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Improved insulin sensitivity after gastric bypass correlates with decreased total body fat, but not with changes in free fatty acids

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Abstract

Background

Increased plasma free fatty acids (FFAs) are considered one of the key elements in the pathogenesis of insulin resistance (IR) and type 2 diabetes (T2DM). We hypothesize that, in diabetic patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB), a postoperative decrease in FFA will correlate with improved insulin sensitivity (Si).

Methods

A total of 30 obese [body mass index ((BMI) >35 kg/m2] patients with a diagnosis of T2DM were studied preoperatively and 12 months after LRYGB in a prospective cohort study. Collected data included intravenous glucose tolerance test (IVGTT), total body composition by dual-energy X-ray absorptiometry and plasma levels of FFA. Si analysis from the IVGTT was estimated from minimal model analysis. Pre- and postoperative variables were compared using a paired sample t test. Relationships between changes in variables were determined with Pearson’s correlation test.

Results

Twelve months after LRYGB the study population showed a significant decrease in BMI (p = 0.001), FFA (p = 0.03), and total body fat (p = 0.03), with an increase in Si (p = 0.001). Postoperative changes in Si significantly correlated (Pearson’s r = –0.53, p = 0.01) with change in total body fat, but not with changes in plasma FFA (Pearson’s r = –0.22, p = 0.31).

Conclusions

Our study challenges the notion that IR is mediated to a significant degree by changes in plasma FFA concentration. Instead, changes in adiposity and consequently changes in adipokine release can be the key players in determining remission of T2DM after LRYGB.

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Disclosures

None of the authors have conflicts of interest or financial ties to disclose relative to this study

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Authors and Affiliations

  1. Department of Surgery, Duke Centre for Metabolic and Bariatric Surgery, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA

    Alessandro Mor, Lawrence Tabone, Philip Omotosho & Alfonso Torquati

Authors
  1. Alessandro Mor
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  2. Lawrence Tabone
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  3. Philip Omotosho
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  4. Alfonso Torquati
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Corresponding author

Correspondence to Alfonso Torquati.

Additional information

Alessandro Mor and Lawrence Tabone have contributed equally to this study.

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Mor, A., Tabone, L., Omotosho, P. et al. Improved insulin sensitivity after gastric bypass correlates with decreased total body fat, but not with changes in free fatty acids. Surg Endosc 28, 1489–1493 (2014). https://doi.org/10.1007/s00464-013-3338-0

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  • DOI: https://doi.org/10.1007/s00464-013-3338-0

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