Lipid metabolism and production of incretins in patients with obesity and type 2 diabetes mellitus after biliopancreatic diversion in Hess-Marceau modification at the early stages of follow-up

Abstract


Objectives: To study the lipid metabolism and secretion of GLP-1 and GIP in obese patients with type 2 diabetes before and 3 months after biliopancreatic diversion (BPD) in Hess-Marceau modification.

Materials and methods: 22 patients (44 [38.0; 55.0] years) with morbid obesity (BMI of 50.1 [41.3; 53.8]) and type 2 diabetes were included in the study. Total cholesterol, LDL-C, HDL-C, TG, GLP-1, GIP were evaluated before and 3 months after BPD.

Results: At 3 months after BPD there were decreases in weight by 15.8% and a reduction in total cholesterol levels and LDL-C, an increase in the number of patients with a target value of total cholesterol and LDL-C (from 4/22 (18%) to 20/22 (91%, p = 0.0001)). TG levels during the first 3 months after BPD did not change, but there was a trend to an increase in the number of patients with TG target levels (from 8/22 (32%) to 15/22 (68%, p = 0.058)). Due to the reduction of total cholesterol intake after malabsorbtive surgery, we saw a regular decrease in HDL-cholesterol. 3 months after BPD there was an increase in basal secretion of GLP-1 and GIP as compared to preoperative levels, and a strong positive association of the basal GIP with the HDL-C (r = 0,8, p = 0.007) and a strong negative association – with the atherogenic index (r = – 0,7, p = 0.009) at 3 weeks after surgery.

Conclusions: The majority of patients with obesity and type 2 diabetes as early as at 3 months after BPD in the modification by Hess-Marceau achieve a significant improvement in the parameters of lipid metabolism; expect positive impact of the GIP on lipid metabolism.


Ekaterina Ershova

Endocrinology Research Centre

Author for correspondence.
Email: yu99pol06@rambler.ru

Russian Federation к.м.н., врач-эндокринолог в отделении терапии с группой ожирения

