Metabolic and Neuroendocrine Responses to Roux-en-Y Gastric Bypass. I: Energy Balance, Metabolic Changes, and Fat Loss (original) (raw)
Journal Article
X. Liu ,
1Departments of Medicine and Surgery, Divisions of Endocrinology, Diabetes and Metabolism (X.L., A.L., I.D., J.E.S.), Springfield, Massachusetts 01199
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A. Lagoy ,
1Departments of Medicine and Surgery, Divisions of Endocrinology, Diabetes and Metabolism (X.L., A.L., I.D., J.E.S.), Springfield, Massachusetts 01199
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1Departments of Medicine and Surgery, Divisions of Endocrinology, Diabetes and Metabolism (X.L., A.L., I.D., J.E.S.), Springfield, Massachusetts 01199
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4Department of Kinesiology (G.P., B.B.), University of Massachusetts, Amherst, Massachusetts 01003
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E. Lewis ,
3Nephrology (E.L., G.B.), Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199
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3Nephrology (E.L., G.B.), Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199
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2Bariatric Surgery (J.R.), Springfield, Massachusetts 01199
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B. Braun ,
4Department of Kinesiology (G.P., B.B.), University of Massachusetts, Amherst, Massachusetts 01003
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1Departments of Medicine and Surgery, Divisions of Endocrinology, Diabetes and Metabolism (X.L., A.L., I.D., J.E.S.), Springfield, Massachusetts 01199
*Address all correspondence and requests for reprints to: J. E. Silva, M.D., 107 Viscount Road, Longmeadow, Massachusetts 01106.
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Received:
03 January 2012
Published:
01 August 2012
Cite
X. Liu, A. Lagoy, I. Discenza, G. Papineau, E. Lewis, G. Braden, J. Romanelli, B. Braun, J. E. Silva, Metabolic and Neuroendocrine Responses to Roux-en-Y Gastric Bypass. I: Energy Balance, Metabolic Changes, and Fat Loss, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 8, 1 August 2012, Pages E1440–E1450, https://doi.org/10.1210/jc.2012-1016
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Abstract
Context:
Obesity is a major health problem. Effective treatment requires understanding the homeostatic responses to caloric restriction.
Objective:
The aim was to study Roux-en-Y gastric bypass patients longitudinally for 6 months after surgery to identify major factors modulating fat loss.
Methods:
We studied 13 patients (11 females and two males) aged 41.2 ± 2 yr. Mean body mass index was 44.6 ± 1.2 kg/m2, with 50 ± 1% body fat (58.3 kg). Selection excluded patients with confounding comorbidities or treatments.
Results:
Caloric intake was reduced 742 ± 82 kcal/d by 1 month and 450 kcal/d between 2 and 4 months postoperatively. By 6 months, relative to baseline, body mass index decreased 24.8 ± 1.1%; percentage body fat, 37.3 ± 3.2% (21.7 kg); fat free mass (FFM), 9.7 ± 1.2%; and resting metabolic rate (RMR), 18.1 ± 4.3%. RMR correlated with FFM at all times (r = 0.71; P < 0.0001), but FFM explained no more than 50% of RMR variance. Exercise capacity (treadmill walking, 53 m/min with increasing grade) improved with time. Mean nonexercise physical activity level was low (1.2, or 20% of RMR), with considerable variance among individuals. Fat loss did not correlate with the aggregate energy deficit or its individual components. Resting or postexercise respiratory exchange ratio (RER) was lowest, whereas plasma β-OH-butyrate and glycerol were highest, between 1 and 2 months after surgery. RER increased linearly with mild exercise, and fat loss correlated positively with physical activity level and RER.
Conclusions:
Although the ultimate cause for weight loss is the energy deficit, the variance in fat loss correlated with glucose oxidation, suggesting that glucose partition between oxidation (muscle) and storage (adipose tissue) is an important factor affecting fat loss in individuals submitted to Roux-en-Y gastric bypass.
Copyright © 2012 by The Endocrine Society
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