Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Impact of Bariatric Surgery on Ghrelin and Obestatin Levels in Obesity or Type 2 Diabetes Mellitus Rat Model Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. Weight Loss, Appetite Suppression, and Changes in Fasting and Postprandial Ghrelin and Peptide-YY Levels After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Prospective, Double Blind Study Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: effects of bariatric surgery vs standard medical therapy Preserved Insulin Secretory Capacity and Weight Loss Are the Predominant Predictors of Glycemic Control in Patients With Type 2 Diabetes Randomized to Roux-en-Y Gastric Bypass GLP-1 Plays a Limited Role in Improved Glycemia Shortly After Roux-en-Y Gastric Bypass: A Comparison With Intensive Lifestyle Modification Changes in measured resting energy expenditure after Roux-en-Y gastric bypass for clinically severe obesity. Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity: experience with 50 patients. Acute effects of gastric bypass versus gastric restrictive surgery on β-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes Weight loss induced by very low calorie diet is associated with a more beneficial systemic inflammatory profile than by Roux-en-Y gastric bypass. Supervised Physical Training Improves Weight Loss After Roux-en-Y Gastric Bypass Surgery: A Randomized Controlled Trial. Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with higher ghrelin levels Progressive rise in gut hormone levels after Roux‐en‐Y gastric bypass suggests gut adaptation and explains altered satiety Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial Enhanced fasting and post-prandial plasma bile acid responses after Roux-en-Y gastric bypass surgery Roux-en-Y gastric bypass and calorie restriction induce comparable time-dependent effects on thyroid hormone function tests in obese female subjects. Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial Changes in bone mineral content after surgical treatment of morbid obesity. The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study Differential Changes in Gut Microbiota After Gastric Bypass and Sleeve Gastrectomy Bariatric Surgery Vary According to Diabetes Remission
BACKGROUND Sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGB ) cause weight loss and metabolic improvement , but results of published studies are contradictory . OBJECTIVES The aim of this study was to compare the effects of SG and RYGB on ghrelin , leptin , and glucose homeostasis in a r and omized controlled trial . SETTING University hospital , Pol and . METHODS Seventy-two morbidly obese patients were r and omly selected to undergo either SG ( n = 36 ) or RYGB ( n = 36 ) .  Fasting ghrelin , leptin , glucose , insulin , C-peptide , glucagon , glycated hemoglobin , and homeostasis model assessment of insulin resistance were assessed preoperatively and at 1 , 6 , and 12 months postoperatively . No differences were found in anthropometric and biochemical parameters between the study groups at baseline . RESULTS Sixty-nine ( 95.8 % ) patients completed the study .  Percentage of excess weight loss at 12 months was 67.6±19.3 % after SG and 64.2±18.5 % after RYGB ( P>.05 ) . Fasting ghrelin levels decreased 1 month after SG ( from 76.8 pmol/L to 35.3 pmol/L ; P<.05 ) and remained reduced until 12 months ( 41.6 pmol/L ; P<.05 ) but increased 12 months after RYGB from 74.6 pmol/L to 130.2 pmol/L ( P<.05 ) . Leptin , glucose , insulin , and C-peptide concentrations and glycated hemoglobin and homeostasis model assessment of insulin resistance values decreased significantly in both groups during 12 months . CONCLUSIONS RYGB and SG induce comparable weight loss and improvement in metabolism of glucose . Ghrelin levels decrease after SG and increase after RYGB , but this difference does not affect similar outcomes of these procedures during 1-year follow-up . The contribution of ghrelin to weight loss or metabolic benefits after bariatric surgery is not straightforward , but rather influenced by multiple factors We aim ed to evaluate the therapeutic efficacy on weight control by different bariatric surgeries and investigate the ghrelin and obestatin changes after these surgeries in obesity and nonobese type 2 diabetes mellitus ( T2DM ) rats . Obese rats were r and omly assigned to receive sleeve gastrectomy ( SG , n = 8) , minigastric bypass ( MGBP , n = 8) , roux-en-Y gastric bypass ( RYGBP , n = 8) , and sham operation ( SO , n = 4 ) . Another 4 rats served as control . Besides , Goto-Kakisaki ( GK ) rats were also r and omly divided into similar groups except for total gastrectomy ( TG , n = 8) group . The results showed that in obese rats , weigh loss in RYGBP group was similar to that in MGBP group but larger than that in SG group . Ghrelin significantly increased in RYGB group , but obestatin increased in MGBP group . Ghrelin/obestatin ratio significantly decreased in SG group . In GK rats , weight loss was most obvious in TG group . Postoperatively , ghrelin was significantly increased in MGBP and RYGB groups but decreased in TG group . Obestatin also showed an increase in MGBP and RYGB groups . Ghrelin/obestatin in TG group decreased significantly . In conclusion , RYGB and MGBP may be more suitable for obese rats , but TG may be the best strategy for T2DM rats to control weight with different mechanisms CONTEXT It has been hypothesized that increased plasma bile acids ( BAs ) contribute to metabolic improvements after Roux-en-Y gastric bypass ( RYGB ) surgery by the G protein-coupled receptor TGR5-mediated effects on glucagon-like peptide-1 secretion and thyroid hormones . OBJECTIVE The objective of this study was to evaluate the importance of bariatric surgery-induced alterations in BA physiology on factors that regulate glucose homeostasis ( insulin secretion and sensitivity ) and energy metabolism ( resting energy expenditure and thyroid hormone axis ) . DESIGN , PARTICIPANTS , INTERVENTION , AND MAIN OUTCOME MEASURE : Eighteen extremely obese subjects were studied before and after 20 % weight loss , induced by either laparoscopic adjustable gastric b and ing ( LAGB ) ( n = 10 ) or RYGB surgery ( n = 8) . RESULTS Plasma BAs more than doubled after RYGB [ fasting : 1.08 ( 0.26 - 1.42 ) to 2.28 ( 1.59 - 3.28 ) μmol/L , P = .03 ; postpr and ial : 2.46 ± 1.59 to 6.00 ± 2.75 μmol/L , P = .01 ] but were either lower or did not change after LAGB [ fasting : 1.80 ( 1.49 - 2.19 ) to 0.92 ( 0.73 - 1.15 ) μmol/L , P = .02 ; postpr and ial : 3.71 ± 2.61 to 2.82 ± 1.75 μmol/L , P = .14 ] . Skeletal muscle expression of TGR5 targets , Kir6.2 and cyclooxygenase IV , increased after RYGB but not LAGB . Surgery-induced changes in BAs were associated with increased peak postpr and ial plasma glucagon-like peptide-1 ( r(2 ) = 0.509 , P = .001 ) and decreased serum TSH ( r(2 ) = 0.562 , P < .001 ) but did not correlate with the change in insulin response to a meal ( r(2 ) = 0.013 , P = .658 ) , insulin sensitivity ( assessed as insulin stimulated glucose disposal during a hyperinsulinemic-euglycemic clamp procedure ) ( r(2 ) = 0.001 , P = .995 ) , or resting energy expenditure ( r(2 ) = 0.004 , P = .807 ) . CONCLUSIONS Compared with LAGB , RYGB increases circulating BAs and TGR5 signaling , but this increase in BAs is not a significant predictor of changes in glucose homeostasis or energy metabolism Background : Bariatric surgery is currently the most effective treatment in morbidly obese patients , leading to durable weight loss . Objective : In this prospect i ve double blind study , we aim to evaluate and compare the effects of  laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) with laparoscopic sleeve gastrectomy ( LSG )  on body weight , appetite , fasting , and postpr and ial ghrelin and peptide-YY ( PYY ) levels . Methods : After r and omization , 16 patients were assigned to LRYGBP and 16 patients to LSG .  Patients were reevaluated on the 1st , 3rd , 6th , and 12th postoperative month . Blood sample s were collected after an overnight fast and in 6 patients in each group after a st and ard 420 kcal mixed meal . Results : Body weight and body mass index ( BMI ) decreased markedly ( P < 0.0001 ) and comparably after either procedure . Excess weight loss was greater after LSG at 6 months ( 55.5 % ± 7.6 % vs. 50.2 % ± 6.5 % , P = 0.04 ) and 12 months ( 69.7 % ± 14.6 % vs. 60.5 % ± 10.7 % , [ P = 0.05 ] ) . After LRYGBP fasting ghrelin levels did not change significantly compared with baseline ( P = 0.19 ) and did not decrease significantly after the test meal . On the other h and , LSG was followed by a marked reduction in fasting ghrelin levels ( P < 0.0001 ) and a significant suppression after the meal . Fasting PYY levels increased after either surgical procedure ( P ≤ 0.001 ) . Appetite decreased in both groups but to a greater extend after LSG . Conclusion : PYY levels increased similarly after either procedure . The markedly reduced ghrelin levels in addition to increased PYY levels after LSG , are associated with greater appetite suppression and excess weight loss compared with LRYGBP The differences in cholesterol metabolism after the 2 most common forms of obesity surgery , Roux-en-Y gastric bypass ( RYGB ) and gastric b and ing ( GB ) , have not been well characterized . In this study , effects of RYGB and GB on cholesterol absorption and synthesis were investigated . To this aim , 1-year follow-up of cholesterol metabolism in 2 nonr and omized cohorts undergoing either RYGB ( n = 29 ; age , 45.2 + /- 7.7 years ; body mass index [ BMI ] , 46.0 + /- 6.1 kg/m(2 ) ) or GB ( n = 26 ; age , 45.9 + /- 8.6 years ; BMI , 50.1 + /- 7.7 kg/m(2 ) ) was performed in a university hospital center specializing in the treatment of morbid obesity .  