Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 5/2010

01-05-2010 | Clinical Research

Effects of Two Variants of Roux-en-Y Gastric Bypass on Metabolism Behaviour: Focus on Plasma Ghrelin Concentrations Over a 2-Year Follow-up

Authors: Noelia Pérez-Romero, Assumpta Serra, Maria Luisa Granada, Miquel Rull, Antonio Alastrué, Maruja Navarro-Díaz, Ramón Romero, Jaime Fernández-Llamazares

Published in: Obesity Surgery | Issue 5/2010

Login to get access

Abstract

Background

To study the effects of two variants of Roux-en-Y gastric bypass (RYGBP) on plasma ghrelin concentrations according to different exposure of gastric fundus to the nutrient pathway.

Methods

A prospective longitudinal 2-year follow-up study was conducted. Ninety-six morbidly obese (MO) patients (age range: 41.6 ± 9.6 years, body mass index: 53 ± 9.5 kg/m2) were assigned to two bariatric surgical (BS) procedures: one that preserves food contact with gastric fundus (ringed RYGBP, n = 50) and the other that avoids it (modified RYGBP, n = 46). Different anthropometric and biochemical parameters were studied, focusing on ghrelin concentrations at baseline and 6, 12, and 24 months post-BS.

Results

At 24 months post-BS, all metabolic parameters studied had improved in all patients compared with those at 1-year follow-up and baseline (p < 0.05). However, high-density lipoprotein cholesterol concentrations took 2 years to normalise in 80% of patients, interleukin-6 decreased significantly in relation to baseline only after 2 years from BS (p < 0.001), and tumour necrosis factor alpha concentrations did not significantly decrease during the 2 years of follow-up. Plasma ghrelin concentrations increased in both surgical groups compare to baseline during the first year (24.6% in modified RYGBP and 36.62% in ringed RYGBP) and remained stable at the second year of follow-up, with no statistical differences between groups.

