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Obesity Surgery
Published in: Obesity Surgery 5/2013

01-05-2013 | Original Contributions

Fasting and Meal-Induced CCK and PP Secretion Following Intragastric Balloon Treatment for Obesity

Authors: Elisabeth M. H. Mathus-Vliegen, Gerrit H. de Groot

Published in: Obesity Surgery | Issue 5/2013

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Abstract

Background

Satiety is centrally and peripherally mediated by gastrointestinal peptides and the vagal nerve. We aimed to investigate whether intragastric balloon treatment affects satiety through effects on fasting and meal-stimulated cholecystokinin (CCK) and pancreatic polypeptide (PP) secretion.

Methods

Patients referred for obesity treatment were randomised to 13 weeks of sham treatment followed by 13 weeks of balloon treatment (group 1; sham/balloon) or to twice a 13-week period of balloon treatment (group 2; balloon/balloon). Blood samples were taken for fasting and meal-stimulated CCK and PP levels at the start (T0) and after 13 (T1) and 26 (T2) weeks. Patients filled out visual analogue scales (VAS) to assess satiety.

Results

Forty-two patients (35 females, body weight 125.1 kg, BMI 43.3 kg/m2) participated. In group 1, basal CCK levels decreased but meal-stimulated response remained unchanged after 13 weeks of sham treatment. In group 2, basal and meal-stimulated CCK levels decreased after 13 weeks of balloon treatment. At the end of the second 13-week period, when group 1 had their first balloon treatment, they duplicated the initial 13-week results of group 2, whereas group 2 continued their balloon treatment and reduced meal-stimulated CCK release. Both groups showed reduced meal-stimulated PP secretions at T1 and T2 compared to T0. Changes in diet composition and VAS scores were similar. Improvements in glucose homeostasis partly explained the PP results.

