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Effects of Fat and Protein Preloads on Pouch Emptying, Intestinal Transit, Glycaemia, Gut Hormones, Glucose Absorption, Blood Pressure and Gastrointestinal Symptoms After Roux-en-Y Gastric Bypass

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Abstract

Background

The aim was to determine the effects of fat and protein preloads on pouch emptying (PE), caecal arrival time (CAT), glucose absorption, blood glucose (BSL), gut hormones, haemodynamics and gastrointestinal (GI) symptoms in subjects who had undergone Roux-en-Y gastric bypass (RYGB) >12 months previously.

Methods

Ten RYGB subjects were studied on three occasions, in randomised order, receiving 200-ml preloads of either water, fat (30 ml olive oil) or whey protein (55 g), 30 min before a mixed meal. PE, CAT, BSL, plasma 3-O-methyl-D-glucopyranose (3-OMG), insulin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1) and glucagon, blood pressure (BP), heart rate (HR) and GI symptoms were assessed over 270 min.

Results

Although fat and protein preloads did not alter PE of either solids or liquids, the CAT of solids, but not liquids, was longer than that after the water preload (fat 68 ± 5 min and protein 71 ± 6 min vs. water 46 ± 5 min; P = 0.02). BSL elevated promptly after the meal on all days (P < 0.001), but after protein, the magnitude and integrated increases in the first 75 min were less than fat and water preloads (area under the curve (AUC(0–75 min)), 18.7 ± 18.2 vs. 107.2 ± 30.4 and 76.1 ± 19.3 mmol/L/min; P < 0.05). Compared to water preload, the protein and fat preloads were associated with greater increases in plasma insulin, GLP-1 and glucagon concentrations, a reduction in BP, and greater increases in HR, fullness, bloating and nausea. Plasma 3-OMG levels were lower after the protein than after the water and fat preloads (P < 0.001).

Conclusions

Given its effects to attenuate post-prandial glycaemia, reduce intestinal glucose absorption and potentiate the “incretin response”, without inducing more adverse post-prandial GI symptom, protein preload may prove clinically useful in RYGB patients and warrant further evaluation, particularly in those with type 2 diabetes (T2DM) and/or dumping syndrome.

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Acknowledgments

Research Support from the National Health and Medical Research Council (NHMRC). Recipient of a New Investigator Project Grant 2010-2013

Conflict of interest

Authors Nam Q Nguyen, Tamara L Debreceni, Carly M Burgstad, Melissa Neo, Max Bellon , Judith M Wishart, Scott Standfield, Dylan Bartholomeusz, Chris K Rayner, Gary Wittert, Michael Horowitz declare that they have no conflict of interest.

Compliance with Ethical Standards

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.

Informed Consent

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

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Authors and Affiliations

  1. Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia

    Nam Q. Nguyen, Tamara L. Debreceni, Carly M. Burgstad, Melissa Neo, Dylan Bartholomeusz & Chris K. Rayner

  2. Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia

    Max Bellon & Dylan Bartholomeusz

  3. Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia

    Nam Q. Nguyen, Judith M. Wishart, Scott Standfield, Chris K. Rayner, Gary Wittert & Michael Horowitz

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  1. Nam Q. Nguyen
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Correspondence to Nam Q. Nguyen.

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Nguyen, N.Q., Debreceni, T.L., Burgstad, C.M. et al. Effects of Fat and Protein Preloads on Pouch Emptying, Intestinal Transit, Glycaemia, Gut Hormones, Glucose Absorption, Blood Pressure and Gastrointestinal Symptoms After Roux-en-Y Gastric Bypass. OBES SURG 26, 77–84 (2016). https://doi.org/10.1007/s11695-015-1722-7

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  • DOI: https://doi.org/10.1007/s11695-015-1722-7

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