Department of Chemistry, Centre for Analysis and Synthesis, Lund University, Lund, Sweden.
Department of Surgery and Urology, Kalmar Hospital, Kalmar, Sweden.
Diabetes. 2020 Sep;69(9):2027-2035. doi: 10.2337/db20-0131. Epub 2020 Jun 11.
Bariatric surgery is an efficient method to induce weight loss and also, frequently, remission of type 2 diabetes (T2D). Unpaired studies have shown bariatric surgery and dietary interventions to differentially affect multiple hormonal and metabolic parameters, suggesting that bariatric surgery causes T2D remission at least partially via unique mechanisms. In the current study, plasma metabolite profiling was conducted in patients with ( = 10) and without T2D ( = 9) subjected to Roux-en-Y gastric bypass surgery (RYGB). Mixed-meal tests were conducted at baseline, after the presurgical very-low-calorie diet (VLCD) intervention, immediately after RYGB, and after a 6-week recovery period. Thereby, we could compare fasted and postprandial metabolic consequences of RYGB and VLCD in the same patients. VLCD yielded a pronounced increase in fasting acylcarnitine levels, whereas RYGB, both immediately and after a recovery period, resulted in a smaller but opposite effect. Furthermore, we observed profound changes in lipid metabolism following VLCD but not in response to RYGB. Most changes previously associated with RYGB were found to be consequences of the presurgical dietary intervention. Overall, our results question previous findings of unique metabolic effects of RYGB and suggest that the effect of RYGB on the metabolite profile is mainly attributed to caloric restriction.
减重手术是一种有效的减肥方法，也经常能缓解 2 型糖尿病（T2D）。非配对研究表明，减重手术和饮食干预会对多种激素和代谢参数产生不同的影响，这表明减重手术至少部分通过独特的机制导致 T2D 缓解。在本研究中，对接受 Roux-en-Y 胃旁路手术（RYGB）的 T2D 患者（n=10）和非 T2D 患者（n=9）进行了血浆代谢物谱分析。在基线、术前极低热量饮食（VLCD）干预后、RYGB 后即刻和 6 周恢复期进行混合餐测试。因此，我们可以在同一患者中比较 RYGB 和 VLCD 的空腹和餐后代谢后果。VLCD 导致空腹酰基辅酶 A 水平显著升高，而 RYGB 无论是在即刻还是恢复期都产生了较小但相反的效果。此外，我们观察到 VLCD 后脂质代谢发生了深刻变化，但 RYGB 没有反应。先前与 RYGB 相关的大多数变化被认为是术前饮食干预的结果。总体而言，我们的结果质疑了 RYGB 具有独特代谢效应的先前发现，并表明 RYGB 对代谢物谱的影响主要归因于热量限制。
