Effects of Two Variants of Roux-en-Y Gastric Bypass on Metabolism Behaviour: Focus on Plasma Ghrelin Concentrations Over a 2-Year Follow-up
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To study the effects of two variants of Roux-en-Y gastric bypass (RYGBP) on plasma ghrelin concentrations according to different exposure of gastric fundus to the nutrient pathway.
A prospective longitudinal 2-year follow-up study was conducted. Ninety-six morbidly obese (MO) patients (age range: 41.6 ± 9.6 years, body mass index: 53 ± 9.5 kg/m2) were assigned to two bariatric surgical (BS) procedures: one that preserves food contact with gastric fundus (ringed RYGBP, n = 50) and the other that avoids it (modified RYGBP, n = 46). Different anthropometric and biochemical parameters were studied, focusing on ghrelin concentrations at baseline and 6, 12, and 24 months post-BS.
At 24 months post-BS, all metabolic parameters studied had improved in all patients compared with those at 1-year follow-up and baseline (p < 0.05). However, high-density lipoprotein cholesterol concentrations took 2 years to normalise in 80% of patients, interleukin-6 decreased significantly in relation to baseline only after 2 years from BS (p < 0.001), and tumour necrosis factor alpha concentrations did not significantly decrease during the 2 years of follow-up. Plasma ghrelin concentrations increased in both surgical groups compare to baseline during the first year (24.6% in modified RYGBP and 36.62% in ringed RYGBP) and remained stable at the second year of follow-up, with no statistical differences between groups.
In the second year of follow-up after BS, morbidity continued to improve in MO patients despite a lesser weight loss in relation to the first year. An increase in plasma ghrelin concentrations was found, regardless of nutrient contact with gastric fundus. Furthermore, changes in plasma ghrelin concentrations appeared to be independent of weight loss.
- Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risks factors. JAMA. 2003;289:76–9. CrossRef
- Kral JG. Morbidity of severe obesity. Surg Clin North Am. 2001;81:1039–61. CrossRef
- Sowers JR. Obesity as a cardiovascular risk factor. Am J Med. 2003;115:37s–41s. CrossRef
- Gastrointestinal surgery for severe obesity. NIH consensus development conference, March 25–27, 1991. Nutrition 1996:12:397–404.
- Stubbs RS, Wickremesekera SK. Insulin resistance in the severely obese and links with metabolic co-morbidities. Obes Surg. 2002;12:343–8. CrossRef
- Pories WJ. Why does the gastric bypass control type 2 diabetes mellitus? Obes Surg. 1992;2:303–11. CrossRef
- Schauer PR, Ikramuddin S, Gourash W. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29. CrossRef
- Unger RH, Eisentraut AM. Entero-insular axis. Arch Intern Med. 1969;123:261–6. CrossRef
- Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60. CrossRef
- Gnanapavan S, Kola B, Bustin SA, et al. The tissue distribution of the mRNA of ghrelin and subtypes of its receptor, GHS-R, in humans. J Clin Endocrinol Metab. 2002;87:2988–91. CrossRef
- Papotti M, Ghè C, Cassoni P, et al. Growth hormone secretagogue binding sites in peripheral human tissues. J Clin Endocrinol Metab. 2000;85:3803–07. CrossRef
- Wren AM, Seal LJ, Cohen MA, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:599–02. CrossRef
- Berthoud HR. Vagal and hormonal gut-brain communication: from satiation to satisfaction. Neurogastroenterol Motil. 2008;20(Suppl 1):64–72. CrossRef
- Date Y, Kojima M, Hosoda H, et al. Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans. Endocrinology. 2000;141:4255–61. CrossRef
- Arisayu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–8. CrossRef
- Wu JT, Kral JG. Ghrelin. Integrative neuroendocrine peptide in health and disease. Ann Surg. 2004;239(4):464–74. CrossRef
- Faraj M, Lu HL, Cianflone K. Diabetes, lipids and adipocyte secretagogues. Biochem Cell Biol. 2004;82:170–9. CrossRef
- Vendrell J, Broch M, Vilarrasa N, et al. Resistin, adiponectin, ghrelin, leptin and proinflammatory cytokines: relationships in obesity. Obes Res. 2004;12:962–71. CrossRef
- Ballantyne G, Gumbs A, Modlin I. Changes in insulin resistance following bariatric surgery and the asipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg. 2005;15:692–9. CrossRef
- Lyon CJ, Law RE, Hsuch WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology. 2003;144:195–200. CrossRef
- Serra A, Granada ML, Romero R, et al. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Clinical Nutricion. 2006;25:400–8. CrossRef
- NIH Consensus Development Conference Draft Statement on Gastrointestinal Surgery for Sever Obesity. Obs Surg 1991; 1:257–65.
- SEEDO. Consensus 2000 para la evaluación del sobrepeso y obesidad y el establecimiento de criterios de intervención terapéutica. Med Clin (Barc). 2000;115:587–97.
- Fobi MA, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35. CrossRef
- Salmon PA. Gastroplasty with distal gastric bypass: a new and more successful weight loss operation for the morbidly obese. Can J Surg. 1988;31:111–3.
- Mason EE. Vertical banded gastroplasty for obesity. Arch Surg. 1982;177:701–6.
- Serra A, Romero R, Lopez D, et al. Renal injury in the extremely obese patients with normal renal function. Kidney Int. 2008;73:947–55. CrossRef
- Friedewald WT, Levy RI. Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of preparative ultracentrifuge. Clin Chem. 1972;18:499–502.
- Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28:412–9. CrossRef
- World Health Organization. Obesity: preventing and managing the global epidemic. In: Report on a WHO Consultation on Obesity: WHO/NUT/NCD/98.1. Geneva, Switzerland: World Health Organization; 1997.
