Abstract
To compare the effects of equivalent weight loss induced by two bariatric surgical techniques on insulin action in severely obese patients. Eighteen nondiabetic patients with severe obesity (mean [± SD] body mass index: 53.5 ± 9.0 kg/m 2) and 20 sex- and age-matched lean subjects (body mass index: 23.8 ± 3.0 kg/m 2) underwent metabolic studies, including measurement of insulin sensitivity by the insulin clamp technique. Patients then underwent either vertical banded gastroplasty with Roux-en-Y gastric bypass, or biliopancreatic diversion, and were restudied at 5 to 6 months and again at 16 to 24 months postsurgery. At baseline, patients were hyperinsulinemic (194 ± 47 pmol/L vs. 55 ± 25 pmol/L, P <0.0001), hypertriglyceridemic (1.56 ± 0.30 mmol/L vs. 0.78 ± 0.32 mmol/L, P <0.0001), and profoundly insulin resistant (insulin-mediated glucose disposal: 20.8 ± 4.4 μmol/min/kg fat-free mass vs. 52.0 ± 10.1 μmol/min/kg, P <0.0001) as compared with controls. Weight loss by the two procedures was equivalent in both amount (averaging -53 kg) and time course. In the gastric bypass group, insulin sensitivity improved (23.8 ± 6.0 μmol/min/kg at 5 months and 33.7 ± 11.3 μmol/min/kg at 16 months, P <0.01 vs. baseline and controls). In contrast, in the biliopancreatic diversion group, insulin sensitivity was normalized already at 6 months (52.5 ± 12.4 μmol/min/kg, P = 0.72 vs. controls) and increased further at 24 months (68.7 ± 9.5 μmol/min/kg, P <0.01 vs. controls) despite a persistent obese phenotype (body mass index: 33.2 ± 8.0 kg/m 2). In surgically treated obese patients, insulin sensitivity improves in proportion to weight loss with use of predominantly restrictive procedures (gastric bypass), but is reversed completely by predominantly malabsorptive approaches (biliopancreatic diversion) long before normalization of body weight. Selective nutrient absorption and gut hormones may interact with one another in the genesis of the metabolic abnormalities of obesity.
| Original language | English |
|---|---|
| Pages (from-to) | 51-57 |
| Number of pages | 7 |
| Journal | American Journal of Medicine |
| Volume | 118 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2005 |
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Keywords
- Biliopancreatic diversion
- Gastric bypass
- Insulin resistance
- Morbid obesity
ASJC Scopus subject areas
- Nursing(all)
Cite this
Differential effect of weight loss on insulin resistance in surgically treated obese patients. / Muscelli, Elza; Mingrone, Gertrude; Camastra, Stefania; Manco, Melania; Pereira, Juliano Alves; Pareja, José Carlos; Ferrannini, Ele.
In: American Journal of Medicine, Vol. 118, No. 1, 01.2005, p. 51-57.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Differential effect of weight loss on insulin resistance in surgically treated obese patients
AU - Muscelli, Elza
AU - Mingrone, Gertrude
AU - Camastra, Stefania
AU - Manco, Melania
AU - Pereira, Juliano Alves
AU - Pareja, José Carlos
AU - Ferrannini, Ele
PY - 2005/1
Y1 - 2005/1
N2 - To compare the effects of equivalent weight loss induced by two bariatric surgical techniques on insulin action in severely obese patients. Eighteen nondiabetic patients with severe obesity (mean [± SD] body mass index: 53.5 ± 9.0 kg/m 2) and 20 sex- and age-matched lean subjects (body mass index: 23.8 ± 3.0 kg/m 2) underwent metabolic studies, including measurement of insulin sensitivity by the insulin clamp technique. Patients then underwent either vertical banded gastroplasty with Roux-en-Y gastric bypass, or biliopancreatic diversion, and were restudied at 5 to 6 months and again at 16 to 24 months postsurgery. At baseline, patients were hyperinsulinemic (194 ± 47 pmol/L vs. 55 ± 25 