Roux-en-Y gastric bypass and calorie restriction : differences and similarities of endocrine and metabolic effects in obesity and type 2 diabetes mellitus

Lips, M.A. (2014)

Doctoral Thesis

In this thesis, we evaluated the acute and more long-term effects of different weight loss strategies; pure calorie restriction by very low calorie diet and gastric banding, versus the drastic surgical procedure Roux-en-Y gastric bypass. Moreover, we found differences between NGT and T2DM subjects at baseline, which enable us to better be able to dissect the subsequent effects of the procedures. To our surprise, and in contrast to previous studies, we observed no additional effect of the RYGB as compared to calorie restriction, on our main outcome parameters: postprandial glucose, insulin and the gut peptide levels three weeks after surgery. Furthermore, both restrictive and RYGB induced weight loss resulted in comparable effects on the lipidome, circulating thyroid hormone levels and the autonomic nervous system. For these outcome parameters, it seems that calorie restriction is the common denominator of the effect of the different weight loss strategies on the short term. Clearly distinct effects of RYGB, however, were seen on bile salt, FGF21 and glucagon levels in response to food intake. Although neither the exact mechanisms, nor the eventual metabolic effect are as yet clear, the gut-liver-pancreas axis may be an important mediator of the effect of the RYGB

• Roux-en-Y gastric bypass surgery
• Calorie restriction
• Diabetes
• Obesity

• All authors: Lips, M.A.
• Supervisor: Pijl, H.; Willems Van Dijk, J.A.P.
• Co-supervisor: Groot, G.H. de
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2014-10-09
• ISBN (print): 9789462592841
• Sponsorship: NOK, Johnson & Johnson, NovoNordisk, Goodlife, Chipsoft