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Serum Bile Acid Levels Before and After Sleeve Gastrectomy and Their Correlation with Obesity-Related Comorbidities

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Abstract

Background and Aims

The rising prevalence of morbid obesity is increasing the demand for bariatric surgery. The benefits observed after bariatric surgery seems to be not fully explained by surgery-induced weight loss or traditional cardiovascular risk factors regression or improvement. Some evidences suggest that bile acid (BA) levels change after bariatric surgery, thus suggesting that BA concentrations could influence some of the metabolic improvement induced by bariatric surgery. In this report, we have characterized circulating BA patterns and compared them to metabolic and vascular parameters before and after sleeve gastrectomy (SG).

Patients and Methods

Seventy-nine subjects (27 males, 52 females, aged 45 ± 12 years, mean BMI 45 ± 7 kg/m2) SG candidates were included in the study. Before and about 12 months after SG, all subjects underwent a clinical examination, blood tests (including lipid profile, plasma glucose and insulin, both used for calculating HOMA-IR, and glycated hemoglobin), ultrasound visceral fat area estimation, ultrasound flow-mediated dilation evaluation, and determination of plasma BA concentrations.

Results

Before SG, both primary and secondary BA levels were higher in insulin-resistant obese subjects than in non-insulin resistant obese, and BA were positively associated with the markers of insulin-resistance. After SG, total (conjugated and unconjugated) cholic acids significantly decreased (p 0.007), and total lithocholic acids significantly increased (p 0.017). SG-induced total cholic and chenodeoxycholic acid changes were directly associated with surgery-induced glycemia (p 0.011 and 0.033 respectively) and HOMA-IR (p 0.016 and 0.012 respectively) changes.

Conclusions

Serum BA are associated with glucose metabolism and particularly with markers of insulin-resistance. SG modifies circulating BA pool size and composition. SG-induced BA changes are associated with insulin-resistance amelioration. In conclusion, an interplay between glucose metabolism and circulating BA exists but further studies are needed.

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Abbreviations

BA:

bile acids

FXR:

farnesoid X receptor

TGR5:

Takeda G protein-coupled receptor-5

SG:

sleeve gastrectomy

BMI:

body mass index

WC:

waist circumference

TC:

total cholesterol

TG:

triglycerides

LDL:

low-density lipoprotein

HDL:

high-density lipoprotein

HbA1c:

glycated hemoglobin

HOMA-IR:

Homeostasis Model Assessment of Insulin Resistance

tCA:

taurocholic acid

tCDCA:

taurochenodeoxycholic acid

tDCA:

taurodeoxycholic acid

tLCA:

taurolithocholic acid

gCA:

glycocholic acid

gCDCA:

glycochenodeoxycholic acid

gCA:

glycolithocholic acid

CA:

cholic acid

CDCA:

chenodeoxycholic acid

DCA:

deoxycholic acid

LCA:

lithocholic acid

VFA:

visceral fat area

FMD:

flow-mediated dilation

FGF-19:

fibroblast growth factor 19

SBP:

systolic blood pressure

DBP:

diastolic blood pressure

CA:

cholic acid

CDCA:

chenodeoxycholic acid

DCA:

deoxycholic acid

LCA:

lithocholic acid

tCA:

taurocholic acid

tCDCA:

taurochenodeoxycholic acid

tDCA:

taurodeoxycholic acid

tLCA:

taurolithocholic acid

gCA:

glycocholic acid

gCDCA:

glycochenodeoxycholic acid

gCA:

glycolithocholic acid

HOMA:

homeostasis model assessment

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Authors and Affiliations

  1. Internal Medicine, “Santa Maria della Misericordia” Hospital, Department of Medicine, University of Perugia, Piazzale Lucio Severi, Sant’Andrea delle Fratte, 06132, Perugia, Italy

    Stefano De Vuono, Maria Anastasia Ricci, Elisa Nulli Migliola, Stefano Ministrini & Graziana Lupattelli

  2. Department of Pharmacy, University of Salerno, Salerno, Italy

    Maria Chiara Monti

  3. PhD Program in Drug Discovery and Development, University of Salerno, Salerno, Italy

    Elva Morretta

  4. Department of Pharmacy, University of Salerno, Salerno, Italy

    Elva Morretta

  5. Department of Surgery, “San Giovanni Battista” Hospital, Perugia, Italy

    Marcello Boni

  6. Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy

    Adriana Carino, Stefano Fiorucci & Eleonora Distrutti

Authors
  1. Stefano De Vuono
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  2. Maria Anastasia Ricci
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Corresponding authors

Correspondence to Stefano De Vuono or Marcello Boni.

Ethics declarations

We state that the article is original and has not been previously published in any form and is not being considered for publication elsewhere in whole or in part. All authors have read and approved the manuscript and have contributed substantially to the conception and completion of the review and to paper draft.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the New Zealand national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

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De Vuono, S., Ricci, M.A., Nulli Migliola, E. et al. Serum Bile Acid Levels Before and After Sleeve Gastrectomy and Their Correlation with Obesity-Related Comorbidities. OBES SURG 29, 2517–2526 (2019). https://doi.org/10.1007/s11695-019-03877-6

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