Enhanced Thermic Effect of Food After Roux-en-Y Gastric Bypass Surgery

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Abstract

Context:

The mechanisms of weight loss after Roux-en-Y gastric bypass (RYGB) surgery are incompletely understood.

Objective:

Our objective was to investigate changes in metabolic processing of ingested food that may contribute to the weight-reducing effect of RYGB surgery.

Design and Setting:

This was a cross-sectional case-control study at the Interdisciplinary Obesity Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

Patients:

Ten formerly obese women (mean ± SEM body mass index [BMI] = 26.6 ± 0.9 kg/m2) who had undergone RYGB surgery 41.9 ± 9.7 months before, 8 severely obese women (BMI = 40.8 ± 2.0 kg/m2), and 10 lean women (BMI = 20.9 ± 0.6 kg/m2).

Intervention:

Intervention was a standardized liquid meal test.

Main Outcome:

The thermic effect of food (TEF), respiratory quotient, and circulating levels of glucose, insulin, and C-peptide were assessed before and repeatedly during the first 90 minutes after the ingestion of a standardized liquid mixed meal containing 39.2 g carbohydrates, 15.4 g protein, and 2.8 g fat.

Results:

TEF area under curve (0–90 minutes) was significantly greater in RYGB patients than in severely obese and lean women (both P < .01). After ingestion of the mixed meal, the respiratory quotient increased to significantly greater values in the RYGB patients than in the severely obese and lean group (P < .001 for ANOVA time × group interaction). Also, the postprandial rise in circulating glucose, insulin, and C-peptide levels was remarkably higher in the RYGB patients than in the other 2 groups (all P < .001 for ANOVA time × group interaction).

Conclusion:

Data demonstrate an enhanced TEF after RYGB surgery. Although this observation likely contributes to the weight-reducing effects of the surgery, data also point to an altered metabolic processing of food in RYGB patients characterized by an enhanced glucose absorption and postprandial carbohydrate oxidation.

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