Ekaterina Troshina

Endocrinology Research Centre

Email: troshina@inbox.ru

Russian Federation MD, PhD, prof

Yury Yashkov

The Center of Endosurgery and Lithotripsy

Email: yu@yashkov.ru
MD, PhD, prof

  1. Дедов И.И., Яшков Ю.И., Ершова Е.В. Инкретины и их влияние на течение сахарного диабета 2 типа у пациентов с морбидным ожирением после бариатрических операций. // Ожирение и метаболизм. – 2012. – Т. 9. – №2 – C. 3-10. [Dedov II, Yashkov YI, Ershova EV. Incretins and their influence on the course of type 2 diabetes in patients with morbid obesity after bariatric oper. Obesity and metabolism. 2012;9(2):3-10. (In Russ.)] doi: 10.14341/omet201223-10
  2. Ершова Е.В., Яшков Ю.И. Состояние углеводного и липидного обмена у пациентов с ожирением и сахарным диабетом 2 типа после билиопанкреатического шунтирования // Ожирение и метаболизм. – 2013. – Т. 10. – №3 – C. 28-36. [Ershova EV, Yashkov YI. Status of carbohydrate and lipid metabolism in obese patients with type 2 diabetes mellitus after biliopancreatic diversion surgery. Obesity and metabolism. 2013;10(3):28-36.(In Russ.)] doi: 10.14341/2071-8713-3862
  3. Климов А.Н. Превентивная кардиология. Под ред. Косицкого Г.Н. – М.:Медицина;1977. [Klimov AN. Preventivnaya kardiologiya. Ed by Kositskiy G.N. Moscow: Medicine;1977. (In Russ.)]
  4. Лебедев Л.В., Седлецкий Ю.И. Хирургическое лечение ожирения и гиперлипидемий. Л.: Медицина;1987. [Lebedev LV, Sedletskiy YI. Khirurgicheskoe lechenie ozhireniya i giperlipidemiy. Lipetsk: Medicine;1987. (In Russ.)]
  5. Мирчук К.К. Частичное илеошунтирование в лечении гиперлипопротеинемий. // Клиническая медицина. – 1992. – Т. 1. – С.16-19. [Mirchuk KK. Chastichnoe ileoshuntirovanie v lechenii giperlipoproteinemiy. Klinicheskaya meditsina. 1992;1:16-19. (In Russ.)]
  6. Яшков Ю.И., Михайлов Ю.Е., Шишло Л.А., и др. Липидный «профиль» у больных с ожирением, перенесших вертикальную гастропластику. // Вестник хирургии им. И.И. Грекова. – 1999. – Т. 6. – № 158. – С. 27-31. [Yashkov YI, Mikhaylov YE., Shishlo LA, et al. Lipidnyy «profil’» u bol’nykh s ozhireniem, perenesshikh vertikal’nuyu gastroplastiku. Vestnik khirurgii im. I.I. Grekova. 1999;6(158):27-31. (In Russ.)]
  7. Яшков Ю.И., Никольский А.В., Бекузаров Д.К., и др. Cемилетний опыт применения операции билиопанкреатического отведения в модификации Hess – Marceau в лечении морбидного ожирения и сахарного диабета 2 типа. // Ожирение и метаболизм. 2012. – Т. 9. – №2 – C. 43-48. [Yashkov YI, Nikol’skiy AV, Bekuzarov DK, et al. A 7-year experience with the surgery of biliopancreatic diversion in the modification of Hess-Marceau for the treatment of morbid obesity and type 2 diabetes. Obesity and metabolism. 2012;9(2):43-48. (In Russ.)] doi: 10.14341/omet2012243-48
  8. Яшков Ю.И., Никольский А.В., Карпова Е.В., и др. Эффективность билиопанкреатического шунтирования в модификации Hess-Marceau у больных сахарным диабетом 2 типа, сочетающимся с ожирением. // Ожирение и метаболизм. – 2008. – Т. 5. – №4 – C. 42-48. [Yashkov YI, Nikol’skiy AV, Karpova EV, Bekuzarov DK, Sineokaya MS. Effektivnost’ biliopankreaticheskogo shuntirovaniya v modifikatsii Hess-Marceau u bol’nykh sakharnym diabetom 2 tipa, sochetayushchimsya s ozhireniem. Obesity and metabolism. 2008;5(4):42-48. (In Russ.)]doi: 10.14341/2071-8713-5226
  9. Bailey CJ, Wilkes LC, Conlon JM, et al. Effects of gastric inhibitory polypeptide, vasoactive intestinal polypeptide and peptide histidine isoleucine on the secretion of hormones by isolated mouse pancreatic islets. J Endocrinol. 1990;125(3):375-379. doi: 10.1677/joe.0.1250375.
  10. Buchwald H. Intestinal bypass for hypercholesterolemia. In: Nylus L.M., Baker R.S. editors Mastery of surgery, vol.3, Boston: LittleBrown; 1984: 901-07.
  11. Buchwald H. Lowering of Cholesterol Absorption and Blood Levels by Ileal Exclusion: Experimental Basis and Preliminary Clinical Report. Circulation. 1964;29(5):713-720. doi: 10.1161/01.cir.29.5.713.
  12. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: A systematic review and meta-analysis. Surgery. 2007;142(4):621-635. doi: 10.1016/j.surg.2007.07.018.
  13. Buchwald H, Stoller DK, Campos CT, et al. Partial Ileal Bypass for Hypercholesterolemia. Ann Surg. 1990;212(3):318-331. doi: 10.1097/00000658-199009000-00010.
  14. Buse JB, Caprio S, Cefalu WT, et al. How Do We Define Cure of Diabetes? Diabetes Care. 2009;32(11):2133-2135. doi: 10.2337/dc09-9036.
  15. Drucker DJ. The role of gut hormones in glucose homeostasis. J Clin Invest. 2007;117(1):24-32. doi: 10.1172/jci30076.
  16. Elahi D, Meneilly G, Minaker K, et al. Regulation of hepatic glucose production by gastric inhibitory polypeptide in man. Can J PhysiolPharmacol. 1986; 65: 18.
  17. Ettinger JEMTM, Marcílio de Souza CA, Santos-Filho PV, et al. Rhabdomyolysis: Diagnosis and Treatment in Bariatric Surgery. Obes Surg. 2007;17(4):525-532. doi: 10.1007/s11695-007-9091-5.
  18. Friedwald W., Levy R., Fredrickson D. Clin. Chem. 1972; 18: 499-502.
  19. de Dios García-Díaz J, Lozano O, Ramos JC, et al. Changes In Lipid Profile after Biliopancreatic Diversion. Obes Surg. 2003;13(5):756-760. doi: 10.1381/096089203322509345.
  20. Holst JJ. On the Physiology of GIP and GLP-1. Horm Metab Res. 2004;36(11/12):747-754. doi: 10.1055/s-2004-826158.
  21. Fried M., Yumuk V., Oppert J. et al. International Federation for the Surgery of Obesity and Metabolic Disorders – European Chapter (IFSO – EC) and European Association for the Study of Obesity (EASO). Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014; 24(1): 42-55.
  22. Noya G, Cossu ML, Coppola M, et al. Biliopancreatic Diversion Preserving the Stomach and Pylorus in the Treatment of Hypercholesterolemia and Diabetes Type II: Results in the First 10 cases. Obes Surg. 1998;8(1):67-72. doi: 10.1381/096089298765555088.
  23. Scopinaro N, Marinari GM, Camerini GB, et al. Specific Effects of Biliopancreatic Diversion on the Major Components of Metabolic Syndrome: A long-term follow-up study. Diabetes Care. 2005;28(10):2406-2411. doi: 10.2337/diacare.28.10.2406.

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