Elsevier

Surgery for Obesity and Related Diseases

Volume 7, Issue 5, September–October 2011, Pages 561-568
Surgery for Obesity and Related Diseases

Original article
Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy—a prospective randomized trial

https://doi.org/10.1016/j.soard.2011.01.044Get rights and content

Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) lead to rapid improvement in insulin sensitivity even before weight loss occurs. Adipokines are closely linked to obesity and insulin resistance. To date, it is unclear whether the different anatomic changes of the various bariatric procedures have different effects on hormones of adipocyte origin. In the present prospective, randomized study, we compared the 1-year follow-up results of LRYGB and LSG concerning weight loss, metabolic control, and fasting adipokine levels.

Methods

Of 23 nondiabetic morbidly obese patients, 12 were randomized to LRYGB and 11 to LSG. The patients were investigated before and 1 week, 3 months, and 12 months after surgery. The fasting levels of glucose, insulin, lipids, and adipokines (leptin, adiponectin, and fibroblast growth factor-21) were analyzed.

Results

The body weight decreased markedly (P <.001) after either procedure (percentage of weight loss 16.4% ± 1.3%, 24.8% ± 1.7%, and 34.5% ± 2.7% after LRYGB and 13.1% ± 1.1%, 20.7% ± 1.5%, and 27.9% ± 2.6% after LSG at 2, 6, and 12 mo, respectively). The Homeostasis Model Assessment Index declined from 8.0 ± 1.5 preoperatively to 2.9 ± .2 at 12 months after LRYGB and from 7.5 ± 1.7 preoperatively to 3.3 ± .3 at 12 months after LSG. The lipid profiles were normalized. The concentrations of circulating leptin levels decreased by almost 50% as early as 1 week postoperatively and continued to decrease until 12 months postoperatively. Adiponectin increased progressively. The fibroblast growth factor-21 levels did not change over time. No difference was found between the LRYGB and LSG groups.

Conclusion

Both procedures led to significant weight loss associated with the resolution of the metabolic syndrome. The serum leptin levels decreased and adiponectin increased with weight loss, paralleled by improved insulin sensitivity.

Section snippets

Patients

All studies were performed according to the principles of the Declaration of Helsinki and were approved by the local research and ethics committee in Basel, Switzerland. Morbidly obese patients were evaluated for bariatric surgery by an interdisciplinary team and were included in the present study if they fulfilled the criteria for bariatric surgery in Switzerland (body mass index [BMI] >40 kg/m2 with co-morbidity, age <60 yr, 2 yr of unsuccessful conservative treatment, and approval for

Results

After randomization, 12 patients underwent LRYGB and 11 LSG. All procedures were successfully concluded laparoscopically with no conversion to open surgery. The demographic characteristics of the 2 groups of patients are listed in Table 1. Both groups had a similar preoperative body weight and BMI. All patients had undergone a complete evaluation at all points of follow-up.

Discussion

The metabolic control of blood glucose levels largely depends on the efficient action of insulin. These fundamental actions of insulin are defective in obesity, with development of insulin resistance, as illustrated by an increased HOMA index (Table 1, Table 2) in our study population. As previously observed, the LRYGB patients were expected to improve rapidly (hindgut hypothesis). In contrast, the improvement in glucose homeostasis in the LSG patients was expected to occur at a later stage, in

Conclusion

The results of the present study have confirmed an intimate association of specific adipokines with obesity and with the changes observed with weight loss after 2 different bariatric surgical procedures with different anatomic changes to the azgastrointestinal tract. The changes observed are complex. The leptin levels were much greater before surgery and had already decreased 1 week postoperatively, similar to the improved glycemic control after bariatric surgery. The improved glycemic control

Disclosures

R. Peterli receives grant support from, and consults for, Ethicon Endosurgery, USA. The remaining authors have no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

We thank the team of the Clinical Research Centre (Luisa Baselgia Jeker and Claudia Bläsi) for expert technical help with these experiments; Silvia Ketterer and Gerdien Gamboni for their work in measuring the hormones; and Ph. Hendrickson for reviewing the manuscript.

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    This research was supported by the Swiss National Science Foundation (grants 3200B0-120020 and 320000-118330) and by a grant from Ethicon Endosurgery.

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