Aukan Marthe Isaksen, Rehfeld Jens Frederik, Holst Jens Juul, Martins Catia
Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Centre of Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.
Int J Obes (Lond). 2025 Feb;49(2):306-314. doi: 10.1038/s41366-024-01658-5. Epub 2024 Nov 21.
Long-term weight loss outcomes are contrasting between bariatric surgery and dietary restriction alone. This is the first study to investigate changes in gastrointestinal (GI) hormones involved in appetite regulation, and subjective appetite feelings, at 1-year follow-up, after initial weight loss induced by a very-low energy (VLED) alone (controls), or with bariatric surgery.
Patients scheduled for Sleeve Gastrectomy (SG) (n = 19) or Roux-en-Y gastric Bypass (RYGB) (n = 19), and controls (n = 16) were recruited. All groups underwent 10 weeks of a VLED (initial phase), followed by a 9-month maintenance phase. Body weight/composition, plasma concentrations of ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY), cholecystokinin (CCK), and appetite ratings were measured before and after a meal, at baseline, week 11(W11), and 1Y follow-up.
Participants who completed all three follow ups were included in the analysis. Initial changes in body weight/composition were comparable across groups. SG (n = 11) and RYGB (n = 12) continued to lose weight from W11 to 1Y, whereas controls (n = 12) had regained weight. Postprandial GLP-1 increased over time post bariatric surgery and remained unchanged and lower in controls. Postprandial PYY increased in all groups, but greatest post-RYGB. Basal ghrelin decreased over time post-SG, while a small or marked increase was seen after RYGB and diet, respectively, with the control group exhibiting the greatest basal and postprandial concentrations at 1Y. A reduction in basal and postprandial CCK was seen in controls at 1Y, while no changes were observed post-bariatric surgery. Overall, small changes in subjective appetite ratings were seen over time.
Weight change at 1Y follow up after SG and RYGB is followed by a GI hormone profile favoring a lower drive to eat and increased satiety. The opposite is seen 1Y after WL induced by dietary restriction alone.
clinicaltrials.gov NCT04051190.
减肥手术和单纯饮食限制的长期减肥效果存在差异。这是第一项研究，旨在调查在极低能量饮食（VLED）单独诱导初始体重减轻后（对照组），或在减肥手术后1年随访时，参与食欲调节的胃肠（GI）激素变化以及主观食欲感受。
招募计划进行袖状胃切除术（SG）（n = 19）或Roux-en-Y胃旁路术（RYGB）（n = 19）的患者以及对照组（n = 16）。所有组均接受10周的VLED（初始阶段），随后是9个月的维持阶段。在基线、第11周（W11）和1年随访时，测量体重/身体成分、空腹及餐后胃饥饿素、胰高血糖素样肽1（GLP-1）、肽YY（PYY）、胆囊收缩素（CCK）的血浆浓度以及食欲评分。
完成所有三次随访的参与者纳入分析。各组体重/身体成分的初始变化相当。SG组（n = 11）和RYGB组（n = 12）从W11到1年持续减重，而对照组（n = 12）体重反弹。减肥手术后餐后GLP-1随时间增加，而对照组保持不变且较低。餐后PYY在所有组中均增加，但RYGB组增加最多。SG术后空腹胃饥饿素随时间降低，而RYGB组和饮食组分别出现小幅或显著增加，对照组在1年时空腹和餐后浓度最高。对照组在1年时空腹和餐后CCK降低，而减肥手术后未观察到变化。总体而言，随着时间推移，主观食欲评分有小的变化。
SG和RYGB术后1年随访时体重变化后，胃肠激素谱有利于降低进食驱动力并增加饱腹感。而单纯饮食限制诱导体重减轻1年后情况相反。
clinicaltrials.gov NCTe04051190 。
