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Surgical Endoscopy

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01-05-2014

Improved insulin sensitivity after gastric bypass correlates with decreased total body fat, but not with changes in free fatty acids

Authors: Alessandro Mor, Lawrence Tabone, Philip Omotosho, Alfonso Torquati

Published in: Surgical Endoscopy | Issue 5/2014

Abstract

Background

Increased plasma free fatty acids (FFAs) are considered one of the key elements in the pathogenesis of insulin resistance (IR) and type 2 diabetes (T2DM). We hypothesize that, in diabetic patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB), a postoperative decrease in FFA will correlate with improved insulin sensitivity (Si).

Methods

A total of 30 obese [body mass index ((BMI) >35 kg/m²] patients with a diagnosis of T2DM were studied preoperatively and 12 months after LRYGB in a prospective cohort study. Collected data included intravenous glucose tolerance test (IVGTT), total body composition by dual-energy X-ray absorptiometry and plasma levels of FFA. Si analysis from the IVGTT was estimated from minimal model analysis. Pre- and postoperative variables were compared using a paired sample t test. Relationships between changes in variables were determined with Pearson’s correlation test.

Results

Twelve months after LRYGB the study population showed a significant decrease in BMI (p = 0.001), FFA (p = 0.03), and total body fat (p = 0.03), with an increase in Si (p = 0.001). Postoperative changes in Si significantly correlated (Pearson’s r = –0.53, p = 0.01) with change in total body fat, but not with changes in plasma FFA (Pearson’s r = –0.22, p = 0.31).

Conclusions

Our study challenges the notion that IR is mediated to a significant degree by changes in plasma FFA concentration. Instead, changes in adiposity and consequently changes in adipokine release can be the key players in determining remission of T2DM after LRYGB.

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Title: Improved insulin sensitivity after gastric bypass correlates with decreased total body fat, but not with changes in free fatty acids
Authors: Alessandro Mor
Lawrence Tabone
Philip Omotosho
Alfonso Torquati
Publication date: 01-05-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3338-0

At a glance: The STEP trials

Springer Medicine

Improved insulin sensitivity after gastric bypass correlates with decreased total body fat, but not with changes in free fatty acids

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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