Glucose Homeostasis Pre and Post Bariatric Surgery

Study Overview
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Brief Summary
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The investigators wish to study the effects of three forms of bariatric surgery: Roux-en-Y gastric bypass, Sleeve Gastrectomy, and Gastric Banding. The surgery is not part of the clinical trial. If your insurance does not cover the procedure, then you are responsible for payment of the surgical process. We are doing pre and post surgery testing to provide a better understanding of the effect of bariatric surgery-induced weight loss on metabolic function.

Detailed Description
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Bariatric surgery is the most effective weight loss therapy for obesity. Moreover, the early improvement in insulin sensitivity and the resolution of type 2 diabetes after bariatric surgery has led to the hypothesis that bariatric surgery has specific beneficial effects on glucose homeostasis beyond weight loss alone. However, this hypothesis has never been adequately evaluated in human subjects. Therefore, the primary goal of this proposal is to provide a better understanding of the effect of bariatric surgery-induced weight loss on insulin action and pancreatic beta cell function.

Official Title
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Effect of Bariatric Surgery-induced Weight Loss on Glucose Homeostasis

Conditions
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Morbid Obesity

Intervention / Treatment
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* Procedure: gastric bypass
* Procedure: gastric banding
* Procedure: sleeve gastrectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BMI ≥ 35 kg/m² on stable dose of medications for at least 4 weeks before the pre-surgery metabolic studies Exclusion Criteria: smokes > 7 cigarettes per day previous malabsorptive or restrictive intestinal surgery pregnant or breastfeeding recent history of neoplasia (< 5 years ago) have malabsorptive syndromes and inflammatory intestinal disease diabetes mellitus show signs of oral disease or xerostomia (i.e., dry mouth) history of chronic rhinitis on medication that might affect metabolism severe organ dysfunction

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Gastric Bypass<br>morbidly obese subjects undergoing gastric bypass surgery | Procedure: gastric bypass<br>* Roux-en-Y gastric bypass<br>* Other names: Roux-en-Y gastric bypass;|
| gastric banding<br>morbidly obese subjects undergoing laparoscopic gastric banding surgery | Procedure: gastric banding<br>* laparoscopic adjustable gastric banding<br>* Other names: lap band;|
| sleeve gastrectomy<br>morbidly obese subjects undergoing sleeve gastrectomy | Procedure: sleeve gastrectomy<br>* vertical sleeve gastrectomy<br>* Other names: gastric sleeve;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The effect of bariatric surgery-induced weight loss (Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable banding) on insulin action |  | at 20% weight loss post surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The effect of bariatric surgery-induced weight loss Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding) on pancreatic beta cell response |  | at 20% weight loss post surgery | 
| Determine the effect of bariatric surgery induced weight loss (Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding) on gut microbiota. |  | at 20% weight loss post surgery | 
| Identify host genes that co-vary with an altered metagenome in obese individuals that undergo bariatric surgery |  | at 20% weight loss post surgery. | 
| Investigate how the metagenome is affected by bariatric surgery procedures leading to weight reduction |  | at 20% weight loss post surgery | 
| The effect of bariatric surgery-induced weight loss (Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding) on postprandial plasma fibroblast growth factor (FGF)21 and FGF19 responses. |  | at 20% weight loss post surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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obesity, gastric bypass, gastric banding, weight loss, insulin sensitivity, sleeve gastrectomy, fibroblast growth factor 21, fibroblast growth factor 19