Roux-en-Y gastric bypass compared with equivalent diet restriction: Mechanistic insights into diabetes remission.
Roux-en-Y gastric bypass compared with equivalent diet restriction: Mechanistic insights into diabetes remission.
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DOI：
10.1111/dom.13287
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Lingvay I
中科院分区：
文献类型：
--
作者：
Pop LM;Mari A;Zhao TJ;Mitchell L;Burgess S;Li X;Adams-Huet B;Lingvay I
探讨Roux-en-Y胃旁路术（RYGB）后糖尿病快速改善的生理机制。特别是，并发围手术期饮食限制的作用，这也可能改变葡萄糖代谢，尚未完全阐明。为了评估饮食和手术对导致RYGB后糖尿病快速改善的机制的不同贡献，我们招募了10名计划接受RYGB的2型糖尿病患者。所有患者均接受了10天的住院患者监督饮食干预，相当于围手术期饮食（仅饮食期），然后在重新平衡（洗脱）期后，进行相同时期的配对匹配饮食联合RYGB（饮食和RYGB期）。我们在6小时混合膳食挑战试验期间进行了广泛的代谢评估，在每次干预之前和之后进行稳定同位素葡萄糖示踪剂输注。两种干预措施均观察到血糖水平、β细胞功能、胰岛素敏感性和餐后肝脏胰岛素抵抗的相似改善。两种干预措施均导致空腹和餐后酰基-胃饥饿素显著降低。仅饮食干预诱导基础肝葡萄糖输出和餐后GIP分泌的更大改善。饮食和RYGB干预诱导餐后GLP-1、PYY和胰高血糖素显著增加。严格的围手术期饮食限制是RYGB后葡萄糖代谢迅速改善的主要原因。RYGB诱导的肠促胰岛素激素（GLP-1和PYY）变化可能通过中枢和外周机制在长期遵守此类主要饮食限制方面发挥重要作用。
To investigate the physiological mechanisms leading to rapid improvement in diabetes after Roux-en-Y Gastric Bypass (RYGB). In particular, the roles of concurrent peri-operative dietary restrictions, which may also alter glucose metabolism, have not been completely elucidated. To assess the differential contributions of diet and surgery to the mechanisms leading to the rapid improvement in diabetes after RYGB we enrolled ten patients with type 2 diabetes scheduled to undergo RYGB. All patients underwent a 10-day inpatient supervised dietary intervention equivalent with the peri-operative diet (Diet only Period), followed by, after a re-equilibration (washout) period, an identical period of pair matched-diet in conjunction with RYGB (Diet and RYGB Period). We conducted extensive metabolic assessments during a 6 hours Mixed Meal Challenge Test with stable isotope glucose tracer infusion performed before and after each intervention. Similar improvements in glucose levels, β-cell function, insulin sensitivity, and post-meal hepatic insulin resistance were observed with both interventions. Both interventions led to significant reductions in fasting and postprandial acyl-ghrelin. The Diet only intervention induced greater improvements in basal hepatic glucose output and post-meal GIP secretion. The Diet and RYGB intervention induced significantly greater increases in post-meal GLP-1, PYY, and glucagon. The strict peri-operative dietary restriction is a main contributor to the rapid improvement in glucose metabolism following RYGB. The RYGB-induced changes in the incretin hormones (GLP-1 and PYY) likely exert a major role in the long-term compliance with such major dietary restrictions through central and peripheral mechanisms.
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仅在发生大量体重减轻并与减肥幅度相关后，才能观察到胃旁路手术后的外周葡萄糖吸收的改善。
影响因子：
3.2
作者：
Campos, Guilherme M.;Rabl, Charlotte;Peeva, Sofia;Ciovica, Ruxandra;Rao, Madhu;Schwarz, Jean-Marc;Havel, Peter;Schambelan, Morris;Mulligan, Kathleen
通讯作者：
Mulligan, Kathleen
影响因子：
8.1
作者：
Mokadem, Mohamad;Zechner, Juliet F.;Aguirre, Vincent
通讯作者：
Aguirre, Vincent
影响因子：
7.7
作者：
Bergman, RN;Ader, M;Van Citters, G
通讯作者：
Van Citters, G
影响因子：
5.8
作者：
Laferrere, Blandine;Teixeira, Julio;Olivan, Blanca
通讯作者：
Olivan, Blanca
影响因子：
--
作者：
AMATRUDA, JM;RICHESON, JF;LOCKWOOD, DH
通讯作者：
LOCKWOOD, DH