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Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction.

Publication ,  Journal Article
Khoo, CM; Muehlbauer, MJ; Stevens, RD; Pamuklar, Z; Chen, J; Newgard, CB; Torquati, A
Published in: Ann Surg
April 2014

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery results in exaggerated postprandial insulin and incretin responses and increased susceptibility to hypoglycemia. OBJECTIVE: We examined whether these features are due to caloric restriction (CR) or altered nutrient handling. METHODS: We performed comprehensive analysis of postprandial metabolite responses during a 2-hour mixed-meal tolerance (MMT) test in 20 morbidly obese subjects with type 2 diabetes who underwent RYGB surgery or matched CR. Acylcarnitines and amino acids (AAs) were measured using targeted mass spectrometry. A linear mixed model was used to determine the main effect of interventions and interaction term to assess the effect of interventions on postprandial kinetics. RESULTS: Two weeks after these interventions, several gut hormones (insulin, glucose-dependent insulinotropic polypeptide, and glucagon-like peptide 1), glucose, and multiple AAs, including branched-chain and aromatic species, exhibited a more rapid rate of appearance and clearance in RYGB surgery subjects than in CR subjects during the MMT test. In the RYGB surgery group, changes in leucine/isoleucine, methionine, phenylalanine, and glucagon-like peptide 1 response were associated with changes in insulin response. Levels of alanine, pyruvate, and lactate decreased significantly at the later stages of meal challenge in RYGB surgery subjects but increased with CR. CONCLUSIONS: RYGB surgery results in improved metabolic flexibility (ie, greater disposal of glucose and AAs and more complete β-oxidation of fatty acids) compared with CR. The changes in the AA kinetics may augment the hormonal responses seen after RYGB surgery. The reduction in key gluconeogenic substrates in the postprandial state may contribute to increased susceptibility to hypoglycemic symptoms in RYGB surgery subjects.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

April 2014

Volume

259

Issue

4

Start / End Page

687 / 693

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Postprandial Period
  • Postoperative Complications
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Linear Models
  • Laparoscopy
  • Insulin
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Khoo, C. M., Muehlbauer, M. J., Stevens, R. D., Pamuklar, Z., Chen, J., Newgard, C. B., & Torquati, A. (2014). Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction. Ann Surg, 259(4), 687–693. https://doi.org/10.1097/SLA.0b013e318296633f
Khoo, Chin Meng, Michael J. Muehlbauer, Robert D. Stevens, Zehra Pamuklar, Jiegen Chen, Christopher B. Newgard, and Alfonso Torquati. “Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction.Ann Surg 259, no. 4 (April 2014): 687–93. https://doi.org/10.1097/SLA.0b013e318296633f.
Khoo CM, Muehlbauer MJ, Stevens RD, Pamuklar Z, Chen J, Newgard CB, et al. Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction. Ann Surg. 2014 Apr;259(4):687–93.
Khoo, Chin Meng, et al. “Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction.Ann Surg, vol. 259, no. 4, Apr. 2014, pp. 687–93. Pubmed, doi:10.1097/SLA.0b013e318296633f.
Khoo CM, Muehlbauer MJ, Stevens RD, Pamuklar Z, Chen J, Newgard CB, Torquati A. Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction. Ann Surg. 2014 Apr;259(4):687–693.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

April 2014

Volume

259

Issue

4

Start / End Page

687 / 693

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Postprandial Period
  • Postoperative Complications
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Linear Models
  • Laparoscopy
  • Insulin