Obesity Surgery

, Volume 23, Issue 11, pp 1790–1798 | Cite as

Long-term Changes in Leptin, Chemerin and Ghrelin Levels Following Different Bariatric Surgery Procedures: Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

  • Ximena Terra
  • Teresa Auguet
  • Esther Guiu-Jurado
  • Alba Berlanga
  • Josep Maria Orellana-Gavaldà
  • Mercè Hernández
  • Fàtima Sabench
  • Jose Antonio Porras
  • Jordi Llutart
  • Salomé Martinez
  • Carmen Aguilar
  • Daniel Del Castillo
  • Cristóbal Richart
Original Contributions



Different studies have evaluated changes in adipo/cytokine levels after bariatric surgery and have given conflicting results. The adipo/cytokines, leptin and chemerin, and the orexigenic hormone, ghrelin, have been shown to play a role in the regulation of metabolism and appetite. The aims of our study were to test the levels of these molecules after bariatric surgery and to compare the results between Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.


We analysed circulating levels of chemerin, ghrelin and leptin in 30 morbidly obese women (body mass index of >40 kg/m2). Subjects were studied at three time points: baseline (before the surgery started), and after 6 and 12 months.


After surgery, chemerin (baseline, 95.03 ± 23.79; after 12 months, 76.80 ± 21.51; p = 0.034) and leptin levels (baseline, 248.17 ± 89.16; after 12 months, 63.85 ± 33.48; p < 0.001) were significantly lower than their baseline levels, whereas ghrelin was higher (baseline, 0.87 ± 0.38; after 12 months, 1.08 ± 0.31; p = 0.010). Fasting glucose, insulin and homeostasis model assessment of insulin resistance levels were markedly lower postoperatively. High-density lipoprotein levels moderately increased and triglyceride levels sharply decreased. There were no differences between the types of bariatric surgery in terms of weight reduction, general metabolic state or adipo/cytokine levels after surgery.


Our study demonstrates a marked decrease in fasting leptin and chemerin levels, and an increase in ghrelin levels, after bariatric surgery-induced weight loss, independently of the type of surgery performed. Further studies are needed on the interrelation between the changes in the circulating levels of these molecules and the efficacy of the bariatric surgery procedures to induce the beneficial metabolic changes and to sustain body weight loss.


Bariatric surgery Body weight loss Predictive model Insulin resistance Metabolic syndrome 


