Glp-1 And Adiponectin: Effect Of Weight Loss After Dietary Restriction And Gastric Bypass In Morbidly Obese Patients With Normal And Abnormal Glucose Metabolism

Background: It has been proposed that there is improvement in glucose and insulin metabolism after weight loss in patients who underwent diet restriction and bariatric surgery. Methods: Eleven normal glucose tolerant (NGT) morbidly obese patients [body mass index (BMI), 46.1∈±∈2.27 g/m 2] and eight abnormal glucose metabolism (AGM) obese patients (BMI, 51.20 kg/m2) were submitted to diet-restriction and bariatric surgery. Prospective study on weight loss changes, over the glucose, insulin metabolism, glucagon-like peptide-1 (GLP-1), and adiponectin levels were evaluated by oral glucose tolerance test during three periods: T1 (first evaluation), T2 (pre-surgery), and T3 (9 months after surgery). Results: Insulin levels improved after surgery. T1 was 131.1∈±∈17.60 pmol/l in the NGT group and 197.57∈±∈57.94 pmol/l in the AGM group, and T3 was 72.48∈±∈3.67 pmol/l in the NGT group and 61.2∈±∈9.33 pmol/l in the AGM group. The major reduction was at the first hour of the glucose load as well as fasting levels. At 9 months after surgery (T3), GLP-1 levels at 30 and 60 min had significantly increased in both groups. It was observed that the AGM group had higher levels of GLP-1 at 30 min (34.06∈±∈6.18 pmol/l) when compared to the NGT group (22.69∈±∈4.04 pmol/l). Homeostasis model assessment of insulin resistance from the NGT and AGM groups had a significant reduction at periods T3 in relation to T1 and T2. Adiponectin levels had increased concentration in both groups before and after surgical weight loss. However, it did not have any statistical difference between periods T1 vs. T2. Conclusions: Weight loss by surgery leads to improvement in the metabolism of carbohydrates in relation to sensitivity to the insulin, contributing to the reduction of type 2 diabetes incidence. This improvement also was expressed by the improvement of the levels of adiponectin and GLP-1. © 2008 Springer Science + Business Media, LLC.193313320Bonadonna, R.C., Groop, L., Kraemer, N., Ferrannini, E., Del Prato, S., Defronzo, R.A., Obesity and insulin resistance in humans: A dose-response study (1990) Metabolism: Clinical and Experimental, 39 (5), pp. 452-459. , DOI 10.1016/0026-0495(90)90002-TDefronzo, R.A., Bonadonna, R.A., Ferranini, E., A balanced overview (1990) Diabetes Care, 15, pp. 318-368Hostamisligil, G.S., Molecular mechanisms of insulin resistance and the role of adipocyte (2000) Int J Obes, 24, pp. 23-S27Park, Y.-W., Zhu, S., Palaniappan, L., Heshka, S., Carnethon, M.R., Heymsfield, S.B., The metabolic syndrome: Prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994 (2003) Archives of Internal Medicine, 163 (4), pp. 427-436. , DOI 10.1001/archinte.163.4.427Colditz, G.A., Willett, W.C., Stamper, M.J., Manson, J.E., Hennekens, C.H., Arky, R.A., Speizer, F.E., Weight as a risk factor for clinical diabetes in women (1990) American Journal of Epidemiology, 132 (3), pp. 501-513Pories, W.J., MacDonald Jr., K.G., Morgan, E.J., Surgical treatment of obesity and its effect on diabetes: 10-y follow-up (1992) Am J Clin Nutr, 55, pp. 582S-585SResidori, L., Garcia-Lorda, P., Flancbaum, L., Pi-Sunyer, F.X., Laferrere, B., Prevalence of co-morbidities in obese patients before bariatric surgery: Effect of race (2003) Obesity Surgery, 13 (3), pp. 333-340. , DOI 10.1381/096089203765887615Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M.D., Pories, W., Fahrbach, K., Schoelles, K., Bariatric surgery: A systematic review and meta-analysis (2004) Journal of the American Medical Association, 292 (14), pp. 1724-1737. , DOI 10.1001/jama.292.14.1724Laferrere, B., Heshka, S., Wang, K., Khan, Y., McGinty, J., Teixeira, J., Hart, A.B., Olivan, B., Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes (2007) Diabetes Care, 30 (7), pp. 1709-1716. , http://care.diabetesjournals.org/cgi/reprint/30/7/1709, DOI 10.2337/dc06-1549MacDonald, P.E., El-Kholy, W., Riedel, M.J., Salapatek, A.M.F., Light, P.E., Wheeler, M.B., The multiple actions of GLP-1 on the process of glucose-stimulated insulin secretion (2002) Diabetes, 51 (SUPPL. 