Serum markers of cholesterol synthesis ( cholestenol , desmosterol , and lathosterol ) and cholesterol absorption ( campesterol , sitosterol , avenasterol , and cholestanol ) were measured preoperatively and at follow-up and expressed as ratios to cholesterol . As expected based on observed weight loss ( 25 % after RYGB and 17 % after GB , P < .001 between groups ) , both operations decreased serum levels of cholesterol synthesis markers by 12 % to 28 % ( all Ps < .001 ) . A decrease in cholesterol absorption markers was only observed after RYGB ( -26 % for sitosterol ) and not after GB ( + 16 % , P = 2 x 10(-6 ) for difference between the groups ) . The difference in sitosterol ratio between the groups remained significant after adjustment for age , BMI , fasting insulin levels , and nutritional status ( P = 2 x 10(-4 ) ) , indicating a specific effect related to RYGB . We conclude that decrease in cholesterol absorption is a novel beneficial effect of RYGB . Together with an improved control of blood glucose , this may contribute to a better cardiovascular risk profile after RYGB Background Roux-en-Y gastric bypass ( RYGB ) is an effective means to achieve sustained weight loss for morbidly obese individuals . Besides rapid weight reduction , patients achieve major improvements of insulin sensitivity and glucose homeostasis . Dysbiosis of gut microbiota has been associated with obesity and some of its co-morbidities , like type 2 diabetes , and major changes of gut microbial communities have been hypothesized to mediate part of the beneficial metabolic effects observed after RYGB . Here we describe changes in gut microbial taxonomic composition and functional potential following RYGB . Methods We recruited 13 morbidly obese patients who underwent RYGB  , carefully phenotyped them , and had their gut microbiomes quantified before ( n = 13 ) and 3 months ( n = 12 ) and 12 months ( n = 8) after RYGB . Following shotgun metagenomic sequencing of the fecal microbial DNA purified from stools , we characterized the gut microbial composition at species and gene levels followed by functional annotation . Results In parallel with the weight loss and metabolic improvements , gut microbial diversity increased within the first 3 months after RYGB and remained high 1 year later . RYGB led to altered relative abundances of 31 species ( P < 0.05 , q < 0.15 ) within the first 3 months , including those of Escherichia coli , Klebsiella pneumoniae , Veillonella spp . , Streptococcus spp . , Alistipes spp . , and Akkermansia muciniphila . Sixteen of these species maintained their altered relative abundances during the following 9 months . Interestingly , Faecalibacterium prausnitzii was the only species that decreased in relative abundance . Fifty-three microbial functional modules increased their relative abundance between baseline and 3 months ( P < 0.05 , q < 0.17 ) . These functional changes included increased potential ( i ) to assimilate multiple energy sources using transporters and phosphotransferase systems , ( ii ) to use aerobic respiration , ( iii ) to shift from protein degradation to putrefaction , and ( iv ) to use amino acids and fatty acids as energy sources . Conclusions Within 3 months after morbidly obese individuals had undergone RYGB , their gut microbiota featured an increased diversity , an altered composition , an increased potential for oxygen tolerance , and an increased potential for microbial utilization of macro- and micro-nutrients . These changes were maintained for the first year post-RYGB.Trial registration Current controlled trials ( ID NCT00810823 , NCT01579981 , and NCT01993511 ) Objective : Roux-en-Y gastric bypass ( RYGB ) produces more durable glycemic control than sleeve gastrectomy ( SG ) or intensive medical therapy ( IMT ) . However , the contribution of acylated ghrelin ( AG ) , a gluco-regulatory/appetite hormone , to improve glucose metabolism and body composition in patients with type 2 diabetes ( T2D ) following RYGB is unknown . Design : STAMPEDE ( Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently ) was a prospect i ve , r and omized controlled trial . Subjects : Fifty-three ( body mass index : 36±3 kg m−2 , age : 49±9 years ) poorly controlled patients with T2D ( HbA1c ( glycated hemoglobin ) : 9.7±2 % ) were r and omized to IMT , IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline , 12 , and 24 months for evaluation of AG suppression ( postpr and ial minus fasting ) and beta-cell function ( oral disposition index ; glucose-stimulated insulin secretion × Matsuda index ) . Total/ and roid body fat ( dual-energy X-ray absorptiometry ) was also assessed . Results : RYGB and SG reduced body fat comparably ( 15–23 kg ) at 12 and 24 months , whereas IMT had no effect . Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months ( P<0.001 ) . However , there was no difference in insulin secretion between SG vs IMT at 24 months ( P=0.32 ) . Fasting AG was reduced fourfold following SG ( P<0.01 ) and did not change with RYGB or IMT at 24 months . AG suppression improved more following RYGB than SG or IMT at 24 months ( P=0.01 vs SG , P=0.07 vs IMT ) . At 24 months , AG suppression was associated with increased postpr and ial glucagon-like peptide-1 ( r=−0.32 , P<0.02 ) and decreased and roid fat ( r=0.38 ; P<0.006 ) . Conclusions : Enhanced AG suppression persists for up to 2 years after RYGB , and this effect is associated with decreased and roid obesity and improved insulin secretion . Together , these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery Improvement in  type 2 diabetes after Roux-en-Y gastric bypass ( RYGB )  has been attributed partly to weight loss , but mechanisms beyond weight loss remain unclear . We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins , insulin sensitivity , and secretion 1 year after r and omization to lifestyle modification and intensive medical management ( LS/IMM ) alone  ( n = 34 ) or in conjunction with RYGB  ( n = 34 ) . The RYGB group lost more weight and had greater improvement in HbA1c . Fasting glucose was lower after RYGB than after LS/IMM , although the glucose area under the curve decreased comparably for both groups . Insulin sensitivity increased in both groups . Insulin secretion was unchanged after LS/IMM but decreased after RYGB , except for a rapid increase during the first 30 min after meal ingestion . Glucagon-like peptide 1 ( GLP-1 ) was substantially increased after RYGB , while gastric inhibitory polypeptide and glucagon decreased . Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups . At baseline , a greater C-peptide index and 90-min postpr and ial C-peptide level were predictive of lower HbA1c at 1 year after RYGB . β-Cell glucose sensitivity , which improved only after RYGB , and improved disposition index were associated with lower HbA1c in both groups , independent of weight loss . Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB Rapid glycemic improvements following Roux-en-Y gastric bypass ( RYGB ) are frequently attributed to the enhanced GLP-1 response , but causality remains unclear . To determine the role of GLP-1 in improved glucose tolerance after surgery , we compared glucose and hormonal responses to a liquid meal test in 20 obese participants with type 2 diabetes mellitus who underwent RYGB or nonsurgical intensive lifestyle modification ( ILM ) ( n = 10 per group ) before and after equivalent short-term weight reduction . The GLP-1 receptor antagonist exendin(9–39)-amide ( Ex-9 ) was administered , in r and om order and in double-blinded fashion , with saline during two separate visits after equivalent weight loss . Despite the markedly exaggerated GLP-1 response after RYGB , changes in postpr and ial glucose and insulin responses did not significantly differ between groups , and glucagon secretion was paradoxically augmented after RYGB . Hepatic insulin sensitivity also increased significantly after RYGB . With Ex-9 , glucose tolerance deteriorated similarly from the saline condition in both groups , but postpr and ial insulin release was markedly attenuated after RYGB compared with ILM . GLP-1 exerts important insulinotropic effects after RYGB and ILM , but the enhanced incretin response plays a limited role in improved glycemia shortly after surgery . Instead , enhanced hepatic metabolism , independent of GLP-1 receptor activation , may be more important for early postsurgical glycemic improvements BACKGROUND Roux-en-Y gastric bypass ( RYGB ) results in sustained weight loss and amelioration of comorbid conditions in patients with clinical ly severe obesity . The mechanism of weight loss after RYGB is not well defined . The objective of this study was to document the changes in measured resting energy expenditure ( MREE ) over time in patients with clinical ly severe obesity after RYGB .  METHODS We prospect ively studied MREE in 70 patients ( 11 male , 59 female ; body mass index [ BMI ] , 40 to 80 kg/m2 ) treated by RYGB .  MREE was measured by indirect calorimetry before operation and at 6 weeks and 3 , 6 , 12 , 18 , and 24 months after operation . Patients were stratified to hypometabolic ( [ HM ] MREE less than 85 % of Harris-Benedict [ HB ] predicted ; n = 22 ) or normal metabolic rate ( [ NM ] MREE + /- 15 % HB predicted ; n = 48 ) before operation ; mean BMI s were HM , 53.4 + /- 11.0 kg/m2 ; NM , 51.4 + /- 9.8 kg/m2 ; p = not significant . MREE , weight loss , percent excess body weight loss ( EWL ) , and energy intake were determined at each time point . RESULTS Overall , MREE was significantly less than HB-predicted REE before operation ( 90 + /- 28 % ) , but rose to become equal to the HB-predicted REE by 6 weeks ( 96 + /- 15 % ) and remained so . When stratified by initial metabolic rate , MREE increased significantly in the HM patients by 6 weeks , from 1329 + /- 604 kcal/day ( 55 % of HB predicted ) to 1882 + /- 398 kcal/day ( 88 % of HB predicted ) ( p < 0.001 ) , and MREE remained normal ( 2332 + /- 484 kcal/day to 2029 + /- 410 kcal/day ) in the NM patients . Percent EWL was similar in both groups at each time . Energy intake was 2603 + /- 982 kcal/day before operation and fell to 815 + /- 196 kcal/day at 3 months , 969 + /- 241 kcal/day at 6 months , 1095 + /- 307 kcal/day at 12 months , 1259 + /- 466 kcal/day at 18 months , and 1373 + /- 