European Surgery

, Volume 40, Issue 3, pp 120–124

Eating behavior in laparoscopic sleeve gastrectomy: Correlation between plasma ghrelin levels and hunger

  • F. B. Langer
  • A. Bohdjalian
  • S. Shakeri-Manesch
  • J. Zacherl
  • R. Riener
  • K. Schindler
  • B. Ludvik
  • G. Prager
Original Scientific Paper


BACKGROUND: Bariatric procedures like gastric banding, vertically banded gastroplasty and Roux-en-Y gastric bypass have impacted on the postoperative eating behavior. Since laparoscopic sleeve gastrectomy (LSG) leads to decreased plasma ghrelin levels, a reduced sensation of hunger following surgery is expected. The aim of this study was to assess the impact of LSG on the eating behavior in correlation with plasma ghrelin levels. METHODS: This prospective study was carried out in 15 morbidly obese patients who underwent LSG. The German version of the self-report Three-Factor Eating Questionnaire (TFEQ) was applied preoperatively and at six months following surgery to assess the impact of LSG on the three dimensions of eating behavior: restraint, disinhibition and hunger. The correlation between plasma ghrelin levels and the sensation of hunger was assessed in a subset of seven patients. RESULTS: Following LSG, increased cognitive restraint and decreased disinhibition of eating were found. Furthermore, a significant decrease in hunger was observed with a significant correlation (r = 0.834, p = 0.01) between circulating plasma ghrelin levels and hunger scores. CONCLUSIONS: Following LSG, a high correlation between decreased ghrelin levels and the reduced sensation of hunger was found. This may contribute to the excellent weight loss observed following laparoscopic sleeve gastrectomy.


Ghrelin Hunger Eating behavior Sleeve gastrectomy TFEQ 

Essverhalten nach laparoskopischer "Sleeve Gastrectomy" – Korrelationen zwischen Plasma-Ghrelin-Spiegeln und Hungerempfinden


GRUNDLAGEN: Bariatrische Operationsverfahren wie das Magenband, VGB und Magenbypass haben nachgewiesenermaßen Einfluss auf das postoperative Essverhalten. Nachdem die laparoskopische "Sleeve gastrectomy" (LSG) zu verringerten Ghrelin-Spiegeln führt, ist eine Reduktion im Hungerempfinden zu erwarten. Ziel dieser Studie war es, den Einfluss der LSG auf das Essverhalten in Korrelation Plasma-Ghrelin-Spiegeln zu bestimmen. METHODIK: In dieser prospektiven Studie von 15 morbid adipösen LSG-Patienten wurde die deutsche Version des "Self-report Three-Factor Eating Questionnaire" (TFEQ) vor der Operation und 6 Monate postoperativ angewandt, um den Einfluss der LSG auf die drei Dimensionen des Essverhaltens: Kontrolle, Irritierbarkeit und Hungerempfinden zu bestimmen. In einer Untergruppe von 7 Patienten wurde die Korrelation zwischen Plasma-Ghrelin-Spiegeln und dem Hungerempfinden untersucht. ERGEBNISSE: LSG führte zu einer Zunahme in der kognitiven Einschränkung und zu einer reduzierten Kontrolle, Irritierbarkeit. Weiters wurde eine signifikante Reduktion im Hungerempfinden nachgewiesen, welche ebenfalls mit den Ghrelin-Spiegeln korrelierte (r = 0.834, p = 0.01). SCHLUSSFOLGERUNGEN: LSG führt zu einem reduzierten Hungerempfinden, welches mit den ebenfalls verringerten Plasma-Ghrelin-Spiegeln korreliert. Diese Effekte können zu dem exzellenten Gewichtsverlust nach LSG beitragen.


