Diurnal urinary output after different types of bariatric surgery.

<p>Diurnal urinary output (U-Volume) in absolute values (upper panel) and in relation to body weight (lower panel) after gastric bypass surgery (GBP), after pure restrictive bariatric surgery (VBG/B) and in non-operated obese controls. Changes from baseline (Δ) at the 2 y and 10 y follow-up visits are displayed. Data are mean values adjusted for sex, age, baseline BMI and the baseline level of the respective variables. The bars represent the 95% confidence intervals. Differences between groups (upper panel) are given as mean (95% confidence intervals).*<i>P</i><0.01 and ***<i>P</i><0.001.</p

Baseline characteristics of study subjects who completed follow-up after 2 y.

<p>Values are mean (±SD) unless otherwise stated. BMI, body mass index. GBP, gastric bypass surgery. VBG/B, pure restrictive bariatric surgery.</p>***<p><i>P</i><0.001,</p>**<p><i>P</i><0.01,</p>*<p><i>P</i><0.05 and ∧<i>P</i><0.10 using Students <i>t</i> test or Chi-square test.</p>¶<p>Daily salt intake was calculated by multiplying urinary sodium values by 0.0585 (molecular weight of NaCl: 58.5).</p

Weight reduction independent changes from baseline after GBP and VBG/B at the 2 year follow up (multiple linear regression analyses).

a<p><b>:</b> Unadjusted difference between year 2 and baseline within each group. Minus signs denote reductions. Means (±SD) ^bDifference between year 2 and baseline within each group after adjustment for change in body mass index (BMI), sex, age, baseline BMI and the baseline level of the respective variables. Minus signs denote reductions. Mean values.</p>b<p><b>:</b> Difference between year 2 and baseline after adjustment for change in body mass index (BMI), sex, age, baseline BMI and the baseline level of the respective variables. Minus signs denote reductions. Mean values.</p>c<p>: Difference between gastric bypass surgery (GBP) and pure restrictive bariatric surgery (VBG/B) after adjustment for BMI change, sex, age, baseline BMI and the baseline level of the respective variables. Minus signs denote larger reductions in GBP compared to VBG/B group. Figures between brackets denote 95% confidence interval.</p>#<p>Daily salt intake was calculated by multiplying urinary sodium values by 0.0585 (molecular weight of NaCl: 58.5).</p>*<p>P<0.05,</p>**<p>P<0.01 and ***P<0.001 for test of difference between the GBP group and the VBG/B group in adjusted changes, using multiple linear regression.</p

Diurnal urinary excretion of sodium after different types of bariatric surgery.

<p>Diurnal urinary excretion of sodium (U-Na⁺) in absolute values (upper panel) and in relation to body weight (lower panel) after gastric bypass surgery (GBP), after pure restrictive bariatric surgery (VBG/B) and in non-operated obese controls. Changes from baseline (Δ) at the 2 y and 10 y follow-up visits are displayed. Data are mean values adjusted for sex, age, baseline BMI and the baseline level of the respective variables. The bars represent the 95% confidence intervals. Differences between groups (upper panel) are given as mean (95% confidence intervals). ***<i>P</i><0.001.</p

Biliopancreatic Diversion is associated with greater increases in energy expenditure than Roux-en-Y Gastric Bypass

<div><p>Objective</p><p>The greater weight loss achieved following Biliopancreatic Diversion with Duodenal Switch (BPDS) versus Roux-en-Y Gastric Bypass (RYGB) has been attributed to the malabsorptive effects of BPDS. Increased weight loss after BPDS could also be underpinned by larger increases in energy expenditure. Hypothetically, the more radical reconfiguration of the small intestine in BPDS could result in an accentuated increase in meal associated thermogenesis (MAT).</p><p>Design</p><p>Female subjects (baseline mean age 40 years, mean BMI-55kg/m²) were assessed four years after randomization to BPDS (n = 6) or RYGB (n = 6). Energy expenditure (EE) and respiratory quotient (RQ) were measured by indirect calorimetry over 24 hours. A detailed protocol allowed for discrimination of basal metabolic rate (BMR), fasting EE and MAT as components of total energy expenditure (TEE) normalised for total and lean tissue by dual-energy x-ray absorptiometry.</p><p>Results</p><p>Median weight loss at follow-up was 1.5-fold higher following BPDS relative to RYGB, resulting in respective median BMIs of 29.5 kg/m² (21.7 to 36.7) after BPDS and 37.8 kg/m² (34.1 to 45.7) after RYGB (p = 0.015). The BPDS group had a lower fat:lean ratio compared to the RYGB group (p = 0.009). Overall 24-hour TEE adjusted for total tissue was higher in the BPDS group, as were BMR, fasting EE and MAT (all p<0.05). Differences between RYGB and BPDS in BMR and TEE were nullified when normalised for lean mass. Postprandial RQ increased significantly but to a similar extent in both groups.</p><p>Conclusion</p><p>Enhanced and prolonged MAT and lower fat:lean mass ratios after BPDS may explain relative increases in total energy expenditure as compared to RYGB.</p></div

Weight reduction independent changes from baseline after GBP and VBG/B at the 10 year follow up (multiple linear regression analyses).

a<p><b>:</b> Unadjusted difference between year 10 and baseline within each group. Minus signs denote reductions. Means (±SD) ^bDifference between year 10 and baseline within each group after adjustment for change in body mass index (BMI), sex, age, baseline BMI and the baseline level of the respective variables. Minus signs denote reductions. Mean values.</p>b<p><b>:</b> Difference between year 10 and baseline after adjustment for change in body mass index (BMI), sex, age, baseline BMI and the baseline level of the respective variables. Minus signs denote reductions. Mean values.</p>c<p>: Difference between gastric bypass surgery (GBP) and pure restrictive bariatric surgery (VBG/B) after adjustment for BMI change, sex, age, baseline BMI and the baseline level of the respective variables. Minus signs denote larger reductions in GBP compared to VBG/B group. Figures between brackets denote 95% confidence interval.</p>#<p>Daily salt intake was calculated by multiplying urinary sodium values by 0.0585 (molecular weight of NaCl: 58.5).</p>*<p>P<0.05,</p>**<p>P<0.01 and ***P<0.001 for test of difference between the GBP group and the VBG/B group in adjusted changes, using multiple linear regression.</p

Baseline characteristics of study subjects who completed follow-up after 10 y.

<p>Values are mean (±SD) unless otherwise stated. BMI, body mass index. GBP, gastric bypass surgery. VBG/B, pure restrictive bariatric surgery.</p>***<p><i>P</i><0.001,</p>**<p><i>P</i><0.01,</p>*<p><i>P</i><0.05 and ̂<i>P</i><0.10 using Students <i>t</i> test or Chi-square test.</p>¶<p>Daily salt intake was calculated by multiplying urinary sodium values by 0.0585 (molecular weight of NaCl: 58.5).</p

Time after surgery & weight loss.

<p>Time after surgery & weight loss.</p

Time after surgery & weight loss.

<p>Time after surgery & weight loss.</p

Six female subjects assessed for energy expenditure during one hour after a 600 kcal standard meal; from 18:20 to 19:20.

<p>Assessments were performed before, visit 1, and at weight stability 20 months after, visit 4, gastric bypass surgery. Data are presented as mean values in kcal/minute and as percentage of total energy expenditure.</p