Physiological and molecular responses to bariatric surgery: markers or mechanisms underlying T2DM resolution?

Hutch, Chelsea R.; Sandoval, Darleen A.

doi:10.1111/nyas.13194

Cited by 20 publications

(10 citation statements)

References 148 publications

(263 reference statements)

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“…The small intestine is capable of important morphological and metabolic adaptations to respond to rapid changes in nutrient intake, stress or partial resection [1][2][3]. Recent evidence underlines inadequate intestinal adaptations in pathophysiological conditions such as obesity and type 2 diabetes (T2D).…”

Section: Introductionmentioning

confidence: 99%

Plasma biomarkers of small intestine adaptations in obesity-related metabolic alterations

Lalande

Drouin‐Chartier

Tremblay

et al. 2020

Diabetol Metab Syndr

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Background: Evidence suggests that pathophysiological conditions such as obesity and type 2 diabetes (T2D) are associated with morphologic and metabolic alterations in the small intestinal mucosa. Exploring these alterations generally requires invasive methods, limiting data acquisition to subjects with enteropathies or undergoing bariatric surgery. We aimed to evaluate small intestine epithelial cell homeostasis in a cohort of men covering a wide range of adiposity and glucose homoeostasis statuses. Methods: Plasma levels of citrulline, a biomarker of enterocyte mass, and I-FABP, a biomarker of enterocyte death, were measured by UHPLC-MS and ELISA in 154 nondiabetic men and 67 men with a T2D diagnosis. Results: Plasma citrulline was significantly reduced in men with insulin resistance and T2D compared to insulin sensitive men. Decreased citrulline levels were, however, not observed in men with uncontrolled metabolic parameters during T2D. Plasma I-FABP was significantly higher in men with T2D, especially in presence of uncontrolled glycemic and lipid profile parameters. Integration of both parameters, which estimate enterocyte turnover, was associated with glucose homeostasis as well as with T2D diagnosis. Differences in biomarkers levels were independent of age and BMI and glucose filtration rates. Conclusions: Our study supports a decreased functional enterocyte mass and an increased enterocyte death rate in presence of metabolic alterations but emphasizes that epithelial cell homeostasis is especially altered in presence of severe insulin resistance and T2D. The marked changes in small intestine cellularity observed in obesity and diabetes are thus suggested to be part of gut dysfunctions, mainly at an advanced stage of the disease.

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Section: Introductionmentioning

confidence: 99%

Plasma biomarkers of small intestine adaptations in obesity-related metabolic alterations

Lalande

Drouin‐Chartier

Tremblay

et al. 2020

Diabetol Metab Syndr

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“…In turn, during a restrictive procedure, such as LSG, a large part of the stomach is removed along the greater curvature [7]. These modifications of intestinal passage contribute to changes in the secretion of gut hormones and peptides and may affect both the absorption of BAs and the serum concentrations thereof [16]. BAs may influence glucose homeostasis acting on muscles, liver, adipose tissue, and pancreatic cells via nuclear FXR and membrane TGR-5 receptors [17,18].…”

Section: Introductionmentioning

confidence: 99%

Evidence That the Length of Bile Loop Determines Serum Bile Acid Concentration and Glycemic Control After Bariatric Surgery

et al. 2018

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Background Bariatric surgery contributes to the improvement in glucose metabolism that may be related to a postoperative increase in serum bile acids (BAs). Three commonly used types of bariatric procedures, laparoscopic sleeve gastrectomy (LSG) (without creation of a bile loop), Roux-en-Y gastric bypass (RYGB), and omega-loop gastric bypass (OLGB) (with creation of shorter 100-150 cm and longer 200-280 cm bile loops, respectively), differ in their effects on glycemic control. The aim of the study was to compare the effects of various bariatric procedures on serum BA concentration and glucose homeostasis. Methods Serum BAs in 26 obese patients were determined by liquid chromatography-mass spectrometry prior to bariatric surgery, as well as 4 days and 3 months thereafter. Results Four days after the surgery, serum concentrations of BAs in LSG and OLGB groups were similar as prior to the procedure, and a slight decrease in serum BAs was observed in the RYGB group. Serum BA level in the LSG group remained unchanged also at 3 months after the surgery, whereas a significant 0.5-and 3-fold increase in this parameter was noted in the RYGB and OLGB groups, respectively. Serum concentration of BAs correlated positively with the length of the bile loop (R = 0.47, p < 0.05). Conclusion The evident improvement of glycemic control observed 3 months after OLGB might be associated with a postoperative increase in serum BAs, resulting from their better absorption from the longer bile loop. However, the changes in serum BAs probably had little or no impact on insulin sensitivity improvement at 4 days post-surgery.

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“…The precise mechanisms behind the weight-independent effects of bariatric surgery involved in IR remain poorly understood [38,39]. BAs have been demonstrated to be altered in obesity and T2DM, and the role of SG in changing their metabolism has been discussed [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background and Objective: In obese patients, sleeve gastrectomy (SG) has shown mixed results on bile acid (BA) values. The aim of our study was to examine the potential ultra-early and early changes of the circulating total BA in relation with the changes of insulin resistance (IR) in obese patients submitted to laparoscopic SG. Materials and Methods: Twenty-four obese subjects were investigated for body mass index (BMI), total fasting BA, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and leptin before and at 7 and 30 d after SG. Results: After surgery, mean BMI decreased at the first (p < 0.001) and at the second time point (p < 0.001) relative to baseline. Total fasting BA values did not change significantly at 7 d (p = 0.938) and at 30 d (p = 0.289) after SG. No significant changes were found at 7 d (p = 0.194, p = 0.34) and 30 d (p = 0.329, p = 0.151) after surgery regarding fasting insulin and HOMA-IR, respectively. However, a trend of increased total fasting BA and decreased fasting insulin and HOMA- after laparoscopic SG has been found. Negative correlations between total fasting BA and insulin (r = −0.807, p = 0.009), HOMA-IR (r = −0.855, p = 0.014), and blood glucose (r = −0.761, p = 0.047), respectively, were observed at one month after SG. Conclusion: In conclusion, here, we found a lack of significant changes in total fasting BA, insulin, and HOMA-IR ultra-early and early after SG, which precluded us to consider a possible relation between the variations of BA and IR. However, the presence of the tendency for total fasting BA to increase and for insulin and HOMA-IR to decrease, as well as of the negative correlations one month after laparoscopic SG, suggest that this surgery brings about some changes that point towards the existence, and possibly towards the restoration, at least to some extent, of the link between BA and glucose metabolism.

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Physiological and molecular responses to bariatric surgery: markers or mechanisms underlying T2DM resolution?

Cited by 20 publications

References 148 publications

Plasma biomarkers of small intestine adaptations in obesity-related metabolic alterations

Plasma biomarkers of small intestine adaptations in obesity-related metabolic alterations

Evidence That the Length of Bile Loop Determines Serum Bile Acid Concentration and Glycemic Control After Bariatric Surgery

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

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