title: Effect of Weight Loss by Diet or Gastric Bypass Surgery on Peptide YY3–36 Levels Laparoscopic Roux-En-Y Gastric Bypass: Significant Long-Term Weight Loss, Improvement of Obesity-Related Comorbidities and Quality of Life Weight Loss, Appetite Suppression, and Changes in Fasting and Postprandial Ghrelin and Peptide-YY Levels After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Prospective, Double Blind Study Early weight regain after gastric bypass does not affect insulin sensitivity but is associated with higher ghrelin levels Role of the foregut in the early improvement in glucose tolerance and insulin sensitivity following Roux-en-Y gastric bypass surgery. Circulating ghrelin levels are decreased in human obesity. Superior appetite hormone profile after equivalent weight loss by gastric bypass compared to gastric banding. Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial.
abstract: Objective : To examine the effect of an equivalent weight loss , by gastric bypass surgery ( GBP ) or by diet , on peptide YY3–36 ( PYY3–36 ) , ghrelin , and leptin levels and to determine the effect of diabetes status on PYY3–36 levels . Summary Background Data : The increased PYY3–36 levels after GBP may be involved in the magnitude and the sustainability of weight loss after surgery . Methods : Of the 30 morbidly obese women who participated in the study , 21 had type 2 diabetes mellitus , and were studied before and after equivalent weight loss of 10 kg by either GBP ( n = 11 ) or by diet ( n = 10 ) . Results : PYY3–36 levels were higher in obese diabetic as compared with nondiabetic individuals ( 64.1 ± 34.4 pg/mL vs. 39.9 ± 21.1 pg/mL ; P < 0.05 ) . PYY3–36 levels increased markedly in response to oral glucose after GBP ( peak : 72.3 ± 20.5 pg/mL–132.7 ± 49.7 pg/mL ; P < 0.001 ; AUC0–180 : 51.5 ± 23.3 pg/mL.min−1–91.1 ± 32.2 pg/mL.min−1 P < 0.001 ) , but not after diet ( peak : 85.5 ± 51.9 pg/mL–84.8 ± 41.13 pg/mL ; P = NS ; AUC0–180 : 68.3 ± 38.5 pg/mL.min−1–61.1 ± 42.2 pg/mL.min−1 P = NS ) . Fasting ghrelin levels increased after diet ( 425 ± 91 pg/mL–519 ± 105 pg/mL ; P < 0.05 ) , but did not change after GBP ( 506 ± 121 pg/mL–482 ± 196 pg/mL ; P = NS ) . Conclusions : Diabetes status seems to be a determinant of PYY3–36 levels . GBP , but not diet-induced weight loss , result ed in markedly increased glucose-stimulated PYY3–36 levels . The increase in stimulated PYY3–36 levels after GBP is likely a result of the surgery rather than a secondary outcome of weight loss . Changes in PYY3–36 levels and ghrelin could contribute to the success of GBP in sustaining weight loss Objective : To present long-term results of a large series of patients su bmi tted to laparoscopic Roux-en-Y gastric bypass ( RYGBP ) for morbid obesity . Background : Reports on long-term results of RYGBP are scarce and focus primarily on weight loss . Our aim is to provide mid- to long-term data of RYGBP , with detailed results on weight loss , evolution of comorbidities and quality of life , also using the BAROS score . Methods : All patients who underwent a primary RYGBP for morbid obesity in our 2 hospitals between 1999 and August 2008 were included . Data were collected prospect ively in a computerized data base , and review ed for the purpose of this study . Results : A total of 379 patients were included in the analysis of long-term results , 282 women , and 97 men , with a mean BMI of 46.3 kg/m2 . After 5 years , 74.9 % of the patients achieved an excess weight loss of at least 50 % , with a mean of 62.7 % and 76.8 % achieved a BMI < 35 kg/m2 . The corresponding figures after 7 years were 64.9 , 58.1 , and 71.9 , respectively . There was a small but significant long-term weight regain . All comorbidities improved markedly in the vast majority of patients , with no significant difference between the 3- and 5-year terms . Quality of life also improved markedly , and more than 95 % of the patients had a good to excellent 5-year overall result according to the BAROS score . Conclusions : Laparoscopic RYGBP for morbid obesity results in good and maintained weight loss up to 7 years in the majority of patients , improves quality of life and markedly improves all the evaluated comorbidities , result ing in good to excellent overall 5-year results in 97 % of the patients according to the BAROS score Background : Bariatric surgery is currently the most effective treatment in morbidly obese patients , leading to durable weight loss . Objective : In this prospect i ve double blind study , we aim to evaluate and compare the effects of  laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) with laparoscopic sleeve gastrectomy ( LSG )  on body weight , appetite , fasting , and postpr and ial ghrelin and peptide-YY ( PYY ) levels . Methods : After r and omization , 16 patients were assigned to LRYGBP and 16 patients to LSG .  