胃旁路手术患者和匹配对照者的肠道对膳食脂质的感知和处理。
Intestinal sensing and handling of dietary lipids in gastric bypass-operated patients and matched controls.
机构信息
Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark.
Danish Diabetes Academy, Odense University Hospital, Odense, Denmark.
出版信息
Am J Clin Nutr. 2020 Jan 1;111(1):28-41. doi: 10.1093/ajcn/nqz272.
BACKGROUND
Altered meal-related gut hormone secretion seems important for weight loss and diabetes remission after Roux-en-Y gastric bypass (RYGB). Elucidating the responsible meal components and receptors could aid discovery of new treatments of obesity and diabetes. Enteroendocrine cells respond to digestion products of dietary triacylglycerol, especially long-chain fatty acids (LCFAs) and 2-oleoyl-glycerol (2-OG), but not medium-chain fatty acids (MCFAs).
OBJECTIVE
We examined the impact of olive oil (20 mL) and its derivates, LCFAs and 2-OG, on enteroendocrine secretions [glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), cholecystokinin (CCK), peptide YY (PYY), and neurotensin (NT)] and on glucose, lipid, and bile acid metabolism in RYGB-operated and unoperated individuals.
METHODS
In an exploratory randomized crossover design, 10 RYGB-operated patients and 10 matched controls ingested 3 equimolar triacylglycerol formulations on separate days: olive oil (digested to 2-OG + LCFAs), C8-dietary oil (2-OG + MCFAs), and tricaprylin (MCFAs; negative control). Hormone responses were calculated as area under the curve (AUC).
RESULTS
Independent of group status, olive oil had greater effects than C8-dietary oil on AUCs of plasma GLP-1 (+32%; 95% CI: 23%, 43%; P < 0.01), CCK (+53%, P < 0.01), and NT (+71%, P < 0.01), whereas the effect on GIP differed between groups (+90% in controls, P < 0.01; +24% in RYGB, P = 0.10). Independent of group status, C8-dietary oil had greater effects than tricaprylin on AUCs of plasma CCK (+40%, P < 0.01) and NT (+32%, P < 0.01), but not GLP-1 (+5%; 95% CI: -2.9%, 13%; P = 0.22), whereas the effect on GIP again differed between groups (+78% in controls, P < 0.01; +39% in RYGB, P = 0.01). Distal (GLP-1/PYY/NT), but not proximal (CCK/GIP), enteroendocrine responses were generally greater in RYGB patients than in controls.
CONCLUSIONS
The combination of LCFAs plus 2-OG was substantially more effective than 2-OG plus MCFAs in stimulating enteroendocrine secretion in RYGB-operated and matched control individuals. Distal lipid-induced gut hormone release was greater after RYGB.This trial was registered at clinicaltrials.gov as NCT03223389.
背景
在 Roux-en-Y 胃旁路手术后（RYGB），改变与进餐相关的肠道激素分泌似乎对减肥和糖尿病缓解很重要。阐明负责的进餐成分和受体有助于发现肥胖和糖尿病的新治疗方法。肠内分泌细胞对膳食三酰甘油的消化产物有反应，特别是长链脂肪酸（LCFAs）和 2-油酰甘油（2-OG），但不反应中链脂肪酸（MCFAs）。
目的
我们研究了橄榄油（20 毫升）及其衍生物 LCFAs 和 2-OG 对 RYGB 手术和未手术个体的肠内分泌分泌[胰高血糖素样肽-1（GLP-1）、葡萄糖依赖性胰岛素释放肽（GIP）、胆囊收缩素（CCK）、肽 YY（PYY）和神经降压素（NT）]以及葡萄糖、脂质和胆汁酸代谢的影响。
方法
在一项探索性随机交叉设计中，10 名 RYGB 手术患者和 10 名匹配的对照者分别在 3 天内摄入 3 种等摩尔三酰甘油制剂：橄榄油（消化为 2-OG+LCFAs）、C8 膳食油（2-OG+MCFAs）和三辛酸甘油酯（MCFAs；阴性对照）。激素反应以曲线下面积（AUC）计算。
结果
无论组间状态如何，橄榄油对 AUC 的影响均大于 C8 膳食油，包括血浆 GLP-1（+32%；95%CI：23%，43%；P<0.01）、CCK（+53%，P<0.01）和 NT（+71%，P<0.01），而 GIP 的影响则因组间而异（对照组+90%，P<0.01；RYGB 组+24%，P=0.10）。无论组间状态如何，C8 膳食油对 AUC 的影响均大于三辛酸甘油酯，包括 CCK（+40%，P<0.01）和 NT（+32%，P<0.01），但对 GIP 的影响则因组间而异（对照组+78%，P<0.01；RYGB 组+39%，P=0.01）。与近端（CCK/GIP）相比，RYGB 患者的远端（GLP-1/PYY/NT）肠内分泌反应通常更大。
结论
在 RYGB 手术和匹配对照个体中，LCFAs 加 2-OG 的组合比 2-OG 加 MCFAs 更有效地刺激肠内分泌分泌。RYGB 后，远端脂质诱导的肠道激素释放更大。这项试验在 clinicaltrials.gov 上注册为 NCT03223389。
Zotero 插件