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Improvements in glucose metabolism early after gastric bypass surgery are not explained by increases in total bile acids and fibroblast growth factor 19 concentrations

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CONTEXT: Bile acids and fibroblast growth factor 19 (FGF19) have been suggested as key mediators of the improvements in glucose metabolism after Roux-en-Y gastric bypass (RYGB).

OBJECTIVE: To describe fasting and postprandial state total bile acid (TBA) and FGF19 concentrations before and after RYGB and relate them to parameters of glucose metabolism, GLP-1, CCK and cholesterol fractions.

DESIGN & SETTING: Prospective descriptive study, performed at the Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark.

PATIENTS: 13 type 2 diabetic (T2D) patients and 12 normal glucose tolerant (NGT) subjects.

INTERVENTION: Four-hour liquid meal test performed before, 1 week, 3 months and 1 year after RYGB.

MAIN OUTCOME MEASURES: Fasting and postprandial TBA and FGF19 concentrations.

RESULTS: Fasting TBA concentrations decreased in NGT subjects (p<0.001) and were unchanged in T2D patients one week after surgery, but then increased gradually in both groups with time from surgery (ANOVA ptime<0.001). AUC TBA was decreased in NGT subjects 1 week after RYGB (pre: 567 mmol x min/L [481-826], 1wk: 419 [381-508], p=0.009) and unchanged in T2D patients (894 [573-1002], 695 [349-1147]; p=0.97) but then increased with time from surgery in both groups (ptime<0.001). Fasting FGF19 concentrations were unchanged acutely after RYGB (NGT: 140 pg/mL [100-162]; 134 [119-204], p=0.42; T2D: 162 [130-196], 154 [104-164], p=0.68) and remained unchanged throughout the follow-up period. AUC FGF19 increased gradually with time after surgery (ptime<0.001), resembling the changes seen with AUC TBA. One week after RYGB, glucose metabolism improved, LDL- and HDL-Cholesterol decreased, CCK and GLP-1 secretion increased, whilst FFA concentrations were unchanged.

CONCLUSION: TBA and FGF19 do not explain acute changes in glucose metabolism, cholesterol fractions and gut hormone secretion after RYGB.

Original languageEnglish
JournalThe Journal of clinical endocrinology and metabolism
Volume100
Issue number3
Pages (from-to)E396-406
ISSN0021-972X
DOIs
Publication statusPublished - 2015

ID: 44892899