620 kcal/day at 24 months , and was similar between the groups at each time point . Percent HB-predicted REE increased significantly after operation despite a significant decrease in energy intake . CONCLUSIONS RYGB is associated with significant changes in MREE over time . In NM patients  MREE fell over time consistent with weight loss but remained normal , whereas patients who were hypometabolic exhibited increases in MREE toward normal . These changes in MREE occurred despite reduced energy intake comparable to a very low calorie diet . This paradoxical effect on MREE may contribute to the enhanced weight loss associated with RYGB BACKGROUND Roux-en-Y gastric bypass is currently considered the gold st and ard surgical option for the treatment of morbid obesity .  Open RYGB is associated with a high risk of complications . Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery . OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period . METHODS The data were collected prospect ively . The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007 . The reported outcome included surgical results , weight loss , and improved status of co-morbidities , with follow-up of up to 19 months . RESULTS The mean age of the 50 patients was 36.7 years . Mean body mass index was 44.7 kg/m2 ( range 35 - 76 kg/m2 ) ; mean duration of surgery was 171 minutes . There was no conversion to open surgery . The mean length of stay was 4 days ( range 2 - 7 days ) . Five patients ( 10 % ) developed a complication , but none of them required early reoperation and there were no deaths . Mean follow-up was 7 months ( range 40 days-19 months ) . The excess body weight loss was 55 % and 61 % at 6 and 12 months respectively . Diabetes resolved completely or significantly improved in all five patients with this condition , as did hypertension in eight patients out of nine . CONCLUSIONS Laparoscopic RYGB is feasible and safe . The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies . However , only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure Context : Hyperglycemia resolves quickly after bariatric surgery , but the underlying mechanism and the most effective type of surgery remains unclear . Objective : To examine glucose metabolism and β-cell function in patients with type 2 diabetes mellitus ( T2DM ) after two types of bariatric intervention ; Roux-en-Y gastric bypass ( RYGB ) and gastric restrictive ( GR ) surgery .  Design : Prospect i ve , nonr and omized , repeated- measures , 4-week , longitudinal clinical trial . Patients : In all , 16 T2DM patients ( 9 males and 7 females , 52±14 years , 47±9 kg m−2 , HbA1c 7.2±1.1 % ) undergoing either RYGB ( N=9 ) or GR ( N=7 ) surgery . Outcome measures : Glucose , insulin secretion , insulin sensitivity at baseline , and 1 and 4 weeks post-surgery , using hyperglycemic clamps and C-peptide modeling kinetics ; glucose , insulin secretion and gut-peptide responses to mixed meal tolerance test ( MMTT ) at baseline and 4 weeks post-surgery . Results : At 1 week post-surgery , both groups experienced a similar weight loss and reduction in fasting glucose ( P<0.01 ) . However , insulin sensitivity increased only after RYGB , ( P<0.05 ) . At 4 weeks post-surgery , weight loss remained similar for both groups , but fasting glucose was normalized only after RYGB ( 95±3 mg 100 ml−1 ) . Insulin sensitivity improved after RYGB ( P<0.01 ) and did not change with GR , whereas the disposition index remained unchanged after RYGB and increased 30 % after GR ( P=0.10 ) . The MMTT elicited a robust increase in insulin secretion , glucagon-like peptide-1 ( GLP-1 ) levels and β-cell sensitivity to glucose only after RYGB ( P<0.05 ) . Conclusion : RYGB provides a more rapid improvement in glucose regulation compared with GR . This improvement is accompanied by enhanced insulin sensitivity and β-cell responsiveness to glucose , in part because of an incretin effect INTRODUCTION Weight loss interventions such as Roux-en-Y gastric bypass ( RYGB ) and very low calorie diets ( VLCD ) lead to improvement of glucose metabolism in obese individuals with type-2 diabetes . Weight loss can also positively influence the unfavorable inflammatory profile associated with obesity . However , a direct comparison of the effect of VLCD and RYGB on systemic inflammation is lacking . METHODS Systemic inflammation was investigated in age- and BMI -matched morbidly obese T2DM women by determining the number and activation- or memory status of peripheral blood leukocytes by flow cytometry , in addition to measuring circulating levels of cytokines and CRP . Systemic inflammation was assessed one month before and three months after RYGB ( n=15 ) or VLCD ( n=12 ) . An age matched group of lean women ( n=12 ) was studied as control group . RESULTS Three months after the intervention , CRP and leptin levels were reduced whereas adiponectin levels were increased both by RYGB and VLCD .  TNF-α levels were increased by RYGB , but reduced by VLCD .  