Effects of sleeve gastrectomy with jejuno-jejunal or jejuno-ileal loop on glycolipid metabolism in diabetic rats

Body roundness index trajectories in Chinese bariatric surgery patients: a retrospective longitudinal study

OBJECTIVE

To investigate the body roundness index (BRI) trajectory categories 12 months post-bariatric surgery and to explore the association between BRI and metabolic abnormalities.

DESIGN AND METHODS

Subject data were pooled from a tertiary hospital at baseline, 3 and 12 months post-surgery. Anthropometric measurements included the BRI and body mass index (BMI). Metabolic biomarkers comprised triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glucose (GLU), and uric acid (UA). The BRI level was categorized using growth mixture model, and a multilevel logistic regression model was employed to explore the relationship between BRI and metabolic risk.

RESULTS

A total of 669 patients were included in this study, comprising 286 males (42.8%) and 383 females (57.2%), with an average age of 31.70 ± 9.53 years (range of 18 to 65 years). Patients were classified into three BRI trajectory categories. Compared to the Low-gradual decline group, the High-rapid decline group had an increased risk of abnormal HDL-C (OR = 2.84 [95% CI, 1.73 ~ 4.67]), and had the highest proportion of sleeve gastrectomy plus jejunojejunal bypass (SG + JJB) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (P < 0.001); while the High-gradual decline group had increased risk of abnormal TG (OR = 3.28 [95%CI,1.67-6.42]), HDL-C (OR = 4.30 [95%CI, 2.31 ~ 8.00]), LDL-C (OR = 2.10 [95%CI, 1.12 ~ 3.93]), and UA (OR = 2.33 [95%CI, 1.33 ~ 4.10]). After adjusting for demographics, lifestyle factors, and surgical procedures, the distribution of risk outcomes remained primarily consistent.

CONCLUSIONS

Sleeve gastrectomy (SG) plus procedures could potentially be associated with improvements in abdominal obesity and metabolic status in patients with high BRI. The post-bariatric trajectories based on BRI may offer insights into the metabolic risk levels of Chinese bariatric patients, but further research is needed to confirm these findings.

A Rodent Model of Jejunal-Ileal Loop Bipartition (JILB): a Novel Malabsorptive Operation

BACKGROUND

We designed a novel malabsorptive procedure named as jejunal-ileal loop bipartition (JILB), in which a jejunal-ileal loop is created to reduce the effective length of food chyme passage in the small bowel, but without exclusion of any segment of the intestine. This study is to investigate the feasibility and efficacy of JILB on weight loss and glycemic control in obese diabetic mouse model.

METHODS

High-fat diet-induced C57BL/6 mice with typical obese and diabetic phenotypes were randomly divided into two groups according to the surgical procedure performed, including JILB (n = 8) and sham group (n = 8). Age-matched naïve C57BL/6 mice fed with rodent chow diet were adopted as normal controls. Body weight, food intake, fasting plasma glucose (FPG), fasting plasma insulin (FPI), and oral glucose tolerance test (OGTT) were measured in vivo before and 2, 4, and 8 weeks after surgery. Plasma glucagon-like peptide 1 (GLP-1) was assayed before and 15 min after oral glucose challenge at the 8th week postoperatively.

RESULTS

Comparing to the sham animals, JILB group consumed similar amount of food, but had lower body weight after surgery (P < 0.01). It led to significant lower FPG (p < 0.05) and improved glucose tolerance with lower FPI (p < 0.001). And GLP-1 secretion at 15 min after oral glucose challenge was higher than shams (P < 0.05). No intestinal obstruction was identified.

CONCLUSIONS

JILB is potentially a metabolic and bariatric procedure that leads to effective weight loss and diabetes remission in obese diabetic subjects.

Changes of Ghrelin/GOAT axis and mTOR pathway in the hypothalamus after sleeve gastrectomy in obese type-2 diabetes rats

AIM

To examine the changes of the ghrelin/ghrelin O-acyltransferase (GOAT) axis and the mammalian target of rapamycin (mTOR) pathway in the hypothalamus after sleeve gastrectomy.

METHODS

A total of 30 obese type-2 diabetes Sprague-Dawley (SD) rats, 6 wk of age, fed with high-sugar and high-fat fodder for 2 mo plus intraperitoneal injection of streptozotocin were randomly divided into three groups: non-operation group (S0 group, n = 10), sham operation group (Sh group, n = 10) and sleeve gastrectomy group (SG group, n = 10). Data of body mass, food intake, oral glucose tolerance test (OGTT), acylated ghrelin (AG) and total ghrelin (TG) were collected and measured at the first day (when the rats were 6 wk old), preoperative day 3 and postoperative week 8. The mRNA expression of preproghrelin, GOAT and neuropeptide Y (NPY), and protein expression of ghrelin, GOAT, GHSR and the mTOR pathway (p-Akt, p-mTOR and p-S6) were measured in the hypothalamus.

RESULTS

SG can significantly improve metabolic symptoms by reducing body mass and food intake. The obese rats showed lower serum TG levels and no change in AG, but the ratio of AG/TG was increased. When compared with the S0 and Sh groups, the SG group showed decreased TG (1482.03 ± 26.55, 1481.49 ± 23.30 and 1206.63 ± 52.02 ng/L, respectively, P < 0.05), but unchanged AG (153.06 ± 13.74, 155.37 ± 19.30 and 144.44 ± 16.689 ng/L, respectively, P > 0.05). As a result, the ratio of AG/TG further increased in the SG group (0.103 ± 0.009, 0.105 ± 0.013 and 0.12 ± 0.016, respectively, P < 0.05). When compared with the S0 group, SG suppressed mRNA and protein levels of preproghrelin (0.63 ± 0.12 vs 0.5 ± 0.11, P < 0.05) and GOAT (0.96 ± 0.09 vs 0.87 ± 0.08, P < 0.05), but did not change NPY mRNA expression (0.61 ± 0.04 vs 0.65 ± 0.07, P > 0.05) in the hypothalamus. The protein levels of p-Akt, p-mTOR and p-S6 were higher in the SG group, which indicated that the hypothalamic mTOR pathway was activated after SG at the postoperative week 8.

CONCLUSION

The reduction of ghrelin expression and activation of the mTOR pathway might have opposite effects on food intake, as SG improves obesity and T2DM.