3), pp. S434-S442Creutzfedt, W., The entero-insulinar axis in type 2 diabetes. Incretins as therapeutic agents (2001) Exp Clin Endocrinol Diabetes, 109, pp. 288-S303Egan, J.M., Meneilly, G.S., Haberner, J.F., Glucagon-like peptide augments insulin-mediated glucose uptake in obese state (2002) J Clin Endocrinol Metab, 87, pp. 3768-3773Valverde, I., Villanueva-Penacarrillo, M.L., Malaisse, W.J., Pancreatic and extrapancreatic effects of GLP-1 (2002) Diabetes and Metabolism, 28, pp. 3S85-3S89Villanueva-Penacarrillo, M.L., Puente, J., Redondo, A., Clemente, F., Valverde, I., Effect of GLP-1 treatment on GLUT2 and GLUT4 expression in type 1 and type 2 rat diabetic models (2001) Endocrine, 15 (2), pp. 241-248. , DOI 10.1385/ENDO:15:2:241Acitores, A., Gonzalez, N., Sancho, V., Arnes, L., Valverde, I., Malaisse, W.J., Villanueva-Penacarrillo, M.L., Participation of protein kinases in the stimulant action of GLP-1 on 2-deoxy-D-glucose uptake by normal rat skeletal muscle (2005) Hormone and Metabolic Research, 37 (5), pp. 275-280. , DOI 10.1055/s-2005-861469Sancho, V., Trigo, M.V., Gonzalez, N., Valverde, I., Malaisse, W.J., Villanueva-Penacarrillo, M.L., Effects of glucagon-like peptide-1 and exendins on kinase activity, glucose transport and lipid metabolism in adipocytes from normal and type-2 diabetic rats (2005) Journal of Molecular Endocrinology, 35 (1), pp. 27-38. , DOI 10.1677/jme.1.01747Ruiz-Grande, C., Alarcón, C., Mérida, E., Lipolytic action of glucagon-like peptides in isolated rat adipocytes (1992) Peptides, 13, pp. 13-16Perea, A., Vinambres, C., Clemente, F., Villanueva-Penacarrillo, M.L., Valverde, I., GLP-1 (7-36) amide: Effects on glucose transport and metabolism in rat adipose tissue (1997) Hormone and Metabolic Research, 29 (9), pp. 417-421Villanueva-Pencarrillo, M.L., Marquez, L., Gonzalez, N., Diaz-Miguel, M., Valverde, I., Effect of GLP-1 on lipid metabolism in human adipocytes (2001) Hormone and Metabolic Research, 33 (2), pp. 73-77. , DOI 10.1055/s-2001-12428Nauck, A., Heinesaat, M.M., Orskov, C., Preserved incretin activity of synthetic human gastric inhibitory polypeptide in patients with type 2 diabetes (1993) J Clin Invest, 91, pp. 301-307Laferrere, B., Heshka, S., Wang, K., Khan, Y., McGinty, J., Teixeira, J., Hart, A.B., Olivan, B., Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes (2007) Diabetes Care, 30 (7), pp. 1709-1716. , http://care.diabetesjournals.org/cgi/reprint/30/7/1709, DOI 10.2337/dc06-1549Maeda, K., Okubo, K., Shimomura, I., Funahashi, T., Matsuzawa, Y., Matsubara, K., CDNA cloning and expression of a novel adipose specific collagen-like factor, apM1 (adipose most abundant gene transcript 1) (1996) Biochemical and Biophysical Research Communications, 221 (2), pp. 286-289. , DOI 10.1006/bbrc.1996.0587Scherer, P.E., Williams, S., Fogliano, M., A novel serum protein similar to C1q, produced exclusively in adipocytes (1995) J Biol Chem, 270, pp. 26746-26749Hu, E., Liang, P., Spiegelman, B.M., AdipoQ is a novel adipose-specific gene dysregulated in obesity (1996) Journal of Biological Chemistry, 271 (18), pp. 10697-10703. , DOI 10.1074/jbc.271.18.10697Takahashi, M., Arita, Y., Yamagata, K., Matsukawa, Y., Okutomi, K., Horie, M., Shimomura, I., Matsuzawa, Y., Genomic structure and mutations in adipose-specific gene, adiponectin (2000) International Journal of Obesity, 24 (7), pp. 