Comparative Study of Resting Metabolic Rate and Plasma Amino Acid Profile in Patients Who Underwent Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: 6-Month Follow-up Study

  • Mahdieh Golzarand
  • Karamollah ToolabiEmail author
  • Mehdi Hedayati
  • Kamal Azam
  • Masoomeh Douraghi
  • Kurosh DjafarianEmail author
Original Contributions



Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common techniques for treatment of morbid obesity. However, a few studies have compared the energy expenditure and plasma amino acid profile after LRYGB and LSG. The present study was conducted to assess the resting metabolic rate (RMR) and plasma amino acid profile in obese patients who underwent LRYGB and LSG before and 6 months after the surgery in order to compare these changes from baseline between the two procedures.

Materials and Methods

Forty-three adult obese patients participated in this study (LRYGB = 22 and LSG = 21) and were followed up for 6 months. RMR was measured by indirect calorimetry. The plasma amino acid profile was determined using high-performance liquid chromatography (HPLC).


Mean percent excess weight loss (%WL) were 22.8 ± 4.5% and 23.3 ± 5.7% in LRYGB and LSG, respectively. RMR reduced significantly from baseline by − 459 ± 202 kcal/day in LRYGB and − 500 ± 262 kcal/day in LSG. RMR reduced beyond the expected decrease in both procedures. A decreasing trend was observed in the plasma concentration of branched-chain amino acids (BCAA), aromatic amino acids (AAA), and amino acid index (AAI) in both techniques. There was no significant difference in weight, RMR analysis, and amino acid change from baseline between LRYGB and LSG.


Our results showed that the effects of LRYGB and LSG on RMR and amino acid profile were comparable.


Gastric bypass Sleeve gastrectomy Resting metabolic rate Amino acid profile Branched-chain amino acid Energy expenditure 



The authors acknowledge Mrs. Roya Farid for critical editing of English grammar of the manuscript.