Conclusions

The reduced CCK and PP secretion after balloon positioning was unexpected and may reflect delayed gastric emptying induced by the balloon. Improved glucose metabolism partly explained the reduced PP secretion. Satiety and weight loss were not adversely influenced by these hormonal changes.
Literature
1.
Schapiro M, Benjamin S, Blackburn G, et al. Obesity and the gastric balloon: a comprehensive workshop. Tarpon Springs, Florida. Gastrointest Endosc. 1987;33:323–7.PubMedCrossRef
2.
Fernandes M, Atallah AN, Soares BG, et al. Intragastric balloon for obesity. Cochrane Database Syst Rev 2007;(1):CD004931.
3.
Mathus-Vliegen EM. Intragastric balloon treatment for obesity: what does it really offer? Dig Dis. 2008;26:40–4.PubMedCrossRef
4.
Imaz I, Martinez-Cervell C, Garcia-Alvarez EE, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18:841–6.PubMedCrossRef
5.
Evans JT, Delegge MH. Intragastric balloon therapy in the management of obesity: why the bad wrap? JPEN J Parenter Enteral Nutr. 2011;35:25–31.PubMedCrossRef
6.
Melton PM, Kissileff HR, Pi-Sunyer FX. Cholecystokinin (CCK-8) affects gastric pressure and ratings of hunger and fullness in women. Am J Physiol. 1992;263(2 Pt 2):R452–6.PubMed
7.
Rigaud D, Trostler N, Rozen R, et al. Gastric distension, hunger and energy intake after balloon implantation in severe obesity. Int J Obes Relat Metab Disord. 1995;19:489–95.PubMed
8.
Feinle C, Christen M, Grundy D, et al. Effects of duodenal fat, protein or mixed-nutrient infusions on epigastric sensations during sustained gastric distension in healthy humans. Neurogastroenterol Motil. 2002;14:205–13.PubMedCrossRef
9.
Rushakoff RA, Goldfine ID, Beccaria LJ, et al. Reduced postprandial cholecystokinin (CCK) secretion in patients with non-insulin-dependent diabetes mellitus: evidence for a role for CCK in regulating postprandial hyperglycemia. J Clin Endocrinol Metab. 1993;76:489–93.PubMedCrossRef
10.
Weickert MO, Möhlig M, Spranger J, et al. Effects of euglycemic hyerinsulinemia and lipid infusion on circulating cholecystokin. J Clin Endocrinol Metab. 2008;93:2328–33.PubMedCrossRef
11.
Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc. 2005;61:19–27.PubMedCrossRef
12.
Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 1998;21:2191–2.PubMedCrossRef
13.
Jansen JB, Lamers CB. Radioimmunoassay of cholecystokinin in human tissue and plasma. Clin Chim Acta. 1983;131:305–16.PubMedCrossRef
14.
Lamers CB, Diemel CM, van Leer E, et al. Mechanism of elevated serum pancreatic polypeptide concentrations in chronic renal failure. J Clin Endocrinol Metab. 1982;55:922–6.PubMedCrossRef
15.
Blundell J, de Graaf C, Hulshof T, et al. Appetite control: methodological aspects of the evaluation of foods. Obes Rev. 2010;11:251–70.PubMedCrossRef
16.
Matthews JN, Altman DG, Campbell MJ, et al. Analysis of serial measurements in medical research. BMJ. 1990;300:230–5.PubMedCrossRef
17.
Cunningham KM, Baker RJ, Horowitz M, et al. Use of technetium-99 m(V)thiocyanate to measure gastric emptying of fat. J Nucl Med. 1991;32:878–81.PubMed
18.
French SJ. The effects of specific nutrients on the regulation of feeding behaviour in human subjects. Proc Nutr Soc. 1999;58:533–9.PubMedCrossRef
19.
Lieverse RJ, van Seters AP, Jansen JB, et al. Relationship between hunger and plasma cholecystokinin during weight reduction with a very low calorie diet. Int J Obes Relat Metab Disord. 1993;17:177–9.PubMed
20.
21.
22.
Mion F, Napoleon B, Roman S, et al. Effects of intragastric balloon on gastric emptying and plasma ghrelin levels in non-morbid obese patients. Obes Surg. 2005;15:510–6.PubMedCrossRef
23.
Geliebter A, Melton PM, Gage D, et al. Gastric balloon to treat obesity: a double-blind study in nondieting subjects. Am J Clin Nutr. 1990;51:584–8.PubMed
24.
Oesch S, Ruegg C, Fischer B, et al. Effect of gastric distension prior to eating on food intake and feelings of satiety in humans. Physiol Behav. 2006;30(87):903–10.CrossRef
25.
Hill P, Garbaczewski L, Koppeschaar H, et al. Peptide and steroid hormones in subjects at different risk for diet-related diseases. Am J Clin Nutr. 1988;48(3 Suppl):782–6.PubMed
26.
Tomita T, Greeley Jr G, Watt L, et al. Protein meal-stimulated pancreatic polypeptide secretion in Prader-Willi syndrome of adults. Pancreas. 1989;4:395–400.PubMedCrossRef
27.
Wisen O, Bjorvell H, Cantor P, et al. Plasma concentrations of regulatory peptides in obesity following modified sham feeding (MSF) and a liquid test meal. Regul Pept. 1992;39:43–54.PubMedCrossRef
28.
