Key result
Sustained weight loss 3 years after Roux-en-Y gastric bypass, but not a lifestyle intervention, was associated with significantly increased fasting plasma levels of ghrelin and obestatin compared to pre-operative controls.
Why the study?
Does sustained weight loss through Roux-en-Y gastric bypass or lifestyle intervention alter fasting and postprandial plasma levels of ghrelin and obestatin in morbidly obese patients?
Cross-Sectional (n=26)
No
Does sustained weight loss through Roux-en-Y gastric bypass or lifestyle intervention alter fasting and postprandial plasma levels of ghrelin and obestatin in morbidly obese patients?
Absolute Event Rate: 729% vs 449%
p-value: p=0.002
Sustained weight loss after Roux-en-Y gastric bypass is associated with increased fasting ghrelin and obestatin levels, suggesting ghrelin suppression is unlikely to be the mechanism for long-term weight loss maintenance.
Ghrelin suppression unlikely to mediate long-term RYGB weight loss; hypothesis-generating for differential hormonal responses versus lifestyle intervention.
BACKGROUND: Appetite-regulating hormones seem to play an important role in weight loss after bariatric surgery. Less is known regarding long-term weight loss maintenance. The objective of the study was to evaluate ghrelin and obestatin levels following long-term weight loss achieved through bariatric surgery or a lifestyle intervention in morbidly obese patients. METHODS: The study was cross-sectional in design carried out in a university research center setting. The participants were weight-stable morbidly obese patients who had undergone, on average, 3 years ago, Roux-en-Y gastric bypass (RYGB) surgery (n=9) or a lifestyle weight loss intervention (n=8), and patients on a waiting list for bariatric surgery (control group; n=9). The main outcome measures were fasting/postprandial plasma levels of total ghrelin and obestatin and ghrelin/obestatin ratio. RESULTS: Fasting ghrelin and obestatin plasma levels were significantly elevated in the RYGB, but not in the lifestyle group, as compared with the control group. There was no statistical significant difference in fasting ghrelin/obestatin ratio among study groups. Ghrelin levels were suppressed after breakfast in all groups, with no significant differences in postprandial levels overtime between them. Obestatin levels did not change postprandially in any of the groups, but the area under the curve was significantly higher in the RYGB than in the control group. CONCLUSIONS: Sustained weight loss maintenance seems to be associated with increased fasting levels of ghrelin and obestatin after RYGB surgery, but not after a lifestyle intervention, while maintaining ghrelin/obestatin ratio. Ghrelin is, therefore, unlikely to contribute to weight loss maintenance after RYGB, and other mechanisms are probably involved.
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Martins et al. (2011) conducted a cross-sectional in Morbid obesity (n=26). Roux-en-Y gastric bypass (RYGB) vs. Morbidly obese patients on a waiting list for bariatric surgery was evaluated on Fasting plasma levels of ghrelin (pmol/L) (p=0.002). Sustained weight loss 3 years after Roux-en-Y gastric bypass, but not a lifestyle intervention, was associated with significantly increased fasting plasma levels of ghrelin and obestatin compared to pre-operative controls.
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