Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
Department of General Surgery, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
Obes Surg. 2021 Jan;31(1):215-223. doi: 10.1007/s11695-020-04894-6. Epub 2020 Aug 15.
Following Roux-en-Y gastric bypass (RYGB), positive alterations are observed in gut microbiota and intestinal peptides. Previous studies demonstrated similar alterations observed in cases when pre-probiotics are used without surgery. The aim of this trial was to evaluate the effectiveness of early use of pre-probiotics after RYGB.
The operation and follow-up of the patients were performed at Istanbul University Medical Faculty. Thirty-two patients who had undergone RYGB were randomized to pre-probiotic group (PreProBG, n = 16; 200 g/day yogurt plus 10 g/day inulin+oligofructose) and probiotic group (ProBG, n = 16; 200 g/day yogurt only) for 6 months. Blood samples (glucose, insulin, A1c, GLP-1, PYY), anthropometric measurements, and appetite ratings have been evaluated at baseline and 3 (m3) and 6 (m6) months after RYGB.
Initial anthropometric measurements and appetite ratings decreased significantly after surgery and there were no significant differences between the groups. The decrease of area under the curve(insulin) was less and has a positive correlation with the changes in anthropometric measurements in PreProBG. GLP-1 and PYY which increased dramatically after surgery in all patients were higher in PreProBG. But this increase had a negative correlation with the changes in anthropometric measurements during the study.
Increased insulin, GLP-1, and PYY secretion was more enhanced by pre-probiotic use in early postoperative period. But this increase not only in anthropometric measurements but also in appetite ratings affects negatively, contrary to expectations. In summary, it should be investigated with new studies that use of pre-probiotics in the late postoperative period may be more effective in patients with weak insulin and incretin response and therefore insufficient weight loss. Trial Registration clinicaltrials.gov Identifier: NCT03517345.
在 Roux-en-Y 胃旁路手术后（RYGB），肠道微生物群和肠肽发生积极改变。先前的研究表明，在使用前益生菌而不进行手术的情况下也观察到类似的改变。本试验的目的是评估 RYGB 后早期使用前益生菌的效果。
手术和患者随访在伊斯坦布尔大学医学院进行。32 例接受 RYGB 的患者被随机分为前益生菌组（PreProBG，n=16；每天 200 克酸奶加 10 克菊粉+低聚果糖）和益生菌组（ProBG，n=16；每天 200 克酸奶），持续 6 个月。在 RYGB 前、术后 3 个月（m3）和 6 个月（m6）时评估血糖、胰岛素、糖化血红蛋白（A1c）、GLP-1、PYY 等血液样本、人体测量学测量和食欲评分。
手术后初始人体测量学测量和食欲评分显著下降，两组间无显著差异。胰岛素曲线下面积（AUC）的下降幅度较小，与 PreProBG 人体测量学测量的变化呈正相关。所有患者术后 GLP-1 和 PYY 急剧增加，PreProBG 更高。但这种增加与研究期间人体测量学测量的变化呈负相关。
早期术后使用前益生菌可更有效地增强胰岛素、GLP-1 和 PYY 的分泌。但这种增加不仅对人体测量学测量有影响，而且对食欲评分也有负面影响，与预期相反。总之，使用新的研究来评估在术后晚期使用前益生菌可能对胰岛素和肠促胰岛素反应较弱、因此体重减轻不足的患者更有效。试验注册临床Trials.gov 标识符：NCT03517345。