  1. 1.
    Gass M, Beglinger C, Peterli R. Metabolic surgery—principles and current concepts. Langenbecks Arch Surg. 2011;396(7):949–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Magee C, Barry J, Arumugasamy M, et al. Laparoscopic sleeve gastrectomy for high-risk patients: weight loss and comorbidity improvement—short-term results. Obes Surg. 2011;21(5):547–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Czupryniak L, Pawlowski M, Kumor A, et al. Predicting maximum Roux-en-Y gastric bypass-induced weight reduction—preoperative plasma leptin or body weight? Obes Surg. 2007;17(2):162–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Hajer GR, van Haeften TW, Visseren FLJ. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J. 2008;29(24):2959–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Beckman LM, Beckman TR, Sibley SD, et al. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass surgery. JPEN J Parenter Enteral Nutr. 2011;35(2):169–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Friedman JM. Obesity in the new millennium. Nature. 2000;404(6778):632–4.PubMedGoogle Scholar
  7. 7.
    Ress C, Tschoner A, Engl J, et al. Effect of bariatric surgery on circulating chemerin levels. Eur J Clin Invest. 2010;40(3):277–80.PubMedCrossRefGoogle Scholar
  8. 8.
    Chakaroun R, Raschpichler M, Klöting N, et al. Effects of weight loss and exercise on chemerin serum concentrations and adipose tissue expression in human obesity. Metab Clin Exp. 2012;61(5):706–14.PubMedCrossRefGoogle Scholar
  9. 9.
    Ernst MC, Sinal CJ. Chemerin: at the crossroads of inflammation and obesity. Trends Endocrinol Metab. 2010;21(11):660–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Bozaoglu K, Bolton K, McMillan J, et al. Chemerin is a novel adipokine associated with obesity and metabolic syndrome. Endocrinology. 2007;148(10):4687–94.PubMedCrossRefGoogle Scholar
  11. 11.
    Bozaoglu K, Segal D, Shields KA, et al. Chemerin is associated with metabolic syndrome phenotypes in a Mexican-American population. J Clin Endocrinol Metab. 2009;94(8):3085–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Kirchner H, Heppner KM, Tschöp MH. The role of ghrelin in the control of energy balance. Handb Exp Pharmacol. 2012;209:161–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Ortega E, Morínigo R, Flores L, et al. Predictive factors of excess body weight loss 1 year after laparoscopic bariatric surgery. Surg Endosc. 2012;26(6):1744–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27(6):1487–95.PubMedCrossRefGoogle Scholar
  15. 15.
    Stefater MA, Wilson-Pérez HE, Chambers AP, et al. All bariatric surgeries are not created equal: Insights from mechanistic comparisons. Endocr Rev. 2012. doi:10.1210/er.2011-1044.PubMedGoogle Scholar
  16. 16.
    Chu SH, Lee MK, Ahn KY, et al. Chemerin and adiponectin contribute reciprocally to metabolic syndrome. PLoS One. 2012;7(4):e34710.PubMedCrossRefGoogle Scholar
  17. 17.
    Shin H, Lee DC, Chu SH, et al. Chemerin levels are positively correlated with abdominal visceral fat accumulation. Clin Endocrinol. 2011;77(1):47–50.CrossRefGoogle Scholar
  18. 18.
    Sell H, Divoux A, Poitou C, et al. Chemerin correlates with markers for fatty liver in morbidly obese patients and strongly decreases after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2010;95(6):2892–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Shiiya T, Nakazato M, Mizuta M, et al. Plasma ghrelin levels in lean and obese humans and the effect of glucose on ghrelin secretion. J Clin Endocrinol Metab. 2002;87(1):240–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Gletsu LE. The effects of gastric surgery on systemic ghrelin levels in the morbidly obese. Arch Surg. 2004;139(7):780–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Peterli R, Steinert R, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Fruhbeck G, Rotellar F, Hernandez-Lizoain JL, et al. Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia. Obes Surg. 2004;14(9):1208–15.PubMedCrossRefGoogle Scholar
  23. 23.
    Faraj M, Havel PJ, Phelis 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(4):1594–602.PubMedCrossRefGoogle Scholar
  24. 24.
    Stratis C, Alexandrides T, Vagenas K, et al. Ghrelin and peptide YY levels after a variant of biliopancreatic diversion with Roux-en-Y gastric bypass versus after colectomy: a prospective comparative study. Obes Surg. 2006;16(6):752–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Delporte C. Recent advances in potential clinical application of ghrelin in obesity. J Obes. 2012. doi:10.1155/2012/535624.PubMedGoogle Scholar
  26. 26.
    Oliván B, Teixeira J, Bose M, et al. Effect of weight loss by diet or gastric bypass surgery on peptide YY3-36 levels. World J Surg. 2011;35:2022–30.CrossRefGoogle Scholar
  27. 27.
    Brethauer S, Heneghan H, Eldar S, et al. Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients. Surg Endosc. 2011;25:2650–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Felberbauer F, Langer F, Shakeri-Manesch S, et al. Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a large series in three Austrian centers. Obes Surg. 2008;18(7):814–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Woelnerhanssen B, Peterli R, Steinert RE, et al. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy—a prospective randomized trial. Surg Obes Relat Dis. 2011;7(5):561–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Franco JV, Ruiz PA, Palermo M, et al. A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding. Obes Surg. 2011;21(9):1458–68.PubMedCrossRefGoogle Scholar
  31. 31.
    Woodard GA, Peraza J, Bravo S, et al. One year improvements in cardiovascular risk factors: a comparative trial of laparoscopic Roux-en-Y gastric bypass vs. adjustable gastric banding. Obes Surg. 2010;20(5):578–82.PubMedCrossRefGoogle Scholar
  32. 32.
    Benaiges D, Goday A, Ramon JM, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis. 2011;7(5):575–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Korner J, Inabnet W, Conwell IM, et al. Differential effects of gastric bypass and banding on circulating gut hormone and leptin levels. Obesity (Silver Spring). 2006;14(9):1553–61.CrossRefGoogle Scholar
  34. 34.
    Bado A, Levasseur S, Attoub S, et al. The stomach is a source of leptin. Nature. 1998;394(6695):790–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ximena Terra
    • 1
  • Teresa Auguet
    • 1
    • 2
    • 5
  • Esther Guiu-Jurado
    • 1
  • Alba Berlanga
    • 1
  • Josep Maria Orellana-Gavaldà
    • 1
  • Mercè Hernández
    • 3
  • Fàtima Sabench
    • 3
  • Jose Antonio Porras
    • 2
  • Jordi Llutart
    • 2
  • Salomé Martinez
    • 4
  • Carmen Aguilar
    • 1
  • Daniel Del Castillo
    • 3
  • Cristóbal Richart
    • 1
    • 2
  1. 1.Grup d’Estudi de Malalties Metabòliques Associades a Insulin Resistència (GEMMAIR), Departament de Medicina i CirurgiaUniversitat Rovira i Virgili (URV)TarragonaSpain
  2. 2.Servei Medicina InternaHospital Universitari Joan XXIII TarragonaTarragonaSpain
  3. 3.Servei de CirurgiaHospital Sant Joan de ReusTarragonaSpain
  4. 4.Servei Anatomia PatològicaHospital Universitari Joan XXIII TarragonaTarragonaSpain
  5. 5.Department of Internal MedicineHospital Universitari de Tarragona Joan XXIII, Universitat Rovira i VirgiliTarragonaSpain

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