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Weight regain

Preoperative ghrelin levels could indicate weight regain

Leptin levels were decreased overall after RYGB (p< 0.001), but increased in the weight regain group between years one and two

Early weight regain after RYGB is not associated with a reversal of improvements in insulin sensitivity and higher preoperative ghrelin levels might identify patients that are more susceptible to weight regain after RYGB, those are the conclusion of a study 'Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with elevated ghrelin', published in the journal Obesity.

The investigators sought to determine: (1) if early weight regain between the first and second years after RTGB was associated with worsened hepatic and peripheral insulin sensitivity, and (2) whether preoperative levels of ghrelin and leptin are associated with early weight regain after RYGB.

The recruited 45 patients and assessed their hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels before RYGB and at one month, six months, one and two years postoperatively. They defined weight regain as ≥5% increase in body weight between years one and two. Forty-nine percent of patients (22/45) has type 2 diabetes before surgery.

Results

They report that weight regain occurred in 33% of subjects, with an average increase in body weight of 10±5% (8.5 ± 3.3kg). The gain in body weight consisted primarily of fat mass and not lean mass (Figure 1A and 1B). There was no significant difference in preoperative age, sex, type 2 diabetes, BMI, or weight between those participants that regained weight and those that maintained or continued to lose weight.

The researchers also reported that weight regain was not associated with worsening of peripheral or hepatic insulin sensitivity. However, patients with weight regain had higher preoperative and postoperative levels of ghrelin compared to those who maintained or lost weight during this time.

Although peripheral and hepatic insulin sensitivity increased significantly over time (p< 0.001), they did not record a difference between the weight regain and maintain/lose groups in the trajectories of peripheral insulin sensitivity (Figure 1C; group by time interaction p=0.191) or hepatic insulin sensitivity (Figure 1D; group by time interaction p=0.137).

Figure 1F demonstrates that the weight regain group maintained these higher levels of ghrelin after surgery (main effect of group p=0.014, group by time interaction effect p=0.707).

Interestingly, leptin levels were decreased overall after RYGB (p< 0.001), but increased in the weight regain group between years one and two (overall interaction p=0.011, 1-2 years interaction contrast p=0.017) (Figure 1E). The trajectories of leptin levels corresponded with fat mass (Figure 1A).

Figure 1. Weight regain at 2 years after RYGB is not associated with worsened insulin sensitivity, but is associated with elevated plasma ghrelin levels. Weight regain was defined as ≥5% weight change between 1 and 2 years after RYGB, and occurred in 33% of the cohort. Trajectories of fat (A) and lean (B) mass losses were similar between groups up to 1 year after RYGB. There was no effect of weight regain on peripheral (C) or hepatic (D) insulin sensitivity (both group by time interaction P ≥ 0.137). Leptin levels (E) increased between 1 and 2 years after RYGB in the weight regain group (group by time interaction P = 0.011). Ghrelin levels (F) were higher in the weight regain group at baseline (P = 0.009) and this stratification was maintained over time (group by time interaction P = 0.707). Data are mean ± SEM.

They note that the findings suggest ghrelin does not impact degree of initial weight loss, but the maintenance of surgical weight loss.

“These findings indicate that early weight regain does not adversely affect insulin sensitivity after RYGB,” the authors conclude. “Importantly, we report that preoperative ghrelin levels might identify those patients more susceptible to weight regain after RYGB and should receive more intense post-surgical follow-up to prevent post-RYGB weight recidivism.”

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