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Bariatric Surgery

The anorexigenic peptide neurotensin relates to insulin sensitivity in obese patients after BPD or RYGB metabolic surgery


Neurotensin is a peptide with effects on appetite and intestinal lipid absorption. Experimental data suggest a role in glucose homeostasis, while human data is missing. Here, 20 morbidly obese subjects either underwent biliopancreatic diversion with duodenal switch (BPD), or Roux-en-Y gastric bypass (RYGB) in a randomized fashion. Before and 1 year after surgery, anthropometric data, body composition, clinical biochemistry, insulin sensitivity by means of euglycemic hyperinsulinemic clamps (HEC) and fasting plasma proneurotensin 1–117 were analyzed. Plasma proneurotensin increased significantly more 1 year after BDP than RYGB (P = 0.028), while weight loss was comparable. After metabolic surgery, proneurotensin correlated positively with insulin sensitivity (M-value) (r = 0.55, P < 0.001), while an inverse relationship with fasting glucose, HOMA-IR and HbA1c was observed (P < 0.05 for all components). After adjustment for age and gender, proneurotensin and BMI remained independently related with delta of M-value (β = 0.46 and β = 0.51, P < 0.05, resp.). From these data we conclude that proneurotensin positively correlates with insulin sensitivity uniquely after weight loss induced by metabolic surgery in humans. BDP leads to a stronger increase in the anorexigenic peptide compared to RYGB.

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These authors contributed equally: Christian von Loeffelholz, Lidia Castagneto Gissey.


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We thank Julia Paditz and Stephan Friebe for excellent technical assistance. This work was funded by grant from the German Research Foundation (DFG) to ALB, GM, AK, SRB (IRTG 2251).

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Conflict of interest

JS is employed by sphingotec GmbH, a company having patent rights in the proneurotensin assay and commercializing it. AB is CEO of sphingotec GmbH and holds shares in this company. The remaining authors declare that they have no conflict of interest.

Correspondence to Christian von Loeffelholz or Andreas L. Birkenfeld.

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