861-868Okamoto, Y., Arita, Y., Nishida, M., Muraguchi, M., Ouchi, N., Takahashi, M., Igura, T., Matsuzawa, Y., An adipocyte-derived plasma protein, adiponectin, adheres to injured vascular walls (2000) Hormone and Metabolic Research, 32 (2), pp. 47-50Ouchi, N., Kihara, S., Arita, Y., Maeda, K., Kuriyama, H., Okamoto, Y., Hotta, K., Matsuzawa, Y., Novel modulator for endothelial adhesion molecules: Adipocyte-derived plasma protein adiponectin (1999) Circulation, 100 (25), pp. 2473-2476Okamoto, Y., Arita, Y., Nishida, M., Muraguchi, M., Ouchi, N., Takahashi, M., Igura, T., Matsuzawa, Y., An adipocyte-derived plasma protein, adiponectin, adheres to injured vascular walls (2000) Hormone and Metabolic Research, 32 (2), pp. 47-50Yokota, T., Oritani, K., Takahashi, I., Ishikawa, J., Matsuyama, A., Ouchi, N., Kihara, S., Matsuzawa, Y., Adiponectin, a new member of the family of soluble defense collagens, negatively regulates the growth of myelomonocytic progenitors and the functions of macrophages (2000) Blood, 96 (5), pp. 1723-1732Weyer, C., Funahashi, T., Tanaka, S., Hotta, K., Matsuzawa, Y., Pratley, R.E., Tataranni, P.A., Hypoadiponectinemia in obesity and type 2 diabetes: Close association with insulin resistance and hyperinsulinemia (2001) Journal of Clinical Endocrinology and Metabolism, 86 (5), pp. 1930-1935. , DOI 10.1210/jc.86.5.1930Yang, W.-S., Lee, W.-J., Funahashi, T., Tanaka, S., Matsuzawa, Y., Chao, C.-L., Chen, C.-L., Chuang, L.-M., Weight reduction increases plasma levels of an adipose-derived anti-inflammatory protein, adiponectin (2001) Journal of Clinical Endocrinology and Metabolism, 86 (8), pp. 3815-3819. , DOI 10.1210/jc.86.8.3815Hotta, K., Funahashi, T., Arita, Y., Takahashi, M., Matsuda, M., Okamoto, Y., Iwahashi, H., Matsuzawa, Y., Plasma concentrations of a novel, adipose-specific protein, adiponectin, in type 2 diabetic patients (2000) Arteriosclerosis, Thrombosis, and Vascular Biology, 20 (6), pp. 1595-1599Stefan, N., Vozarova, B., Funahashi, T., Matsuzawa, Y., Weyer, C., Lindsay, R.S., Youngren, J.F., Antonio Tataranni, P., Plasma adiponectin concentration is associated with skeletal muscle insulin receptor tyrosine phosphorylation, and low plasma concentration precedes a decrease in whole-body insulin sensitivity in humans (2002) Diabetes, 51 (6), pp. 1884-1888(2003) The Seventh Report of Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII), pp. 2-3. , National Institutes of Health NIH Publication no. 03-5233. EUAFobi, M.A.L., Lee, H., Igwe Jr., D., Felahy, B., James, E., Stanczyk, M., Tambi, J., Eyong, P., Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: A review of 65 cases (2001) Obesity Surgery, 11 (2), pp. 190-195. , DOI 10.1381/096089201321577866Fulcher, G.R., Farrer, M., Walker, M., A comparison of measurements of lean body mass derived by bioelectrical impedance, skinfold thickness and total body potassium. A study in obese and non-obese normal subjects (1991) Scand J Lab Invest, 51, pp. 245-253Report of the expert committee on the diagnosis and classification of diabetes mellitus. Clinical practice recommendations 2003: Committee report. the expert committee on the diagnosis and classification of diabetes mellitus (2003) Diabetes Care, 26 (1), pp. 4-S20. , American Diabetes AssociationPotteiger, J.A., Jacobsen, D.J., Donnelly, J.E., A comparison of methods for analyzing glucose and insulin areas under the curve following nine months of exercise in overweight adults (2002) International Journal of Obesity, 26 (1), pp. 87-89. , DOI 10.1038/sj/ijo/0801839McAuley, K.A., Williams, S.M., Mann, J.I., Walker, R.J., Lewis-Barned, N.J., Temple, L.A., Duncan, A.W., Diagnosing insulin resistance in the general population (2001) Diabetes Care, 24 (3), pp. 460-464Matthews, D.R., Hosker, J.P., Rudenski, A.S., Homeostasis