Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids
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CONTEXT: It has been hypothesized that increased plasma bile acids (BAs) contribute to metabolic improvements after Roux-en-Y gastric bypass (RYGB) surgery by the G protein-coupled receptor TGR5-mediated effects on glucagon-like peptide-1 secretion and thyroid hormones. OBJECTIVE: The objective of this study was to evaluate the importance of bariatric surgery-induced alterations in BA physiology on factors that regulate glucose homeostasis (insulin secretion and sensitivity) and energy metabolism (resting energy expenditure and thyroid hormone axis). DESIGN, PARTICIPANTS, INTERVENTION, AND MAIN OUTCOME MEASURE: Eighteen extremely obese subjects were studied before and after 20% weight loss, induced by either laparoscopic adjustable gastric banding (LAGB) (n = 10) or RYGB surgery (n = 8). RESULTS: Plasma BAs more than doubled after RYGB [fasting: 1.08 (0.26-1.42) to 2.28 (1.59-3.28) μmol/L, P = .03; postprandial: 2.46 ± 1.59 to 6.00 ± 2.75 μmol/L, P = .01] but were either lower or did not change after LAGB [fasting: 1.80 (1.49-2.19) to 0.92 (0.73-1.15) μmol/L, P = .02; postprandial: 3.71 ± 2.61 to 2.82 ± 1.75 μmol/L, P = .14]. Skeletal muscle expression of TGR5 targets, Kir6.2 and cyclooxygenase IV, increased after RYGB but not LAGB. Surgery-induced changes in BAs were associated with increased peak postprandial plasma glucagon-like peptide-1 (r(2) = 0.509, P = .001) and decreased serum TSH (r(2) = 0.562, P < .001) but did not correlate with the change in insulin response to a meal (r(2) = 0.013, P = .658), insulin sensitivity (assessed as insulin stimulated glucose disposal during a hyperinsulinemic-euglycemic clamp procedure) (r(2) = 0.001, P = .995), or resting energy expenditure (r(2) = 0.004, P = .807). CONCLUSIONS: Compared with LAGB, RYGB increases circulating BAs and TGR5 signaling, but this increase in BAs is not a significant predictor of changes in glucose homeostasis or energy metabolism.
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Increased circulating levels of primary and secondary bile acids have been observed after RYGB.
“Increased circulating levels of primary and secondary bile acids have been observed after RYGB (Ahmad et al., 2013; Glicksman et al., 2010; Kohli et al., 2013; Patti et al., 2009) and have been linked to increased GLP-1 and reduced glucose and triglyceride levels (Nakatani et al., 2009; Patti et al., 2009; Pournaras et al., 2012; Simonen et al., 2012).”
From Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation (2015) · cites this paper as Kohli et al., 2013
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References 20 · Cited by 265
- Authors
- Kohli, R., Bradley, D., Setchell, K. D., Eagon, J. C., Abumrad, N., & Klein, S.
- Affiliations
- Division of Gastroenterology, Hepatology, and Nutrition (R.K.), Cincinnati, Ohio 45229
- Washington University in St. Louis (US)
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Klein, Samuel
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-04-01
- Volume
- 98
- Issue
- 4
- Pages
- E708-E712
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3615197
- OpenAlex
- W2027954881
- Cited by
- 265
- References
- 20
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 13 · 2022: 14 · 2021: 15 · 2020: 18 · 2019: 30 · 2018: 19 · 2017: 40 · 2016: 31 · 2015: 42 · 2014: 18 · 2013: 10
- FWCI
- 33.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk060022-19, UL1TR000448, DK56341, RR024992, UL1‐RR024992)
- National Heart, Lung, and Blood Institute (T32HL007456)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK084310, DK37948, DK56341, K08DK084310, R01DK037948, U01 DK08505, R01-DK-060022, P30DK056341, P30DK020579)
- National Center for Research Resources (UL1RR024992)
- Ethicon Endo-Surgery
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, bariatric surgery, bile acids, TGR5, glucagon-like peptide-1, thyroid-stimulating hormone, insulin sensitivity, insulin secretion, resting energy expenditure, Kir6.2, obesity, weight loss, glucose homeostasis
- MeSH terms
- Adult, Anastomosis, Roux-en-Y, Bile Acids and Salts, Energy Metabolism, Fasting, Female, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Rest, Gastric Bypass, Gastroplasty, Weight Loss, Up-Regulation, Postprandial Period
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