Small Intestinal Length Associates with Serum Triglycerides Before and After LRYGB

Overview

Journal Obes Surg

Date 2018 Aug 15

PMID 30105660

Citations 3

Authors

Pirjo Kakela

Ville Mannisto

Maija Vaittinen

Sari Venesmaa

Vesa Karja

Kirsi Virtanen

Hannu Paajanen

Jussi Pihlajamaki

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Different bariatric procedures have been associated with variable weight loss and decrease in serum levels of lipids and lipoproteins. This variation could be partly related to the length of the small intestinal bypass. We evaluated the association of the small intestinal length with the non-alcoholic fatty liver disease (NAFLD) at baseline and with lipid metabolism before and after laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods: Seventy consecutive morbidly obese patients were recruited to this prospective study. A standard 60-cm biliopancreatic limb (BPL) and 120-cm alimentary limb (AL) was performed, and thereafter, the common channel (CC) length was measured during elective LRYGB. Histological analysis of liver biopsy to diagnose NAFLD was performed. The mRNA expression of genes participating in the cholesterol and fatty acid metabolism in the liver was analyzed.

Results: Female sex (p = 0.006), serum triglycerides (TG, p = 0.016), serum alanine aminotransferase (ALT, p = 0.007), and liver steatosis (p = 0.001) associated with the small intestinal length (BPL + AL + CC) at baseline. Association remained significant between levels of serum TG and CC length (p = 0.048) at 1-year follow-up. Liver mRNA expression of genes regulating cholesterol synthesis and bile metabolism did not associate with the baseline small intestinal length.

Conclusions: Our findings support the suggestions that small intestinal length regulates TG metabolism before and after LRYGB. Therefore, modification of the length of bypassed small intestine based on measured total small intestinal length could optimize the outcomes of the elective LRYGB.

Citing Articles

Early effects of Roux-en-Y gastric bypass on dietary fatty acid absorption and metabolism in people with obesity and normal glucose tolerance.

Hindso M, Bojsen-Moller K, Kristiansen V, Holst J, van Hall G, Madsbad S Int J Obes (Lond). 2022; 46(7):1359-1365.

PMID: 35459799 DOI: 10.1038/s41366-022-01123-1.

The Importance of Intestinal Length in Triglyceride Metabolism and in Predicting the Outcomes of Comorbidities in Laparoscopic Roux-en-Y Gastric Bypass-a Narrative Review.

Kakela P, Rantanen T, Virtanen K Obes Surg. 2021; 31(7):3291-3295.

PMID: 33914241 PMC: 8175306. DOI: 10.1007/s11695-021-05421-x.

Proximal Roux-en-Y gastric bypass: Addressing the myth of limb length.

Ahmed B, King W, Gourash W, Hinerman A, Belle S, Pomp A Surgery. 2019; 166(4):445-455.

PMID: 31378475 PMC: 6778033. DOI: 10.1016/j.surg.2019.05.046.

References

Valera-Mora M, Simeoni B, Gagliardi L, Scarfone A, Nanni G, Castagneto M . Predictors of weight loss and reversal of comorbidities in malabsorptive bariatric surgery. Am J Clin Nutr. 2005; 81(6):1292-7. DOI: 10.1093/ajcn/81.6.1292. View

Lewis M, Phillips M, Slavotinek J, Kow L, Thompson C, Toouli J . Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006; 16(6):697-701. DOI: 10.1381/096089206777346682. View

Yki-Jarvinen H . Nutritional Modulation of Non-Alcoholic Fatty Liver Disease and Insulin Resistance. Nutrients. 2015; 7(11):9127-38. PMC: 4663582. DOI: 10.3390/nu7115454. View

Sovik T, Aasheim E, Taha O, Engstrom M, Fagerland M, Bjorkman S . Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Intern Med. 2011; 155(5):281-91. DOI: 10.7326/0003-4819-155-5-201109060-00005. View

Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G . Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015; 386(9997):964-73. DOI: 10.1016/S0140-6736(15)00075-6. View

Pinheiro J, Schiavon C, Pereira P, Correa J, Noujaim P, Cohen R . Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis. 2008; 4(4):521-5. DOI: 10.1016/j.soard.2007.12.016. View

Jammah A . Endocrine and metabolic complications after bariatric surgery. Saudi J Gastroenterol. 2015; 21(5):269-77. PMC: 4632250. DOI: 10.4103/1319-3767.164183. View

Guzman I, Fitch L, VARCO R, Buchwald H . Small bowel length in hyperlipidemia and massive obesity. Am J Clin Nutr. 1977; 30(7):1006-8. DOI: 10.1093/ajcn/30.7.1006. View

Johnson W, DeMaria E . Surgical treatment of obesity. Curr Treat Options Gastroenterol. 2006; 9(2):167-74. DOI: 10.1007/s11938-006-0035-2. View

10.

Colquitt J, Pickett K, Loveman E, Frampton G . Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014; (8):CD003641. PMC: 9028049. DOI: 10.1002/14651858.CD003641.pub4. View

11.

Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N . Bariatric Surgery Worldwide 2013. Obes Surg. 2015; 25(10):1822-32. DOI: 10.1007/s11695-015-1657-z. View

12.

Hosseinpour M, Behdad A . Evaluation of small bowel measurement in alive patients. Surg Radiol Anat. 2008; 30(8):653-5. DOI: 10.1007/s00276-008-0398-2. View

13.

Puri P, Baillie R, Wiest M, Mirshahi F, Choudhury J, Cheung O . A lipidomic analysis of nonalcoholic fatty liver disease. Hepatology. 2007; 46(4):1081-90. DOI: 10.1002/hep.21763. View

14.

Tacchino R . Bowel length: measurement, predictors, and impact on bariatric and metabolic surgery. Surg Obes Relat Dis. 2015; 11(2):328-34. DOI: 10.1016/j.soard.2014.09.016. View

15.

Rubino F, Rbibo S, Del Genio F, Mazumdar M, McGraw T . Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Nat Rev Endocrinol. 2010; 6(2):102-9. PMC: 2999518. DOI: 10.1038/nrendo.2009.268. View

16.

Abdeen G, le Roux C . Mechanism Underlying the Weight Loss and Complications of Roux-en-Y Gastric Bypass. Review. Obes Surg. 2015; 26(2):410-21. PMC: 4709370. DOI: 10.1007/s11695-015-1945-7. View

17.

Lee G, Cha Y . Cardiovascular benefits of bariatric surgery. Trends Cardiovasc Med. 2016; 26(3):280-9. DOI: 10.1016/j.tcm.2015.07.006. View

18.

Odstrcil E, Martinez J, Santa Ana C, Xue B, Schneider R, Steffer K . The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass. Am J Clin Nutr. 2010; 92(4):704-13. DOI: 10.3945/ajcn.2010.29870. View

19.

Puri P, Wiest M, Cheung O, Mirshahi F, Sargeant C, Min H . The plasma lipidomic signature of nonalcoholic steatohepatitis. Hepatology. 2009; 50(6):1827-38. PMC: 5031239. DOI: 10.1002/hep.23229. View

20.

Simonen P, Kotronen A, Hallikainen M, Sevastianova K, Makkonen J, Hakkarainen A . Cholesterol synthesis is increased and absorption decreased in non-alcoholic fatty liver disease independent of obesity. J Hepatol. 2010; 54(1):153-9. DOI: 10.1016/j.jhep.2010.05.037. View