Department of Surgery, Innlandet Hospital Trust, Gjøvik, Norway.
Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
BMC Endocr Disord. 2020 Jul 22;20(1):108. doi: 10.1186/s12902-020-00594-5.
Zonulin is a biomarker of impaired intestinal permeability, which has been associated with various disorders. The primary aim was to study serum zonulin (s-zonulin) in individuals with morbid obesity before and after a conservative weight loss intervention followed by bariatric surgery. The secondary aims were to explore predictors of s-zonulin, and the associations between the changes of the predictors and changes in s-zonulin, and to compare the associations in the two treatment periods.
Individuals with morbid obesity were included. Data before any weight loss interventions, after a 6 months' conservative weight loss intervention, and 6 months after bariatric surgery were used. S-zonulin was measured with an ELISA method from Immundiagnostik AB, Bensheim, Germany. Data were analysed with mixed models.
The mean body mass index was 42.1 kg/m (SD 3.8) at inclusion and was reduced to 38.7 kg/m (SD 3.8) and 29.8 kg/m (SD 3.8) after the conservative treatment and bariatric surgery respectively. S-zonulin was 63 ng/mL (SD 32) at inclusion and was reduced with 19 ng/ml (95% CI 12 to 26, p < 0.001) after conservative treatment and 11 ng/ml (95% CI 0 to 21, p = 0.04) after bariatric surgery. At inclusion, s-zonulin was significantly associated with factors including p-glucose (B = 2.21, 95% CI 1.09 to 3.33, p < 0.001), c-reactive protein (B = 1.02, 95% CI 0.45 to 1.58, p < 0.001) and the intake of proteins (B = 0.23, 95% CI 0.08 to 0.38, p = 0.003) and non-nutritive sweeteners (B = 0.68, 95% CI 0.19 to 1.17, p = 0.007). The reduction in s-zonulin after the conservative weight loss intervention was significantly associated with improvement in diarrhoea (B = 6.6, 95% CI 1.3 to 11.8, p = 0.02), HbA1c (B = 9.7, 95% CI 1.1 to 18.3, p = 0.03), p-glucose (B = 3.5, 95% CI 1.2 to 5.9, p = 0.004) and gamma-GT (B = 0.28, 95% CI 0.09 to 0.47, p = 0.004), but not associated with the change in body mass index (B = 0.9, 95% CI - 1.5 to 3.3, p = 0.46).
S-zonulin was markedly reduced after the conservative weight loss intervention, and further reduced after bariatric surgery. The reduction in s-zonulin was associated with improvement of diarrhoea, markers of glucose intolerance and liver disease, but not associated with the change in body mass index.
zonulin 是肠通透性受损的生物标志物，与各种疾病有关。主要目的是研究病态肥胖患者在保守减肥干预后和减肥手术后接受减肥手术前的血清 zonulin（s-zonulin）。次要目的是探索 s-zonulin 的预测因子，并研究预测因子变化与 s-zonulin 变化之间的关系，并比较两种治疗期的关联。
纳入病态肥胖患者。使用任何减肥干预前、保守减肥干预后 6 个月和减肥手术后 6 个月的数据。使用来自 Immundiagnostik AB（德国本斯海姆）的 ELISA 方法测量 s-zonulin。使用混合模型进行数据分析。
纳入时的平均体重指数为 42.1kg/m（SD 3.8），经保守治疗和减肥手术后分别降至 38.7kg/m（SD 3.8）和 29.8kg/m（SD 3.8）。纳入时的 s-zonulin 为 63ng/mL（SD 32），经保守治疗后降低 19ng/ml（95%CI 12 至 26，p<0.001），减肥手术后降低 11ng/ml（95%CI 0 至 21，p=0.04）。纳入时，s-zonulin 与包括 p-葡萄糖（B=2.21，95%CI 1.09 至 3.33，p<0.001）、c-反应蛋白（B=1.02，95%CI 0.45 至 1.58，p<0.001）和蛋白质摄入量（B=0.23，95%CI 0.08 至 0.38，p=0.003）和非营养性甜味剂（B=0.68，95%CI 0.19 至 1.17，p=0.007）等因素显著相关。保守减肥干预后 s-zonulin 降低与腹泻改善（B=6.6，95%CI 1.3 至 11.8，p=0.02）、HbA1c（B=9.7，95%CI 1.1 至 18.3，p=0.03）、p-葡萄糖（B=3.5，95%CI 1.2 至 5.9，p=0.004）和γ-GT（B=0.28，95%CI 0.09 至 0.47，p=0.004）显著相关，但与体重指数变化无关（B=0.9，95%CI -1.5 至 3.3，p=0.46）。
保守减肥干预后 s-zonulin 明显降低，减肥手术后进一步降低。s-zonulin 的降低与腹泻、葡萄糖耐量和肝脏疾病标志物的改善有关，但与体重指数的变化无关。
