The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery

James M Isbell, Robyn A Tamboli, Erik N Hansen, Jabbar Saliba, Julia P Dunn, Sharon E Phillips, Pamela A Marks-Shulman, Naji N Abumrad, James M Isbell, Robyn A Tamboli, Erik N Hansen, Jabbar Saliba, Julia P Dunn, Sharon E Phillips, Pamela A Marks-Shulman, Naji N Abumrad

Abstract

Objective: Many of the metabolic benefits of Roux-en-Y gastric bypass (RYGB) occur before weight loss. In this study we investigated the influence of caloric restriction on the improvements in the metabolic responses that occur within the 1st week after RYGB. RESEARCH METHODS AND DESIGN: A mixed meal was administered to nine subjects before and after RYGB (average 4 +/- 0.5 days) and to nine matched, obese subjects before and after 4 days of the post-RYGB diet.

Results: Weight loss in both groups was minimal; the RYGB subjects lost 1.4 +/- 5.3 kg (P = 0.46) vs. 2.2 +/- 1.0 kg (P = 0.004) in the calorically restricted group. Insulin resistance (homeostasis model assessment of insulin resistance) improved with both RYGB (5.0 +/- 3.1 to 3.3 +/- 2.1; P = 0.03) and caloric restriction (4.8 +/- 4.1 to 3.6 +/- 4.1; P = 0.004). The insulin response to a mixed meal was blunted in both the RYGB and caloric restriction groups (113 +/- 67 to 65 +/- 33 and 85 +/- 59 to 65 +/- 56 nmol x l(-1) x min(-1), respectively; P < 0.05) without a change in the glucose response. Glucagon-like peptide 1 levels increased (9.2 +/- 8.6 to 12.2 +/- 5.5 pg x l(-1) x min(-1); P = 0.04) and peaked higher (45.2 +/- 37.3 to 84.8 +/- 33.0 pg/ml; P = 0.01) in response to a mixed meal after RYGB, but incretin responses were not altered after caloric restriction.

Conclusions: These data suggest that an improvement in insulin resistance in the 1st week after RYGB is primarily due to caloric restriction, and the enhanced incretin response after RYGB does not improve postprandial glucose homeostasis during this time.

Trial registration: ClinicalTrials.gov NCT00765596.

Figures

Figure 1
Figure 1
Metabolic responses during a mixed-meal before and after RYGB and diet. Blood was drawn before (time 0), immediately after the ingestion of a mixed-meal (time 20), and every subsequent hour for 4 h. Plasma levels of glucose (A), insulin (B), GLP-1 (C), GIP (D), and total ghrelin (E) were measured at each time point at baseline (●) and 4 days after RYGB (□) or 3 days after a post–bariatric surgery diet (□). Data are means ± SEM.

References

    1. Rubino F, Gagner M, Gentileschi P, Kini S, Fukuyama S, Feng J, Diamond E: The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg 2004; 240: 236–242
    1. Gumbs AA, Modlin IM, Ballantyne GH: Changes in insulin resistance following bariatric surgery: role of caloric restriction and weight loss. Obes Surg 2005; 15: 462–473
    1. Bose M, Oliván B, Teixeira J, Pi-Sunyer FX, Laferrère B: Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence? Obes Surg 2009; 19: 217–229
    1. Lara-Castro C, Newcomer BR, Rowell J, Wallace P, Shaughnessy SM, Munoz AJ, Shiflett AM, Rigsby DY, Lawrence JC, Bohning DE, Buchthal S, Garvey WT: Effects of short-term very low-calorie diet on intramyocellular lipid and insulin sensitivity in nondiabetic and type 2 diabetic subjects. Metabolism 2008; 57: 1–8
    1. Preitner F, Ibberson M, Franklin I, Binnert C, Pende M, Gjinovci A, Hansotia T, Drucker DJ, Wollheim C, Burcelin R, Thorens B: Gluco-incretins control insulin secretion at multiple levels as revealed in mice lacking GLP-1 and GIP receptors. J Clin Invest 2004; 113: 635–645
    1. Vestergaard ET, Gormsen LC, Jessen N, Lund S, Hansen TK, Moller N, Jorgensen JO: Ghrelin infusion in humans induces acute insulin resistance and lipolysis independent of growth hormone signaling. Diabetes 2008; 57: 3205–3210
    1. Soares JB, Leite-Moreira AF: Ghrelin, des-acyl ghrelin and obestatin: three pieces of the same puzzle. Peptides 2008; 29: 1255–1270
    1. Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, Purnell JQ: Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002; 346: 1623–1630
    1. Varady KA, Tussing L, Bhutani S, Braunschweig CL: Degree of weight loss required to improve adipokine concentrations and decrease fat cell size in severely obese women. Metabolism 2009; 58: 1096–1101
    1. Campos GM, Rabl C, Peeva S, Ciovica R, Rao M, Schwarz JM, Havel P, Schambelan M, Mulligan K: Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg 2010; 14: 15–23
    1. Laferrère B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, Kovack B, Bawa B, Koshy N, Lee H, Yapp K, Olivan B: Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab 2008; 93: 2479–2485
    1. Oliván B, Teixeira J, Bose M, Bawa B, Chang T, Summe H, Lee H, Laferrère B: Effect of weight loss by diet or gastric bypass surgery on peptide YY3–36 levels. Ann Surg 2009; 249: 948–953
    1. Saliba J, Wattacheril J, Abumrad NN: Endocrine and metabolic response to gastric bypass. Curr Opin Clin Nutr Metab Care 2009; 12: 515–521
    1. Levy JC, Matthews DR, Hermans MP: Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care 1998; 21: 2191–2192
    1. Wickremesekera K, Miller G, Naotunne TD, Knowles G, Stubbs RS: Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study. Obes Surg 2005; 15: 474–481
    1. Wallace TM, Levy JC, Matthews DR: Use and abuse of HOMA modeling. Diabetes Care 2004; 27: 1487–1495
    1. Jazet IM, Pijl H, Frölich M, Romijn JA, Meinders AE: Two days of a very low calorie diet reduces endogenous glucose production in obese type 2 diabetic patients despite the withdrawal of blood glucose-lowering therapies including insulin. Metabolism 2005; 54: 705–712
    1. Clements RH, Gonzalez QH, Long CI, Wittert G, Laws HL: Hormonal changes after Roux-en Y gastric bypass for morbid obesity and the control of type-II diabetes mellitus. Am Surg 2004; 70: 1–4; discussion 4–5
    1. Laferrère B, Heshka S, Wang K, Khan Y, McGinty J, Teixeira J, Hart AB, Olivan B: Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care 2007; 30: 1709–1716
    1. le Roux CW, Welbourn R, Werling M, Osborne A, Kokkinos A, Laurenius A, Lönroth H, Fändriks L, Ghatei MA, Bloom SR, Olbers T: Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg 2007; 246: 780–785
    1. Morínigo R, Lacy AM, Casamitjana R, Delgado S, Gomis R, Vidal J: GLP-1 and changes in glucose tolerance following gastric bypass surgery in morbidly obese subjects. Obes Surg 2006; 16: 1594–1601
    1. Vella A, Rizza RA: Extrapancreatic effects of GIP and GLP-1. Horm Metab Res 2004; 36: 830–836
    1. Tschöp M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML: Circulating ghrelin levels are decreased in human obesity. Diabetes 2001; 50: 707–709
    1. Morínigo R, Casamitjana R, Moizé V, Lacy AM, Delgado S, Gomis R, Vidal J: Short-term effects of gastric bypass surgery on circulating ghrelin levels. Obes Res 2004; 12: 1108–1116

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren