Bariatric Times

NOV 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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14 Review Bariatric Times • November 2017 loss. In contrast to diet alone or older purely restrictive procedures, today's most popular bariatric surgery procedures (SG and RYGB), improve and enhance levels of anorexigenic gut peptides without increasing ghrelin. Future research on pharmacological, genetic, and surgical methods to better use these pathways in attempt to shift them toward a more anorexigenic promoting milieu will likely continue. REFERENCES 1. Berthoud HR. The vagus nerve, food intake and obesity. Regul Pept. 2008; 149:15–25. 2. Ochner CN, Gibson C, Carnell S, et al. The neurohormonal regulation of energy intake in relation to bariatric surgery for obesity. Physiol Behav. 2010;100(5):549–559. 3. Camilleri M. Peripheral mechanisms in appetite regulation. Gastroenterology. 2015;148(6):1219–1233. 4. Scalfani A. Gut-brain nutrient signaling: appetition vs. satiation. Appetite. 2013;71: doi:10.1016/j.appet.2012.05.024. 5. Ochner CN, Gibson C, Shanik M, et al. Changes in neurohormonal gut peptides following bariatric surgery. Int J Obes (Lond). 2011;35(2):153–166. 6. Kim GW, Lin JE, Valentino MA, et al. Regulation of appetite to treat obesity. Expert Rev Clin Pharmacol. 2011;4(2):243–259. 7. Lean MEJ, Malkova D. Altered gut and adipose tissue hormones in overweight and obese individuals: cause or consequence? Int J Obes. 2016;40:622–632. 8. Ramón JM, Salvans S, Crous X, et al. Effect of Roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial. J Gastrointest Surg. 2012; 16:1116– 1122. 9. Reda TK, Geliebter A, Pi-Sunyer X. Amylin, food intake, and obesity. Obes Res. 2002; 10(10):1087–1091. 10. Laferrere B, Swerdlow N, Bawa B, et al. Rise of oxyntomodulin in response to oral glucose after gastric bypass surgery in patients with type 2 diabetes. J Clin Endocrinol Metab. 2010;95(8):4072–4076. 11. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Eng J Med. 2011;365:1597–604. 12. Malin SK, Kashyap SR. Differences in weight loss and gut hormones: Rouxen-Y gastric bypass and sleeve gastrectomy surgery. Curr Obes Rep. 2015;4:279–286. 13. Yong-ho L, Magkos F, Mantzoros CS, et al. Effects of leptin and adiponectin on pancreatic β-cell function. Metabolism. 2011;60:1664–1672. 14. Owyang C, Heldsinger A. Vagal control of satiety and hormonal regulation of appetite. J Neurogastroenterol Motil. 2011;17(4):338–348. 15. Michalakis K, le Roux C. Gut hormones and leptin: impact on energy control and changes after bariatric surgery—what the future holds. Obes Surg. 2012; 22:1648– 1657. 16. Korczala-Zwirska K, Konturek SJ, Sodowski M, et al. Basal and postprandial plasma levels of PYY, ghrelin, cholecystokinin, gastrin and insulin in women with moderate and morbid obesity and metabolic syndrome. J Physiol Pharmacol. 2007;58:Suppl 1:13–35. 17. Dimitriadis E, Daskalakis M, Kampa M, et al. Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study. Ann Surg. 2013; 257:647–654. 18. Terra X, Auguet T, Guiu-Jurado E, et al. Long-term changes in leptin, chemerin and ghrelin levels following different bariatric surgery procedures: Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(11):1790-8. 19. le Roux CW, Aylwin SJ, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006; 243:108–114. 20. Reinehr T, Roth CL, Schernthaner GH, et al. Peptide YY and glucagon- like peptide-1 in morbidly obese patients before and after surgically induced weight loss. Obes Surg. 2007; 17:1571–1577. FUNDING: No funding was provided. DISCLOSURES: The author report no conflicts of interest relevant to the content of this article. AUTHOR AFFILIATION: April Smith, PharmD, MA, BCPS, is Associate Professor of Pharmacy Practice at the School of Pharmacy & Health Professions at Creighton University in Omaha, Nebraska. ADDRESS FOR CORRESPONDENCE: April Smith, PharmD, MA, BCPS; E-mail: april.smith@creighton.edu TABLE 1. Function of gastrointestinal related peptides and impact on obesity and weight loss 5–12 PEPTIDE RELEASED FROM TARGETS CLINICAL EFFECT L EVELS IN SUBJECTS WITH OBESITY VS. NORMAL WEIGHT L EVELS AFTER BARIATRIC SURGERY LEVELS AFTER DIET INDUCED WEIGHT LOSS AGB SG RYGB Leptin Adipose tissue ARC, inhibits NPY/AgRP signlaing, increases POMC/CART signaling Decreases appetite Elevated, reflects leptin resistance ↓ ↓ ↓ ↓ Ghrelin Stomach (gastric fundus) Vagus nerve; ARC Increases appetite Reduced ↑ ↓ ↓ ↑ Amylin Β-cells of pancreas; r eleased with insulin Vagus nerve; DVC→ARC Decreases appetite, slows g astric emptying Elevated, reflects amylin resistance ↔ ↔ ↓ ↓ Insulin Β-cells of pancreas ARC, inhibits NPY/AgRP signaling, increases POMC/CART signaling Decreases appetite, slows gastric emptying Elevated, reflects insulin resistance ↓ (fasting) ↓ (fasting) ↓ (fasting) ↓ (fasting) GLP-1 Ileocolonic L-cells ARC and DVC D ecreases appetite, slows gastric emptying Decreased ↔ ↑ ↑ ↓ PYY Ileocolonic L-cells Vagus nerve; ARC, inhibits NPY/AgRP neurons Decreases appetite; slows gastric emptying Decreased, induced deficiency as opposed to resistance ↑ /↔ ↑ ↑ ↓ OXM Ileocolonic L-cells ARC; stimulates POMC neurons Decreases appetite; increases engery expenditure Decreased postprandial levels ↔ ? ↑ ↔ CCK I-cells in upper small bowel Vagus nerve; ARC, inhibits NPY/AgRP neurons Decreases appetite; slows gastric emptying Decreased postprandial levels ↔ ↑ ↔ ↓ ABG: Adjustable gastric banding; SG: Sleeve gastrectomy; RYGB: Roux-en-Y gastric bypass; ARC: arcuate nucleus; NPY: Neuropeptide Y; AgRP: Agouti-related protein; POMC: Pro-opiomelancortin; CART: Cocaine and amphetamine related transcript; DVC: dorsal vagal complex; GLP-1: glucagon-like peptide 1; PYY: Peptide YY; OXM: Oxyntomodulin; CCK: cholecystokinin; ↑: increased; ↓: decreased; ↔: stay the same

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