Long-Term Modulation of Appetitive Hormones and Sweet Cravings After Adjustable Gastric Banding and Roux-en-Y Gastric Bypass.

Abstract

BACKGROUND:

Roux-en-Y gastric bypass (RYGB) produces greater weight loss compared with a purely restrictive procedure such as laparoscopic adjustable gastric banding (LAGB).

OBJECTIVE:

The objective of this study was to quantify changes in hormones that regulate energy homeostasis and appetitive sensations before and after LAGB (n = 18) and RYGB (n = 38) in order to better understand the mechanisms underlying the greater weight loss after RYGB.

METHODS:

A standardized test meal was administered prior to surgery, at 6 months, and annually thereafter to year 2 after LAGB and year 4 after RYGB. Blood samples were obtained in the fasted state and 30, 60, 90, and 120 min post-meal.

RESULTS:

Progressive increases in fasting PYY were observed after RYGB together with increases in postprandial area under the curve (AUC) levels that were unchanged after LAGB. GLP-1 AUC increased only after RYGB. There was a weight loss-related increase in fasting ghrelin levels after LAGB that was unchanged 1 year after RYGB despite greater percentage weight loss; ghrelin subsequently increased at years 2-4 post-RYGB. HOMA-IR decreased after both procedures but correlated with weight loss only after LAGB, whereas leptin correlated with weight loss in both groups. Sweet cravings decreased after RYGB.

CONCLUSION:

A number of weight loss-independent changes in the gut hormonal milieu likely act in concert to promote a decrease in insulin resistance and greater weight loss efficacy after RYGB. A progressive change in hormone levels over time may reflect gut enteroplasticity after RYGB. A decrease in sweet cravings specific to RYGB may further promote superior weight loss outcomes.

• Authors: Alina I Tsouristakis, Gerardo Febres, Donald J McMahon, Beverly Tchang, Irene M Conwell, Amanda J Tsang, Leaque Ahmed, Marc Bessler, Judith Korner
• Journal: Obesity surgery (Obes Surg) Vol. 29 Issue 11 Pg. 3698-3705 (11 2019) ISSN: 1708-0428 [Electronic] United States
• PMID: 31376135 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Ghrelin
• Insulin
• Glucagon-Like Peptide 1

Topics

• Appetite (physiology)
• Bariatric Surgery (statistics & numerical data)
• Craving (physiology)
• Ghrelin (blood)
• Glucagon-Like Peptide 1 (blood)
• Humans
• Insulin (blood)
• Obesity (metabolism, surgery)
• Weight Loss (physiology)