Compliance with Ethical Standards

The study protocol was approved by the Ethics Committee of Tehran University of Medical Sciences and written consent was obtained from all patients.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Zehetner J, Holzinger F, Triaca H, et al. A 6-year experience with the Swedish adjustable gastric band prospective long-term audit of laparoscopic gastric banding. Surg Endosc. 2005;19(1):21–8.CrossRefGoogle Scholar
  2. 2.
    Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.CrossRefGoogle Scholar
  3. 3.
    Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes. 2013;37(6):889–91.CrossRefGoogle Scholar
  4. 4.
    Spivak H, Abdelmelek MF, Beltran OR, et al. Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States. Surg Endosc. 2012;26(7):1909–19.CrossRefGoogle Scholar
  5. 5.
    Zarate X, Arceo-Olaiz R, Montalvo Hernandez J, et al. Long-term results of a randomized trial comparing banded versus standard laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(3):395–7.CrossRefGoogle Scholar
  6. 6.
    Rutledge T, Braden AL, Woods G, et al. Five-year changes in psychiatric treatment status and weight-related comorbidities following bariatric surgery in a veteran population. Obes Surg. 2012;22(11):1734–41.CrossRefGoogle Scholar
  7. 7.
    Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc. 2017;31(11):4331–45.CrossRefGoogle Scholar
  8. 8.
    Wang X, You T, Lenchik L, et al. Resting energy expenditure changes with weight loss: racial differences. Obesity (Silver Spring). 2010;18(1):86–91.CrossRefGoogle Scholar
  9. 9.
    McNeil J, Schwartz A, Rabasa-Lhoret R, et al. Changes in leptin and peptide YY do not explain the greater-than-predicted decreases in resting energy expenditure after weight loss. J Clin Endocrinol Metab. 2015;100(3):E443–52.CrossRefGoogle Scholar
  10. 10.
    Bray GA, Smith SR, DeJonge L, et al. Effect of diet composition on energy expenditure during weight loss: the POUNDS LOST Study. Int J Obes. 2012;36(3):448–55.CrossRefGoogle Scholar
  11. 11.
    Rabl C, Rao MN, Schwarz JM, et al. Thermogenic changes after gastric bypass, adjustable gastric banding or diet alone. Surgery. 2014;156(4):806–12.CrossRefGoogle Scholar
  12. 12.
    Trexler E, Smith-Ryan A, Norton L. Metabolic adaption to weight loss: implications for the athlete. J Int Soc Sports Nutr. 2014;11(1):7.CrossRefGoogle Scholar
  13. 13.
    Browning MG, Franco RL, Cyrus JC, et al. Changes in resting energy expenditure in relation to body weight and composition following gastric restriction: a systematic review. Obes Surg. 2016;26(7):1607–15.CrossRefGoogle Scholar
  14. 14.
    Faria SL, Faria OP, Buffington C, et al. Energy expenditure before and after Roux-en-Y gastric bypass. Obes Surg. 2012;22(9):1450–5.CrossRefGoogle Scholar
  15. 15.
    Gomes DL, de Almeida Oliveira D, Dutra ES, et al. Resting energy expenditure and body composition of women with weight regain 24 months after bariatric surgery. Obes Surg. 2016;26(7):1443–7.CrossRefGoogle Scholar
  16. 16.
    Iannelli A, Martini F, Rodolphe A, et al. Body composition, anthropometrics, energy expenditure, systemic inflammation, in premenopausal women 1 year after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2014;28(2):500–7.CrossRefGoogle Scholar
  17. 17.
    Moehlecke M, Andriatta Blume C, Rheinheimer J, et al. Early reduction of resting energy expenditure and successful weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2017;13(2):204–9.CrossRefGoogle Scholar
  18. 18.
    Bettini S, Bordigato E, Fabris R, et al. Modifications of resting energy expenditure after sleeve gastrectomy. Obes Surg. 2018;28:2481–6.CrossRefGoogle Scholar
  19. 19.
    Schneider J, Peterli R, Gass M, et al. Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass lead to equal changes in body composition and energy metabolism 17 months postoperatively: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(3):563–70.CrossRefGoogle Scholar
  20. 20.
    Johannsen DL, Knuth ND, Huizenga R, et al. Metabolic slowing with massive weight loss despite preservation of fat-free mass. J Clin Endocrinol Metab. 2012;97(7):2489–96.CrossRefGoogle Scholar
  21. 21.
    Knuth ND, Johannsen DL, Tamboli RA, et al. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring). 2014;22(12):2563–9.Google Scholar
  22. 22.
    Thivel D, Brakonieki K, Duche P, et al. Surgical weight loss: impact on energy expenditure. Obes Surg. 2013;23(2):255–66.CrossRefGoogle Scholar
  23. 23.
    Takashina C, Tsujino I, Watanabe T, et al. Associations among the plasma amino acid profile, obesity, and glucose metabolism in Japanese adults with normal glucose tolerance. Nutr Metab (Lond). 2016;13:5.CrossRefGoogle Scholar
  24. 24.
    Bi X, Henry CJ. Plasma-free amino acid profiles are predictors of cancer and diabetes development. Nutr Diabetes. 2017;7(3):e249.CrossRefGoogle Scholar
  25. 25.
    Tochikubo O, Nakamura H, Jinzu H, et al. Weight loss is associated with plasma free amino acid alterations in subjects with metabolic syndrome. Nutr Diabetes. 2016;6:e197.CrossRefGoogle Scholar
  26. 26.
    Geidenstam N, Magnusson M, Danielsson APH, et al. Amino acid signatures to evaluate the beneficial effects of weight loss. Int J Endocrinol. 2017;2017:6490473.CrossRefGoogle Scholar
