Hormonal mechanisms of weight loss and diabetes resolution after bariatric surgery

Cummings, David E.; Overduin, Joost; Shannon, Michael H.; Foster-Schubert, Karen E.

doi:10.1016/j.soard.2005.03.208

Cited by 92 publications

(80 citation statements)

References 115 publications

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“…Earlier human studies of RYGB have reported the following findings (reviewed in Cummings et al 10,14 ). The insulin sensitivity index, determined with intravenous glucose tolerance testing and minimal modeling, increases by 4-5 fold.…”

Section: Mechanisms Of Diabetes Improvement Following Bariatric Surgerymentioning

confidence: 92%

“…Complementary observations have been made in humans following the malabsorptive bariatric procedure BPD, which has been studied more rigorously to date than RYGB in terms of mechanisms underlying glycemic improvement (reviewed in Cummings et al 10,14 ). After BPD, favorable changes occur in genes regulating fatty acid and glucose metabolism in muscle.…”

Section: Mechanisms Of Diabetes Improvement Following Bariatric Surgerymentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14] None of these theories is necessarily exclusive of these others, and any or all them may be operational to some degree.…”

Section: Theories Regarding Weight-independent Anti-diabetic Mechanismentioning

confidence: 99%

“…RYGB causes weight loss through gastric restriction and additional mechanisms involving changes in gut hormones and other processes under active investigation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] RYGB and BPD produce the highest and most rapid rates of remission of type 2 diabetes mellitus (T2DM).…”

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confidence: 99%

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Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

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Bariatric surgery is currently the most effective method to promote major, sustained weight loss. Roux-en-Y gastric bypass (RYGB), the most commonly performed bariatric operation, ameliorates virtually all obesity-related comorbid conditions, the most impressive being a dramatic resolution of type 2 diabetes mellitus (T2DM). After RYGB, 84% of patients with T2DM experience complete remission of this disease, and virtually all have improved glycemic control. Increasing evidence indicates that the impact of RYGB on T2DM cannot be explained by the effects of weight loss and reduced energy intake alone. Weightindependent antidiabetic actions of RYGB are apparent because of the very rapid resolution of T2DM (before weight loss occurs), the greater improvement of glucose homeostasis after RYGB than after an equivalent weight loss from other means, and the occasional development of very late-onset, pancreatic b-cell hyperfunction. Several mechanisms probably mediate the direct antidiabetic impact of RYGB, including enhanced nutrient stimulation of L-cell peptides (for example, GLP-1) from the lower intestine, intriguing but still uncharacterized phenomena related to exclusion of the upper intestine from contact with ingested nutrients, compromised ghrelin secretion, and very probably other effects that have yet to be discovered. Research designed to prioritize these mechanisms and identify potential additional mechanisms promises to help optimize surgical design and might also reveal novel pharmaceutical targets for diabetes treatment. Keywords: diabetes; gastric bypass; bariatric surgery; ghrelin; GLP-1 Bariatric operations traditionally have been thought to cause weight loss through gastric restriction and/or intestinal malabsorption. Restrictive operations such as adjustable gastric banding (AGB) create a small pouch in the proximal stomach to reduce functional gastric capacity and retard gastric emptying. Malabsorptive procedures such as biliopancreatic diversion (BPD) leave much of the stomach intact but divert ingested food from the stomach to the ileum; thus, only a small segment of the distal bowel can absorb nutrients. The typical proximal Roux-en-Y gastric bypass (RYGB) creates gastric restriction and also causes food to bypass most of the stomach and a short segment of the proximal intestine, primarily the duodenum, leaving enough intact small bowel in digestive continuity to avoid clinically significant malabsorption. RYGB causes weight loss through gastric restriction and additional mechanisms involving changes in gut hormones and other processes under active investigation. 1-14 RYGB and BPD produce the highest and most rapid rates of remission of type 2 diabetes mellitus (T2DM). Remission of diabetes after RYGBAlthough bariatric surgery was designed to facilitate weight loss, anecdotal reports of rapid postoperative remission of T2DM emerged as early as the 1970s. In 1995, Pories et al. 4 reported long term results from 608 severely obese patients who underwent gastric bypass, with a 93% follow-up rate ov...

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Section: Mechanisms Of Diabetes Improvement Following Bariatric Surgerymentioning

confidence: 92%

Section: Mechanisms Of Diabetes Improvement Following Bariatric Surgerymentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14] None of these theories is necessarily exclusive of these others, and any or all them may be operational to some degree.…”

Section: Theories Regarding Weight-independent Anti-diabetic Mechanismentioning

confidence: 99%

mentioning

confidence: 99%

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Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

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“…In hypothalamic neurons, CaMKK regulates orexigenic NPY production [65, 66]. Ghrelin activates the ghrelin receptor (GHSR), a seven transmembrane G-coupled protein linked to Gq and activation of these receptors on Arc NPY neurons increases intracellular Ca 2+ levels and activates CamKK [67]. Activated CaMKK stimulates AMPK pathways, that results in increased ATP generation and fatty acid oxidation, which leads directly to increased ROS production in the cells [68, 69].…”

Section: Role Of Calcium/calcium Binding Proteins In the Hypothalamusmentioning

confidence: 99%

Oxidative Stress in the Hypothalamus: the Importance of Calcium Signaling and Mitochondrial ROS in Body Weight Regulation

Gyengési

Paxinos

Andrews³

2012

Current Neuropharmacology

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A considerable amount of evidence shows that reactive oxygen species (ROS) in the mammalian brain are directly responsible for cell and tissue function and dysfunction. Excessive reactive oxygen species contribute to various conditions including inflammation, diabetes mellitus, neurodegenerative diseases, tumor formation, and mental disorders such as depression. Increased intracellular calcium levels have toxic roles leading to cell death. However, the exact connection between reactive oxygen production and high calcium stress is not yet fully understood. In this review, we focus on the role of reactive oxygen species and calcium stress in hypothalamic arcuate neurons controlling feeding. We revisit the role of NPY and POMC neurons in the regulation of appetite and energy homeostasis, and consider how ROS and intracellular calcium levels affect these neurons. These novel insights give a new direction to research on hypothalamic mechanisms regulating energy homeostasis and may offer novel treatment strategies for obesity and type-2 diabetes.

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Bariatric Surgery for Weight Loss and Glycemic Control in Nonmorbidly Obese Adults With Diabetes

Maggard-Gibbons

Maglione²,

Livhits³

et al. 2013

JAMA

207

113

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Hormonal mechanisms of weight loss and diabetes resolution after bariatric surgery

Cited by 92 publications

References 115 publications

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Oxidative Stress in the Hypothalamus: the Importance of Calcium Signaling and Mitochondrial ROS in Body Weight Regulation

Bariatric Surgery for Weight Loss and Glycemic Control in Nonmorbidly Obese Adults With Diabetes

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