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Bariatric Surgery

Biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) result in distinct post-prandial hormone profiles

International Journal of Obesity volume 43, pages 2518–2527 (2019)Cite this article

Subjects

Abstract

Background/objective

Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric intervention to treat morbid obesity and related disorders. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a new bariatric procedure devised with the purpose of simplifying the complexity of the BPD-DS technique while maintaining its efficacy. However, whether BPD-DS and SADI-S result in similar fasting and post-prandial hormone profiles has not yet been studied. Therefore, the purpose of this study was to assess and compare the hormone response to a standardized mixed meal in subjects operated with BPD-DS or SADI-S.

Subjects/methods

Subjects submitted to BPD-DS (n = 9) or SADI-S (n = 9) 1.5 years earlier on average, with no past nor current diabetes diagnosis underwent a liquid mixed-meal tolerance test (MMTT) to assess the baseline and post-prandial profile of glucose, enteropancreatic hormones and total bile acids.

Results

Fasting glucose, enteropancreatic hormones and total bile acids levels after BPD-DS and SADI-S were similar. After the MMTT, the response of subjects who underwent SADI-S was characterized by higher glucose (t = 30 min: p < 0.05; iAUC: 156.1 ± 46.2 vs. 103.4 ± 35.8 mmol/L × min, p = 0.02), GLP-1 (t = 30 min: p < 0.05; iAUC: 5388 ± 3010 vs. 2959.0 ± 2146 pmol/L × min, p = 0.02), glucagon (t = 30 min: p < 0.05; iAUC: 678.7 ± 295.2 vs. 376.9 ± 215.7 pmol/L × min, p = 0.02), insulin (t = 30 and 45 min: p < 0.05); and C-peptide levels (t = 30 and 45 min: p < 0.05), when compared to BPD-DS.

Conclusions

The post-prandial hormone secretion profile after SADI-S is characterized by increased GLP-1, glucagon and insulin secretion, when compared to BPD-DS, which suggests the existence of different endocrine driven mechanisms leading to weight loss and metabolic improvement after the two procedures.

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Acknowledgements

Authors would like to thank the Senior Nurse Sandra Tavares (Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal) for her technical assistance during the MMTT; and Lene Brus Albaek (Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark), and Lene Ravn (Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark) for their technical assistance with assays.

Funding:

UMIB is funded by grants from Foundation for Science and Technology (FCT) Portugal (UID/ Multi/00215/2013 and UID/MULTI/0215/2016). JJH holds an unrestricted grant from the NNF Center for Basic Metabolic Research, Copenhagen, Denmark. The NNF Center for Basic Metabolic Research is an independent research institution at the University of Copenhagen, Denmark.

Author contributions:

Conceived and designed the experiments: MG, MN, JJH, MPM; performed the experiments: SSP, MG, RA, AMP, CBL, BH, MN, LH; analyzed data: SSP, CBL, BH; contributed reagents/materials/analysis tools: LH, JJH, MN, MMP; discussed the results and implications: SSP, MG, MN, JJH, MPM; wrote or reviewed the paper: SSP, MG, RA, AMP, CBL, BH, LH, JJH, MN, MPM. All authors have approved the final version of the manuscript.

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Authors and Affiliations

  1. Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal

    Sofia S. Pereira, Marta Guimarães, Carolina B. Lobato, Mário Nora & Mariana P. Monteiro

  2. Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal

    Sofia S. Pereira, Marta Guimarães, Carolina B. Lobato & Mariana P. Monteiro

  3. Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

    Marta Guimarães, Rui Almeida, Ana M. Pereira & Mário Nora

  4. Faculty of Health Sciences, Department of Biomedical Sciences, NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark

    Bolette Hartmann & Jens J. Holst

  5. Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Linda Hilsted

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Pereira, S.S., Guimarães, M., Almeida, R. et al. Biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) result in distinct post-prandial hormone profiles. Int J Obes 43, 2518–2527 (2019). https://doi.org/10.1038/s41366-018-0282-z

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