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Endocrine Abstracts (2022) 81 RC5.6 | DOI: 10.1530/endoabs.81.RC5.6

ECE2022 Rapid Communications Rapid Communications 5: Diabetes, Obesity, Metabolism and Nutrition 2 (8 abstracts)

Effects of bariatric surgery and dietary intervention on changes in insulin resistance and appetite hormones over the period of 3 years

Malgorzata Brzozowska 1,2,3 , Michelle Isaacs 2,4 , Dana Bliuc 2,3 , Paul Baldock 2,3,5 , John Eisman 2,3,4,5 , Chris White 2,6,7 , Jerry Greenfield 2,3,4 & Jacqueline Center 2,3,4,5


1The Sutherland Hospital, Endocrinology, Caringbah, Australia; 2UNSW Sydney, Faculty of Medicine, Sydney, Australia; 3Garvan Institute of Medical Research, Healthy Ageing Theme, Darlinghurst, Australia; 4St Vincent’s Hospital Sydney, Endocrinology, Darlinghurst, Australia; 5The University of Notre Dame Australia, School of Medicine, Darlinghurst, Australia; 6Prince Of Wales Hospital, NSW Health Pathology, Randwick, Australia; 7Prince Of Wales Hospital, Endocrinology, Randwick, Australia


Objectives: Little is known about the mechanisms responsible for improvement in insulin resistance after bariatric surgery. We examined the impact of three types of bariatric surgery, in comparison with dietary intervention (DIET) on concurrent changes in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and appetite hormones over the period of 3 years. We also investigated the weight loss independent hormonal effects on insulin resistance.

Methods: Fifty-five adults undergoing weight-loss interventions, Roux-en-Y gastric bypass RYGB ( n= 7), gastric sleeve GS ( n= 21), laparoscopic adjustable gastric banding surgery LAGB ( n= 11) and DIET ( n= 16) were studied at baseline and at 1, 3, 6, 12, 24 and 36-months post intervention. Measurements of glucose (BSL), HbA1c, insulin levels, fasting and postprandial PYY and GLP1, adiponectin, C-reactive protein (CRP), retinol-binding protein 4 (RBP4), fibroblast growth factor-21 (FGF21) and dual-Xray absorptiometry were performed throughout the study. Two separate, random, intercept mixed-effects models examined the HOMA-IR changes within individual groups and in comparison with DIET during the initial phase of rapid weight loss (0-12 months) and during the stage of weight stability (12-36 months).

Results: During the first 12 months, RYGB, GS and DIET, but not LAGB, led to significant reductions in HOMA-IR. However, after controlling for the lost weight, postoperative HOMA-IR values were no longer different to the DIET group. During the phase of weight stability, all three bariatric procedures, achieved significant reductions in HOMA-IR, with the greatest difference in the RYGB group (-3.7; 95% CI: -5.4, -2.1; P=0.001). After controlling for the weight loss procedure, weight and body composition changes, HOMA-IR level decreased by 1.1 (95% CI: -2.1, -0.06; P=0.045) for every 2-fold increase from baseline in postprandial PYY. Fasting insulin declined by 3.4 mU/l (95% CI: -7.2, 0.09; P=0.06) for every 2-fold increase in adiponectin level. Initial, non-sustained changes in RBP4 and FGF21 had no significant association with HOMA-IR values.

Conclusions: An initial rapid weight loss after bariatric surgery is a major contributing factor to the decline in HOMA-IR score. The exaggerated secretions of the PYY hormone and adiponectin are associated with weight-independent improvements in HOMA-IR during weight stability. The metabolic roles of RBP4 and FGF21 may be related to rapid fluctuations in weight or changes in nutritional intake. Further mechanistic studies involving larger numbers of subjects are needed to fully understand the complex neuroendocrine regulation of weight, appetite, and glucose homeostasis in bariatric patients.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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