Chronic Elevation of Systemic Glucagon-Like Peptide-1 Following Surgical Weight Loss: Association with Nausea and Vomiting and Effects on Adipokines

Abstract

We determined whether persistent nausea and vomiting (N/V) symptoms following Roux-en-Y gastric bypass surgery is due to elevated systemic glucagon-like peptide-1 (GLP-1) and leptin in female non-diabetic subjects. Subjects with N/V post-Roux-en-Y gastric bypass (RYGB) surgery had significantly elevated fasting GLP-1 levels compared to that with post-operative asymptomatic subjects and to morbidly obese, obese and lean subjects not undergoing surgery. Weight loss, glycaemia, insulin and post-prandial GLP-1 levels were similar in all post-operative subjects. Despite comparable BMI, leptin was significantly lower in symptomatic subjects. Furthermore, leptin secretion from subcutaneous adipose tissue was inhibited by GLP-1 (0.1–1.0 nM; n = 6). Persistent N/V following RYGB surgery is associated with elevated fasting GLP-1, but lower leptin levels. The latter may be a consequence of the direct GLP-1 inhibition of leptin secretion from adipose tissue.

Changes in Bone Metabolism After Sleeve Gastrectomy Versus Gastric Bypass: a Meta-Analysis

“…However, the mechanism of osteoporosis after weight loss surgery remains unidentified. There are several hypotheses: (1) reduction in mechanical loads on bone followed by a decrease in bone mass resulted from weight loss [42]; (2) postoperative changes in hormones such as leptin, adiponectin, insulin, GLP-1, and ghrelin [43][44][45][46][47]; and (3) surgical changes in the gastrointestinal tract leading to deficiencies in vitamin D and calcium [48].…”

Changes in Bone Metabolism in Morbidly Obese Patients After Bariatric Surgery: A Meta-Analysis

“…The other mechanism involves the anatomic changes to the gastrointestinal tract, resulting in an alteration in gutderived appetite-regulatory hormones such as peptide YY (RYY) [32,33], glucagon-like peptide-1 (GLP-1) [34], and ghrelin [35]. Reduced ghrelin, increased plasma PYY, and chronic elevation of systemic GLP-1 can lead to bone loss after bariatric surgery as can declining concentrations of fat-derived adipokines such as leptin [36] and elevated adiponectin [21].…”

OAGB Bowel Function in Patients With up to 5 Years Follow-Up: Updated Outcomes

“…[ 32 , 33 ], initial gastroparesis that regresses over time. Al-Rasheid N. et al [ 34 ] found in their study that symptoms of persistent nausea and vomiting after surgery were mediated by elevated fasting GLP-1 levels. We can also infer, as a hypothesis, that nausea may be related to the rapid entry of the food bolus into the CL and, consequently, to the sudden distension of the intestinal wall.…”

“…We can also infer, as a hypothesis, that nausea may be related to the rapid entry of the food bolus into the CL and, consequently, to the sudden distension of the intestinal wall. In a small percentage of cases of bending or torsion of the single anastomosis, the food bolus can preferably be directed toward the BPL, and the resulting distension can also contribute to this aspect [ 34 ]. We may also put the hypothesis that in some cases peristaltic reaction may push the food back to the pouch contributing also to nausea and gastro-esophageal reflux as well.…”