Gastric Bypass Surgery Improves Metabolic and Hepatic Abnormalities Associated With Nonalcoholic Fatty Liver Disease

Klein, Samuel; Mittendorfer, Bettina; Eagon, J. Christopher; Patterson, Bruce W.; Grant, Lafaine; Feirt, Nikki; Seki, Ekihiro; Brenner, David A.; Korenblat, Kevin; McCrea, Jennifer

doi:10.1053/j.gastro.2006.01.042

Cited by 257 publications

(158 citation statements)

References 41 publications

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“…Furthermore, reduced glucagon responses to OGTTs have been observed in GK diabetic rats following DJB [37]. In line with these observations, reduced hepatic glucose production (or endogenous glucose production) has been reported in individuals treated with RYGB [38]. However, the available data on glucagon secretion following RYGB are sparse, and it should be emphasised that elevated glucagon levels have also been observed following RYGB [39].…”

Section: Does Diabetic Hyperglucagonaemia Originate From the Proximalmentioning

confidence: 65%

Resolution of type 2 diabetes following gastric bypass surgery: involvement of gut-derived glucagon and glucagonotropic signalling?

Knop

2009

Diabetologia

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Certain types of bariatric surgical procedures have proved not only to be effective with regard to treating obesity, but they also seem to be associated with endocrine changes which independently of weight loss give rise to remission of type 2 diabetes. Currently, it is speculated that surgical re-routing of nutrients triggers changes in the release of gastrointestine-derived hormones, which in turn cause amelioration of the diabetic state. The 'hindgut hypothesis' states that surgical re-routing of nutrients to the distal part of the small intestine results in increased secretion and concomitant glucose-lowering effects of glucagon-like peptide-1, whereas the 'foregut hypothesis' emphasises that surgical bypass of the foregut prevents the release of a hitherto unidentified nutrient-induced diabetogenic signal in susceptible individuals. Recent studies have shown that in patients with type 2 diabetes, glucagon is differentially secreted in response to oral and i.v. glucose, respectively, with lack of suppression (and initial net secretion) during oral glucose administration and a perfectly normal suppression during isoglycaemic i.v. glucose administration. These findings could point towards a role for glucagon or gut-derived glucagonotropic signalling as putative diabetogenic signals of the foregut hypothesis. In the present paper the hypotheses describing the glucoselowering mechanisms of bariatric surgical procedures sharing the common feature of a bypass of the duodenum and the proximal jejunum are outlined and a possible role for glucagon in these is proposed.

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Section: Does Diabetic Hyperglucagonaemia Originate From the Proximalmentioning

confidence: 65%

Resolution of type 2 diabetes following gastric bypass surgery: involvement of gut-derived glucagon and glucagonotropic signalling?

Knop

2009

Diabetologia

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“…Free fatty acid (FFA) concentrations were measured by colorimetric assay (Wako Diagnostic). Plasma glucose TTR was determined by using electron impact ionization gas chromatography-mass spectrometry (MSD 5973 system with capillary column; HewlettPackard, Palo Alto, CA) as we have described previously (30).…”

mentioning

confidence: 99%

Metabolic response to high-carbohydrate and low-carbohydrate meals in a nonhuman primate model

Fabbrini

Higgins

Magkos

et al. 2013

American Journal of Physiology-Endocrinology and Metabolism

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We established a model of chronic portal vein catheterization in an awake nonhuman primate to provide a comprehensive evaluation of the metabolic response to low-carbohydrate/high-fat (LCHF; 20% carbohydrate and 65% fat) and high-carbohydrate/low-fat (HCLF; 65% carbohydrate and 20% fat) meal ingestion. Each meal was given 1 wk apart to five young adult (7.8 Ϯ 1.3 yr old) male baboons. A [U-13 C]glucose tracer was added to the meal, and a [6,6-2 H2]glucose tracer was infused systemically to assess glucose kinetics. Plasma areas under the curve (AUCs) of glucose, insulin, and C-peptide in the femoral artery and of glucose and insulin in the portal vein were higher (P Յ 0.05) after ingestion of the HCLF compared with the LCHF meal. Compared with the LCHF meal, the rate of appearance of ingested glucose into the portal vein and the systemic circulation was greater after the HCLF meal (P Ͻ 0.05). Endogenous glucose production decreased by ϳ40% after ingestion of the HCLF meal but was not affected by the LCHF meal (P Ͻ 0.05). Portal vein blood flow increased (P Ͻ 0.001) to a similar extent after consumption of either meal. In conclusion, a LCHF diet causes minimal changes in the rate of glucose appearance in both portal and systemic circulations, does not affect the rate of endogenous glucose production, and causes minimal stimulation of C-peptide and insulin. These observations demonstrate that LCHF diets cause minimal perturbations in glucose homeostasis and pancreatic ␤-cell activity.stable isotope tracers; portal vein catheterization; ␤-cell function THE TYPICAL DIET IN THE US provides ϳ50% of ingested calories as carbohydrate, 35% as fat, and 15% as protein (4). However, data from several studies have shown that a low-carbohydrate diet containing 35-40% of calories as carbohydrate can have therapeutic effects in patients with type 2 diabetes by lowering plasma glucose, triglyceride, and very low-density lipoprotein (VLDL) cholesterol, by increasing plasma high-density lipoprotein (HDL) cholesterol concentrations, and by decreasing insulin requirements (17)(18)(19). In addition, low-carbohydrate diets are often used to help induce weight loss in obese people (15). Although the use of low-carbohydrate diets continues to be a popular dietary therapy, the metabolic response to highand low-carbohydrate meals has not been carefully evaluated.The metabolic response to a meal is carefully coordinated among several organ systems to prevent large excursions in plasma glucose concentration and to deliver ingested nutrients to appropriate tissues for storage or utilization. The normal regulation of postprandial plasma glucose involves an increase in insulin secretion from pancreatic ␤-cells into the portal vein, insulin-mediated suppression of endogenous (primarily hepatic) glucose production, and insulin-mediated stimulation of glucose uptake by peripheral tissues (primarily skeletal muscle). In fact, abnormalities in plasma glucose concentration after an oral glucose load is ingested are used as a clinical tool to diagnose...

