Caloric Restriction and Weight Loss Are Primary Factors in the Early Tissue-Specific Metabolic Changes After Bariatric Surgery

Charles Robb Flynn, Robyn A Tamboli, Joseph Antoun, Reem M Sidani, Brandon Williams, Matthew D Spann, Wayne J English, E Brian Welch, Sinju Sundaresan, Naji N Abumrad, Charles Robb Flynn, Robyn A Tamboli, Joseph Antoun, Reem M Sidani, Brandon Williams, Matthew D Spann, Wayne J English, E Brian Welch, Sinju Sundaresan, Naji N Abumrad

Abstract

Objective: To evaluate changes in insulin sensitivity, hormone secretion, and hepatic steatosis immediately after caloric restriction, vertical sleeve gastrectomy (VSG), and Roux-en-Y gastric bypass (RYGB).

Research design and methods: Obese subjects were assessed for 1) insulin sensitivity with hyperinsulinemic-euglycemic clamp with glucose tracer infusion, 2) adipokine concentrations with serum and subcutaneous adipose interstitial fluid sampling, and 3) hepatic fat content with MRI before and 7-10 days after VSG, RYGB, or supervised caloric restriction.

Results: Each group exhibited an ∼5% total body weight loss, accompanied by similar improvements in hepatic glucose production and hepatic, skeletal muscle, and adipose tissue insulin sensitivity. Leptin concentrations in plasma and adipose interstitial fluid were equally decreased, and reductions in hepatic fat were similar.

Conclusions: The improvements in insulin sensitivity and adipokine secretion observed early after bariatric surgery are replicated by equivalent caloric restriction and weight loss.

Trial registration: ClinicalTrials.gov NCT01474785.

© 2022 by the American Diabetes Association.

Figures

Figure 1
Figure 1
Insulin sensitivity before (Pre) and after (Post) RYGB, VSG, or diet. A: Hepatic insulin sensitivity index. B: Skeletal muscle insulin sensitivity. C: Adipose tissue insulin resistance index. Data are means ± SEM for n = 11 RYGB and n = 15 VSG (A–C), n = 14 diet (A), and n = 13 diet (B and C). GxT, group-by-time interaction; T, time.

References

    1. Schauer PR, Bhatt DL, Kirwan JP, et al. .; STAMPEDE Investigators . Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med 2017;376:641–651
    1. Bojsen-Møller KN, Dirksen C, Jørgensen NB, et al. . Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass. Diabetes 2014;63:1725–1737
    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. Patriti A, Facchiano E, Annetti C, et al. . Early improvement of glucose tolerance after ileal transposition in a non-obese type 2 diabetes rat model. Obes Surg 2005;15:1258–1264
    1. Yoshino M, Kayser BD, Yoshino J, et al. . Effects of diet versus gastric bypass on metabolic function in diabetes. N Engl J Med 2020;383:721–732
    1. Gifford A, Towse TF, Walker RC, Avison MJ, Welch EB. Characterizing active and inactive brown adipose tissue in adult humans using PET-CT and MR imaging. Am J Physiol Endocrinol Metab 2016;311:E95–E104
    1. Plum L, Ahmed L, Febres G, et al. . Comparison of glucostatic parameters after hypocaloric diet or bariatric surgery and equivalent weight loss. Obesity (Silver Spring) 2011;19:2149–2157
    1. Camastra S, Gastaldelli A, Mari A, et al. . Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia 2011;54:2093–2102
    1. Gastaldelli A, Iaconelli A, Gaggini M, et al. . Short-term effects of laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass. Diabetes Care 2016;39:1925–1931
    1. Campos GM, Rabl C, Peeva S, et al. . 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. Dunn JP, Abumrad NN, Breitman I, et al. . Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy. Diabetes Care 2012;35:137–142
    1. Lima MM, Pareja JC, Alegre SM, et al. . Acute effect of roux-en-y gastric bypass on whole-body insulin sensitivity: a study with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010;95:3871–3875
    1. Vetter ML, Wadden TA, Teff KL, et al. . GLP-1 plays a limited role in improved glycemia shortly after Roux-en-Y gastric bypass: a comparison with intensive lifestyle modification. Diabetes 2015;64:434–446
    1. Johansson L, Roos M, Kullberg J, et al. . Lipid mobilization following Roux-en-Y gastric bypass examined by magnetic resonance imaging and spectroscopy. Obes Surg 2008;18:1297–1304
    1. Edholm D, Kullberg J, Karlsson FA, Haenni A, Ahlström H, Sundbom M. Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis 2015;11:602–606

Source: PubMed

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