2DM. Methods: Patients with T2DM undergoing abdominoplasty for cosmesis were studied (n=25). Subjects were 36.91.3 years with a preoperative body mass index (BMI) of 40.60.5kg/m(2) and mean glycated hemoglobin (HbA1c) of 7.4%+/- 0.2%. Fifteen matched patients undergoing bariatric surgery were selected as a comparator group. Weight, BMI, waist circumference (WC), random blood glucose (RBG), and HbA1c were evaluated at baseline and 3, 6, and 12 months postsurgery. Results: By 12 months, abdominoplasty reduced weight by 5.6 +/- 0.3kg p<0.01), and HbA1c was reduced to 6.8%+/- 0.3% (p<0.01). After 12 months, bariatric surgery reduced BMI from 42.2 +/- 1kg/m(2) to 26.6 +/- 0.4kg/m(2) (p<0.01). HbA1c reduced from 7.9%+/- 0.4% to 5.5%+/- 0.2% (p<0.01). WC was similar between both groups at 3 months, although HbA1c reductions were superior after bariatric surgery. Conclusions: Reducing subcutaneous adipose tissue with abdominoplasty results in a small improvement in glycemic control in patients with T2DM. Despite equivalent WC at 3 months, bariatric surgery outperformed abdominoplasty on all metabolic parameters then and thereafter.
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| 8. |
- Arora, Tulika, et al.
(författare)
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Diabetes-associated microbiota in fa/fa rats is modified by Roux-en-Y gastric bypass
- 2017
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Ingår i: Isme Journal. - : Springer Science and Business Media LLC. - 1751-7362 .- 1751-7370. ; 11:9, s. 2035-2046
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Tidskriftsartikel (refereegranskat)abstract
- Roux-en-Y gastric bypass (RYGB) and duodenal jejunal bypass (DJB), two different forms of bariatric surgery, are associated with improved glucose tolerance, but it is not clear whether the gut microbiota contributes to this effect. Here we used fa/fa rats as a model of impaired glucose tolerance to investigate whether (i) the microbiota varies between fa/fa and nondiabetic fa/+ rats; (ii) the microbiota of fa/fa rats is affected by RYGB and/or DJB; and (iii) surgically induced microbiota alterations contribute to glucose metabolism. We observed a profound expansion of Firmicutes (specifically, Lactobacillus animalis and Lactobacillus reuteri) in the small intestine of diabetic fa/fa compared with nondiabetic fa/+ rats. RYGB-, but not DJB-, treated fa/fa rats exhibited greater microbiota diversity in the ileum and lower L. animalis and L. reuteri abundance compared with shamoperated fa/fa rats in all intestinal segments, and their microbiota composition resembled that of unoperated fa/+ rats. To investigate the functional role of RYGB-associated microbiota alterations, we transferred microbiota from sham-and RYGB-treated fa/fa rats to germ-free mice. The metabolic phenotype of RYGB-treated rats was not transferred by the transplant of ileal microbiota. In contrast, postprandial peak glucose levels were lower in mice that received cecal microbiota from RYGBversus sham-operated rats. Thus, diabetes-associated microbiota alterations in fa/fa rats can be modified by RYGB, and modifications in the cecal microbiota may partially contribute to improved glucose tolerance after RYGB.
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| 9. |
- Pournaras, D. J., et al.
(författare)
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Improved glucose metabolism after gastric bypass: evolution of the paradigm
- 2016
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 12:8, s. 1457-1465
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Tidskriftsartikel (refereegranskat)abstract
- Background: Glucose metabolism is improved in patients with type 2 diabetes after Roux-en-Y gastric bypass (RYGB). Objectives: To quantify the relative contribution of calorie restriction, rerouting of nutrients, and adipose tissue reduction. Methods: Fifteen diabetic patients, (47 +/- 9 yr, body mass index 41.3 +/- 4.2 kg/m(2)) were randomized to a 2-week very low-calorie diet (VLCD) regimen or normal diet before RYGB. A euglycemic-hyperinsulinemic clamp, indirect calorimetry, and a standard meal test were performed prediet, postdiet (preoperatively), and 2 weeks and 12 months postoperatively. The primary outcome was whole-body insulin sensitivity (M) measured with the clamp 2 weeks postoperatively. Results: In the VLCD group, after 2 weeks of calorie restriction, M improved (2.9 +/- 1.3 to 4.2 +/- 1.1 mg/kg/min, P = .005) with no further change at 2 weeks postoperatively. In the normal diet group 2 weeks postoperatively, M was similar to the VLCD group (4.7 +/- 1.7 versus 4.2 +/- 1.1, P = .61). One year postoperatively, M improved further in both groups. The improvement in insulin-stimulated glucose uptake after VLCD and RYGB was entirely accounted for by nonoxidative glucose disposal (NOGD), whereas weight loss at 1 year postoperatively was associated with an increase in NOGD and glucose oxidation. Postprandial glucose improved after VLCD (P < .05) and even more 2 weeks after RYGB (P < .05) with no further change after 1 year. Conclusion: Improved whole-body insulin sensitivity and postprandial glucose response occur early after RYGB. Low calorie intake and rerouting of nutrients contribute through distinct mechanisms. Weight loss contributes by increasing whole-body insulin sensitivity, including glucose oxidation and NOGD. These data suggest that the combination of different mechanisms is what makes RYGB an effective intervention for type 2 diabetes. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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| 10. |
- le Roux, Carel W., et al.
(författare)
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Bariatric Surgery : There Is a Room for Improvement to Reduce Mortality in Patients with Type 2 Diabetes
- 2021
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428.
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Tidskriftsartikel (refereegranskat)abstract
- The new Scandinavian Obesity Surgery Registry (SOReg) report may influence current guidelines. Patients without type 2 diabetes (T2DM) prior to bariatric surgery had lower mortality over 6.3 years compared to those with T2DM. Moreover, patients with T2DM who achieved remission within 1 year after surgery had lower mortality than those who did not remit. Finally, there was no threshold at 10 years, but rather a linear relationship between duration of T2DM and glycemic remission. The SOReg report challenges existing recommendations and clinical practice. A case may also be made for patients with T2DM who did not achieve glycemic remission after 1 year to have a combination approach of surgery with medicines rather than surgery alone. Ultimately, the impact of T2DM duration on glycemic remission again suggest that patients with T2DM should have bariatric surgery earlier.
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