Fanni Giovanni, Hukema Fleur, Hetty Susanne, Mathioudaki Argyri, Sundbom Magnus, Risérus Ulf, Kullberg Joel, Pereira Maria J, Ahlström Håkan, Eriksson Jan W
Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Surgery, Uppsala University, Uppsala, Sweden.
Diabetes Obes Metab. 2025 Sep;27(9):4836-4846. doi: 10.1111/dom.16526. Epub 2025 Jun 16.
In addition to weight loss, obesity surgery (OS) leads to metabolic improvements that seem at least partly independent of weight loss and are also mediated by various endocrine pathways and the brain. For the first time, we compared the short-term effects of weight loss achieved by either OS or a low-energy diet (LED) on several hormonal systems, at fasting and upon an oral glucose challenge.
This study presents sub-analyses from a randomized controlled trial including 24 participants with obesity but without diabetes (BMI 35-45 kg/m), randomized 2:1 to either OS or 4-week LED leading to comparable weight loss. Circulating levels of gut, pituitary, adrenal, thyroid hormones, glucagon, insulin-like growth factor-1 and sex hormone-binding globulin were measured at baseline and 4 weeks after either intervention, both at fasting and during an oral glucose tolerance test (OGTT).
At 4 weeks, similar weight loss was achieved for the two interventions (7.7 for OS vs. 7.4% for LED). glucagon-like peptide-1 and peptide YY secretion during the OGTT increased after OS (p < 0.001 for OGTT for both hormones), but not LED, while glucagon secretion remained unaffected. Adrenocorticotropin, cortisol and prolactin levels during OGTT were increased after OS (p = 0.04, p < 0.001, p = 0.002, respectively), while parathyroid hormone levels were decreased (p = 0.007). Fasting triiodothyronine levels were reduced after OS (p = 0.01). Fasting sex hormone-binding globulin levels decreased after both interventions (p < 0.01).
Rapid and extensive hormonal changes occur after OS, but not LED, despite similar weight loss. Of note, few differences were seen in the fasting state, whereas multiple endocrine pathways were affected during the oral glucose challenge. The findings suggest altered responses to oral glucose after OS in several hypothalamus-pituitary endocrine axes and peripheral endocrine glands.
除了体重减轻外，肥胖症手术（OS）还能带来代谢改善，这种改善似乎至少部分独立于体重减轻，并且还由多种内分泌途径和大脑介导。我们首次比较了通过OS或低能量饮食（LED）实现的体重减轻对几种激素系统在空腹和口服葡萄糖耐量试验时的短期影响。
本研究呈现了一项随机对照试验的亚分析，该试验纳入了24名肥胖但无糖尿病的参与者（BMI 35 - 45kg/m²），按2:1随机分为OS组或4周LED组，两组体重减轻程度相当。在基线以及干预后4周，于空腹和口服葡萄糖耐量试验（OGTT）期间，测量肠道、垂体、肾上腺、甲状腺激素、胰高血糖素、胰岛素样生长因子-1和性激素结合球蛋白的循环水平。
4周时，两种干预措施实现了相似的体重减轻（OS组为7.7%，LED组为7.4%）。OS后OGTT期间胰高血糖素样肽-1和肽YY分泌增加（两种激素的OGTT结果均为p < 0.001），而LED组未增加，同时胰高血糖素分泌未受影响。OS后OGTT期间促肾上腺皮质激素、皮质醇和催乳素水平升高（分别为p = 0.04、p < 0.001、p = 0.002），而甲状旁腺激素水平降低（p = 0.007）。OS后空腹三碘甲状腺原氨酸水平降低（p = 0.01）。两种干预后空腹性激素结合球蛋白水平均降低（p < 0.01）。
尽管体重减轻程度相似，但OS后会出现快速且广泛的激素变化，而LED后则不会。值得注意的是，空腹状态下差异不大，而在口服葡萄糖耐量试验期间多个内分泌途径受到影响。这些发现表明OS后几个下丘脑 - 垂体内分泌轴和外周内分泌腺对口服葡萄糖的反应发生了改变。