- American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27:S5–10. CrossRef
- Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91:4223–31. CrossRef
- Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:239–50. CrossRef
- Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46. CrossRef
- Smith S, Edwards CB, Goodman GN. Changes in diabetic management after Roux-en-Y gastric bypass. Obes Surg. 1996;6:345–8. CrossRef
- Cowan GS, Buffington CK. Significant changes in blood pressure, glucose, and lipids with gastric bypass surgery. World J Surg. 1998;22:987–92. CrossRef
- Pardina E, López-Tejero MD, Llamas R, et al. Ghrelin and apolipoprotein AIV levesl show opposite trends to leptin levels during weight loss in morbidly obese patients. Obes Surg 2009;19:1414–23.
- Vazquez LA, Pazos F, Berrazueta JR, et al. Effects of change in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery. J Clin Endocrinol Metab. 2005;90:316–22. CrossRef
- Faraj M, Havel PJ, Phélis S, et al. Plasma acylation-stimulating protein, adiponectin, leptin and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2003;88:1594–02. CrossRef
- Holdstock C, Engström BE, Ohrvall M, et al. Ghrelin and adipose tissue regulatory peptides: effect of gastric bypass surgery in obese humans. J Clin Endocrinol Metab. 2003;88:3177–83. CrossRef
- Hansen TK, Dall R, Hosoda H, et al. Weight loss increases circulating levels of ghrelin in human obesity. Clin Endocrinol. 2002;56:203–06. CrossRef
- Shimizu Y, Noritoshi N, Isobe T, et al. Increased plasma ghrelin levels in lung cancer cachexia. Clin Cancer Res. 2003;9:774–78.
- Nagaya N, Uematsu M, Kojima M, et al. Elevated circulating level of ghrelin in cachexia associated with chronic heart failure. Circulation. 2001;104:2034–8. CrossRef
- Tacke F, Brabant G, Kruck E, et al. Ghrelin in chronic liver disease. J hepatol. 2003;38:447–54. CrossRef
- Otto B, Cuntz U, Fruehauf E, et al. Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa. Eur J Endocrinol. 2001;145:669–73. CrossRef
- Adami GF, Cordera R, Andraghetti G, et al. Changes in serum ghrelin concentrations following biliopancreatic diversion for obesity. Obes Res. 2004;12:684–7. CrossRef
- Nijhuis J, van Dielen FMH, Buurman WA, et al. Ghrelin, leptin and insulin levels after restrictive surgery: 2-year follow-up study. Obes Surg. 2004;14:783–7. CrossRef
- Schindler K, Prager G, Ballaban T, et al. Impact of laparoscopic adjustable gastric banding on plasma ghrelin, eating behaviour and body weight. Eur J Clin Invest. 2004;34:549–54. CrossRef
- Stratis CH, Alexandrides TK, Vagenas K, et al. Ghrelin and peptide YY levels after variant of biliopancreatic diversion with Roux-en-Y gastric bypass versus after colectomy: a prospective comparative study. Obes Surg. 2006;16:752–8. CrossRef
- Garcia-Unzueta MT, Fernández-Santiago R, Domínguez-Díez A, et al. Fasting plasma ghrelin levels increase progressively after biliopancreatic diversion: one-year follow-up. Obes Surg. 2005;15:187–90. CrossRef
- Geloneze B, Tambascia MA, Pilla VF, et al. Ghrelin: a gut-brain hormone: effect of gastric bypass surgery. Obes Surg. 2003;13:17–22. CrossRef
- Frühbeck G, Díez-Caballero A, Gil MJ, et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12. CrossRef
- Kotidis EV, Koliakos G, Papavramidis TS, et al. The effect of biliopancreatic diversion with pylori-preserving sleeve gastrectomy and duodenal switch on fasting serum ghrelin, leptin and adiponectin levels: Is there a hormonal contribution to the weight-reducing effect of this procedure? Obes Surg. 2006;16:554–9. CrossRef
- Adami GF, Cordera R, Marinari G, et al. Plasma ghrelin concentrations in the short-term following biliopancreatic diversion. Obes Surg. 2003;13:889–92. CrossRef
- Stoeckli R, Chanda R, Langer I, et al. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res. 2004;12:346–50. CrossRef
- Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels alter diet-induced weight los sor gastric bypass surgery. N Engl J Med. 2002;346:1623–30. CrossRef
- Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7. CrossRef
- Ybarra J, Bobbioni-Harsch E, Chassot G, et al. Persistent correlation of ghrelin plasma levels with body mass index both in stable weight conditions and during gastric-bypass induced weight loss. Obes surg. 2009;19:327–31. CrossRef
- Garcia-fuentes E, Garrido-Sánchez L, Garcia-Almeida JM, et al. Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of Scopinaro on serum PYY and ghrelin levels. Obes Surg. 2008;18:1424–9. CrossRef
- Effects of Two Variants of Roux-en-Y Gastric Bypass on Metabolism Behaviour: Focus on Plasma Ghrelin Concentrations Over a 2-Year Follow-up
Volume 20, Issue 5 , pp 600-609
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Bariatric surgery
- Gastric fundus
- Weight loss
- Industry Sectors
- Author Affiliations
- 1. General Surgery Department, Hospital Universitari Germans Trias i Pujol, C/Muntanya no. 27–08758 Cervelló, Barcelona, Spain
- 2. Nephrology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- 3. Clinical Biochemistry Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- 4. General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- 5. Chief of Nephrology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- 6. Cathedratic of Surgery of Barcelona Autonomous University and Chief of General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain