Gastrointestinal changes after bariatric surgery

Quercia, Iliana; Dutia, Roxanne; Kotler, Donald P.; Belsley, Scott; Laferrère, Blandine

doi:10.1016/j.diabet.2013.11.003

Cited by 109 publications

(68 citation statements)

References 100 publications

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“…Indeed, there is a push to rename bariatric procedures as “metabolic surgeries,” to highlight that improvements extend beyond simple weight loss and are likely mediated by changes in the hormonal profile after surgery. Bariatric surgery is associated with dramatic changes in gut‐derived hormones, such as ghrelin, GLP‐1, and PYY, as well as changes in bile acid metabolism . Similarly, the large alterations in body composition after bariatric surgery are accompanied by changes in estradiol and adipocytic hormones (eg, leptin, adiponectin, visfatin, resistin) .…”

Section: Mechanisms Of Bone Loss After Bariatric Surgerymentioning

confidence: 99%

Bone Metabolism After Bariatric Surgery

2014

Journal of Bone and Mineral Research

186

138

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Bariatric surgery is a popular and effective treatment for severe obesity, but may have negative effects on the skeleton. This review summarizes changes in bone density and bone metabolism from animal and clinical studies of bariatric surgery, with specific attention to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Skeletal imaging artifacts from obesity and weight loss are also considered. Despite challenges in bone density imaging, the preponderance of evidence suggests that bariatric surgery procedures have negative skeletal effects that persist beyond the first year of surgery, and that these effects vary by surgical type. The long-term clinical implications and current clinical recommendations are presented. Further study is required to determine mechanisms of bone loss after bariatric surgery. Although early studies focused on calcium/vitamin D metabolism and mechanical unloading of the skeleton, it seems likely that surgically-induced changes in the hormonal and metabolic profile may be responsible for the skeletal phenotypes observed after bariatric surgery.

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Section: Mechanisms Of Bone Loss After Bariatric Surgerymentioning

confidence: 99%

Bone Metabolism After Bariatric Surgery

2014

Journal of Bone and Mineral Research

186

138

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“…This effect is in part independent of body weight loss and may involve early absorption of dietary carbohydrates together with enhanced secretion of gut peptides stimulating insulin secretion (1)(2)(3). RYGB also corrects dyslipidemia in patients with obesity (4,5), but the mechanisms responsible for improved lipid homeostasis remain largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Effects of roux‐en‐Y gastric bypass surgery on postprandial fructose metabolism

Surowska

Giorgi

Theytaz

et al. 2016

Obesity

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Objective: Fructose is partly metabolized in small bowel enterocytes, where it can be converted into glucose or fatty acids. It was therefore hypothesized that Roux-en-Y gastric bypass (RYGB) may significantly alter fructose metabolism. Methods: We performed a randomized clinical study in eight patients 12-17 months after RYGB and eight control (Ctrl) subjects. Each participant was studied after ingestion of a protein and lipid meal (PL) and after ingestion of a protein1lipid1fructose1glucose meal labeled with 13 C-fructose (PLFG). Postprandial blood glucose, fructose, lactate, apolipoprotein B48 (apoB48), and triglyceride (TG) concentrations, 13 C-palmitate concentrations in chylomicron-TG and VLDL-TG, fructose oxidation ( 13 CO 2 production), and gluconeogenesis from fructose (GNGf) were measured over 6 hours. Results: After ingestion of PLFG, postprandial plasma fructose, glucose, insulin, and lactate concentrations increased earlier and reached higher peak values in RYGB than in Ctrl. GNGf was 33% lower in RYGB than Ctrl (P 5 0.041), while fructose oxidation was unchanged. Postprandial incremental areas under the curves for total TG and chylomicrons-TG were 72% and 91% lower in RYGB than Ctrl (P 5 0.064 and P 5 0.024, respectively). ApoB48 and 13 C-palmitate concentrations were not significantly different. Conclusions: Postprandial fructose metabolism was not grossly altered, but postprandial lipid concentrations were markedly decreased in subjects having had RYGB surgery.

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“…; Park and Torquati ; Quercia et al. ). Despite these physiological alterations, long‐term weight loss maintenance requires substantial and sustained changes in eating related behaviors.…”

Section: Introductionmentioning

confidence: 99%

Comparison of surgical versus diet‐induced weight loss on appetite regulation and metabolic health outcomes

et al. 2019

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Bariatric surgery is associated with significant and sustained weight loss and improved metabolic outcomes. It is unclear if weight loss alone is the main mechanism of improved metabolic health. The purpose of this trial was to compare indices of appetite regulation, insulin sensitivity and energy intake ( EI ) between participants achieving 10 kg of weight loss via Roux‐en‐Y Gastric Bypass ( RYGB ) or dietary restriction ( DIET ); intake of a very low calorie liquid diet (800 kcal/d; 40% protein, 40% fat, 20% carbohydrate that matched the post‐ RYGB dietary protocol). Adults qualifying for bariatric surgery were studied before and after 10 kg of weight loss ( RYGB [ n = 6]) or DIET [ n = 17]). Appetite (hunger, satiety, and prospective food consumption [ PFC ]), appetite–related hormones, and metabolites (ghrelin, PYY , GLP ‐1, insulin, glucose, free fatty acids [ FFA ], and triglycerides [ TG ]) were measured in the fasting state and every 30 min for 180 min following breakfast. Participants were provided lunch to evaluate acute ad libitum EI , which was similarly reduced in both groups from pre to post weight loss. Fasting ghrelin was reduced to a greater extent following RYGB compared to DIET ( P = 0.04). Area under the curve ( AUC ) for ghrelin ( P = 0.01), hunger ( P < 0.01) and PFC ( P < 0.01) increased after DIET compared to RYGB , following 10 kg weight loss. Satiety AUC increased after RYGB and decreased after DIET ( P < 0.01). Glucose and insulin (fasting and AUC ) decreased in both groups. FFA increased in both groups, with a greater increase in AUC seen after RYGB versus DIET ( P = 0.02). In summary, appetite–related indices were altered in a manner that, if maintained, may promote a sustained reduction in energy intake with RYGB compared to DIET . Future work with a larger sample size and longer follow‐up will be important to confirm and extend these findings.

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Gastrointestinal changes after bariatric surgery

Cited by 109 publications

References 100 publications

Bone Metabolism After Bariatric Surgery

Bone Metabolism After Bariatric Surgery

Effects of roux‐en‐Y gastric bypass surgery on postprandial fructose metabolism

Comparison of surgical versus diet‐induced weight loss on appetite regulation and metabolic health outcomes

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