pmol/L, P <0.0001), hypertriglyceridemic (1.56 ± 0.30 mmol/L vs. 0.78 ± 0.32 mmol/L, P <0.0001), and profoundly insulin resistant (insulin-mediated glucose disposal: 20.8 ± 4.4 μmol/min/kg fat-free mass vs. 52.0 ± 10.1 μmol/min/kg, P <0.0001) as compared with controls. Weight loss by the two procedures was equivalent in both amount (averaging -53 kg) and time course. In the gastric bypass group, insulin sensitivity improved (23.8 ± 6.0 μmol/min/kg at 5 months and 33.7 ± 11.3 μmol/min/kg at 16 months, P <0.01 vs. baseline and controls). In contrast, in the biliopancreatic diversion group, insulin sensitivity was normalized already at 6 months (52.5 ± 12.4 μmol/min/kg, P = 0.72 vs. controls) and increased further at 24 months (68.7 ± 9.5 μmol/min/kg, P <0.01 vs. controls) despite a persistent obese phenotype (body mass index: 33.2 ± 8.0 kg/m 2). In surgically treated obese patients, insulin sensitivity improves in proportion to weight loss with use of predominantly restrictive procedures (gastric bypass), but is reversed completely by predominantly malabsorptive approaches (biliopancreatic diversion) long before normalization of body weight. Selective nutrient absorption and gut hormones may interact with one another in the genesis of the metabolic abnormalities of obesity.
AB - To compare the effects of equivalent weight loss induced by two bariatric surgical techniques on insulin action in severely obese patients. Eighteen nondiabetic patients with severe obesity (mean [± SD] body mass index: 53.5 ± 9.0 kg/m 2) and 20 sex- and age-matched lean subjects (body mass index: 23.8 ± 3.0 kg/m 2) underwent metabolic studies, including measurement of insulin sensitivity by the insulin clamp technique. Patients then underwent either vertical banded gastroplasty with Roux-en-Y gastric bypass, or biliopancreatic diversion, and were restudied at 5 to 6 months and again at 16 to 24 months postsurgery. At baseline, patients were hyperinsulinemic (194 ± 47 pmol/L vs. 55 ± 25 pmol/L, P <0.0001), hypertriglyceridemic (1.56 ± 0.30 mmol/L vs. 0.78 ± 0.32 mmol/L, P <0.0001), and profoundly insulin resistant (insulin-mediated glucose disposal: 20.8 ± 4.4 μmol/min/kg fat-free mass vs. 52.0 ± 10.1 μmol/min/kg, P <0.0001) as compared with controls. Weight loss by the two procedures was equivalent in both amount (averaging -53 kg) and time course. In the gastric bypass group, insulin sensitivity improved (23.8 ± 6.0 μmol/min/kg at 5 months and 33.7 ± 11.3 μmol/min/kg at 16 months, P <0.01 vs. baseline and controls). In contrast, in the biliopancreatic diversion group, insulin sensitivity was normalized already at 6 months (52.5 ± 12.4 μmol/min/kg, P = 0.72 vs. controls) and increased further at 24 months (68.7 ± 9.5 μmol/min/kg, P <0.01 vs. controls) despite a persistent obese phenotype (body mass index: 33.2 ± 8.0 kg/m 2). In surgically treated obese patients, insulin sensitivity improves in proportion to weight loss with use of predominantly restrictive procedures (gastric bypass), but is reversed completely by predominantly malabsorptive approaches (biliopancreatic diversion) long before normalization of body weight. Selective nutrient absorption and gut hormones may interact with one another in the genesis of the metabolic abnormalities of obesity.
KW - Biliopancreatic diversion
KW - Gastric bypass
KW - Insulin resistance
KW - Morbid obesity
UR - http://www.scopus.com/inward/record.url?scp=11444261322&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=11444261322&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2004.08.017
DO - 10.1016/j.amjmed.2004.08.017
M3 - Article
C2 - 15639210
AN - SCOPUS:11444261322
VL - 118
SP - 51
EP - 57
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 1
ER -