Lieverse RJ, Masclee AA, Jansen JB, et al. Plasma cholecystokinin and pancreatic polypeptide secretion in response to bombesin, meal ingestion and modified sham feeding in lean and obese persons. Int J Obes Relat Metab Disord. 1994;18:123–7.
29.
Zwirska-Korczala K, Konturek SJ, Sodowski M, et al. Basal and postprandial plasma levels of PYY, ghrelin, cholecystokinin, gastrin and insulin in women with moderate and morbid obesity and metabolic syndrome. J Physiol Pharmacol. 2007;58 Suppl 1:13–35.PubMed
30.
Goedecke JH, Barsdorf M, Beglinger C, et al. Effects of a lipase inhibitor (Orlistat) on cholecystokinin and appetite in response to a high-fat meal. Int J Obes Relat Metab Disord. 2003;27:1479–85.PubMedCrossRef
31.
Burhol PG, Jenssen TG, Jorde R, et al. Plasma cholecystokinin (CCK) before and after a jejunoileal bypass operation in obese patients with reference to appetite regulation. Int J Obes. 1984;8:233–6.PubMed
32.
Lassmann V, Vague P, Vialettes B, et al. Low plasma levels of pancreatic polypeptide in obesity. Diabetes. 1980;29:428–30.PubMedCrossRef
33.
Marco J, Zulueta MA, Correas I, et al. Reduced pancreatic polypeptide secretion in obese subjects. J Clin Endocrinol Metab. 1980;50:744–7.PubMedCrossRef
34.
Holst JJ, Schwartz TW, Lovgreen NA, et al. Diurnal profile of pancreatic polypeptide, pancreatic glucagon, gut glucagon and insulin in human morbid obesity. Int J Obes. 1983;7:529–38.PubMed
35.
Lawson MJ, Gehling RN, Butler RN, et al. Human pancreatic polypeptide release and gallbladder response after amino acid and cephal vagal stimuli in obese and non-obese subjects. Med Sci Res. 1987;15:183–4.
36.
Glaser B, Zoghlin G, Pienta K, et al. Pancreatic polypeptide response to secretin in obesity: effects of glucose intolerance. Horm Metab Res. 1988;20:288–92.PubMedCrossRef
37.
Asakawa A, Inui A, Yuzuriha H, et al. Characterization of the effects of pancreatic polypeptide in the regulation of energy balance. Gastroenterology. 2003;124:1325–36.PubMedCrossRef
38.
Kojima S, Ueno N, Asakawa A, et al. A role for pancreatic polypeptide in feeding and body weight regulation. Peptides. 2007;28:459–63.PubMedCrossRef
39.
Peterson HR, Rothschild M, Weinberg CR, et al. Body fat and the activity of the autonomic nervous system. N Engl J Med. 1988;318:1077–83.PubMedCrossRef
40.
Teff K. Learning hunger: conditioned anticipatory ghrelin responses in energy homeostasis. Endocrinology. 2006;147:20–2.PubMedCrossRef
41.
Berger D, Floyd JC, Pek SB. The effect of treatment of type 2 (insulin independent) diabetes mellitus on plasma concentrations of pancreatic polypeptide and glucagon. Diabetologia. 1981;21:120–5.PubMedCrossRef
42.
Gingerich RL, Nagulesparan L, Bennion L, et al. Pancreatic polypeptide in Pima Indians: the influence of obesity and diabetes. Metabolism. 1985;34:25–9.PubMedCrossRef
43.
Weyer C, Salbe AD, Lindsay RS, et al. Exaggerated pancreatic polypeptide secretion in Pima Indians: can an increased parasympathetic drive to the pancreas contribute to hyperinsulinemia, obesity, and diabetes in humans? Metabolism. 2001;50:223–30.PubMedCrossRef
44.
Vozarova de Courten B, Weyer C, et al. Parasympathetic blockade attenuates augmented pancreatic polypeptide but not insulin secretion in Pima Indians. Diabetes. 2004;53:663–71.PubMedCrossRef
45.
Powley TL, Phillips RJ. Gastric satiation is volumetric, intestinal satiation is nutritive. Physiol Behav. 2004;82:69–74.PubMedCrossRef
46.
Kissileff HR, Carretta JC, Geliebter A, et al. Cholecystokinin and stomach distension combine to reduce food intake in humans. Am J Physiol Regul Integr Comp Physiol. 2003;285:R992–8.PubMed
47.
Jones KL, Doran SM, Hveem K, et al. Relation between postprandial satiation and antral area in normal subjects. Am J Clin Nutr. 1997;66:127–32.PubMed
48.
Sturm K, Parker B, Wishart J, et al. Energy intake and appetite are related to antral area in healthy young and older subjects. Am J Clin Nutr. 2004;80:656–67.PubMed
49.
Mundt MW, Hausken T, Smout AJ, et al. Relationships between gastric accommodation and gastrointestinal sensations in healthy volunteers. A study using the barostat technique and two- and three-dimensional ultrasonography. Dig Dis Sci. 2005;50:1654–60.PubMedCrossRef
Metadata
Title
Fasting and Meal-Induced CCK and PP Secretion Following Intragastric Balloon Treatment for Obesity
Authors
Elisabeth M. H. Mathus-Vliegen
Gerrit H. de Groot
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 5/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0834-6

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