Weight-Independent Mechanisms of Glucose Control After Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass results in large and sustained weight loss and resolution of type 2 diabetes in 60% of cases at 1–2 years. In addition to calorie restriction and weight loss, various gastro-intestinal mediated mechanisms, independent of weight loss, also contribute to glucose control. The anatomical re-arrangement of the small intestine after gastric bypass results in accelerated nutrient transit, enhances the release of post-prandial gut hormones incretins and of insulin, alters the metabolism and the entero-hepatic cycle of bile acids, modifies intestinal glucose uptake and metabolism, and alters the composition and function of the microbiome. The amelioration of beta cell function after gastric bypass in individuals with type 2 diabetes requires enteric stimulation. However, beta cell function in response to intravenous glucose stimulus remains severely impaired, even in individuals in full clinical diabetes remission. The permanent impairment of the beta cell may explain diabetes relapse years after surgery

Race, Menopause, Health-Related Quality of Life, and Psychological Well-Being in Obese Women

Race, menopause, health-related quality of life, and psychological well-being in obese women. Obes Res. 2002;10:1270 –1275. Objective: To investigate the health-related quality of life (HR-QOL) in African-American (AA) and white (W) obese women. Research Methods and Procedures: Participants were 145 obese women (80 AA and 65 W; 87 premenopausal and 58 postmenopausal) who completed the Medical Outcomes Study short form, the Brief Symptom Inventory, the Life Distress Inventory, the Satisfaction With Life Scale, and the Rosenberg Self-Esteem Scale before entering a weight-loss study. The mean age of the subjects was 46.3   11.1 years and the mean body mass index was 35.2   4.2 kg/m2. Results: Although AA women were slightly heavier (95.3   10.3 kg vs. 91.5   11.6 kg, p   0.05) and less educated (14.2   3.7 years vs. 15.7   3.7 years, p   0.05) than the W women in the sample, there was no difference between the two ethnic groups in any of the reported HR-QOL variables. Menopausal status had a significant effect on HR-QOL, with premenopausal women being more distressed (p   0.002), having more limitations in social activity (p   0.007), and having less vitality (p   0.001) than the postmenopausal women. This was especially true in the AA women. Discussion: These data show no difference in HR-QOL between AA and W obese women and suggest that menopausal status may have an impact on HR-QOL, especially in AA women

Stress and Obesity: The Role of the Hypothalamic-Pituitary-Adrenal Axis in Metabolic Disease

PURPOSE OF REVIEW: Chronic stress, combined with positive energy balance, may be a contributor to the increased risk for obesity, especially upper body obesity, and other metabolic diseases. This association may be mediated by alterations in the hypothalamic-pituitary-adrenal (HPA) axis. In this review, we summarize the major research that has been conducted on the role of the HPA axis in obesity and metabolic disease. RECENT FINDINGS: Dysregulation in the HPA axis has been associated with upper body obesity, but data are inconsistent, possibly due to methodological differences across studies. In addition to systemic effects, changes in local cortisol metabolism in adipose tissue may also influence the risk for obesity. HPA axis dysregulation may be the causal link between conditions such as maternal malnutrition and sleep deprivation with metabolic disease. SUMMARY: The present review provides evidence for the relationship between chronic stress, alterations in HPA activity, and obesity. Understanding these associations and its interactions with other factors will be important in developing effective treatments for obesity and related metabolic diseases

Surgical Weight Loss: Impact on Energy Expenditure

Erratum: In the original publication, an erroneous date is given in the information on Prior Presentations in the Acknowledgements section. The correct date for the AHRQ Health Information Technology conference is June 2-4, 2010 as opposed to September 27, 2010. In the original publication, the given and surnames of the fourth and fifth authors were reversed. The correct names are Béatrice Morio (B. Morio) and Yves Boirie (Y. Boirie). (Erratum to: Surgical Weight Loss: Impact on Energy Expenditure, Obesity Surgery, Volume 23, Issue 5, p 734, doi: 10.1007/s11695-013-0870-x)International audienceDiet-induced weight loss is often limited in its magnitude and often of short duration, followed by weight regain. On the contrary, bariatric surgery now commonly used in the treatment of severe obesity favors large and sustained weight loss, with resolution or improvement of most obesity-associated comorbidities. The mechanisms of sustained weight loss are not well understood. Whether changes in the various components of energy expenditure favor weight maintenance after bariatric surgery is unclear. While the impact of diet-induced weight loss on energy expenditure has been widely studied and reviewed, the impact of bariatric surgery on total energy expenditure, resting energy expenditure, and diet-induced thermogenesis remains unclear. Here, we review data on energy expenditure after bariatric surgery from animal and human studies. Bariatric surgery results in decreased total energy expenditure, mainly due to reduced resting energy expenditure and explained by a decreased in both fat-free mass and fat mass. Limited data suggest increased diet-induced thermogenesis after gastric bypass, a surgery that results in gut anatomical changes and modified the digestion processes. Physical activity and sustained intakes of dietary protein may be the best strategies available to increase non-resting and then total energy expenditure, as well as to prevent the decline in lean mass and resting energy expenditure

Do Incretins Play a Role in the Remission of Type 2 Diabetes After Gastric Bypass Surgery: What Are the Evidence?

