Improved insulin sensitivity after gastric bypass correlates with decreased total body fat, but not with changes in free fatty acids
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Increased plasma free fatty acids (FFAs) are considered one of the key elements in the pathogenesis of insulin resistance (IR) and type 2 diabetes (T2DM). We hypothesize that, in diabetic patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB), a postoperative decrease in FFA will correlate with improved insulin sensitivity (Si).
A total of 30 obese [body mass index ((BMI) >35 kg/m2] patients with a diagnosis of T2DM were studied preoperatively and 12 months after LRYGB in a prospective cohort study. Collected data included intravenous glucose tolerance test (IVGTT), total body composition by dual-energy X-ray absorptiometry and plasma levels of FFA. Si analysis from the IVGTT was estimated from minimal model analysis. Pre- and postoperative variables were compared using a paired sample t test. Relationships between changes in variables were determined with Pearson’s correlation test.
Twelve months after LRYGB the study population showed a significant decrease in BMI (p = 0.001), FFA (p = 0.03), and total body fat (p = 0.03), with an increase in Si (p = 0.001). Postoperative changes in Si significantly correlated (Pearson’s r = –0.53, p = 0.01) with change in total body fat, but not with changes in plasma FFA (Pearson’s r = –0.22, p = 0.31).
Our study challenges the notion that IR is mediated to a significant degree by changes in plasma FFA concentration. Instead, changes in adiposity and consequently changes in adipokine release can be the key players in determining remission of T2DM after LRYGB.
KeywordsBariatric surgery Laparoscopic Roux-en-Y gastric bypass Free fatty acid Insulin sensitivity Insulin resistance Total body fat Adiposity
- 23.Khoo CM, Chen J, Pamuklar Z, Torquati A (2013) Effects of Roux-en-Y gastric bypass or diabetes support and education on insulin sensitivity and insulin secretion in morbidly obese patients with type 2 diabetes. Ann Surg. doi:10.1097/SLA.0b013e318294d19c
- 24.American Diabetes Assocation (2004) Diagnosis and classification of diabetes mellitus. Diabetes Care 27(Suppl 1):S5–S10Google Scholar
- 25.No authors listed (1991) NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 115(12):956–961Google Scholar
- 27.Miller MR, Pereira RI, Langefeld CD et al (2012) Levels of free fatty acids (FFA) are associated with insulin resistance but do not explain the relationship between adiposity and insulin resistance in Hispanic Americans: the IRAS Family Study. J Clin Endocrinol Metab 97(9):3285–3291PubMedCentralPubMedCrossRefGoogle Scholar