Differential Changes in Gut Microbiota After Gastric Bypass and Sleeve Gastrectomy Bariatric Surgery Vary According to Diabetes Remission
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It is unclear whether specific gut microbiota is associated with remission of type 2 diabetes (T2D) after distinct types of bariatric surgery.
The aim of this study is to examine gut microbiota changes after laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery in obese patients with T2D.
Whole-metagenome shotgun sequencing of DNA fragments using Illumina HiSeq2000 was obtained from stool samples collected from 14 obese T2D patients pre-operatively (while on very low calorie diet) and 1 year after randomisation to laparoscopic SG (n = 7) or RYGB (n = 7). Resulting shotgun reads were annotated with Kyoto Encyclopedia of Genes and Genomes (KEGG).
Body weight reduction and dietary change was similar 1 year after both surgery types. Identical proportions (n = 5/7) achieved diabetes remission (HbA1c < 48 mmol/mol without medications) 1 year after RYGB and SG. RYGB resulted in increased Firmicutes and Actinobacteria phyla but decreased Bacteroidetes phyla. SG resulted in increased Bacteroidetes phyla. Only an increase in Roseburia species was observed among those achieving diabetes remission, common to both surgery types. KEGG Orthology and pathway analysis predicted contrasting and greater gut microbiota metabolism changes after diabetes remission following RYGB than after SG. Those with persistent diabetes post-operatively had higher Desulfovibrio species pre-operatively.
Overall, RYGB produces greater and more predicted favourable changes in gut microbiota functional capacity than SG. An increase in Roseburia species was the only compositional change common to both types of surgery among those achieving diabetes remission.
KeywordsGut microbiota Metagenome shotgun sequencing Bariatric surgery Sleeve gastrectomy Roux-en-Y gastric bypass
The results from this study were presented at the annual European Association for the Study of Diabetes meeting in Stockholm in September 2015. We acknowledge the assistance of Wafa Elasheg (University of Auckland) and Greg Smith (University of Auckland) for their assistance with collecting samples for this study. We are grateful to the surgical and diabetes teams at North Shore Hospital involved in the successful conduct of the randomized clinical trial. We acknowledge New Zealand Genomics Limited for the high-throughput sequencing facility.
RM designed the research and drafted the manuscript. PT performed the bioinformatics analysis. MJ performed the pathway analysis. AL analysed the food diary data. LP supervised the clinical assessments including body composition and resting energy expenditure analysis. MB performed the surgeries and provided oversight of the clinical trial. All authors contributed to the interpretation of the data and approved the final manuscript.
Compliance with Ethical Standards
Conflict of Interest
No authors have any conflicts to disclose.
All study procedures were in accordance with the ethical standards of the national research ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Maurice Wilkins Centre for Molecular Biodiscovery: Flexible research seeding programme funded biospecimen collection and analysis for the gut microbiota and gut hormone sub-study. We acknowledge funding support for the main clinical trial from Waitemata District Health Board, which provides limited publically funded bariatric surgery. Funding for blood sample storage and a research nurse salary was provided by Johnson and Johnson (NZ), Covidien (NZ) and Obex (NZ). DEXA scanning for body composition was provided by the Diabetes Research Fund (NZ), and Maurice & Phyllis Paykel Trust (NZ). No funders had any role in study design, data analysis or interpretation.
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