Department of Medicine, Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.
Eur J Endocrinol. 2011 Feb;164(2):231-8. doi: 10.1530/EJE-10-0804. Epub 2010 Nov 15.
The effects of various weight loss strategies on pancreatic beta cell function remain unclear. We aimed to compare the effect of intensive lifestyle intervention (ILI) and Roux-en-Y gastric bypass surgery (RYGB) on beta cell function.
One year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104).
One hundred and nineteen morbidly obese participants without known diabetes from the MOBIL study (mean (s.d.) age 43.6 (10.8) years, body mass index (BMI) 45.5 (5.6) kg/m², 84 women) were allocated to RYGB (n = 64) or ILI (n = 55). The patients underwent repeated oral glucose tolerance tests (OGTTs) and were categorised as having either normal (NGT) or abnormal glucose tolerance (AGT). Twenty-nine normal-weight subjects with NGT (age 42.6 (8.7) years, BMI 22.6 (1.5) kg/m², 19 women) served as controls. OGTT-based indices of beta cell function were calculated.
One year weight reduction was 30% (8) after RYGB and 9% (10) after ILI (P < 0.001). Disposition index (DI) increased in all treatment groups (all P<0.05), although more in the surgery groups (both P < 0.001). Stimulated proinsulin-to-insulin (PI/I) ratio decreased in both surgery groups (both P < 0.001), but to a greater extent in the surgery group with AGT at baseline (P < 0.001). Post surgery, patients with NGT at baseline had higher DI and lower stimulated PI/I ratio than controls (both P < 0.027).
Gastric bypass surgery improved beta cell function to a significantly greater extent than ILI. Supra-physiological insulin secretion and proinsulin processing may indicate excessive beta cell function after gastric bypass surgery.
各种减肥策略对胰岛β细胞功能的影响尚不清楚。本研究旨在比较强化生活方式干预（ILI）和 Roux-en-Y 胃旁路手术（RYGB）对胰岛β细胞功能的影响。
为期 1 年的对照临床试验（ClinicalTrials.gov 标识符 NCT00273104）。
来自 MOBIL 研究的 119 名患有肥胖症但无糖尿病的参与者（平均（标准差）年龄 43.6（10.8）岁，体重指数（BMI）45.5（5.6）kg/m²，84 名女性）被分配到 RYGB（n=64）或 ILI（n=55）组。患者接受了重复口服葡萄糖耐量试验（OGTT），并分为正常糖耐量（NGT）或异常糖耐量（AGT）。29 名体重正常且 NGT 的受试者（年龄 42.6（8.7）岁，BMI 22.6（1.5）kg/m²，19 名女性）作为对照组。计算了基于 OGTT 的胰岛β细胞功能指数。
RYGB 术后 1 年体重减轻 30%（8 例），ILI 术后 9%（10 例）（P<0.001）。所有治疗组的胰岛β细胞功能指数（DI）均增加（所有 P<0.05），但手术组增加更为显著（两组均 P<0.001）。刺激后胰岛素原与胰岛素的比值（PI/I）在两组手术中均降低（两组均 P<0.001），但在基线时 AGT 的手术组中降低更为显著（P<0.001）。术后，基线时 NGT 的患者的 DI 较高，刺激后的 PI/I 比值较低，与对照组相比差异均有统计学意义（均 P<0.027）。
与 ILI 相比，胃旁路手术可显著改善胰岛β细胞功能。术后出现超生理胰岛素分泌和胰岛素原加工可能表明胃旁路手术后胰岛β细胞功能过度。