IL-2 and IL-6 levels were reduced and IL-4 levels were increased by VLCD but not affected by RYGB . The number of activated peripheral cytotoxic T ( CD8+CD25 + ) and B ( CD19+CD38 + ) cells was significantly higher after RYGB than after VLCD . CONCLUSION In conclusion , RYGB and VLCD have differential effects on the activation status of peripheral leukocytes and levels of cytokines in obese women with T2DM , despite comparable weight loss three months after the intervention . VLCD seems to have more favorable effects on the inflammatory profile as compared to RYGB OBJECTIVE Bariatric surgery results in significant weight loss and reduces cardiovascular morbidity . However , a large variation in postsurgery weight loss is seen . Physical activity promotes weight loss in nonsurgically treated subjects with obesity . The aim of this study was to investigate the effects of 6 months of supervised physical training following Roux-en-Y gastric bypass surgery ( RYGB ) on body weight and cardiovascular risk markers . METHODS Sixty participants eligible for RYGB were included . Six months post surgery , the participants were r and omly assigned to either twice-weekly supervised physical training sessions in a fitness center ( INT ) or a control group ( CON ) for 26 weeks . Before surgery and 6 , 12 , and 24 months after surgery , the participants underwent an examination program that included  anthropometric measurements , blood pressure , heart rate , blood sample s  , and an  abdominal computed tomography scan .  RESULTS RYGB significantly reduced body weight and improved cardiovascular risk markers ( all P < 0.01 ) . The supervised physical training intervention result ed in a 4.2-kg ( CI : -0.2 to -8.3 kg ) lower body weight in INT compared with CON at the study end ( P = 0.042 ) . The high-density lipoprotein concentration was significantly higher in INT than in CON at the termination of the intervention , but this was not maintained at the 24-months examination . CONCLUSIONS Physical training following RYGB improves weight loss and cardiovascular health Objectives We sought to determine : 1 ) if early weight regain between one and two years after RYGB is associated with worsened hepatic and peripheral insulin sensitivity , and 2 ) if preoperative levels of ghrelin and leptin are associated with early weight regain after RYGB . Design and Methods Hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels were assessed longitudinally in 45 subjects before RYGB  and at one month , six months , one year , and two years post operatively . Weight regain was defined as ≥ 5 % increase in body weight between one and two years after RYGB . Results Weight regain occurred in 33 % of subjects , with an average increase in body weight of 10 ± 5 % ( 8.5 ± 3.3 kg ) . Weight regain was not associated with worsening of peripheral or hepatic insulin sensitivity . Subjects with weight regain after RYGB had higher preoperative and postoperative levels of ghrelin compared to those who maintained or lost weight during this time . Conversely , the trajectories of leptin levels corresponded with the trajectories of fat mass in both groups . Conclusions Early weight regain after RYGB is not associated with a reversal of improvements in insulin sensitivity . Higher preoperative ghrelin levels might identify patients that are more susceptible to weight regain after RYGB Bariatric surgery is the most effective treatment for achieving long‐term weight loss in morbidly obese patients . This study investigated prospect i ve changes in gut hormones and metabolic indices after Roux‐en‐$\font\ss = cmss10 scaled 1000 \hbox{\ss Y}$ gastric bypass ( RYGB ) Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson Abstract Objective . Exogenous bile acid ( BA ) administration is associated with beneficial metabolic effects very similar to those seen after Roux-en-Y gastric bypass ( RYGB ) surgery . Re-routing of bile into a biliopancreatic limb with simultaneous exclusion of food occurs after RYGB , with subsequent increased fasting plasma BAs . The study assessed fasting and post-pr and ial plasma BA response before and 15 months after RYGB . Material and methods . The prospect i ve study recruited 63 obese individuals ( 43 females ) , aged 43 ( 36–56 ) [ median ( IQR ) ] years .  Blood sample s were collected before and every 30 min for 120 min after a st and ard 400 kcal meal .  