model assessment: Insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man (1985) Diabetologia, 28 (7), pp. 412-419. , DOI 10.1007/BF00280883Sjostrom, C.D., Peltonen, M., Wedel, H., Sjostrom, L., Differentiated long-term effects of intentional weight loss on diabetes and hypertension (2000) Hypertension, 36 (1), pp. 20-25Marin, D., (2007) Resistência À Insulina e Função da Célula Beta: Efeito da Perda de Peso Após Bypass Gástrico, , PhD Thesis, Universidade Estadual de Campinas. Faculdade de Ciências Médicas;Ohta, T., Buiting, K., Kokkonen, H., McCandless, S., Heeger, S., Leisti, H., Driscoll, D.J., Nicholls, R.D., Molecular mechanism of Angelman syndrome in two large families involves an imprinting mutation (1999) American Journal of Human Genetics, 64 (2), pp. 385-396Tomas, E., Tsao, T.-S., Saha, A.K., Murrey, H.E., Zhang, C.C., Itani, S.I., Lodish, H.F., Ruderman, N.B., Enhanced muscle fat oxidation and glucose transport by ACRP30 globular domain: Acetyl-CoA carboxylase inhibition and AMP-activated protein kinase activation (2002) Proceedings of the National Academy of Sciences of the United States of America, 99 (25), pp. 16309-16313. , DOI 10.1073/pnas.222657499Yamauchi, T., Kamon, J., Minokoshi, Y., Ito, Y., Waki, H., Uchida, S., Yamashita, S., Kadowaki, T., Adiponectin stimulates glucose utilization and fatty-acid oxidation by activating AMP-activated protein kinase (2002) Nature Medicine, 8 (11), pp. 1288-1295. , DOI 10.1038/nm788Yokota, T., Oritani, K., Takahashi, I., Ishikawa, J., Matsuyama, A., Ouchi, N., Kihara, S., Matsuzawa, Y., Adiponectin, a new member of the family of soluble defense collagens, negatively regulates the growth of myelomonocytic progenitors and the functions of macrophages (2000) Blood, 96 (5), pp. 1723-1732Weyer, C., Funahashi, T., Tanaka, S., Hotta, K., Matsuzawa, Y., Pratley, R.E., Tataranni, P.A., Hypoadiponectinemia in obesity and type 2 diabetes: Close association with insulin resistance and hyperinsulinemia (2001) Journal of Clinical Endocrinology and Metabolism, 86 (5), pp. 1930-1935. , DOI 10.1210/jc.86.5.1930Fruebis, J., Tsao, T.-S., Javorschi, S., Ebbets-Reed, D., Erickson, M.R.S., Yen, F.T., Bihain, B.E., Lodish, H.F., Proteolytic cleavage product of 30-kDa adipocyte complement-related protein increases fatty acid oxidation in muscle and causes weight loss in mice (2001) Proceedings of the National Academy of Sciences of the United States of America, 98 (4), pp. 2005-2010. , DOI 10.1073/pnas.041591798Holst, J.J., On the physiology of GIP and GLP-1 (2004) Hormone and Metabolic Research, 36 (11-12), pp. 747-754. , DOI 10.1055/s-2004-826158Vilsboll, T., Holst, J.J., Incretins, insulin secretion and Type 2 diabetes mellitus (2004) Diabetologia, 47 (3), pp. 357-366. , DOI 10.1007/s00125-004-1342-6Greenway, S.E., Greenway Iii, F.L., Klein, S., Effects of obesity surgery on non-insulin-dependent diabetes mellitus (2002) Archives of Surgery, 137 (10), pp. 1109-1117Drucker, D.J., Glucagon-Like Peptide-1 and the Islet β-Cell: Augmentation of Cell Proliferation and Inhibition of Apoptosis (2003) Endocrinology, 144 (12), pp. 5145-5148. , DOI 10.1210/en.2003-1147Zander, M., Madsbad, S., Madsen, J.L., Holst, J.J., Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and β-cell function in type 2 diabetes: A parallel-group study (2002) Lancet, 359 (9309), pp. 824-830. , DOI 10.1016/S0140-6736(02)07952-7Drucker, D.J., Enhancing incretin action for the treatment of type 2 diabetes (2003) Diabetes Care, 26 (10), pp. 2929-2940. , DOI 10.2337/diacare.26.10.2929Cummings, D.E., Overduin, J., Foster-Schubert, K.E., Gastric bypass for obesity: Mechanisms of weight loss and diabetes resolution (2004) Journal of Clinical Endocrinology and Metabolism, 89 (6), pp. 2608-2615. , DOI 10.1210/jc.2004-043