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Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass

International Journal of Obesity volume 33, pages 786–795 (2009)Cite this article

Abstract

Objective:

The objective of this study was to quantify hormones that regulate energy and glucose homeostasis to establish possible mechanisms for the greater efficacy of Roux-en-Y gastric bypass (RYGB) compared with laparoscopic adjustable gastric banding (LAGB) in achieving weight loss and improved insulin sensitivity.

Design:

Longitudinal study of patients undergoing LAGB (n=15) and RYGB (n=28) who were studied before surgery and at 2, 12, 26 and 52 weeks afterwards.

Measurements:

Fasting blood samples were drawn at each visit. Postprandial blood samples were also obtained before surgery and at 26 and 52 weeks. Samples were assayed for peptide YY (PYY), ghrelin, glucagon-like peptide-1 (GLP-1), glucose, insulin, leptin, thyrotropic hormone, free T4 and free T3.

Results:

At 1 year there was greater weight loss in RYGB compared with LAGB patients (30 vs 15%), but final body mass index was similar (34 vs 33 kg m−2). At week 52, area under the curve (AUC) for PYY in RYGB subjects was greater than LAGB (P<0.01). GLP-1 levels at 30 min after meal were threefold greater after RYGB compared with LAGB (P<0.001). Conversely, ghrelin AUC increased after LAGB at week 52 (P<0.05) but tended to decrease after RYGB. Fasting glucose, insulin, and leptin and homeostasis model of assessment (HOMA-IR) decreased in both groups over time but were significantly lower at week 52 after RYGB compared with LAGB. The change in leptin correlated significantly with weight loss in LAGB (r=0.86) and RYGB (r=0.77), however, HOMA-IR correlated significantly with weight loss only in LAGB (r=0.78), and not RYGB (r=0.15). There was a significant decrease in free T3 (P<0.01) after RYGB.

Conclusions:

Differences in levels of gut hormones may play a role in promoting greater weight loss and insulin sensitivity after RYGB compared with LAGB, however, weight loss may be limited by decreases in free T3 and leptin.

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Acknowledgements

We thank the participants in this study. This work was supported by NIH grants DK072011 (to JK) and RR00645 (to the General Clinical Research Center).

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Authors and Affiliations

  1. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    J Korner, G Febres, I M Conwell, D J McMahon, R Salas & C Taveras

  2. Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA

    W Inabnet, B Schrope & M Bessler

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  1. J Korner
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Correspondence to J Korner.

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Korner, J., Inabnet, W., Febres, G. et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes 33, 786–795 (2009). https://doi.org/10.1038/ijo.2009.79

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