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Early effects of Roux-en-Y gastric bypass on dietary fatty acid absorption and metabolism in people with obesity and normal glucose tolerance

International Journal of Obesity volume 46, pages 1359–1365 (2022)Cite this article

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Abstract

Introduction

Roux-en-Y gastric bypass (RYGB) surgery markedly increases the rate of intestinal nutrient exposure after food intake, accelerates intestinal absorption of dietary glucose and protein, and alters the postprandial gut hormone response. However, our understanding of postprandial fat absorption and metabolism after RYGB is incomplete.

Methods

Stable palmitate tracers were administered intravenously (K-[2,2-2H2]palmitate) and orally with a mixed meal ([U-13C16]palmitate) to study fatty acid absorption and metabolism before and 3 months after RYGB in 10 participants with obesity and normal glucose tolerance.

Results

There was a tendency toward reduced fasting plasma nonesterified palmitate concentrations after RYGB, but neither fasting palmitate kinetics nor fasting triacylglycerol (TAG) concentrations changed compared with before surgery. Postprandial TAG concentrations were numerically, but nonsignificantly, reduced 3−4 h after meal intake after compared with before RYGB. However, the postprandial appearance of the oral palmitate tracer in the plasma TAG pool and overflow into the nonesterified palmitate pool were initially faster but overall reduced after RYGB by 50% (median, IQR: [47;64], P = 0.004) and 46% (median, IQR: [33;70], P = 0.041), respectively. The maximal postprandial suppression of plasma nonesterified palmitate concentrations was slightly greater but shorter lasting after RYGB ('time × visit' interaction: P < 0.001), without detectable effects of surgery on the rate of appearance and disappearance of plasma palmitate.

Conclusion

RYGB resulted in an initially accelerated but overall ~50% reduced 4-h postprandial systemic appearance of dietary palmitate in participants with obesity and normal glucose tolerance. This is likely a result of faster but incomplete intestinal fat absorption combined with enhanced chylomicron–TAG clearance, but it needs further investigation in studies specifically designed to investigate these mechanisms.

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Fig. 1: Plasma TAG concentrations and the fate of meal-derived palmitate.
Fig. 2: Plasma nonesterified palmitate concentrations and kinetics, and insulin concentrations.

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Data availability

Reasonable requests for access to the datasets should be addressed to the corresponding author.

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Acknowledgements

We thank Siv Hesse Jacobsen (Hvidovre Hospital, Denmark) for her important role in the practical conduct of the study. Moreover, this work relied on professional help from Dorthe Baunbjerg Nielsen, Sussi Polmann, and Alis Sloth Andersen (Hvidovre Hospital, Denmark) and Daniel Halling Breiner (Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Denmark).

M.H. and K.N.B.-M. are funded by a Novo Nordic Foundation Excellence Project Grant (NNF18 OC0032330).

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Author notes

  1. These authors contributed equally: Morten Hindsø, Kirstine Nyvold Bojsen-Møller.

  2. These authors contributed equally: Gerrit van Hall, Sten Madsbad.

Authors and Affiliations

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

    Morten Hindsø, Kirstine Nyvold Bojsen-Møller & Sten Madsbad

  2. Department of Surgical Gastroenterology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    Viggo Bjerregaard Kristiansen

  3. Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark

    Jens Juul Holst & Gerrit van Hall

  4. Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark

    Jens Juul Holst

  5. Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark

    Gerrit van Hall

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Contributions

M.H. performed the statistical data analysis and graphical presentation of the results, wrote the paper, and is primarily responsible for the final content of the paper. K.N.B.-M. contributed to the design and practical conduct of the study, data generation and analysis, and discussion; and reviewed/edited the paper. V.B.K. contributed to data analysis and discussion and reviewed/edited the paper. S.M. initiated the study and together with J.J.H. and G.v.H. contributed to the design of the study, data generation and analysis and discussion, and reviewed/edited the paper. All authors approved the final version of the paper before submission.

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Correspondence to Morten Hindsø.

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Hindsø, M., Bojsen-Møller, K.N., Kristiansen, V.B. et al. Early effects of Roux-en-Y gastric bypass on dietary fatty acid absorption and metabolism in people with obesity and normal glucose tolerance. Int J Obes 46, 1359–1365 (2022). https://doi.org/10.1038/s41366-022-01123-1

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