In the Journals

Early weight regain after Roux-en-Y did not affect insulin sensitivity, but ghrelin could be predictor

Weight regain in the couple years following Roux-en-Y gastric bypass does not reverse improvements in insulin sensitivity, according to research published in Obesity.

Higher ghrelin levels before surgery, however, could help identify patients more likely to regain weight, results from a longitudinal study showed.

“Being able to identify these patients would provide the opportunity to intervene and prevent weight regain,” Robyn A. Tamboli, PhD, of the Department of Surgery at Vanderbilt University School of Medicine in Nashville, Tenn., told Endocrine Today.

Tamboli and colleagues, looked at 45 patients before Roux-en-Y gastric bypass (RYGB) and again at 1 month, 6 months, 1 year and 2 years.

The researchers assessed hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels. Weight regain was defined as ≥5% increase in body weight between 1 and 2 years following RYGB.

Weight was regained by 33% of patients; the average increase in body weight was 10±5%

(8.5±3.3 kg). No association was seen between weight regain and deterioration of hepatic or peripheral insulin sensitivity.

Patients who regained weight demonstrated higher preoperative and postoperative levels of ghrelin compared with patients who maintained or lost weight during that time. However, the trajectories of leptin levels and fat mass corresponded in both groups.

Intervention options could include vertical sleeve gastrectomy, where the part of the stomach with the highest density of ghrelin-producing cells is removed as part of the surgical procedure, or using ghrelin antagonists pharmacologic adjuvant to RYGB, according to Tamboli.

“While the substantial metabolic improvements that occur after RYGB are durable through a small degree of weight gain, this should be explored further in long-term studies,” Tamboli said.

 — by Allegra Tiver

Disclosures: This research was supported by grants from the NIH to one researcher and to Vanderbilt University.

Weight regain in the couple years following Roux-en-Y gastric bypass does not reverse improvements in insulin sensitivity, according to research published in Obesity.

Higher ghrelin levels before surgery, however, could help identify patients more likely to regain weight, results from a longitudinal study showed.

“Being able to identify these patients would provide the opportunity to intervene and prevent weight regain,” Robyn A. Tamboli, PhD, of the Department of Surgery at Vanderbilt University School of Medicine in Nashville, Tenn., told Endocrine Today.

Tamboli and colleagues, looked at 45 patients before Roux-en-Y gastric bypass (RYGB) and again at 1 month, 6 months, 1 year and 2 years.

The researchers assessed hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels. Weight regain was defined as ≥5% increase in body weight between 1 and 2 years following RYGB.

Weight was regained by 33% of patients; the average increase in body weight was 10±5%

(8.5±3.3 kg). No association was seen between weight regain and deterioration of hepatic or peripheral insulin sensitivity.

Patients who regained weight demonstrated higher preoperative and postoperative levels of ghrelin compared with patients who maintained or lost weight during that time. However, the trajectories of leptin levels and fat mass corresponded in both groups.

Intervention options could include vertical sleeve gastrectomy, where the part of the stomach with the highest density of ghrelin-producing cells is removed as part of the surgical procedure, or using ghrelin antagonists pharmacologic adjuvant to RYGB, according to Tamboli.

“While the substantial metabolic improvements that occur after RYGB are durable through a small degree of weight gain, this should be explored further in long-term studies,” Tamboli said.

 — by Allegra Tiver

Disclosures: This research was supported by grants from the NIH to one researcher and to Vanderbilt University.