Obesity Surgery

, Volume 27, Issue 4, pp 1031–1036 | Cite as

Plasma Ghrelin Levels and Weight Regain After Roux-en-Y Gastric Bypass Surgery

  • Barham K. Abu Dayyeh
  • Pichamol Jirapinyo
  • Christopher C. Thompson
Original Contributions
First Online:

Abstract

Purpose

Ghrelin is a gut hormone that induces hunger, gastric acid secretion, and gastrointestinal motility. A number of studies have previously demonstrated a possible correlation between a decrease in ghrelin level and weight loss after Roux-en-Y gastric bypass (RYGB). This study aimed to assess if there was a relationship between ghrelin level and weight regain after RYGB nadir weight had been achieved.

Materials and Methods

Sixty-three consecutive RYGB patients who were referred for an upper endoscopy were enrolled. Weight and responses to the 21-item Three-Factor Eating Questionnaire (TFEQ-R21) were collected. Ghrelin levels were measured. Upper endoscopy was performed to evaluate pouch length and stoma diameter. Multivariate linear regression was performed to assess an association between ghrelin level, TFEQ-R21 score, pouch length, stoma diameter, and percentage of weight regained.

Results

Subjects were 47 ± 10 years old and had a BMI of 38 ± 7.7 kg/m2. Out of 63 patients, 76 % had weight regain (gaining of ≥20 % of maximal weight lost after the RYGB) and 24 % did not. Average pouch length was 44 ± 13 mm, stoma diameter 20 ± 6.6 mm, and ghrelin levels 125 ± 99 ng/ml. Ghrelin level was not associated with weight regain (β = 0.17, p = 0.2). GJ stoma diameter was associated with weight regain (β = 0.39, p < 0.01) and the uncontrolled eating domain of the TFEQ-R21 (β = 0.45, p < 0.01).

Conclusion

Ghrelin levels do not appear to correlate with weight change after RYGB nadir weight has been achieved. A dilated GJ stoma diameter is a risk factor for weight regain and uncontrolled eating behavior after RYGB.

Keywords

Obesity RYGB Ghrelin Stoma diameter Endoscopy Weight regain 
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Notes

Acknowledgment

The project was supported by Harvard Digestive Diseases Center at Harvard Medical School (DK034854).

Authors’ Contributions

Both B. Abu Dayyeh and P. Jirapinyo contributed equally to the project and agreed to be co-first authors.

B. Abu Dayyeh: Data collection and analysis; drafting of the manuscript.

P. Jirapinyo: Data collection and analysis; drafting of the manuscript.

C. Thompson: Study design, critical revision of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Informed Consent Statement

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

Statement of Human Rights

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.

References

  1. 1.
    Lim SS et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systemic analysis for the global burden disease study. Lancet. 2012;380:2224–60.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Acosta A et al. Recent advances in clinical practice challenges and opportunities in the management of obesity. Gut. 2014;63:687–95.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Phillips RJ, Powley TL. Gastric volume rather than nutrient content inhibits food intake. Am J Phys. 1996;271:R766–9.Google Scholar
  4. 4.
    Cummings DE et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30.CrossRefPubMedGoogle Scholar
  5. 5.
    Ochner CN et al. Selective reduction in neural responses to high calorie foods following gastric bypass surgery. Ann Surg. 2011;253:502–7.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Cushing CC et al. Longitudinal trends in hedonic hunger after Roux-en-Y gastric bypass in adolescents. Surg Obes Relat Dis. 2014;10:125–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Borg CM et al. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93:210–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Holdstock C et al. Effect of bariatric surgery on adipose tissue regulatory peptides and growth hormone secretion. Asia Pac J Clin Nutr. 2004;13:S41.Google Scholar
  9. 9.
    Sjostrom L et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Sjostrom L et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2001;9:228–33.CrossRefGoogle Scholar
  12. 12.
    Heneghan HM et al. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis. 2012;8:408–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Shah M, Simha V, Garg A. REVIEW: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91:4223–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Ariyasu H et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Schwartz MW et al. Central nervous system control of food intake. Nature. 2000;404:661–71.PubMedGoogle Scholar
  17. 17.
    Cummings DE et al. Plasma ghrelin levels and hunger scores in humans initiating meals voluntarily without time- and food-related cues. Am J Physiol Endocrinol Metab. 2004;287:E297–304.CrossRefPubMedGoogle Scholar
  18. 18.
    Hanusch-Enserer U et al. Plasma ghrelin in obesity before and after weight loss after laparoscopical adjustable gastric banding. J Clin Endocrinol Metab. 2004;89:3352–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Mariani LM et al. Transient increase of plasma ghrelin after laparoscopic adjustable gastric banding in morbid obesity. Horm Metab Res. 2005;37:242–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Fruhbeck G et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12.CrossRefPubMedGoogle Scholar
  21. 21.
    Fruhbeck G et al. Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia. Obes Surg. 2004;14:1208–15.CrossRefPubMedGoogle Scholar
  22. 22.
    Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2004;89:2608–15.CrossRefPubMedGoogle Scholar
  23. 23.
    Stylopoulos N et al. Changes in serum ghrelin predict weight loss after Roux-en-Y gastric bypass in rats. Surg Endosc. 2005;19:942–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Crujeiras AB, Goyenechea E, Abete I, et al. Weight regain after a diet-induced loss is predicted by higher baseline leptin and lower ghrelin plasma levels. J Clin Endocrinol Metab. 2010;95:5037–44.CrossRefPubMedGoogle Scholar
  25. 25.
    Garcia JM, Iyer D, Poston WS, et al. Rise of plasma ghrelin with weight loss is not sustained during weight maintenance. Obesity. 2006;14:1716–23.CrossRefPubMedGoogle Scholar
  26. 26.
    Soni AC, Conroy MB, Mackey RH, et al. Ghrelin, leptin, adiponectin, and insulin levels and concurrent and future weight change in overweight, post-menopausal women. Menopause. 2011;18:296–301.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365:1597–604.CrossRefPubMedGoogle Scholar
  28. 28.
    Santo MA, Riccioppo D, Pajecki D, et al. Weight regain after gastric bypass: influence of gut hormones. Obes Surg. 2016;26:919–25.CrossRefPubMedGoogle Scholar
  29. 29.
    Fiegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307:491–7.CrossRefGoogle Scholar
  30. 30.
    Buchwald H, Consensus Conference Panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005;1:371–81.CrossRefPubMedGoogle Scholar
  31. 31.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systemic review and meta-analysis. Am J Med. 2009;122:248–56.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Barham K. Abu Dayyeh
    • 1
    • 2
    • 3
  • Pichamol Jirapinyo
    • 1
    • 2
  • Christopher C. Thompson
    • 1
    • 2
  1. 1.Division of GastroenterologyBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Mayo ClinicRochesterUSA

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