Gastric bypass surgery (GBP), in addition to weight loss, results in dramatic remission of type 2 diabetes (T2DM). The mechanisms by which this remission occurs are unclear. Besides weight loss and caloric restriction, the changes in gut hormones that occur after GBP are increasingly gaining recognition as key players in glucose control. Incretins are gut peptides that stimulate insulin secretion postprandially; the levels of these hormones, particularly glucagon-like peptide-1, increase after GBP in response to nutrient stimulation. Whether these changes are causal to changes in glucose homeostasis remain to be determined. The purpose of this review is to assess the evidence on incretin changes and T2DM remission after GBP, and the possible mechanisms by which these changes occur. Our goals are to provide a thorough update on this field of research so that recommendations for future research and criteria for bariatric surgery can be evaluated

Effect on Nitrogen Balance, Thermogenesis, Body Composition, Satiety, and Circulating Branched Chain Amino Acid Levels up to One Year after Surgery: Protocol of a Randomized Controlled Trial on Dietary Protein During Surgical Weight Loss

This project is supported by the National Center for Advancing Translational Sciences, and the National Institutes of Health (Grant Number UL1 TR000040), formerly the National Center for Research Resources (Grant Number UL1 RR024156). VM is funded by the Marie Curie International Outgoing Fellowships for Career Development (FP7-PEOPLE-2012-IOF, Proposal #326342)Background:Bariatric surgery (BS), the most effective treatment for severe obesity, typically results in 40-50 kg weight loss in the year following the surgery. Beyond its action on protein metabolism, dietary protein intake (PI) affects satiety, thermogenesis, energy efficiency, and body composition (BC). However, the required amount of PI after surgical weight loss is not known. The current daily PI recommendation for diet-induced weight loss is 0.8 g/kg ideal body weight (IBW) per day, but whether this amount is sufficient to preserve fat-free mass during active surgical weight loss is unknownObjective:To evaluate the effect of a 3-month dietary protein supplementation (PS) on nitrogen balance (NB), BC, energy expenditure, and satiety in women undergoing either gastric bypass or vertical sleeve gastrectomy.Methods:In this randomized prospective study, participants will be randomized to a high protein supplementation group (1.2 g/kg IBW per day) or standard protein supplementation group (0.8 g/kg IBW per day) based on current guidelines. Outcome measures including NB, BC, circulating branched chain amino acids, and satiety, which will be assessed presurgery, and at 3-months and 12-months postsurgeryResults:To date, no studies have examined the effect of dietary PS after BS. Current guidelines for PI after surgery are based on weak evidenceConclusions: The results of this study will contribute to the development of evidence-based data regarding the safe and optimal dietary PI and supplementation after B

Short sleep duration, glucose dysregulation and hormonal regulation of appetite in men and women

STUDY OBJECTIVE: To determine the hormonal effects of reducing sleep duration under controlled feeding conditions. DESIGN: Randomized, crossover study. SETTING: Inpatient. PARTICIPANTS: Twenty-seven normal weight, 30- to 45-yr-old men and women habitually sleeping 7-9 hr/night. INTERVENTION: Participants were studied under two sleep conditions: short (4 hr in bed) or habitual (9 hr in bed) sleep. A controlled diet was provided for each 4-day study period. MEASUREMENTS AND RESULTS: Fasting blood samples were obtained daily and frequent blood samples were obtained throughout day 4. The main outcomes measures included glucose, insulin, leptin, ghrelin, adiponectin, total glucagon-like peptide 1 (GLP-1) and peptide YY(3-36) (PYY(3-36)) concentrations. Body weights were reduced by 2.2 ± 0.4 lb and 1.7 ± 0.4 lb during the habitual and short sleep phases, respectively (both P < 0.0001). There was no effect of sleep duration on glucose, insulin, and leptin profiles (all P > 0.05). Ghrelin and GLP-1 responses differed by sex. Short sleep increased fasting (P = 0.054) and morning (08:00-12:00) (P = 0.042) total ghrelin in men but not women. The reverse was observed for GLP-1: afternoon levels (12:30-19:00) were lower (P = 0.016) after short sleep compared with habitual sleep in women but not men. CONCLUSIONS: These data suggest that, in the context of negative energy balance, short sleep does not lead to a state of increased insulin resistance, but may predispose to overeating via separate mechanisms in men and women. CLINICAL TRIAL INFORMATION: Trial registration on http://www.clinicaltrials.gov. #NCT00935402. CITATION: St-Onge MP; O'Keeffe M; Roberts AL; RoyChoudhury A; Laferrère B. Short sleep duration, glucose dysregulation and hormonal regulation of appetite in men and women. SLEEP 2012;35(11):1503-1510