Conclusions

In the second year of follow-up after BS, morbidity continued to improve in MO patients despite a lesser weight loss in relation to the first year. An increase in plasma ghrelin concentrations was found, regardless of nutrient contact with gastric fundus. Furthermore, changes in plasma ghrelin concentrations appeared to be independent of weight loss.
Literature
1.
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risks factors. JAMA. 2003;289:76–9.CrossRefPubMed
2.
3.
4.
Gastrointestinal surgery for severe obesity. NIH consensus development conference, March 25–27, 1991. Nutrition 1996:12:397–404.
5.
Stubbs RS, Wickremesekera SK. Insulin resistance in the severely obese and links with metabolic co-morbidities. Obes Surg. 2002;12:343–8.CrossRefPubMed
6.
Pories WJ. Why does the gastric bypass control type 2 diabetes mellitus? Obes Surg. 1992;2:303–11.CrossRefPubMed
7.
Schauer PR, Ikramuddin S, Gourash W. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.CrossRefPubMed
8.
9.
Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.CrossRefPubMed
10.
Gnanapavan S, Kola B, Bustin SA, et al. The tissue distribution of the mRNA of ghrelin and subtypes of its receptor, GHS-R, in humans. J Clin Endocrinol Metab. 2002;87:2988–91.CrossRefPubMed
11.
Papotti M, Ghè C, Cassoni P, et al. Growth hormone secretagogue binding sites in peripheral human tissues. J Clin Endocrinol Metab. 2000;85:3803–07.CrossRefPubMed
12.
Wren AM, Seal LJ, Cohen MA, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:599–02.CrossRef
13.
Berthoud HR. Vagal and hormonal gut-brain communication: from satiation to satisfaction. Neurogastroenterol Motil. 2008;20(Suppl 1):64–72.CrossRefPubMed
14.
Date Y, Kojima M, Hosoda H, et al. Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans. Endocrinology. 2000;141:4255–61.CrossRefPubMed
15.
Arisayu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–8.CrossRef
16.
Wu JT, Kral JG. Ghrelin. Integrative neuroendocrine peptide in health and disease. Ann Surg. 2004;239(4):464–74.CrossRefPubMed
17.
Faraj M, Lu HL, Cianflone K. Diabetes, lipids and adipocyte secretagogues. Biochem Cell Biol. 2004;82:170–9.CrossRefPubMed
18.
Vendrell J, Broch M, Vilarrasa N, et al. Resistin, adiponectin, ghrelin, leptin and proinflammatory cytokines: relationships in obesity. Obes Res. 2004;12:962–71.CrossRefPubMed
19.
Ballantyne G, Gumbs A, Modlin I. Changes in insulin resistance following bariatric surgery and the asipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg. 2005;15:692–9.CrossRefPubMed
20.
Lyon CJ, Law RE, Hsuch WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology. 2003;144:195–200.CrossRef
21.
Serra A, Granada ML, Romero R, et al. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Clinical Nutricion. 2006;25:400–8.CrossRef
22.
NIH Consensus Development Conference Draft Statement on Gastrointestinal Surgery for Sever Obesity. Obs Surg 1991; 1:257–65.
23.
SEEDO. Consensus 2000 para la evaluación del sobrepeso y obesidad y el establecimiento de criterios de intervención terapéutica. Med Clin (Barc). 2000;115:587–97.
24.
Fobi MA, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35.CrossRefPubMed
25.
Salmon PA. Gastroplasty with distal gastric bypass: a new and more successful weight loss operation for the morbidly obese. Can J Surg. 1988;31:111–3.PubMed
26.
Mason EE. Vertical banded gastroplasty for obesity. Arch Surg. 1982;177:701–6.
27.
Serra A, Romero R, Lopez D, et al. Renal injury in the extremely obese patients with normal renal function. Kidney Int. 2008;73:947–55.CrossRefPubMed
28.
Friedewald WT, Levy RI. Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of preparative ultracentrifuge. Clin Chem. 1972;18:499–502.PubMed
29.
Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985;28:412–9.CrossRefPubMed
30.
World Health Organization. Obesity: preventing and managing the global epidemic. In: Report on a WHO Consultation on Obesity: WHO/NUT/NCD/98.1. Geneva, Switzerland: World Health Organization; 1997.
31.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27:S5–10.CrossRef
32.
Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91:4223–31.CrossRefPubMed
33.
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:239–50.CrossRef
34.
Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.CrossRefPubMed
35.
Smith S, Edwards CB, Goodman GN. Changes in diabetic management after Roux-en-Y gastric bypass. Obes Surg. 1996;6:345–8.CrossRefPubMed
36.
Cowan GS, Buffington CK. Significant changes in blood pressure, glucose, and lipids with gastric bypass surgery. World J Surg. 1998;22:987–92.CrossRefPubMed
37.
Pardina E, López-Tejero MD, Llamas R, et al. Ghrelin and apolipoprotein AIV levesl show opposite trends to leptin levels during weight loss in morbidly obese patients. Obes Surg 2009;19:1414–23.
38.
Vazquez LA, Pazos F, Berrazueta JR, et al. Effects of change in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery. J Clin Endocrinol Metab. 2005;90:316–22.CrossRefPubMed