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“…The beneficial effect of bariatric surgery on NAFLD, by reducing the weight and improving metabolic syndrome, has been already described 16,17,18 . Mattar et al followed 70 patients who underwent bariatric surgery with a diagnosis of NAFLD confirmed by liver biopsy and detected resolution of hepatic steatosis in 37% of patients and fibrosis in 20%.…”

Section: Overall Ratingmentioning

confidence: 94%

Relação entre o estado nutricional de vitamina a e a regressão da esteatose hepática após gastroplastia em Y- de- Roux para tratamento da obesidade classe III

Silva

Manso²,

Silva

et al. 2012

ABCD, arq. bras. cir. dig.

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-Background -Vitamin A participates in several essentials functions in the human body and their serum concentrations may be decreased in non-transmissible diseases. Aim -To assess the relationship of the nutritional status of Vitamin A through the serum concentrations of retinol and beta carotene, with regression of hepatic steatosis in individuals who undergone Roux-en-Y gastric bypass surgery for treatment of class III obesity. Methods -Were included 30 individuals, male and female, submitted to Roux-en-Y gastric bypass for treatment of class III obesity, who were diagnosed through an abdominal ultrasonography as presenting hepatic steatosis. From the result of an ultrasonography screened six months after the surgical procedure those subjects were divided into two groups: group 1 -patients with steatosis detected in the ultrasonography (16 subjects) and group 2 -patients without steatosis detected in the ultrasonography (14 subjects). Before and six months after the surgery, were carried out anthropometrical analyses and biochemical exams (basal insulin, glicemy, Homeostasis Model Assessment Index (HOMA IR), cholesterol, HDL, LDL, triglycerides, AST, ALT, Gamma-GT, albumin, total bilirubin, retinol, and beta carotene. Results -The individuals presented an average weight loss of 35.05 + 10.47 (p<0.01) and a decrease in the Body Mass Index (BMI) of 11.6 + 4.99 Kg/m² (p<0.01). After six months, all the biochemical exams presented a significant decrease in their basal concentrations (p<0.05). In the post-operative period the group 2 (without steatosis) presented concentrations significantly lower (p<0.05) in the following variables: weight, BMI, AST, ALT, Gamma-GT, HOMA IR, basal insulin. The albumin serum concentrations presented close average values, with no significant difference in the two periods evaluated. In the assessment of retinol and beta carotene, higher serum concentrations and a small decrease in relation to the concentrations of the pre-operative period in the group without steatosis were observed, however, no statistical difference was found. Conclusion -An adequate nutritional status of vitamin A might contribute in the improvement of the hepatic esteatosis after Roux-en-Y gastric bypass for class III obesity treatment. ABCDDV/879RESUMO -Racional -A vitamina A participa de várias funções primordiais no organismo humano e as suas concentrações séricas podem estar diminuídas nas doenças crônicas não transmissíveis. Objetivo -Avaliar a relação entre o estado nutricional da vitamina A, e a regressão da esteatose hepática em indivíduos submetidos à gastroplastia em Y-de-Roux para tratamento da obesidade classe III.

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Gastric Bypass Surgery Improves Metabolic and Hepatic Abnormalities Associated With Nonalcoholic Fatty Liver Disease

Cited by 257 publications

References 41 publications

Resolution of type 2 diabetes following gastric bypass surgery: involvement of gut-derived glucagon and glucagonotropic signalling?

Resolution of type 2 diabetes following gastric bypass surgery: involvement of gut-derived glucagon and glucagonotropic signalling?

Metabolic response to high-carbohydrate and low-carbohydrate meals in a nonhuman primate model

Relação entre o estado nutricional de vitamina a e a regressão da esteatose hepática após gastroplastia em Y- de- Roux para tratamento da obesidade classe III

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