changes in gastrointestinal hormones after the roux-en-y gastric bypass procedure: a review
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Changes in Gastrointestinal Hormones after the Roux-en-Y Gastric Bypass Procedure: A Review. Lauren M. Beckman, MS, RD: University of Minnesota (UM) Tiffany R. Beckman, MD, MPH: UM Carrie P. Earthman, PhD, RD, LD: UM. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION. - PowerPoint PPT PresentationTRANSCRIPT
Changes in Gastrointestinal Hormones after the Roux-en-Y Gastric
Bypass Procedure: A Review
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
Lauren M. Beckman, MS, RD: University of Minnesota (UM)
Tiffany R. Beckman, MD, MPH: UM Carrie P. Earthman, PhD, RD, LD: UM
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Gastrointestinal (GI) Hormones and Leptin Characteristics
Hormone GI Hormone
Secreted By Effect on Appetite
Mechanism of Action
Glucagon-Like Peptide-1 (GLP-1)
Yes L-cells of the gut in response to energy intake
Promotes satiety
Slows gastric emptying, promotes insulin release, inhibits glucagon and gastric acid secretion, and acts on the central nervous system
Peptide YY (PYY)
Yes L-cells of the gut in response to energy intake
Promotes satiety
Slows gastric emptying, inhibits gastric acid secretion, and and acts on the central nervous system
Leptin No - adipocytokine
Adipocytes in proportion to adipose tissue mass
Not applicable
Acts on the hypothalamus to decrease food intake and increase energy expenditure
Ghrelin Yes Pituitary gland and stomach
Stimulates appetite
Increases GI motility and decreases insulin secretion
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Effect of Weight Loss on Gastrointestinal Hormones and Leptin Concentrations
Glucagon-Like Peptide-1 (GLP-1)
Peptide YY (PYY)
Leptin Ghrelin
Weight loss
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Gastrointestinal Hormones and Leptin Response after Roux-en Y Gastric Bypass (RYGB)
Post-RYGB Glucagon-Like Peptide-1 (GLP-1)
Post-RYGB Peptide YY (PYY)
Post-RYGB Leptin
Post-RYGB Ghrelin
Lean/Normal weight
Overweight
Obese
Other weight loss surgery No data
Weight loss via diet/exercise No data No data
Pre-RYGB
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Glucagon-Like Peptide-1 (GLP-1) after Roux-en Y Gastric Bypass (RYGB)
• When post-RYGB patients were still considered obese, GLP-1 levels were significantly higher compared to lean
• Suggests that a component of the RYGB procedure alters the GLP-1 profile
• GLP-1 is secreted from the distal ileum in response to nutrient intake
• Increased GLP-1 levels post-RYGB hypothesized to occur due to surgical component that promotes more rapid delivery of nutrients to the distal gut
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
• PYY response to a test meal or an oral glucose tolerance test was exaggerated, occurred earlier, and remained elevated above baseline levels for the remainder of the sampling time period
• Occurs as early as 2 days post-RYGB, prior to any weight loss
• In some studies the effect was seen as long as 6 months post-RYGB
Peptide YY (PYY) after Roux-en Y Gastric Bypass (RYGB)
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Leptin after Roux-en Y Gastric Bypass (RYGB)
• Studies that examined the correlation between anthropometric measurements and leptin levels found:• Change in leptin concentration significantly correlated with
change in BMI, body weight, and fat mass
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Ghrelin after Roux-en Y Gastric Bypass (RYGB)
• Ghrelin reduction post-RYGB first reported by Cummings et al. in 2002, who also found that ghrelin levels were significantly increased following weight loss due to caloric restriction• This suggests that RYGB had a positive effect on the
“hunger hormone” while other methods of weight loss did not
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Ghrelin after Roux-en Y Gastric Bypass (RYGB)
• Ghrelin significantly decreases immediately post-RYGB• One study reported reduction 30 minutes post-RYGB
• Evidence documents decreased ghrelin is maintained for more than one year post-RYGB
• Consistent finding of decreased ghrelin levels post-RYGB offers a partial explanation for the success of the procedure• Low ghrelin levels would not contribute to feelings of
hunger and thereby weight gain
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Ghrelin after Roux-en Y Gastric Bypass (RYGB)
• Possible component of RYGB that promotes altered ghrelin:• Distal stomach (site of ghrelin release) is bypassed
ghrelin secretion is suppressed hunger is reduced
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Ghrelin after Roux-en Y Gastric Bypass (RYGB)
• To determine what component of the RYGB is responsible for the changes in ghrelin, one study collected plasma immediately before, during, and after the procedure and found the greatest decline after dividing the stomach
BLOOD COLLECTION TIME POINTS
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).
JOURNAL OFTHE AMERICAN DIETETICASSOCIATION
Summary
• Glucagon-Like Peptide-1 (GLP-1), Peptide YY (PYY), leptin, and ghrelin change favorably after Roux-en Y Gastric Bypass (RYGB)
• Compared to those undergoing other surgical procedures, those who are normal weight, overweight, or obese, or who lost weight by conventional methods, post-RYGB patients have:• Increased GLP-1 and PYY• Decreased ghrelin• Decreased leptin in proportion to body weight
Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review
Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).