39.
Faraj M, Havel PJ, Phélis S, et al. Plasma acylation-stimulating protein, adiponectin, leptin and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2003;88:1594–02.CrossRef
40.
Holdstock C, Engström BE, Ohrvall M, et al. Ghrelin and adipose tissue regulatory peptides: effect of gastric bypass surgery in obese humans. J Clin Endocrinol Metab. 2003;88:3177–83.CrossRefPubMed
41.
Hansen TK, Dall R, Hosoda H, et al. Weight loss increases circulating levels of ghrelin in human obesity. Clin Endocrinol. 2002;56:203–06.CrossRef
42.
Shimizu Y, Noritoshi N, Isobe T, et al. Increased plasma ghrelin levels in lung cancer cachexia. Clin Cancer Res. 2003;9:774–78.PubMed
43.
Nagaya N, Uematsu M, Kojima M, et al. Elevated circulating level of ghrelin in cachexia associated with chronic heart failure. Circulation. 2001;104:2034–8.CrossRefPubMed
44.
45.
Otto B, Cuntz U, Fruehauf E, et al. Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa. Eur J Endocrinol. 2001;145:669–73.CrossRefPubMed
46.
Adami GF, Cordera R, Andraghetti G, et al. Changes in serum ghrelin concentrations following biliopancreatic diversion for obesity. Obes Res. 2004;12:684–7.CrossRefPubMed
47.
Nijhuis J, van Dielen FMH, Buurman WA, et al. Ghrelin, leptin and insulin levels after restrictive surgery: 2-year follow-up study. Obes Surg. 2004;14:783–7.CrossRefPubMed
48.
Schindler K, Prager G, Ballaban T, et al. Impact of laparoscopic adjustable gastric banding on plasma ghrelin, eating behaviour and body weight. Eur J Clin Invest. 2004;34:549–54.CrossRefPubMed
49.
Stratis CH, Alexandrides TK, Vagenas K, et al. Ghrelin and peptide YY levels after variant of biliopancreatic diversion with Roux-en-Y gastric bypass versus after colectomy: a prospective comparative study. Obes Surg. 2006;16:752–8.CrossRefPubMed
50.
Garcia-Unzueta MT, Fernández-Santiago R, Domínguez-Díez A, et al. Fasting plasma ghrelin levels increase progressively after biliopancreatic diversion: one-year follow-up. Obes Surg. 2005;15:187–90.CrossRefPubMed
51.
Geloneze B, Tambascia MA, Pilla VF, et al. Ghrelin: a gut-brain hormone: effect of gastric bypass surgery. Obes Surg. 2003;13:17–22.CrossRefPubMed
52.
Frühbeck G, Díez-Caballero A, Gil MJ, et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12.CrossRefPubMed
53.
Kotidis EV, Koliakos G, Papavramidis TS, et al. The effect of biliopancreatic diversion with pylori-preserving sleeve gastrectomy and duodenal switch on fasting serum ghrelin, leptin and adiponectin levels: Is there a hormonal contribution to the weight-reducing effect of this procedure? Obes Surg. 2006;16:554–9.CrossRefPubMed
54.
Adami GF, Cordera R, Marinari G, et al. Plasma ghrelin concentrations in the short-term following biliopancreatic diversion. Obes Surg. 2003;13:889–92.CrossRefPubMed
55.
Stoeckli R, Chanda R, Langer I, et al. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res. 2004;12:346–50.CrossRefPubMed
56.
Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels alter diet-induced weight los sor gastric bypass surgery. N Engl J Med. 2002;346:1623–30.CrossRefPubMed
57.
Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.CrossRefPubMed
58.
Ybarra J, Bobbioni-Harsch E, Chassot G, et al. Persistent correlation of ghrelin plasma levels with body mass index both in stable weight conditions and during gastric-bypass induced weight loss. Obes surg. 2009;19:327–31.CrossRefPubMed
59.
Garcia-fuentes E, Garrido-Sánchez L, Garcia-Almeida JM, et al. Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of Scopinaro on serum PYY and ghrelin levels. Obes Surg. 2008;18:1424–9.CrossRefPubMed
Metadata
Title
Effects of Two Variants of Roux-en-Y Gastric Bypass on Metabolism Behaviour: Focus on Plasma Ghrelin Concentrations Over a 2-Year Follow-up
Authors
Noelia Pérez-Romero
Assumpta Serra
Maria Luisa Granada
Miquel Rull
Antonio Alastrué
Maruja Navarro-Díaz
Ramón Romero
Jaime Fernández-Llamazares
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 5/2010
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-009-0035-0

Other articles of this Issue 5/2010

Obesity Surgery 5/2010 Go to the issue

Letter to the Editor

Internal Hernias and Nonclosure of Mesenteric Defects During Laparoscopic Roux-en-Y Gastric Bypass

Review

A Review of Weight Loss Following Roux-en-Y Gastric Bypass vs Restrictive Bariatric Surgery: Impact on Adiponectin and Insulin

Letter to the Editor

Response to the Letter to the Editor “Bariatric Surgery and the Assessment of Copper and Zinc Nutriture” by Leslie M. Klevay

Basic Science Research

SIRT1 Transcription Is Decreased in Visceral Adipose Tissue of Morbidly Obese Patients with Severe Hepatic Steatosis

Clinical Research

Revision Laparoscopic Gastric Bypass: An Effective Approach Following Failure of Primary Bariatric Procedures

Clinical Research

Diagnostic Medical Radiation Dose in Patients After Laparoscopic Bariatric Surgery