Patients were reevaluated on the 1st , 3rd , 6th , and 12th postoperative month . Blood sample s were collected after an overnight fast and in 6 patients in each group after a st and ard 420 kcal mixed meal . Results : Body weight and body mass index ( BMI ) decreased markedly ( P < 0.0001 ) and comparably after either procedure . Excess weight loss was greater after LSG at 6 months ( 55.5 % ± 7.6 % vs. 50.2 % ± 6.5 % , P = 0.04 ) and 12 months ( 69.7 % ± 14.6 % vs. 60.5 % ± 10.7 % , [ P = 0.05 ] ) . After LRYGBP fasting ghrelin levels did not change significantly compared with baseline ( P = 0.19 ) and did not decrease significantly after the test meal . On the other h and , LSG was followed by a marked reduction in fasting ghrelin levels ( P < 0.0001 ) and a significant suppression after the meal . Fasting PYY levels increased after either surgical procedure ( P ≤ 0.001 ) . Appetite decreased in both groups but to a greater extend after LSG . Conclusion : PYY levels increased similarly after either procedure . The markedly reduced ghrelin levels in addition to increased PYY levels after LSG , are associated with greater appetite suppression and excess weight loss compared with LRYGBP Objectives We sought to determine : 1 ) if early weight regain between one and two years after RYGB is associated with worsened hepatic and peripheral insulin sensitivity , and 2 ) if preoperative levels of ghrelin and leptin are associated with early weight regain after RYGB . Design and Methods Hepatic and peripheral insulin sensitivity and ghrelin and leptin plasma levels were assessed longitudinally in 45 subjects before RYGB  and at one month , six months , one year , and two years post operatively . Weight regain was defined as ≥ 5 % increase in body weight between one and two years after RYGB . Results Weight regain occurred in 33 % of subjects , with an average increase in body weight of 10 ± 5 % ( 8.5 ± 3.3 kg ) . Weight regain was not associated with worsening of peripheral or hepatic insulin sensitivity . Subjects with weight regain after RYGB had higher preoperative and postoperative levels of ghrelin compared to those who maintained or lost weight during this time . Conversely , the trajectories of leptin levels corresponded with the trajectories of fat mass in both groups . Conclusions Early weight regain after RYGB is not associated with a reversal of improvements in insulin sensitivity . Higher preoperative ghrelin levels might identify patients that are more susceptible to weight regain after RYGB Bypass of the foregut following Roux-en-Y gastric bypass ( RYGB ) surgery results in altered nutrient absorption , which is proposed to underlie the improvement in glucose tolerance and insulin sensitivity . We conducted a prospect i ve crossover study in which a mixed meal was delivered orally before RYGB ( gastric ) and both orally ( jejunal ) and by gastrostomy tube ( gastric ) postoperatively ( 1 and 6 wk ) in nine subjects .  Glucose , insulin , and incretin responses were measured , and whole-body insulin sensitivity was estimated with the insulin sensitivity index composite . RYGB result ed in an improved glucose , insulin , and glucagon-like peptide-1 ( GLP-1 ) area under the curve ( AUC ) in the first 6 wk postoperatively ( all P ≤ 0.018 ) ; there was no effect of delivery route ( all P ≥ 0.632 ) or route × time interaction ( all P ≥ 0.084 ) . The glucose-dependent insulinotropic polypeptide ( GIP ) AUC was unchanged after RYGB ( P = 0.819 ) ; however , GIP levels peaked earlier after RYGB with jejunal delivery . The ratio of insulin AUC to GLP-1 and GIP AUC decreased after surgery ( P = .001 and 0.061 , respectively ) without an effect of delivery route over time ( both P ≥ 0.646 ) . Insulin sensitivity improved post-RYGB ( P = 0.001 ) with no difference between the gastric and jejunal delivery of the mixed meal over time ( P = 0.819 ) . These data suggest that exclusion of nutrients from the foregut with RYGB does not improve glucose tolerance or insulin sensitivity . However , changes in the foregut response post-RYGB due to lack of nutrient exposure can not be excluded . Our findings suggest that foregut bypass may alter the incretin response by enhanced nutrient delivery to the hindgut Ghrelin is a novel endogenous natural lig and for the growth hormone ( GH ) secretagogue receptor that has recently been isolated from the rat stomach . Ghrelin administration stimulates GH secretion but also causes weight gain by increasing food intake and reducing fat utilization in rodents . To investigate the possible involvement of ghrelin in the pathogenesis of human obesity , we measured body composition ( by dual X-ray absorption ) as well as fasting plasma ghrelin concentrations ( radioimmunoassay ) in 15 Caucasians ( 8 men and 7 women , 31+/-9 years of age , 92+/-24 kg body wt , and 29+/-10 % body fat , mean + /- SD ) and 15 Pima Indians ( 8 men and 7 women , 33+/-5 years of age , 97+/-29 kg body wt , and 30+/-8 % body fat ) .  