Improved insulin sensitivity after gastric bypass correlates with decreased total body fat, but not with changes in free fatty acids


Journal Article

Background: Increased plasma free fatty acids (FFAs) are considered one of the key elements in the pathogenesis of insulin resistance (IR) and type 2 diabetes (T2DM). We hypothesize that, in diabetic patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB), a postoperative decrease in FFA will correlate with improved insulin sensitivity (Si). Methods: A total of 30 obese [body mass index ((BMI) >35 kg/m2] patients with a diagnosis of T2DM were studied preoperatively and 12 months after LRYGB in a prospective cohort study. Collected data included intravenous glucose tolerance test (IVGTT), total body composition by dual-energy X-ray absorptiometry and plasma levels of FFA. Si analysis from the IVGTT was estimated from minimal model analysis. Pre- and postoperative variables were compared using a paired sample t test. Relationships between changes in variables were determined with Pearson's correlation test. Results: Twelve months after LRYGB the study population showed a significant decrease in BMI (p = 0.001), FFA (p = 0.03), and total body fat (p = 0.03), with an increase in Si (p = 0.001). Postoperative changes in Si significantly correlated (Pearson's r = -0.53, p = 0.01) with change in total body fat, but not with changes in plasma FFA (Pearson's r = -0.22, p = 0.31). Conclusions: Our study challenges the notion that IR is mediated to a significant degree by changes in plasma FFA concentration. Instead, changes in adiposity and consequently changes in adipokine release can be the key players in determining remission of T2DM after LRYGB. © 2013 Springer Science+Business Media.

Full Text

Duke Authors

Cited Authors

  • Mor, A; Tabone, L; Omotosho, P; Torquati, A

Published Date

  • January 1, 2014

Published In

Volume / Issue

  • 28 / 5

Start / End Page

  • 1489 - 1493

Electronic International Standard Serial Number (EISSN)

  • 1432-2218

International Standard Serial Number (ISSN)

  • 0930-2794

Digital Object Identifier (DOI)

  • 10.1007/s00464-013-3338-0

Citation Source

  • Scopus