1] Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark [2] Novo Nordisk Foundation Centre for Basic Metabolic Research, the Panum Institute, University of Copenhagen, Copenhagen N, Denmark.
Int J Obes (Lond). 2013 Nov;37(11):1452-9. doi: 10.1038/ijo.2013.15. Epub 2013 Feb 19.
To identify factors contributing to the variation in weight loss after Roux-en-Y gastric bypass (RYGB).
Cross-sectional study of patients with good (excess body mass index lost (EBL) >60%) and poor weight loss response (EBL <50%) >12 months after RYGB and a lean control group matched for age and gender.
Sixteen patients with good weight loss response, 17 patients with poor weight loss response, and eight control subjects were included in the study. Participants underwent dual energy X-ray absorptiometry scan, indirect calorimetry and a 9 h multiple-meal test with measurements of glucose, insulin, total bile acids (TBA), glucagon-like peptide (GLP)-1, peptide YY3-36 (PYY), cholecystokinin (CCK), ghrelin, neurotensin and pancreatic polypeptide (PP) as well as assessment of early dumping and appetite.
Suppression of hunger was more pronounced in the good than the poor responders in response to the multiple-meal test (P=0.006). In addition, the good responders had a larger release of GLP-1 (P=0.009) and a greater suppression of ghrelin (P=0.037) during the test, whereas the postprandial secretion of CCK was highest in the poor responders (P=0.005). PYY, neurotensin, PP and TBA release did not differ between the RYGB-operated groups. Compared with control subjects, patients had exaggerated release of GLP-1 (P<0.001), PYY (P=0.008), CCK (P=0.010) and neurotensin (P<0.001). Early dumping was comparable in the good and poor responders, but more pronounced than in controlled subjects. Differences in resting energy expenditure between the three groups were entirely explained by differences in body composition.
Favorable meal-induced changes in hunger and gut hormone release in patients with good compared with poor weight loss response support the role of gut hormones in the weight loss after RYGB.
确定影响 Roux-en-Y 胃旁路术（RYGB）后体重减轻差异的因素。
对 RYGB 后 12 个月以上体重减轻良好（多余体重指数丢失（EBL）>60%）和体重减轻不良（EBL<50%）的患者和年龄、性别匹配的瘦对照组进行横断面研究。
本研究纳入了 16 例体重减轻良好的患者、17 例体重减轻不良的患者和 8 例对照组。参与者接受双能 X 射线吸收法扫描、间接热量测定和 9 小时多次进餐试验，测量血糖、胰岛素、总胆汁酸（TBA）、胰高血糖素样肽（GLP）-1、肽 YY3-36（PYY）、胆囊收缩素（CCK）、胃饥饿素、神经降压素和胰多肽（PP），并评估早期倾倒和食欲。
与体重减轻不良的患者相比，体重减轻良好的患者在多次进餐试验中对饥饿的抑制更为明显（P=0.006）。此外，良好的应答者在试验中释放出更多的 GLP-1（P=0.009），并抑制了更多的胃饥饿素（P=0.037），而在不良应答者中，餐后 CCK 的分泌最高（P=0.005）。PYY、神经降压素、PP 和 TBA 的释放在 RYGB 手术组之间没有差异。与对照组相比，患者释放出更多的 GLP-1（P<0.001）、PYY（P=0.008）、CCK（P=0.010）和神经降压素（P<0.001）。良好和不良应答者的早期倾倒没有差异，但比对照组更明显。三组之间静息能量消耗的差异完全可以用身体成分的差异来解释。
与体重减轻不良的患者相比，体重减轻良好的患者在进食时饥饿感和肠道激素释放的变化更好，这支持了肠道激素在 RYGB 后体重减轻中的作用。
