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Impact of Laparoscopic Sleeve Gastrectomy on Gut Permeability in Morbidly Obese Subjects

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A Correction to this article was published on 29 April 2021

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Abstract

Background

Recent studies have suggested that obesity is associated with an increased intestinal permeability as well as an altered microbiota profile. These conditions can promote the translocation of lipopolysaccharide into the circulation and, subsequently, contribute to the observed systemic inflammation. Our aim was to assess gut permeability in patients with obesity compared to non-obese subjects as well as after excessive weight loss following laparoscopic sleeve gastrectomy (LSG).

Methods

We analyzed the dietary intake, metabolic and inflammatory markers, gut permeability (four-probe sugar test), and microbiota composition in 17 morbidly obese patients before and after LSG as well as in 17 age- and gender-matched non-obese subjects. Additionally, we compared gut permeability and inflammatory markers in patients of different stages of obesity.

Results

Patients with obesity showed elevated levels of C-reactive protein and lipopolysaccharide-binding protein as compared to non-obese subjects, but no differences were noted for gut permeability between these two groups. LSG led to improvements in metabolic and inflammatory parameters in the obese patients. Moreover, gastroduodenal as well as small intestinal permeability decreased, whereas colonic permeability increased after surgery. Regarding gut microbiota, differences were noted for main phyla and alpha-diversity between non-obese and obese subjects. After surgery, the composition of the microbiota showed a tendency toward the pattern of the non-obese group.

Conclusions

Gut permeability is not dependent on body mass index, whereas weight loss after LSG initiates distinct changes in gastroduodenal, intestinal, and colonic permeability. These changes do not seem to be associated with changes in the microbiota composition.

Clinical Trial Registry Number and Website

The trials were registered at https://www.drks.de/drks_web/ with the number DRKS00009008 and DRKS00006210.

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Acknowledgments

We highly acknowledge Prof. Dr. Thomas Hüttl, Dr. Peter Stauch, Dr. Otto Dietl, and Hildegard Wood together with their whole team at the Adipositas Zentrum München Bogenhausen; Dr. Georg Dechantsreiter and team at the Krankenhaus Landshut Achdorf; and Dr. Andreas Limberger and team at the Kreiskrankenhaus Schrobenhausen for their support in recruitment and sample collection. Additionally, we are thankful to Martina Werich for the analysis of sugars in the urine samples. We are grateful to Manuela Hubersberger for her excellent technical assistance and to the ZIEL Core Facility Microbiome/NGS at the TU Munich for support with high-throughput 16S rRNA gene amplicon sequencing and analysis.

Funding

The study was founded by the DFG (Deutsche Forschungsgemeinschaft) as part of the Graduiertenkolleg 1482 as well as by the BMBF (Federal Ministry of Education and Research, grant no. 0315674) and in part by the Else Kröner-Fresenius-Foundation, Bad Homburg v. d. H., Germany.

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Authors and Affiliations

  1. Else Kröner-Fresenius-Center of Nutritional Medicine, Technical University of Munich, Freising, Germany

    Teresa Kellerer, Hans Hauner & Thomas Skurk

  2. ZIEL Institute for Food and Health, Core Facility Human Studies, Technical University of Munich, Freising, Germany

    Beate Brandl & Thomas Skurk

  3. Charité-Universitätsmedizin Berlin, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany

    Janine Büttner

  4. ZIEL Institute for Food and Health, Core Facility Microbiome/NGS, Technical University of Munich, Freising, Germany

    Ilias Lagkouvardos

  5. Institute of Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Hans Hauner

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Correspondence to Thomas Skurk.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Supplemental Figure 1

Multidimensional scaling (MDS) plot of phylogenetic distances (β-diversity). Non-obese: non-obese group, n = 17; PPI V1: obese patients with PPI medication before surgery, n = 5; no PPI V1: obese patients without PPI medication before surgery, n = 12; PPI V2: obese patients with PPI medication 6 months after surgery, n = 7; no PPI V2: obese patients without PPI medication 6 months after surgery, n = 10. (PNG 356 kb)

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Kellerer, T., Brandl, B., Büttner, J. et al. Impact of Laparoscopic Sleeve Gastrectomy on Gut Permeability in Morbidly Obese Subjects. OBES SURG 29, 2132–2143 (2019). https://doi.org/10.1007/s11695-019-03815-6

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