Roux-en-Y gastric bypass versus calorie restriction: support for surgery as the direct contributor to aloncltered responses of insulin and incretins to a mixed meal
(2017) In Surgery for Obesity and Related Diseases 13(2). p.234-242- Abstract
- Abstract
Objective
To study the immediate effects of Roux-en-Y gastric bypass (RYGB) on glucose homeostasis, insulin, and incretin responses to mixed-meal tests compared with the effects of calorie restriction (CR).
Setting
University-affiliated bariatric surgery clinic.
Background
RYGB induces remission of type 2 diabetes (T2 D) long before significant weight loss occurs. The time course and underlying mechanisms of this remission remain enigmatic. A prevailing theory is that secretory patterns of incretin hormones are altered due to rearrangement of the gastrointestinal tract. To what extent reduced calorie intake contributes to the remission of T2 D is... (More) - Abstract
Objective
To study the immediate effects of Roux-en-Y gastric bypass (RYGB) on glucose homeostasis, insulin, and incretin responses to mixed-meal tests compared with the effects of calorie restriction (CR).
Setting
University-affiliated bariatric surgery clinic.
Background
RYGB induces remission of type 2 diabetes (T2 D) long before significant weight loss occurs. The time course and underlying mechanisms of this remission remain enigmatic. A prevailing theory is that secretory patterns of incretin hormones are altered due to rearrangement of the gastrointestinal tract. To what extent reduced calorie intake contributes to the remission of T2 D is unknown.
Methods
Nine normoglycemic patients and 10 T2 D patients were subjected to mixed-meal tests (MMT) 4 weeks before surgery before initiation of a very low calorie diet regimen (MMT-4 w), 1 day before surgery on a very low calorie diet regimen (MMT-1 d), on the morning of the first day after surgery (MMT+1 d; first postsurgical meal), and 6 weeks after surgery (MMT+6 w). Insulin, glucose, active glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were measured.
Results
CR lowered insulin in T2 D patients, whereas glucose, GIP, and GLP-1 were unaffected. RYGB immediately increased plasma insulin and GIP. The GLP-1 response was delayed compared with the GIP response. T2 D patients exhibited lower insulin responses after RYGB compared with normoglycemic patients. GIP responses were similar in both groups at all occasions, whereas T2 D patients displayed markedly elevated GLP-1 responses 6 weeks after RYGB. Glucose was unaffected by CR and RYGB in both groups. Insulin sensitivity was unaffected by CR but improved with RYGB.
Conclusion
RYGB exerts powerful and immediate effects on insulin and incretin responses to food, independently of changes caused by CR.
(Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/36558f12-ef1e-41fc-85f7-4e9d64fc2b83
- author
- BERGGREN, JOHAN LU ; Lindqvist, Andreas LU ; Hedenbro, Jan LU ; Groop, Leif LU and Wierup, Nils LU
- organization
- publishing date
- 2017
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Bariatric surgery, gastric bypass, incretins, calorie restriction
- in
- Surgery for Obesity and Related Diseases
- volume
- 13
- issue
- 2
- pages
- 234 - 242
- publisher
- Elsevier
- external identifiers
-
- scopus:85007399004
- pmid:27894746
- pmid:27894746
- wos:000396802900018
- ISSN
- 1550-7289
- DOI
- 10.1016/j.soard.2016.09.017
- language
- English
- LU publication?
- yes
- id
- 36558f12-ef1e-41fc-85f7-4e9d64fc2b83
- alternative location
- http://www.sciencedirect.com/science/article/pii/S1550728916307146
- date added to LUP
- 2016-11-23 11:36:13
- date last changed
- 2024-05-03 14:19:58
@article{36558f12-ef1e-41fc-85f7-4e9d64fc2b83,
abstract = {{Abstract<br/><br/>Objective<br/><br/>To study the immediate effects of Roux-en-Y gastric bypass (RYGB) on glucose homeostasis, insulin, and incretin responses to mixed-meal tests compared with the effects of calorie restriction (CR).<br/><br/>Setting<br/><br/>University-affiliated bariatric surgery clinic.<br/><br/>Background<br/><br/>RYGB induces remission of type 2 diabetes (T2 D) long before significant weight loss occurs. The time course and underlying mechanisms of this remission remain enigmatic. A prevailing theory is that secretory patterns of incretin hormones are altered due to rearrangement of the gastrointestinal tract. To what extent reduced calorie intake contributes to the remission of T2 D is unknown.<br/><br/>Methods<br/><br/>Nine normoglycemic patients and 10 T2 D patients were subjected to mixed-meal tests (MMT) 4 weeks before surgery before initiation of a very low calorie diet regimen (MMT-4 w), 1 day before surgery on a very low calorie diet regimen (MMT-1 d), on the morning of the first day after surgery (MMT+1 d; first postsurgical meal), and 6 weeks after surgery (MMT+6 w). Insulin, glucose, active glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were measured.<br/><br/>Results<br/><br/>CR lowered insulin in T2 D patients, whereas glucose, GIP, and GLP-1 were unaffected. RYGB immediately increased plasma insulin and GIP. The GLP-1 response was delayed compared with the GIP response. T2 D patients exhibited lower insulin responses after RYGB compared with normoglycemic patients. GIP responses were similar in both groups at all occasions, whereas T2 D patients displayed markedly elevated GLP-1 responses 6 weeks after RYGB. Glucose was unaffected by CR and RYGB in both groups. Insulin sensitivity was unaffected by CR but improved with RYGB.<br/><br/>Conclusion<br/><br/>RYGB exerts powerful and immediate effects on insulin and incretin responses to food, independently of changes caused by CR.<br/>}},
author = {{BERGGREN, JOHAN and Lindqvist, Andreas and Hedenbro, Jan and Groop, Leif and Wierup, Nils}},
issn = {{1550-7289}},
keywords = {{Bariatric surgery; gastric bypass; incretins; calorie restriction}},
language = {{eng}},
number = {{2}},
pages = {{234--242}},
publisher = {{Elsevier}},
series = {{Surgery for Obesity and Related Diseases}},
title = {{Roux-en-Y gastric bypass versus calorie restriction: support for surgery as the direct contributor to aloncltered responses of insulin and incretins to a mixed meal}},
url = {{http://dx.doi.org/10.1016/j.soard.2016.09.017}},
doi = {{10.1016/j.soard.2016.09.017}},
volume = {{13}},
year = {{2017}},
}