Systems Epidemiology, Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland.
Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland.
Obes Surg. 2024 Feb;34(2):625-634. doi: 10.1007/s11695-023-07042-y. Epub 2024 Jan 9.
The Roux-en-Y gastric bypass (RYGB) is a common bariatric surgery to treat obesity. Its metabolic consequences are favourable and long-term clinical corollaries beneficial. However, detailed assessments of various affected metabolic pathways and their mediating physiological factors are scarce.
We performed a clinical study with 30 RYGB patients in preoperative and 6-month postoperative visits. NMR metabolomics was applied to profiling of systemic metabolism via 80 molecular traits, representing core cardiometabolic pathways. Glucose, glycated haemoglobin (HbA1c), insulin, and apolipoprotein B-48 were measured with standard assays. Logistic regression models of the surgery effect were used for each metabolic measure and assessed individually for multiple mediating physiological factors.
Changes in insulin concentrations reflected those of BMI with robust decreases due to the surgery. Six months after the surgery, triglycerides, remnant cholesterol, and apolipoprotein B-100 were decreased -24%, -18%, and -14%, respectively. Lactate and glycoprotein acetyls, a systemic inflammation biomarker, decreased -16% and -9%, respectively. The concentrations of branched-chain (BCAA; leucine, isoleucine, and valine) and aromatic (phenylalanine and tyrosine) amino acids decreased after the surgery between -17% for tyrosine and -23% for leucine. Except for the most prominent metabolic changes observed for the BCAAs, all changes were almost completely mediated by weight change and insulin. Glucose and type 2 diabetes had clearly weaker effects on the metabolic changes.
The comprehensive metabolic analyses indicate that weight loss and improved insulin sensitivity during the 6 months after the RYGB surgery are the key physiological outcomes mediating the short-term advantageous metabolic effects of RYGB. The clinical study was registered at ClinicalTrials.gov as NCT01330251.
Roux-en-Y 胃旁路术（RYGB）是一种常见的减肥手术，用于治疗肥胖症。其代谢效果良好，长期临床结果有益。然而，目前对各种受影响的代谢途径及其介导的生理因素的详细评估还很少。
我们对 30 名 RYGB 患者进行了临床研究，分别在术前和术后 6 个月进行访视。通过 80 种分子特征（代表核心的心血管代谢途径），我们应用 NMR 代谢组学对全身代谢进行了分析。采用标准检测方法测定血糖、糖化血红蛋白（HbA1c）、胰岛素和载脂蛋白 B-48。对每种代谢指标，我们都采用手术效果的逻辑回归模型进行分析，并分别对多个介导的生理因素进行评估。
胰岛素浓度的变化反映了体重的变化，由于手术，胰岛素浓度显著降低。术后 6 个月，甘油三酯、残余胆固醇和载脂蛋白 B-100 分别降低了 24%、18%和 14%。乳酸和糖蛋白乙酰基（一种全身性炎症生物标志物）分别降低了 16%和 9%。术后，支链氨基酸（亮氨酸、异亮氨酸和缬氨酸）和芳香族氨基酸（苯丙氨酸和酪氨酸）的浓度分别降低了 17%至 23%，其中酪氨酸的降低幅度最大。除了观察到 BCAAs 最显著的代谢变化外，所有的变化几乎完全由体重变化和胰岛素介导。葡萄糖和 2 型糖尿病对代谢变化的影响明显较弱。
综合代谢分析表明，RYGB 术后 6 个月的体重减轻和胰岛素敏感性改善是介导 RYGB 短期有利代谢效果的关键生理结果。这项临床研究在 ClinicalTrials.gov 上注册为 NCT01330251。
