Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
C-ENDO Endocrinology Clinic, Calgary, AB, Canada.
Int J Obes (Lond). 2016 Feb;40(2):281-90. doi: 10.1038/ijo.2015.162. Epub 2013 Aug 25.
Increased energy expenditure (EE) has been proposed as an important mechanism for weight loss following Roux-en-Y gastric bypass (RYGB). However, this has never been investigated in a controlled setting independent of changes in energy balance. Similarly, only few studies have investigated the effect of RYGB on glycaemic control per se. Here, we investigated the effect of RYGB on EE, appetite, glycaemic control and specific signalling molecules compared with a control group in comparable negative energy balance.
SUBJECTS/METHODS: Obese normal glucose-tolerant participants were randomized to receive RYGB after 8 (n=14) or 12 weeks (n=14). The protocol included a visit at week 0 and three visits (weeks 7, 11 and 78) where 24-h EE, appetite and blood parameters were assessed. Participants followed a low-calorie diet from weeks 0-11, with those operated at week 12 serving as a control group for those operated at week 8.
Compared with controls, RYGB-operated participants had lower body composition-adjusted 24-h EE and basal EE 3 weeks postoperatively (both P<0.05) but EE parameters at week 78 were not different from preoperative values (week 7). Surgery changed the postprandial response of glucagon-like peptide-1 (GLP-1), peptide YY3-36 (PYY), ghrelin, cholecystokinin, fibroblast growth factor-19 and bile acids (all P<0.05). Particularly, increases in GLP-1, PYY and decreases in ghrelin were associated with decreased appetite. None of HOMA-IR (homeostasis model assessment-estimated insulin resistance), Matsuda index, the insulinogenic index, the disposition index and fasting hepatic insulin clearance were different between the groups, but RYGB operated had lower fasting glucose (P<0.05) and the postprandial glucose profile was shifted to the left (P<0.01).
Our data do not support that EE is increased after RYGB. More likely, RYGB promotes weight loss by reducing appetite, partly mediated by changes in gastrointestinal hormone secretion. Furthermore, we found that the early changes in glycaemic control after RYGB is to a large extent mediated by caloric restriction.
增加能量消耗（EE）被认为是 Roux-en-Y 胃旁路术（RYGB）后减肥的重要机制。然而，这从未在不改变能量平衡的情况下在独立的对照环境中进行过研究。同样，只有少数研究调查了 RYGB 对血糖控制本身的影响。在这里，我们研究了与对照组相比，RYGB 对 EE、食欲、血糖控制和特定信号分子的影响，对照组处于相似的负能平衡状态。
肥胖的正常糖耐量参与者被随机分为 RYGB 组（8 周，n=14）和 RYGB 组（12 周，n=14）。该方案包括在第 0 周和第 3 周（第 7 周、第 11 周和第 78 周）进行一次访视，评估 24 小时 EE、食欲和血液参数。参与者从第 0-11 周接受低热量饮食，第 12 周接受手术的参与者作为第 8 周接受手术的对照组。
与对照组相比，RYGB 术后 3 周患者的身体成分调整后 24 小时 EE 和基础 EE 较低（均 P<0.05），但 78 周时的 EE 参数与术前值（第 7 周）无差异。手术改变了胰高血糖素样肽-1（GLP-1）、肽 YY3-36（PYY）、ghrelin、胆囊收缩素、成纤维细胞生长因子-19 和胆汁酸的餐后反应（均 P<0.05）。特别是，GLP-1、PYY 的增加和 ghrelin 的减少与食欲下降有关。各组间 HOMA-IR（稳态模型评估-估计的胰岛素抵抗）、Matsuda 指数、胰岛素原指数、处置指数和空腹肝胰岛素清除率均无差异，但 RYGB 术后空腹血糖较低（P<0.05），且餐后血糖谱向左偏移（P<0.01）。
我们的数据不支持 RYGB 后 EE 增加。更有可能的是，RYGB 通过降低食欲来促进体重减轻，部分是通过胃肠道激素分泌的变化介导的。此外，我们发现 RYGB 后早期血糖控制的变化在很大程度上是由热量限制介导的。
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