Fasting plasma ghrelin was negatively correlated with percent body fat ( r = -0.45 ; P = 0.01 ) , fasting insulin ( r = -0.45 ; P = 0.01 ) and leptin ( r = -0.38 ; P = 0.03 ) concentrations . Plasma ghrelin concentration was decreased in obese Caucasians as compared with lean Caucasians ( P < 0.01 ) . Also , fasting plasma ghrelin was lower in Pima Indians , a population with a very high prevalence of obesity , compared with Caucasians ( 87+/-28 vs. 129+/-34 fmol/ml ; P < 0.01 ) . This result did not change after adjustment for fasting plasma insulin concentration . There was no correlation between fasting plasma ghrelin and height . Prospect i ve clinical studies are now needed to establish the role of ghrelin in the pathogenesis of human obesity The goal of this study was to underst and the mechanisms of greater weight loss by  gastric bypass ( GBP )  compared to gastric b and ing ( GB ) surgery .  Obese weight- and age-matched subjects were studied before ( T0 ) , after a 12 kg weight loss ( T1 ) by GBP ( n = 11 ) or GB ( n = 9 ) , and at 1 year after surgery ( T2 ) . peptide YY(3 - 36 ) ( PYY(3 - 36 ) ) , ghrelin , glucagon-like peptide-1 ( GLP-1 ) , leptin , and amylin were measured after an oral glucose challenge . At T1 , glucose-stimulated GLP-1 and PYY levels increased significantly after GBP but not GB . Ghrelin levels did not change significantly after either surgery . In spite of equivalent weight loss , leptin and amylin decreased after GBP , but not after GB . At T2 , weight loss was greater after GBP than GB ( P = 0.003 ) . GLP-1 , PYY , and amylin levels did not significantly change from T1 to T2 ; leptin levels continued to decrease after GBP , but not after GB at T2 . Surprisingly , ghrelin area under the curve ( AUC ) increased 1 year after GBP ( P = 0.03 ) . These data show that , at equivalent weight loss , favorable GLP-1 and PYY changes occur after GBP , but not GB , and could explain the difference in weight loss at 1 year . Mechanisms other than weight loss may explain changes of leptin and amylin after GBP BACKGROUND Sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGB ) cause weight loss and metabolic improvement , but results of published studies are contradictory . OBJECTIVES The aim of this study was to compare the effects of SG and RYGB on ghrelin , leptin , and glucose homeostasis in a r and omized controlled trial . SETTING University hospital , Pol and . METHODS Seventy-two morbidly obese patients were r and omly selected to undergo either SG ( n = 36 ) or RYGB ( n = 36 ) .  Fasting ghrelin , leptin , glucose , insulin , C-peptide , glucagon , glycated hemoglobin , and homeostasis model assessment of insulin resistance were assessed preoperatively and at 1 , 6 , and 12 months postoperatively . No differences were found in anthropometric and biochemical parameters between the study groups at baseline . RESULTS Sixty-nine ( 95.8 % ) patients completed the study .  Percentage of excess weight loss at 12 months was 67.6±19.3 % after SG and 64.2±18.5 % after RYGB ( P>.05 ) . Fasting ghrelin levels decreased 1 month after SG ( from 76.8 pmol/L to 35.3 pmol/L ; P<.05 ) and remained reduced until 12 months ( 41.6 pmol/L ; P<.05 ) but increased 12 months after RYGB from 74.6 pmol/L to 130.2 pmol/L ( P<.05 ) . Leptin , glucose , insulin , and C-peptide concentrations and glycated hemoglobin and homeostasis model assessment of insulin resistance values decreased significantly in both groups during 12 months . CONCLUSIONS RYGB and SG induce comparable weight loss and improvement in metabolism of glucose . Ghrelin levels decrease after SG and increase after RYGB , but this difference does not affect similar outcomes of these procedures during 1-year follow-up . The contribution of ghrelin to weight loss or metabolic benefits after bariatric surgery is not straightforward , but rather influenced by multiple factors
target: Meta-regression showed that gastric pouch volume , alimentary limb length and biliopancreatic limb length were not associated with changes in ghrelin levels .
  Conclusion Fasting total ghrelin levels decreased in the short term ( ≤ 3 months ) and increased in the long term ( > 3 months ) after RYGB
background: Background Roux-en-Y gastric bypass ( RYGB ) is considered effective for weight loss and for treatment of many obesity-related metabolic diseases .
  Ghrelin is an essential orexigenic peptide that plays an indispensable role in controlling body weight and energy homeostasis of post-operative patients .
  This systematic review and meta- analysis aim ed to investigate changes in the level of fasting total ghrelin following RYGB .