Original Article
International Journal of Obesity (2006) 30, 1203–1210. doi:10.1038/sj.ijo.0803255; published online 7 February 2006
Influences of fat restriction and lipase inhibition on gastric emptying in obesity
E M H Mathus-Vliegen1, M L van Ierland-van Leeuwen2 and R J Bennink3
- 1Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 2Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
- 3Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Correspondence: Professor Dr EMH Mathus-Vliegen, Department of Gastroenterology and Hepatology, Academic Medical Center, PO Box 22 660, 1100 DD Amsterdam, Netherlands. E-mail: e.mathus-vliegen@amc.uva.nl
Received 3 August 2005; Revised 16 December 2005; Accepted 19 December 2005; Published online 7 February 2006.
Abstract
Objective:
Accelerated gastric emptying of solids may play a role in the pathogenesis of obesity. Orlistat, a potent lipase inhibitor, induces fat malabsorption and body weight loss but might accelerate gastric emptying as a result of suppressed CCK release. The aim was to investigate the role of fat restriction and lipase inhibition in CCK release and gastric emptying.
Subjects:
A total of 28 patients (three male (M)/25 female (F); mean (s.d.) BMI 37.4(3.9) kg/m2) entering a randomized, double-blind, placebo-controlled study.
Measurements:
CCK release and gastric emptying by scintigraphy at the start (T0), after 1 month of an energy- and fat-restricted diet and placebo (T1), and after 1 month (T2) and 1 year (T3) of randomization to placebo or 120 mg orlistat three times a day.
Results:
One month of dieting and a weight loss of 2.3 kg (2.1% of initial weight) did not affect gastric emptying of liquids and solids. Basal and meal-stimulated CCK levels remained unaltered. Placebo-treated subjects who continued the diet for 1 month demonstrated a borderline significant suppressed CCK secretion and a weight loss of 1.2 kg (1.0%) without an effect on gastric emptying. After 1 year, the CCK secretion recovered to or beyond values at the start. A significantly slower emptying of solids (17.6 (T3) versus 25.9 (T1)%/h) and a weight loss of 10.4 kg (9.9%) was observed. Subjects on 120 mg orlistat lost 2.5 kg (2.5%) after 1 month, and 9.8 kg (9.9%) after 1 year. Basal and postprandial CCK release decreased significantly after the first month of orlistat treatment but normalized after 1 year. Diet and lipase inhibition did not have any influence on gastric emptying.
Conclusion:
Energy and fat restriction of 1 month did not alter gastric emptying in the whole group. Continuation of the diet for 1 year resulted in a delayed gastric emptying of solids. Lipase inhibition did not result in a sustained depressed CCK release and the anticipated acceleration of gastric emptying did not occur.
Keywords:
gastric emptying, CCK release, weight reduction, lipase inhibition, energy restriction
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