Fasting and post-pr and ial plasma BAs , glucagons like peptide-1 ( GLP-1 ) , –tyrosine ( PYY ) , fasting C-reactive protein ( CRP ) , glucose and insulin were measured and homeostasis model assessment -insulin resistance ( HOMA-IR ) was calculated . Results . Following RYGB , body mass index , CRP , fasting glucose and HOMA-IR decreased ; 43.7 ( 39.3–49.2 ) kg/m2 to 29.2 ( 25.1–35.0 ) kg/m2 , 7.9 ( 4.1–11.9 ) mg/L to 0.4 ( 0.2–1.0 ) mg/L , 5.5 ( 5.0–6.0 ) mmol/L to 4.6 ( 4.3–4.9 ) mmol/L and 5.9 ( 3.5–9.2 ) to 1.7 ( 1.1–2.2 ) , respectively , all P < 0.001 . Fasting total BAs , GLP-1 and PYY increased after RYGB ; 1.69 ( 0.70–2.56 ) µmol/L to 2.43 ( 1.23–3.82 ) µmol/L ( P = 0.02 ) , 6.8 ( 1.5–15.3 ) pmol/L to 17.1 ( 12.6–23.9 ) pmol/L ( P < 0.001 ) and 4.0 ( 1.0–7.1 ) pmol/L to 15.2 ( 10.0–28.3 ) pmol/L ( P < 0.001 ) , respectively . The area under the curve for post-pr and ial total BAs , total glycine-conjugated BAs , GLP-1 and PYY were greater after RYGB ; 486 ( 312–732 ) µmol/L/min versus 1012 ( 684–1921 ) µmol/L/min , 315 ( 221–466 ) µmol/L/min versus 686 ( 424–877 ) µmol/L/min , 3679 ( 3162–4537 ) pmol/L/min versus 5347 ( 4727–5781 ) pmol/L/min and 1887 ( 1423–2092 ) pmol/L/min versus 3296 ( 2534–3834 ) pmol/L/min , respectively , all P < 0.0001 . Conclusion . Weight loss following RYGB is associated with an increase in post-pr and ial plasma BA response due to larger amounts of glycine-conjugated BAs . This suggests up regulation of BA production and conjugation after RYGB OBJECTIVE Obesity and weight loss influence thyroid hormone physiology . The effects of weight loss by calorie restriction vs Roux-en-Y gastric bypass ( RYGB ) in obese subjects have not been studied in parallel . We hypothesized that differences in transient systemic inflammation and catabolic state between the intervention types could lead to differential effects on thyroid hormone physiology . DESIGN AND METHODS We recruited 12 lean and 27 obese females with normal fasting glucose ( normal glucose tolerant ( NGT ) ) and 27 obese females with type 2 diabetes mellitus ( T2DM ) for this study . Weight loss was achieved by restrictive treatment ( gastric b and ing or high-protein-low-calorie diet ) or by RYGB .  Fasting serum leptin , TSH , triiodothyronine ( T₃ ) , reverse T₃ ( rT₃ ) , and free thyroxine ( fT₄ ) concentrations were measured at baseline and 3 weeks and 3 months after the start of the interventions . RESULTS Obesity was associated with higher TSH , T₃ , and rT₃ levels and normal fT₄ levels in all the subjects when compared with the controls . After 3 weeks , calorie restriction and RYGB induced a decline in TSH levels and a rise in rT₃ and fT₄ levels . The increase in rT₃ levels correlated with serum interleukin 8 ( IL8 ) and IL6 levels . After 3 months , fT₄ and rT₃ levels returned to baseline levels , whereas TSH and T₃ levels were persistently decreased when compared with baseline levels . No differences in the effects on thyroid hormone parameters between the interventions or between NGT and T2DM subjects were observed at any time point . CONCLUSIONS In summary , weight loss directly influences thyroid hormone regulation , independently of the weight loss strategy used . The effects may be explained by a combination of decreased leptin levels and transient changes in peripheral thyroid hormone metabolism Gut microbiota likely impact obesity and metabolic diseases . We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity . We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10 % weight loss in adults with diabetes who were r and omized to medical weight loss ( MWL , n = 4 ) , adjustable gastric b and ing ( AGB , n = 4 ) , or Roux-en-Y gastric bypass ( RYGB , n = 4 ) . All participants were female , 75 % reported black race with mean age of 51 years . At similar weight loss amount and glycemic improvement , the RYGB group had the most number of bacterial species ( 10 increased , 1 decreased ) that significantly changed ( p < 0.05 ) in relative abundance . Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB ( observed species for AGB vs. MWL , p = 0.0093 ; AGB vs. RYGB , p = 0.0093 ) . The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB , 1 after AGB , and 1 after MWL . At similar weight loss and glycemic improvement , the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium , F. prausnitzii . Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL . Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes . NCTDK089557— Clinical Weight loss reduces bone mass and increases the risk of osteoporosis . This study was undertaken to assess changes of bone metabolism following Roux-en-Y gastric bypass ( RYGB ) and adjustable silicone gastric b and ing ( ASGB ) as compared to nonoperated controls of morbidly obese subjects . Fourteen female and 5 male patients with a mean ( + /-SEM ) age of 44.3 + /- 1.8 years participated in the 24-month prospect i ve study . Nine patients underwent ASGB , 4 patients RYGB operation  , and 6 patients were included in the  control  group . Bone metabolism was assessed by determination of serum parathyroid hormone ( PTH ) , osteocalcin , urinary deoxypyridinoline , and dual energy x-ray absorptiometry ( DXA ) before , and 6 , 12 , and 24 months after intervention . The body mass index ( BMI ) decreased from 41.0 + /- 1.1 to 34.0 + /- 1.4 kg/m2 in the ASGB group ( P = .001 ) , from 42.7 + /- 2.2 to 30.5 + /- 2.2 kg/m2 in the RYGB group ( P = .006 ) , and remained unchanged in the control group ( from 41.2 + /- 1.2 to 41.4 + /- 1.4 kg/m2 ) after 24 months . Bone mineral content ( BMC ) showed no significant change in the ASGB group ( from 3,079 + /- 140 to 3,064 + /- 129 g ) and in the control group ( from 2,945 + /- 130 to 2,940 + /- 111 g ) , whereas it decreased from 2,968 + /- 111 to 2,621 + /- 139 g in the RYGB group ( P = .005 ) . The loss in BMC was accompanied by significant increases in urinary deoxypyridinoline ( P < .05 ) and in serum osteocalcin ( P < .01 ) after RYGB , suggesting both , increased bone resorption and increased bone formation . The authors were aware of the fact that the study groups were small and conclusions need to be regarded as preliminary . However , the RYGB operation result ed in enhanced weight loss and significant net loss of bone mass in comparison to ASGB and obese control subjects . Patients losing large amounts of body weight should be monitored regularly regarding prevention of osteoporosis Background Data on gastrointestinal ( GI ) and dietary changes following bariatric surgery are scarce in the Middle Eastern region . The objective of this work was to retrospectively compare dietary intake , food preferences , and GI symptoms in subjects with extreme obesity after Roux-en-Y gastric bypass ( RYGB ) and sleeve gastrectomy ( SG ) . Methods Sixty subjects equally divided between RYGB and SG with a postoperative period of ≥6 months were recruited for a retrospective , non-r and omized , and observational study . All subjects completed three question naires ( GI symptoms , food preferences , and quantitative food frequency question naire ( FFQ ) ) and three 24-h recalls . Results At one year postoperatively , both surgical groups showed similar percentage of excess weight loss that exceeded 50 % . In addition , percentage of carbohydrate , protein , and sugar intake from total energy , frequency of daily consumption from the eight food categories and daily energy intake were comparable between surgical groups . RYGB subjects consumed significantly more fruits and juices from total energy ( P < 0.05 ) whereas SG subjects tended to consume more sweets and desserts . Heartburn ( P < 0.001 ) , regurgitation ( P < 0.01 ) , nausea ( P < 0.01 ) , vomiting ( P < 0.001 ) , and constipation ( P < 0.05 ) were significantly more frequent among SG subjects . Flatulence ( P < 0.001 ) and diarrhea ( P < 0.05 ) , as well as dizziness ( P < 0.001 ) , and fast heartbeat ( P < 0.05 ) after eating were significantly more frequent after RYGB . Conclusions There were no major differences in dietary intake and food preferences between RYGB and SG groups . There was a trend for sweet-eating in SG subjects with less dumping symptoms to suggest different mechanisms of action for each procedure , which might impact eating behavior Background It is unclear whether specific gut microbiota is associated with remission of  type 2 diabetes ( T2D ) after distinct types of bariatric surgery . Aims The aim of this study is to examine gut microbiota changes after laparoscopic Roux-en-Y gastric bypass ( RYGB ) or sleeve gastrectomy ( SG ) surgery in obese patients with T2D . Methods Whole-metagenome shotgun sequencing of DNA fragments using Illumina HiSeq2000 was obtained from stool sample s collected from 14 obese T2D patients pre-operatively ( while on very low calorie diet ) and 1 year after r and omisation to laparoscopic SG ( n = 7 ) or RYGB ( n = 7 ) . Result ing shotgun reads were annotated with Kyoto Encyclopedia of Genes and Genomes ( KEGG ) . Results Body weight reduction and dietary change was similar 1 year after both surgery types . Identical proportions ( n = 5/7 ) achieved diabetes remission ( HbA1c < 48 mmol/mol without medications ) 1 year after RYGB and SG . RYGB result ed in increased Firmicutes and Actinobacteria phyla but decreased Bacteroidetes phyla . SG result ed in increased Bacteroidetes phyla . Only an increase in Roseburia species was observed among those achieving diabetes remission , common to both surgery types . KEGG Orthology and pathway analysis predicted contrasting and greater gut microbiota metabolism changes after diabetes remission following RYGB than after SG . Those with persistent diabetes post-operatively had higher Desulfovibrio species pre-operatively . Conclusions Overall , RYGB produces greater and more predicted favourable changes in gut microbiota functional capacity than SG . An increase in Roseburia species was the only compositional change common to both types of surgery among those achieving diabetes remission
Meta-regression showed that gastric pouch volume , alimentary limb length and biliopancreatic limb length were not associated with changes in ghrelin levels .
Conclusion Fasting total ghrelin levels decreased in the short term ( ≤ 3 months ) and increased in the long term ( > 3 months ) after RYGB
Background Roux-en-Y gastric bypass ( RYGB ) is considered effective for weight loss and for treatment of many obesity-related metabolic diseases .
Ghrelin is an essential orexigenic peptide that plays an indispensable role in controlling body weight and energy homeostasis of post-operative patients .
This systematic review and meta- analysis aim ed to investigate changes in the level of fasting total ghrelin following RYGB .