Ghrelin Hunger Essverhalten Sleeve gastrectomy TFEQ 


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  1. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. Jama 2004;292:1724–37PubMedCrossRefGoogle Scholar
  2. Raftopoulos I, Ercole J, Udekwu AO, Luketich JD, Courcoulas AP. Outcomes of Roux-en-Y gastric bypass stratified by a body mass index of 70 kg/m2: a comparative analysis of 825 procedures. J Gastrointest Surg 2005;9:44–52; discussion –3PubMedCrossRefGoogle Scholar
  3. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000;10:233–239PubMedCrossRefGoogle Scholar
  4. Zinzindohoue F, Chevallier JM, Douard R, Elian N, Ferraz JM, Blanche JP, Berta JL, Altman JJ, Safran D, Cugnenc PH. Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg 2003;237:1–9PubMedCrossRefGoogle Scholar
  5. Chapman AE, Kiroff G, Game P, Foster B, O'Brien P, Ham J, Maddern GJ. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 2004;135:326–51PubMedCrossRefGoogle Scholar
  6. Langer FB, Bohdjalian A, Hoda A, Silberhumer G, Felberbauer FX, Rasoul-Rockenschaub S, Zacherl J, Wenzl E, Prager G. Early results of laparoscopic adjustable gastric banding using the new low-pressure Soft-Gastric-Band. Eur Surg 2004;36: 345–9CrossRefGoogle Scholar
  7. Hell E, Miller KA, Moorehead MK, Norman S. Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding. Obes Surg 2000;10:214–9PubMedCrossRefGoogle Scholar
  8. Dixon JB, O'Brien PE. Changes in comorbidities and improvements in quality of life after LAP-BAND placement. Am J Surg 2002;184:51S–4SPubMedCrossRefGoogle Scholar
  9. Arcila D, Velazquez D, Gamino R, Sierra M, Salin-Pascual R, Gonzalez-Barranco J, Herrera MF. Quality of life in bariatric surgery. Obes Surg 2002;12:661–5PubMedCrossRefGoogle Scholar
  10. Weiner R, Blanco-Engert R, Weiner S, Matkowitz R, Schaefer L, Pomhoff I. Outcome after laparoscopic adjustable gastric banding – 8 years experience. Obes Surg 2003;13:427–34PubMedCrossRefGoogle Scholar
  11. Kalarchian MA, Marcus MD, Wilson GT, Labouvie EW, Brolin RE, LaMarca LB. Binge eating among gastric bypass patients at long-term follow-up. Obes Surg 2002;12:270–5PubMedCrossRefGoogle Scholar
  12. Guisado JA, Vaz FJ, Lopez-Ibor JJ Jr, Rubio MA. Eating behavior in morbidly obese patients undergoing gastric surgery: differences between obese people with and without psychiatric disorders. Obes Surg 2001;11:576–80PubMedCrossRefGoogle Scholar
  13. Burgmer R, Grigutsch K, Zipfel S, Wolf AM, de Zwaan M, Husemann B, Albus C, Senf W, Herpertz S. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg 2005;15:684–91PubMedCrossRefGoogle Scholar
  14. Boan J, Kolotkin RL, Westman EC, McMahon RL, Grant JP. Binge eating, quality of life and physical activity improve after Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2004;14:341–8PubMedCrossRefGoogle Scholar
  15. Schindler K, Prager G, Ballaban, Kretschmer S, Riener R, Buranyi B, Maier C, Luger A, Ludvik B. Impact of laparoscopic adjustable gastric banding on plasma ghrelin, eating behaviour and body weight. Eur J Clin Invest 2004;34:549–54PubMedCrossRefGoogle Scholar
  16. Nickel C, Widermann C, Harms D, Leiberich PL, Tritt K, Kettler C, Lahmann C, Rother WK, Loew TH, Nickel MK. Patients with extreme obesity: change in mental symptoms three years after gastric banding. Int J Psychiatry Med 2005;35:109–22PubMedCrossRefGoogle Scholar
  17. Baltasar A, Serra C, Perez N, Bou R, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 2005;15:1124–8PubMedCrossRefGoogle Scholar
  18. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg 2004;14:492–7PubMedCrossRefGoogle Scholar
  19. Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg 2005;15:1030–3PubMedCrossRefGoogle Scholar
  20. Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13:861–4PubMedCrossRefGoogle Scholar
  21. Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, Karkavitsas N. Sleeve gastrectomy: a restrictive procedure? Obes Surg 2007;17:57–62PubMedCrossRefGoogle Scholar
  22. Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today 2007;37:275–81PubMedCrossRefGoogle Scholar
  23. Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg 2006;16:1323–6PubMedCrossRefGoogle Scholar
  24. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006;16:1450–6PubMedCrossRefGoogle Scholar
  25. Han SM, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 2005;15:1469–75CrossRefGoogle Scholar
