Carbohydrates and Gut Hormones After Gastric Bypass Surgery

Study Overview
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Brief Summary
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To investigate the secretion of gut hormones, in particular glucagon-like peptide 1 (GLP-1), after ingestion of glucose and fructose as separate monosaccharides or combined in the disaccharides sucrose and isomaltulose and the effect of acarbose in gastric bypass operated subjects and BMI-matched controls.

Detailed Description
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Disaccharides such as sucrose or isomaltulose (also called palatinose) require digestion into monosaccharides (both are digested to glucose and fructose) by enzymes located in the brush border of the small intestine to be absorbed. The study will investigate the influence of carbohydrate digestion on gut hormone secretion.

Official Title
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Effects of Carbohydrates on Gut Hormone Secretion After Gastric Bypass Surgery

Conditions
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Overweight

Intervention / Treatment
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* Other: Glucose + Fructose
* Other: Sucrose
* Other: Isomaltulose
* Other: Sucrose + Acarbose


Participation Criteria
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Eligibility Criteria
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Gastric bypass operated patients: Inclusion Criteria: uncomplicated gastric bypass surgery performed minimum 12 months prior to study Exclusion Criteria: Type 1 or 2 diabetes mellitus prior to or after gastric bypass surgery Pregnancy or breastfeeding Haemoglobin levels below 6,5 mM Healthy control subjects: Exclusion Criteria: Bariatric surgery or complicated upper abdominal surgery Pregnancy or breastfeeding Haemoglobin levels below 6,5 mM Co-morbidities or medicine significantly affecting glucose metabolism or appetite regulation

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 10 gastric bypass operated patients<br>4 different carbohydrate loads ingested at separate study days will be tested against each others ability to induce GLP-1 secretion. | Other: Glucose + Fructose<br>* Ingestion of the separate monosaccharides glucose (25 g) and fructose (25 g) dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>Other: Sucrose<br>* Ingestion of the disaccharide sucrose (47.5 g) dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>Other: Isomaltulose<br>* Ingestion of the slowly digestable disaccharide isomaltulose (47.5 g) dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>Other: Sucrose + Acarbose<br>* Ingestion of the disaccharide sucrose (47.5 g) and the alpha glucosidase inhibitor acarbose dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>|
| Experimental: 10 healthy control subjects<br>4 different carbohydrate loads ingested at separate study days will be tested against each others ability to induce GLP-1 secretion. | Other: Glucose + Fructose<br>* Ingestion of the separate monosaccharides glucose (25 g) and fructose (25 g) dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>Other: Sucrose<br>* Ingestion of the disaccharide sucrose (47.5 g) dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>Other: Isomaltulose<br>* Ingestion of the slowly digestable disaccharide isomaltulose (47.5 g) dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>Other: Sucrose + Acarbose<br>* Ingestion of the disaccharide sucrose (47.5 g) and the alpha glucosidase inhibitor acarbose dissolved in 200 mL of water. The load provides 0.1385 mol glucose and 0.1385 mol fructose.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Within group difference in GLP-1 secretion (evaluated by iAUC). | Comparison of the GLP-1 responses (evaluated by iAUC) induced by the different carbohydrate loads. | 0-240 min following carbohydrate ingestion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Between group comparison of GLP-1 secretion (evaluated by iAUC). | GLP-1 secretion (evaluated by iAUC) in gastric bypass operated patients compared to BMI-matched control subjects for each of the carbohydrate loads. | 0-240 min following carbohydrate ingestion | 
| Between group comparison of differences in GLP-1 secretion (evaluated by iAUC). | Differences in GLP-1 secretion (evaluated by iAUC) induced by the different carbohydrate loads in gastric bypass operated patients compared to differences in BMI-matched control subjects. | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of glucose within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of insulin within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of C-Peptide within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of peptide YY (PYY) within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of Gastric Inhibitory Peptide (GIP) within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of glucagon within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of oxyntomodulin within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of cholecystokinin (CCK) within and between groups. |  | 0-240 min following carbohydrate ingestion | 
| Responses (evaluated by iAUC) of bile acids within and between groups. |  | 0-240 min following carbohydrate ingestion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Glucagon-Like Peptide 1, Carbohydrates, Gastric bypass, Bariatric Surgery, Overweight