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Different Malabsorptive Obesity Surgery Interventions Result in Distinct Postprandial Amino Acid Metabolomic Signatures

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Abstract

Purpose

Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective weight loss surgical procedure. Yet, BPD-DS is technically difficult to perform and carries a higher risk of nutrient deficiencies as compared with other surgical interventions. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modified BPD-DS procedure conceived with the aim of decreasing the technical complexity, while retaining the weight loss efficiency. Whether the two surgical procedures diverge in nutrient absorption rates and malnutrition risk is still matter of debate. Our aim was to determine if postprandial nutrient absorption rates are different in patients subjected to BPD-DS or SADI-S for weight loss.

Materials and Methods

Plasma amino acid metabolomic profiling during mixed-meal tolerance test (MMTT) was performed in subjects (N = 18) submitted to BPD-DS (n = 9) or SADI-S (n = 9) 1.6 ± 0.1 years earlier.

Results

Patients submitted to SADI-S or BPD-DS presented distinct postprandial metabolomic profiles. Postprandial excursions of total and essential amino acids—leucine, isoleucine, and valine—were higher after SADI-S as compared with BPD-DS.

Conclusion

Our study demonstrates that a simplified malabsorptive bariatric surgery procedure SADI-S results in greater essential branched-chain amino acid absorption when compared with the classical BPD-DS intervention. These findings suggest that SADI-S can potentially lower lifetime risk of postoperative protein malnutrition, as well as have a positive impact on systemic metabolism and glucose homeostasis.

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Acknowledgments

Authors would like to thank the Senior Nurse Sandra Tavares (Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal) for her technical assistance during the MMTT.

Funding

Unit for Multidisciplinary Research in Biomedicine (UMIB) is funded by Foundation for Science and Technology (FCT) Portugal (UID/Multi/00215/2019). JJH holds an unrestricted grant from the NNF Center for Basic Metabolic Research, Copenhagen, Denmark. The NNF foundation Center for Basic Metabolic Research is an independent research institution at the University of Copenhagen, Denmark.

Author information

Author notes

  1. Sofia S. Pereira and Ivana Jarak contributed equally to this work.

Authors and Affiliations

  1. Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal

    Sofia S. Pereira, Marta Guimarães & Mariana P. Monteiro

  2. Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal

    Sofia S. Pereira, Marta Guimarães & Mariana P. Monteiro

  3. Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal

    Sofia S. Pereira

  4. Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal

    Sofia S. Pereira

  5. Department of Microscopy, Laboratory of Cell Biology and Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal

    Ivana Jarak & Marco G. Alves

  6. Department of Life Sciences, Faculty of Science and Technology (FCTUC), University of Coimbra, Coimbra, Portugal

    Rui A. Carvalho

  7. QOPNA & LAQV, Department of Chemistry, University of Aveiro, Aveiro, Portugal

    Pedro F. Oliveira

  8. Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

    Marta Guimarães, Rui Almeida, Ana M. Pereira & Mário Nora

  9. Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Nicolai J. Wewer Albrechtsen & Jens J. Holst

  10. Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2100, Copenhagen, Denmark

    Nicolai J. Wewer Albrechtsen & Jens J. Holst

  11. Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark

    Nicolai J. Wewer Albrechtsen

Authors
  1. Sofia S. Pereira
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  2. Ivana Jarak
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  4. Pedro F. Oliveira
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  7. Rui Almeida
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  8. Ana M. Pereira
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  11. Mário Nora
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  12. Mariana P. Monteiro
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Corresponding author

Correspondence to Mariana P. Monteiro.

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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.

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Pereira, S.S., Jarak, I., Carvalho, R.A. et al. Different Malabsorptive Obesity Surgery Interventions Result in Distinct Postprandial Amino Acid Metabolomic Signatures. OBES SURG 30, 4019–4028 (2020). https://doi.org/10.1007/s11695-020-04774-z

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  • DOI: https://doi.org/10.1007/s11695-020-04774-z

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