Division of Endocrinology, Department of Medicine, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS) and Santiago de Compostela University (USC), Santiago de Compostela, La Coruña, Spain.
CIBER de Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Santiago de Compostela, Spain.
Int J Obes (Lond). 2017 Oct;41(10):1570-1578. doi: 10.1038/ijo.2017.138. Epub 2017 Jun 7.
Fibroblast growth factor 21 (FGF21) has been suggested to be an endocrine signal of nutritional status and an active regulator of metabolism. However, there is no agreement on the effect of weight-loss therapies on circulating levels of FGF21 in humans.
To assess FGF21 circulating levels in adiposity excess and after different weight-loss strategies prescribed in five different groups from four independent centers.
Body composition, ketosis, insulin sensitivity and FGF21 were evaluated in 181 excess body weight and 14 normal-weight subjects. From the excess body weight patients, two independent groups (discovery cohort; n=20 and validation cohort; n=28) undertook a very low-calorie ketogenic (VLCK) diet, a third group followed a low-calorie (LC) diet (n=84) and other two groups underwent bariatric surgery (discovery cohort; n=24 and validation cohort; n=25). The follow-up was 4 to 6 or 12 months, respectively.
FGF21 levels were higher in excess body weight patients than in normal-weight subjects. The energy-restriction therapy to lose weight induced a significant decrease, with respect to baseline, in circulating levels of FGF21 (VLCK: -62.5 pg ml or -14.8 pg ml and LC diet: -67.9 pg ml). There were no differences in FGF21 levels between both energy-restriction treatments. On the contrary, after bariatric surgery morbidly obese patients showed a significant increase in FGF21, especially 1 month after surgery (148.8 pg ml higher than baseline). The FGF21 differential changes occur concomitantly with a non-induced ketosis situation (0.66±0.56 mm) in bariatric surgery, and an improvement in adiposity and insulin sensitivity induced by the three therapies.
FGF21 levels were reduced after energy-restricted treatments and severely increased after bariatric surgery, independently of the weight reduction magnitude, insulin sensitivity or ketosis. Therefore, FGF21 appears to be a marker of severe nutritional stress.
成纤维细胞生长因子 21（FGF21）被认为是营养状况的内分泌信号，也是代谢的活跃调节剂。然而，对于减肥疗法对人体循环中 FGF21 水平的影响，尚无共识。
评估 4 个独立中心的 5 个不同组中肥胖和不同减肥策略后 FGF21 的循环水平。
评估了 181 名超重和 14 名正常体重受试者的身体成分、酮症、胰岛素敏感性和 FGF21。从超重患者中，两个独立的组（发现队列；n=20 和验证队列；n=28）接受了极低热量生酮（VLCK）饮食，第三组接受了低热量（LC）饮食（n=84），另外两组接受了减肥手术（发现队列；n=24 和验证队列；n=25）。随访时间分别为 4-6 个月或 12 个月。
超重患者的 FGF21 水平高于正常体重受试者。能量限制减肥疗法导致循环 FGF21 水平与基线相比显著降低（VLCK：-62.5 pg/ml 或-14.8 pg/ml 和 LC 饮食：-67.9 pg/ml）。两种能量限制治疗方法之间的 FGF21 水平没有差异。相反，减肥手术后肥胖患者的 FGF21 水平显著升高，尤其是手术后 1 个月（比基线高 148.8 pg/ml）。FGF21 的差异变化与减肥手术后非诱导酮症状态（0.66±0.56 mm）同时发生，并且三种治疗方法都可改善肥胖和胰岛素敏感性。
能量限制治疗后 FGF21 水平降低，减肥手术后严重升高，与减重幅度、胰岛素敏感性或酮症无关。因此，FGF21 似乎是严重营养应激的标志物。
