Division of Gastroenterology, Department of Internal Medicine, University of California, Davis, Sacramento, CA, 95616, USA.
The UC Davis Comprehensive Cancer Center, Sacramento, CA, 95616, USA.
Obes Surg. 2024 Sep;34(9):3420-3433. doi: 10.1007/s11695-024-07420-0. Epub 2024 Jul 23.
INTRODUCTION: Excess body fat elevates colorectal cancer risk. While bariatric surgery (BRS) induces significant weight loss, its effects on the fecal stream and colon biology are poorly understood. Specifically, limited data exist on the impact of bariatric surgery (BRS) on fecal secondary bile acids (BA), including lithocholic acid (LCA), a putative promotor of colorectal carcinogenesis. METHODS: This cross-sectional case-control study included 44 patients with obesity; 15 pre-BRS (controls) vs. 29 at a median of 24.1 months post-BRS. We examined the fecal concentrations of 11 BA by liquid chromatography and gene abundance of BA-metabolizing bacterial enzymes through fecal metagenomic sequencing. Differences were quantified using non-parametric tests for BA levels and linear discriminant analysis (LDA) effect size (LEfSe) for genes encoding BA-metabolizing enzymes. RESULTS: Total fecal secondary BA concentrations trended towards lower levels post- vs. pre-BRS controls (p = 0.07). Individually, fecal LCA concentrations were significantly lower post- vs. pre-BRS (8477.0 vs. 11,914.0 uM/mg, p < 0.008). Consistent with this finding, fecal bacterial genes encoding BA-metabolizing enzymes, specifically 3-betahydroxycholanate-3-dehydrogenase (EC 1.1.1.391) and 3-alpha-hydroxycholanate dehydrogenase (EC 1.1.1.52), were also lower post- vs. pre-BRS controls (LDA of - 3.32 and - 2.64, respectively, adjusted p < 0.0001). Post-BRS fecal BA concentrations showed significant inverse correlations with weight loss, a healthy diet quality, and increased physical activity. CONCLUSIONS: Concentrations of LCA, a secondary BA, and bacterial genes needed for BA metabolism are lower post-BRS. These changes can impact health and modulate the colorectal cancer cascade. Further research is warranted to examine how surgical alterations and the associated dietary changes impact bile acid metabolism.
简介:体脂肪过多会增加结直肠癌的风险。虽然减重手术(BRS)可显著减轻体重,但人们对其对粪便流和结肠生物学的影响知之甚少。具体来说,关于减重手术(BRS)对粪便次级胆汁酸(BA)的影响,包括胆酸(LCA)的数据有限,LCA 是结直肠癌变的潜在促进剂。 方法:本横断面病例对照研究纳入 44 例肥胖患者;15 例术前(对照组)与 29 例术后中位数为 24.1 个月。我们通过液相色谱法检测 11 种 BA 的粪便浓度,并通过粪便宏基因组测序检测 BA 代谢细菌酶的基因丰度。使用非参数检验和线性判别分析(LDA)效应大小(LEfSe)对 BA 代谢酶编码基因进行量化。 结果:与术前对照组相比,术后总粪便次级 BA 浓度呈下降趋势(p=0.07)。单独来看,术后粪便 LCA 浓度明显低于术前(8477.0 与 11914.0 uM/mg,p<0.008)。与此发现一致的是,粪便中编码 BA 代谢酶的细菌基因,特别是 3-β-羟胆酸-3-脱氢酶(EC 1.1.1.391)和 3-α-羟胆酸脱氢酶(EC 1.1.1.52),术后也低于术前对照组(LDA 分别为-3.32 和-2.64,调整后的 p<0.0001)。术后粪便 BA 浓度与体重减轻、健康饮食质量和增加体力活动呈显著负相关。 结论:术后 LCA 等次级 BA 的浓度和 BA 代谢所需的细菌基因均降低。这些变化可能会影响健康并调节结直肠癌级联反应。需要进一步研究手术改变和相关饮食变化如何影响胆汁酸代谢。
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