Vagal activation alters prandial bile acid composition and glycemia in patients with hypoglycemia after Roux-en-Y gastric bypass surgery.
Vagal activation alters prandial bile acid composition and glycemia in patients with hypoglycemia after Roux-en-Y gastric bypass surgery.
复制标题
迷走神经激活改变了 Roux-en-Y 胃绕道手术后低血糖患者的餐时胆汁酸成分和血糖。
DOI：
10.1111/nmo.14763
复制
发表时间：
2024
影响因子：
3.5
通讯作者：
Salehi,Marzieh
中科院分区：
文献类型：
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作者：
Honka,Henri;Bhattacharjee,Jashdeep;Zadeh,Mansour;Kohli,Rohit;Gastaldelli,Amalia;Salehi,Marzieh
背景：Roux - en - Y胃分流术（RYGB）后的低血糖患者餐后血糖反应的改变被夸大。胰高血糖素样肽1 （GLP - 1）对膳食胰岛素分泌的增加在RYGB后低血糖的发生中起关键作用，但非激素肠道因素的作用尚不清楚。在这里，迷走神经激活对与葡萄糖、胰岛素和肠道激素反应相关的膳食胆胆酸（BA）组成的影响在一小组非糖尿病受试者中进行了比较，这些受试者在胆囊完整的RYGB后与未手术的对照组相比。方法：在改良的假喂养（咀嚼和吐痰）之前，分别进行（MTT - Sham）和（MTT）的餐耐量试验，测量两名记录有低血糖（HGB）的RYGB受试者、三名无症状的RYGB治疗组（AGB）和四名胆囊完整的未手术对照者的血糖、激素和BAs浓度。关键结果：膳食摄入提高了RYGB治疗组的血清总BAs，而未手术对照组没有任何影响。改良假喂养同样增加了所有受试者中共轭BAs （CBAs）的膳食诱导反应（与单独MTT相比p< 0.05），而非共轭BAs (UBAs)，主要是脱氧胆酸和鹅去氧胆酸，仅在HGB组中升高（相互作用p< 0.001）。在MTT‐Sham期间，膳食UBAs与血糖最低点呈负相关（r= - 0.75,p< 0.05），并与ISR和GLP‐1直接相关。结论和推论在这个小的队列中，改良假喂养的迷走神经激活增加了手术和非手术受试者的膳食CBAs，但仅在记录为RYGB后低血糖的患者中增加了UBAs。我们的研究结果强调了非激素肠道因素（如BA和肠道微生物组）在RYGB后葡萄糖异常中的潜在作用。
BackgroundAltered prandial glycemic response after Roux‐en‐Y gastric bypass (RYGB) is exaggerated in patients with post‐RYGB hypoglycemia. Increased contribution of glucagon‐like peptide 1 (GLP‐1) to prandial insulin secretion plays a key role in developing hypoglycemia after RYGB, but the role of nonhormonal gut factors remains unknown. Here, the effect of vagal activation on prandial bile acid (BA) composition in relation to glucose, insulin and gut hormone responses was examined in a small size group of nondiabetic subjects after RYGB with intact gallbladder compared to nonoperated controls.MethodsConcentrations of blood glucose, hormones, and BAs were measured in two RYGB subjects with documented hypoglycemia (HGB), three asymptomatic RYGB‐treated subjects (AGB), and four nonoperated controls with intact gallbladders during a meal‐tolerance test with (MTT‐Sham) and without (MTT) preceding modified sham feeding (chew and spit).Key ResultsMeal ingestion raised serum total BAs in RYGB‐treated subjects without any effect in nonoperated controls. Modified sham feeding similarly increased meal‐induced responses of conjugated BAs (CBAs) in all subjects (p< 0.05 compared to MTT alone), whereas unconjugated BAs (UBAs), mainly deoxycholic and chenodeoxycholic acid, were raised only in the HGB group (p <0.001 for interaction). Prandial UBAs had an inverse correlation with glucose nadir (r= −0.75,p< 0.05) and were directly associated with ISR and GLP‐1 during MTT‐Sham.Conclusions & InferencesIn this small cohort, vagal activation by modified sham feeding increases prandial CBAs in both operated and nonoperated subjects but enhances UBAs only in patients with documented post‐RYGB hypoglycemia. Our findings highlight a potential role for nonhormonal gut factors, such as BA and gut microbiome, in glucose abnormalities after RYGB.