Mechanisms in bariatric surgery: Gut hormones, diabetes resolution, and weight loss

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Jens Juul Holst, Sten Madsbad, Kirstine N Bojsen-Møller, Maria Saur Svane, Nils Bruun Jørgensen, Carsten Dirksen, Christoffer Martinussen

Gastric bypass surgery leads to profound changes in the secretion of gut hormones with effects on metabolism, appetite, and food intake. Here, we discuss their contributions to the improvement in glucose tolerance and the weight loss that results from the operations. We find that the improved glucose tolerance is due the following events: a negative energy balance and resulting weight loss, which improve first hepatic and later peripheral insulin sensitivity, in combination with increased postprandial insulin secretion elicited particularly by exaggerated glucagon-like peptide-1 responses. The weight loss is due to loss of appetite resulting in reduced energy intake, and we find it probable that this process is driven by exaggerated secretion of appetite-regulating gut hormones including, but probably not limited to, glucagon-like peptide-1 and peptide-YY. The increased secretion is due to an accelerated exposure to and absorption of nutrients in the small intestine. This places the weight loss and the gut hormones in key positions with respect to the metabolic improvements after bypass surgery.

Original languageEnglish
JournalSurgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
Volume14
Issue number5
Pages (from-to)708-714
Number of pages7
ISSN1550-7289
DOIs
Publication statusPublished - May 2018

    Research areas

  • Appetite/physiology, Bariatric Surgery, Diabetes Mellitus, Type 2/surgery, Dietary Carbohydrates/metabolism, Dietary Proteins/metabolism, Digestion/physiology, Eating/physiology, Gastric Bypass, Gastrointestinal Hormones/physiology, Glucagon-Like Peptide 1/physiology, Humans, Insulin Resistance/physiology, Intestinal Absorption/physiology, Nutrients/metabolism, Obesity, Morbid/complications, Peptide YY/physiology, Weight Loss/physiology

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