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Clinical Studies and Practice

Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass

International Journal of Obesity volume 37, pages 1452–1459 (2013)Cite this article

Subjects

Abstract

Objective:

To identify factors contributing to the variation in weight loss after Roux-en-Y gastric bypass (RYGB).

Design:

Cross-sectional study of patients with good (excess body mass index lost (EBL) >60%) and poor weight loss response (EBL <50%) >12 months after RYGB and a lean control group matched for age and gender.

Materials and methods:

Sixteen patients with good weight loss response, 17 patients with poor weight loss response, and eight control subjects were included in the study. Participants underwent dual energy X-ray absorptiometry scan, indirect calorimetry and a 9 h multiple-meal test with measurements of glucose, insulin, total bile acids (TBA), glucagon-like peptide (GLP)-1, peptide YY3–36 (PYY), cholecystokinin (CCK), ghrelin, neurotensin and pancreatic polypeptide (PP) as well as assessment of early dumping and appetite.

Results:

Suppression of hunger was more pronounced in the good than the poor responders in response to the multiple-meal test (P=0.006). In addition, the good responders had a larger release of GLP-1 (P=0.009) and a greater suppression of ghrelin (P=0.037) during the test, whereas the postprandial secretion of CCK was highest in the poor responders (P=0.005). PYY, neurotensin, PP and TBA release did not differ between the RYGB-operated groups. Compared with control subjects, patients had exaggerated release of GLP-1 (P<0.001), PYY (P=0.008), CCK (P=0.010) and neurotensin (P<0.001). Early dumping was comparable in the good and poor responders, but more pronounced than in controlled subjects. Differences in resting energy expenditure between the three groups were entirely explained by differences in body composition.

Conclusion:

Favorable meal-induced changes in hunger and gut hormone release in patients with good compared with poor weight loss response support the role of gut hormones in the weight loss after RYGB.

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Acknowledgements

The authors are grateful for technical assistance to Alis Andersen and Dorthe Baunbjerg (Department of Endocrinolgy, Hvidovre Hospital, Denmark), Lene Albak and Sofie Pilgaard (Department of Biomedical Sciences, the Panum Institute, University of Copenhagen, Denmark), Rikke Kröncke (Department of Clinical Biochemistry, Rigshospitalet, Denmark) and Gitte Kølander Hansen (Diabetes and Obesity Biology, Novo Nordisk, Denmark). The present study was carried out as a part of UNIK: Food, Fitness and Pharma for Health and Disease at the University of Copenhagen (www.foodfitnesspharma.ku.dk). The UNIK project is funded by the Danish Ministry of Science, Technology and Innovation. Further funding was received from the Strategic Research Council for the Capital Area and Hvidovre Hospital.

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Authors and Affiliations

  1. Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark

    C Dirksen, N B Jørgensen, K N Bojsen-Møller, U Kielgast, S H Jacobsen, D Worm, S Madsbad & D L Hansen

  2. Novo Nordisk Foundation Centre for Basic Metabolic Research, the Panum Institute, University of Copenhagen, Copenhagen N, Denmark

    C Dirksen, N B Jørgensen, K N Bojsen-Møller, S H Jacobsen, B Hartmann & J J Holst

  3. Department of Biomedical Sciences, the Panum Institute, University of Copenhagen, Copenhagen N, Denmark

    N B Jørgensen, B Hartmann & J J Holst

  4. Diabetes and Obesity Biology, Novo Nordisk A/S, Måløv, Denmark

    T R Clausen

  5. Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    J F Rehfeld

  6. Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark

    M Damgaard & J L Madsen

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Correspondence to C Dirksen.

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Competing interests

Carsten Dirksen, Kirstine N Bojsen-Møller, Nils B Jørgensen, Siv H Jacobsen, Bolette Hartmann and Jens J Holst are affiliated with the Novo Nordisk Foundation Centre for Basic Metabolic Research, which is funded by the Novo Nordisk Foundation. Nils B Jørgensen and Siv H Jacobsen have one-third of their PhD scholarship funded by Novo Nordisk A/S. Trine R Clausen is employed by Novo Nordisk A/S and owns stock in Novo Nordisk A/S and Zealand Pharma A/S. Urd Kielgast, Dorte Worm, Jens F Rehfeld, Morten Damgaard, Jan L Madsen, Sten Madsbad and Dorte L Hansen declare no conflict of interest.

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Dirksen, C., Jørgensen, N., Bojsen-Møller, K. et al. Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass. Int J Obes 37, 1452–1459 (2013). https://doi.org/10.1038/ijo.2013.15

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