Bile Acid and Fibroblast Growth Factor 19 Regulation in Obese Diabetics, and Non-Alcoholic Fatty Liver Disease after Sleeve Gastrectomy

Abstract

Background: Sleeve gastrectomy (SG) is an effective treatment for obesity and type 2 diabetes mellitus (T2DM), and non-alcoholic fatty liver disease (NAFLD); however, the mechanism is not completely understood. Bile acids and fibroblast growth factors (FGFs) are involved in the regulation of energy metabolism. Methods: We investigated the roles of total bile acid and FGF 19 in T2DM remission and NAFLD improvement in obese subjects undergoing SG. A total of 18 patients with obesity and T2DM undergoing laparoscopic SG were enrolled in this study. Serial plasma total bile acid and FGF 19 levels were measured, while the fatty liver index was calculated before and after surgery. Results: The FGF 19 level significantly increased, and the total bile acid level and fatty liver index decreased 1 year after surgery. The complete T2DM remission rate was 66.7% one year after surgery; the complete remitters had significantly lower FGF 19 levels and higher insulin levels than the non-complete remitters. The complete remitters also had significantly decreased total bile acid levels and increased FGF 19 levels 1 year after surgery compared with those before surgery. The fatty improvers had significantly decreased total bile acid levels and increased FGF 19 levels 1 year after surgery compared with those before surgery. Conclusion: The total bile acids level and fatty liver index decreased, and the FGF 19 levels increased 1 year after SG. Both T2DM complete remitters and NAFLD improvers showed significantly decreased total bile acid levels and increased FGF 19 levels 1 year after SG. Plasma total bile acids and FGF 19 might have roles in T2DM remission and NAFLD improvement. Low preoperative FGF 19 levels might be a predictor for NAFLD improvement after SG.

Ultra-Early and Early Changes in Bile Acids and Insulin after Sleeve Gastrectomy among Obese Patients

“…Following SG, data are less consistent. Some researchers showed increased [13,29,30] or decreased [31] levels, whereas others showed transiently decreased [40] or unchanged [17,32,33] levels at different time points after surgery associated, or not, with metabolic improvements (Table 3). Still, the question arises if there is an acute change at one week and one month after surgery and if this change is related or not to the improvement of IR.…”

“…However, while circulating BAs have been demonstrated to increase following RYGB [13,18,[26][27][28], the effect of SG on BA has shown mixed results. Namely, some authors reported increased concentrations [13,29,30], others decreased [31] circulating levels of BA, and finally, others detected no change after SG [32,33]. Most importantly, the exact timing of the BA changes and their potential role in the reduction of IR and restauration of insulin sensitivity are not fully elucidated [3,11,34].…”

Short‐Term Results Suggest That Sleeved Stomach without Resection Is as Effective as Sleeve Gastrectomy in Improving Glucose Control in Type 2 Diabetes Mellitus Sprague‐Dawley Rat Model

“…Our SG procedure was performed using 4-0 nonabsorbable silk sutures and according to the method of Al-Sabah et al [10]. Overall, the SG procedure resulted in the resection of the greater curvature from the distal antrum (approximately 0.5 cm proximal to the pylorus) until the angle of His, resecting the fundus completely [11,12].…”

How is the digestive system affected by coronavirus disease?

“…The interaction between human ACE2 and SARS-CoV-2 is a reasonable but partial explanation of the mechanism of gastrointestinal and hepatic manifestations. Gut hormones 12 – 14 and hepatokines such as bile acid and fibroblast growth factor, 15 which regulate appetite, nutrient absorption, and immunometabolism, may deserve further exploration. Further investigations are needed for elucidation of the comprehensive pathophysiology and possible treatments of COVID-19.…”