We examined fasting plasma insulin, acylation-stimulating protein (ASP), leptin, adiponectin, ghrelin, and metabolic/cardiovascular risk profile before and 15 +/- 6 months after isolated Roux-en-Y gastric bypass surgery in 50 morbidly obese subjects. Average preoperative plasma lipids were mostly normal, whereas ASP, insulin, and leptin were elevated, and adiponectin and ghrelin were decreased. Postoperatively, body weight decreased significantly (-36.4 +/- 9.6%) and was best predicted by preoperative adiponectin concentration in weight-stable subjects (r = -0.59; P = 0.02). Plasma lipids and insulin resistance improved, leptin and ASP decreased (-76.3 +/- 14.6% and -35.9 +/- 52.2%; P < 0.001), and adiponectin increased (50.1 +/- 47.0%; P < 0.001). The decrease in apolipoprotein B was best predicted by the decrease in ASP (r = 0.55; P = 0.009), whereas the improved postoperative insulin sensitivity was best predicted by the increase in adiponectin (r = 0.70; P = 0.01). Despite bypassing 95% of the stomach and isolating the fundus from contact with ingested nutrients, circulating ghrelin did not decrease after surgery. In fact, plasma ghrelin increased postoperatively in the subset of subjects undergoing active weight loss (+60.5 +/- 23.2%; P< 0.001); ghrelin, however, remained unchanged in weight-stable subjects. In summary, 1) preoperative adiponectin concentrations may be predictive of the extent of weight loss; 2) changes in ASP and adiponectin are predictive of decreased apolipoprotein B and improved insulin action, respectively; and 3) plasma ghrelin increases after gastric bypass surgery in patients experiencing active weight loss.

The present data suggest involvement of the ASP/adipsin pathway in the pathogenesis of obesity.

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The rate of the Jaffé reaction depends on the concentration of sodium hydroxide; the pseudo-first-order rate constant of the reaction, at 37 degrees C in 10 mmol/L picrate solution, is 0.004 mmol/L. We formulated an automated method to determine urinary creatinine directly without manual sample dilution. The conditions are as follows: 10 mmol/L picrate and 60 mmol/L sodium hydroxide (final concentrations); ratio of sample to final volume, 1:41; temperature, 37 degrees C; wavelengths of measurement, 500 or 510 nm; interval of measurement, 30 to 90 s; and mode of measurement, kinetic. Determinations of creatinine in patients' samples by the new method compared favorably with those obtained with the AutoAnalyzer and aca. The run-to-run CVs were 3.6% or less, and the method was accurate for concentrations of creatinine up to 3000 mg/L. We recommend this method as a good replacement for the AutoAnalyzer or aca methods.