Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.
Surg Obes Relat Dis. 2018 Aug;14(8):1126-1132. doi: 10.1016/j.soard.2018.03.033. Epub 2018 Apr 17.
Gastric bypass surgery for weight reduction often corrects dysglycemia in diabetic patients, but a full understanding of the underlying biochemical pathways continues to be investigated.
To explore the effects of weight loss by surgical and dietary interventions on plasma metabolites using both targeted and discovery-oriented metabolomics platforms.
An academic medical center in the United States.
Improvement in homeostatic model assessment for insulin resistance (HOMA-IR), as an index of insulin resistance, was compared at 6 months in 11 patients that underwent Roux-en-Y gastric bypass against 11 patients that were matched for weight loss in the Weight Loss Maintenance (WLM) program. Metabolites in plasma were evaluated by nontargeted gas chromatography/mass spectrometry for the potential detection of >1100 biochemical markers.
Among multiple metabolites detected, 2-hydroxybutyric acid (2-HBA) declined most significantly after 6 months in comparing patients that underwent Roux-en-Y gastric bypass with those in WLM (P < .001), corresponding with declines in HOMA-IR (P = .025). Baseline levels of 2-HBA for all patients were correlated with preintervention levels of HOMA-IR (R = .565, P < .001). Moreover, the changes in 2-HBA after 6 months were correlated with changes in HOMA-IR (R = .399, P = .0016).
Correlation between insulin resistance and 2-HBA suggests the utility of the latter as an excellent biomarker for tracking glycemic improvement, and offers further insight into the pathways that control diabetes. This is the first report of a decline in 2-HBA in response to bariatric surgery.
减重胃旁路手术通常可纠正糖尿病患者的糖代谢异常，但人们仍在深入研究其潜在的生化途径。
通过靶向和发现导向的代谢组学平台，探讨手术和饮食干预减肥对血浆代谢物的影响。
美国一家学术医疗中心。
比较 11 例接受 Roux-en-Y 胃旁路手术患者和 11 例体重减轻匹配的体重维持（WLM）项目患者的 Homeostatic Model Assessment for Insulin Resistance（HOMA-IR）改善情况，HOMA-IR 作为胰岛素抵抗的指标，在 6 个月时进行评估。采用非靶向气相色谱/质谱法评估血浆中的代谢物，以潜在检测 >1100 种生化标志物。
在检测到的多种代谢物中，比较 Roux-en-Y 胃旁路手术患者和 WLM 患者，6 个月时 2-羟丁酸（2-HBA）下降最显著（P <.001），与 HOMA-IR 下降一致（P = .025）。所有患者的 2-HBA 基线水平与干预前的 HOMA-IR 水平相关（R = .565，P <.001）。此外，6 个月后 2-HBA 的变化与 HOMA-IR 的变化相关（R = .399，P = .0016）。
胰岛素抵抗与 2-HBA 之间的相关性表明后者作为监测血糖改善的优秀生物标志物的效用，并为控制糖尿病的途径提供了更深入的了解。这是首次报道 2-HBA 对减肥手术的反应下降。
