Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with elevated ghrelin

Robyn A Tamboli, Igal Breitman, Pam A Marks-Shulman, Kareem Jabbour, Willie Melvin, Brandon Williams, Ronald H Clements, Irene D Feurer, Naji N Abumrad, Robyn A Tamboli, Igal Breitman, Pam A Marks-Shulman, Kareem Jabbour, Willie Melvin, Brandon Williams, Ronald H Clements, Irene D Feurer, Naji N Abumrad

Abstract

Objectives: We sought to determine: (1) if early weight regain between 1 and 2 years after Roux-en-Y gastric bypass (RYGB) is associated with worsened hepatic and peripheral insulin sensitivity, and (2) if preoperative levels of ghrelin and leptin are associated with early weight regain after RYGB.

Methods: Hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels were assessed longitudinally in 45 subjects before RYGB and at 1 month, 6 months, 1 year, and 2 years postoperatively. Weight regain was defined as ≥5% increase in body weight between 1 and 2 years after RYGB.

Results: Weight regain occurred in 33% of subjects, with an average increase in body weight of 10 ± 5% (8.5 ± 3.3 kg). Weight regain was not associated with worsening of peripheral or hepatic insulin sensitivity. Subjects with weight regain after RYGB had higher preoperative and postoperative levels of ghrelin compared to those who maintained or lost weight during this time. Conversely, the trajectories of leptin levels corresponded with the trajectories of fat mass in both groups.

Conclusions: Early weight regain after RYGB is not associated with a reversal of improvements in insulin sensitivity. Higher preoperative ghrelin levels might identify patients that are more susceptible to weight regain after RYGB.

Keywords: gastric bypass surgery; ghrelin; insulin sensitivity; weight regain.

Copyright © 2014 The Obesity Society.

Figures

Figure 1. Weight regain at two years…
Figure 1. Weight regain at two years after RYGB is not associated with worsened insulin sensitivity, but is associated with elevated plasma ghrelin levels
Weight regain was defined as ≥ 5% weight change between one and two years after RYGB, and occurred in 33% of the cohort. Trajectories of fat (A) and lean (B) mass losses were similar between groups up to one year after RYGB. There was no effect of weight regain on peripheral (C) or hepatic (D) insulin sensitivity (both group by time interaction P ≥ 0.137). Leptin levels (E) increased between one and two years after RYGB in the weight regain group (group by time interaction P = 0.011). Ghrelin levels (F) were higher in the weight regain group at baseline (P = 0.009) and this stratification was maintained over time (group by time interaction P = 0.707). Data are mean ± SEM.

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Source: PubMed

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