| Role of the foregut in the early improvement in glucose tolerance and insulin sensitivity following Roux-en-Y gastric bypass surgery. | |
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MedLine Citation:
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PMID: 21372167 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Bypass of the foregut following Roux-en-Y gastric bypass (RYGB) surgery results in altered nutrient absorption, which is proposed to underlie the improvement in glucose tolerance and insulin sensitivity. We conducted a prospective crossover study in which a mixed meal was delivered orally before RYGB (gastric) and both orally (jejunal) and by gastrostomy tube (gastric) postoperatively (1 and 6 wk) in nine subjects. Glucose, insulin, and incretin responses were measured, and whole-body insulin sensitivity was estimated with the insulin sensitivity index composite. RYGB resulted in an improved glucose, insulin, and glucagon-like peptide-1 (GLP-1) area under the curve (AUC) in the first 6 wk postoperatively (all P ≤ 0.018); there was no effect of delivery route (all P ≥ 0.632) or route × time interaction (all P ≥ 0.084). The glucose-dependent insulinotropic polypeptide (GIP) AUC was unchanged after RYGB (P = 0.819); however, GIP levels peaked earlier after RYGB with jejunal delivery. The ratio of insulin AUC to GLP-1 and GIP AUC decreased after surgery (P =.001 and 0.061, respectively) without an effect of delivery route over time (both P ≥ 0.646). Insulin sensitivity improved post-RYGB (P = 0.001) with no difference between the gastric and jejunal delivery of the mixed meal over time (P = 0.819). These data suggest that exclusion of nutrients from the foregut with RYGB does not improve glucose tolerance or insulin sensitivity. However, changes in the foregut response post-RYGB due to lack of nutrient exposure cannot be excluded. Our findings suggest that foregut bypass may alter the incretin response by enhanced nutrient delivery to the hindgut. |
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Authors:
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Erik N Hansen; Robyn A Tamboli; James M Isbell; Jabbar Saliba; Julia P Dunn; Pamela A Marks-Shulman; Naji N Abumrad |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2011-03-03 |
Journal Detail:
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Title: American journal of physiology. Gastrointestinal and liver physiology Volume: 300 ISSN: 1522-1547 ISO Abbreviation: Am. J. Physiol. Gastrointest. Liver Physiol. Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-04-28 Completed Date: 2011-06-28 Revised Date: 2012-05-01 |
Medline Journal Info:
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Nlm Unique ID: 100901227 Medline TA: Am J Physiol Gastrointest Liver Physiol Country: United States |
Other Details:
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Languages: eng Pagination: G795-802 Citation Subset: IM |
Affiliation:
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Departments of Surgery, Vanderbilt Univ. School of Medicine, Nashville, TN 37232-2730, USA. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00765596 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anastomosis, Roux-en-Y* Area Under Curve Blood Glucose / metabolism Body Weight / physiology Diabetes Mellitus, Type 2 / complications Duodenum / physiology* Female Food Gastric Bypass* Ghrelin / blood Glucagon-Like Peptide 1 / metabolism Glucose Tolerance Test* Humans Incretins / blood Insulin / blood Insulin Resistance / physiology* Jejunum / physiology* Laparoscopy Male Metabolism / physiology Middle Aged |
| Grant Support | |
ID/Acronym/Agency:
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1 UL1 RR024975/RR/NCRR NIH HHS; DK058404/DK/NIDDK NIH HHS; DK20593/DK/NIDDK NIH HHS; R01 DK070860-02/DK/NIDDK NIH HHS; R01-DK070860/DK/NIDDK NIH HHS; T32-DK007061-31A1/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 0/Ghrelin; 0/Incretins; 0/Insulin; 89750-14-1/Glucagon-Like Peptide 1 |
| Comments/Corrections | |
Comment In:
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Am J Physiol Gastrointest Liver Physiol. 2011 Nov;301(5):G938-9; author reply G940-1
[PMID:
22039038
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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