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

  1. 1Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  3. 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.

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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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