  26. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 1999;402:656–60PubMedCrossRefGoogle Scholar
  27. Ariyasu H, Takaya K, Tagami T, Ogawa Y, Hosoda K, Akamizu T, Suda M, Koh T, Natsui K, Toyooka S, Shirakami G, Usui T, Shimatsu A, Doi K, Hosoda H, Kojima M, Kangawa K, Nakao K. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab 2001;86:4753–8PubMedCrossRefGoogle Scholar
  28. Wren AM, Seal LJ, Cohen MA, Brynes AE, Frost GS, Murphy KG, Dhillo WS, Ghatei MA, Bloom SR. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab 2001;86:5992–5PubMedCrossRefGoogle Scholar
  29. Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes 2001;50:1714–9PubMedCrossRefGoogle Scholar
  30. Langer FB, Reza Hoda MA, Bohdjalian A, Felberbauer FX, Zacherl J, Wenzl E, Schindler K, Luger A, Ludvik B, Prager G. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005;15:1024–9PubMedCrossRefGoogle Scholar
  31. Cohen R, Uzzan B, Bihan H, Khochtali I, Reach G, Catheline JM. Ghrelin Levels and Sleeve Gastrectomy in Super-Super-Obesity. Obes Surg 2005;15:1501–2PubMedCrossRefGoogle Scholar
  32. Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr 1992;55:615S–9SGoogle Scholar
  33. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 1985;29:71–83PubMedCrossRefGoogle Scholar
  34. Klingler A. Statistical methods in surgical research – a practical guide. Eur Surg 2004;36:80–4CrossRefGoogle Scholar
  35. Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg 2003;13:159–60PubMedCrossRefGoogle Scholar
  36. Pudel V, Westenhöfer J. Fragebogen zum Essverhalten: Handanweisung [Eating Inventory, German version, Manual]. Göttingen: Hogrefe; 1989Google Scholar
  37. Lang T, Hauser R, Buddeberg C, Klaghofer R. Impact of gastric banding on eating behavior and weight. Obes Surg 2002;12:100–7PubMedCrossRefGoogle Scholar
  38. Asakawa A, Inui A, Kaga T, Yuzuriha H, Nagata T, Ueno N, Makino S, Fujimiya M, Niijima A, Fujino MA, Kasuga M. Ghrelin is an appetite-stimulatory signal from stomach with structural resemblance to motilin. Gastroenterology 2001;120:337–45PubMedCrossRefGoogle Scholar
  39. Cummings DE, Shannon MH. Roles for ghrelin in the regulation of appetite and body weight. Arch Surg 2003;138:389–96PubMedCrossRefGoogle Scholar
  40. Tschop M, Smiley DL, Heiman ML. Ghrelin induces adiposity in rodents. Nature 2000;407:908–13PubMedCrossRefGoogle Scholar
  41. Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, Purnell JQ. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002;346:1623–30PubMedCrossRefGoogle Scholar
  42. St-Pierre DH, Karelis AD, Cianflone K, Conus F, Mignault D, Rabasa-Lhoret R, St-Onge M, Tremblay-Lebeau A, Poehlman ET. Relationship between ghrelin and energy expenditure in healthy young women. J Clin Endocrinol Metab 2004;89:5993–7PubMedCrossRefGoogle Scholar
  43. Geloneze B, Tambascia MA, Pilla VF, Geloneze SR, Repetto EM, Pareja JC. Ghrelin: a gut-brain hormone: effect of gastric bypass surgery. Obes Surg 2003;13:17–22PubMedCrossRefGoogle Scholar
  44. Fruhbeck G, Rotellar F, Hernandez-Lizoain JL, Gil MJ, Gomez-Ambrosi J, Salvador J, Cienfuegos JA. Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia. Obes Surg 2004;14:1208–15PubMedCrossRefGoogle Scholar
  45. Nijhuis J, van Dielen FM, Buurman WA, Greve JW. Ghrelin, leptin and insulin levels after restrictive surgery: a 2-year follow-up study. Obes Surg 2004;14:783–7PubMedCrossRefGoogle Scholar
  46. Stoeckli R, Chanda R, Langer I, Keller U. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res 2004;12:346–50PubMedCrossRefGoogle Scholar
  47. Busetto L, Segato G, De Marchi F, Foletto M, De Luca M, Caniato D, Favretti F, Lise M, Enzi G. Outcome predictors in morbidly obese recipients of an adjustable gastric band. Obes Surg 2002;12:83–92PubMedCrossRefGoogle Scholar
  48. Larsen JK, van Ramshorst B, Geenen R, Brand N, Stroebe W, van Doornen LJ. Binge eating and its relationship to outcome after laparoscopic adjustable gastric banding. Obes Surg 2004;14:1111–7PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • F. B. Langer
    • 1
  • A. Bohdjalian
    • 1
  • S. Shakeri-Manesch
    • 1
  • J. Zacherl
    • 1
  • R. Riener
    • 2
  • K. Schindler
    • 2
  • B. Ludvik
    • 2
  • G. Prager
    • 1
  1. 1.Division of General Surgery, Department of SurgeryUniversity of ViennaViennaAustria
  2. 2.Division of Endocrinology and Metabolism, Department of Medicine IIIMedical University of ViennaViennaAustria

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