  27. 27.
    Golzarand M, Toolabi K, Djafarian K. Changes in body composition, dietary intake, and substrate oxidation in patients underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a comparative prospective study. Obes Surg. 2019;29(2):406–13.CrossRefGoogle Scholar
  28. 28.
    Toolabi K, Arefanian S, Golzarand M, et al. Effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) on weight loss and biomarker parameters in morbidly obese patients: a 12-month follow-up. Obes Surg. 2011;21(12):1834–42.CrossRefGoogle Scholar
  29. 29.
    Browning MG, Khoraki J, Campos GM. Regression-based approach is needed to compare predicted and measured resting metabolic rate after weight loss and body composition changes. Surg Obes Relat Dis. 2018;14(6):807–9.CrossRefGoogle Scholar
  30. 30.
    Yamakado M, Tanaka T, Nagao K, et al. Plasma amino acid profile is associated with visceral fat accumulation in obese Japanese subjects. Clin Obes. 2012;2(1–2):29–40.CrossRefGoogle Scholar
  31. 31.
    Das SK, Roberts SB, McCrory MA, et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr. 2003;78(1):22–30.CrossRefGoogle Scholar
  32. 32.
    de Castro Cesar M, de Lima Montebelo MI, Rasera Jr I, et al. Effects of Roux-en-Y gastric bypass on resting energy expenditure in women. Obes Surg. 2008;18(11):1376–80.CrossRefGoogle Scholar
  33. 33.
    Olbers T, Bjorkman S, Lindroos A, et al. Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg. 2006;244(5):715–22.CrossRefGoogle Scholar
  34. 34.
    Ramirez-Marrero FA, Edens KL, Joyner MJ, et al. Predicted vs. actual resting energy expenditure and activity coefficients: post-gastric bypass, lean and obese women. Obes Control Ther. 2014;1(2):1–7.Google Scholar
  35. 35.
    Tam CS, Rigas G, Heilbronn LK, et al. Energy adaptations persist 2 years after sleeve gastrectomy and gastric bypass. Obes Surg. 2016;26(2):459–63.CrossRefGoogle Scholar
  36. 36.
    Iannelli A, Anty R, Schneck AS, et al. Evolution of low-grade systemic inflammation, insulin resistance, anthropometrics, resting energy expenditure and metabolic syndrome after bariatric surgery: a comparative study between gastric bypass and sleeve gastrectomy. J Visc Surg. 2013;150(4):269–75.CrossRefGoogle Scholar
  37. 37.
    Schwartz A, Doucet E. Relative changes in resting energy expenditure during weight loss: a systematic review. Obes Rev. 2010;11(7):531–47.CrossRefGoogle Scholar
  38. 38.
    Dulloo AG, Jacquet J, Montani JP, et al. Adaptive thermogenesis in human body weight regulation: more of a concept than a measurable entity? Obes Rev. 2012;13(Suppl 2):105–21.CrossRefGoogle Scholar
  39. 39.
    Carrasco F, Papapietro K, Csendes A, et al. Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass. Obes Surg. 2007;17(5):608–16.CrossRefGoogle Scholar
  40. 40.
    Karl JP, Roberts SB, Schaefer EJ, et al. Effects of carbohydrate quantity and glycemic index on resting metabolic rate and body composition during weight loss. Obesity (Silver Spring). 2015;23(11):2190–8.CrossRefGoogle Scholar
  41. 41.
    Laferrere B, Reilly D, Arias S, et al. Differential metabolic impact of gastric bypass surgery versus dietary intervention in obese diabetic subjects despite identical weight loss. Sci Transl Med. 2011;3(80):80re2.CrossRefGoogle Scholar
  42. 42.
    Lips MA, Van Klinken JB, van Harmelen V, Dharuri HK, t Hoen PA, Laros JF, et al. Roux-en-Y gastric bypass surgery, but not calorie restriction, reduces plasma branched-chain amino acids in obese women independent of weight loss or the presence of type 2 diabetes. Diabetes Care 2014;37(12):3150–3156.Google Scholar
  43. 43.
    Magkos F, Bradley D, Schweitzer GG, et al. Effect of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding on branched-chain amino acid metabolism. Diabetes. 2013;62(8):2757–61.CrossRefGoogle Scholar
  44. 44.
    Nicoletti CF, Morandi Junqueira-Franco MV, dos Santos JE, Marchini JS, Salgado W, Jr., and Nonino CB. Protein and amino acid status before and after bariatric surgery: a 12-month follow-up study. Surg Obes Relat Dis 2013;9(6):1008–1012.Google Scholar
  45. 45.
    Tan HC, Khoo CM, Tan MZ, et al. The effects of sleeve gastrectomy and gastric bypass on branched-chain amino acid metabolism 1 year after bariatric surgery. Obes Surg. 2016;26(8):1830–5.CrossRefGoogle Scholar
  46. 46.
    Hanvold SE, Vinknes KJ, Bastani NE, et al. Plasma amino acids, adiposity, and weight change after gastric bypass surgery: are amino acids associated with weight regain? Eur J Nutr. 2018;57(7):2629–35.CrossRefGoogle Scholar
  47. 47.
    Mutch DM, Fuhrmann JC, Rein D, et al. Metabolite profiling identifies candidate markers reflecting the clinical adaptations associated with Roux-en-Y gastric bypass surgery. PLoS One. 2009;4(11):e7905.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
  2. 2.Department of Surgery, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
  3. 3.Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
  4. 4.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
  5. 5.Department of Pathobiology, School of Public HealthTehran University of Medical SciencesTehranIran

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