Effect of Laparoscopic Sleeve Gastrectomy on Fasting Gastrointestinal, Pancreatic, and Adipose-Derived Hormones and on Non-Esterified Fatty Acids

Abstract

Background: Alterations in gastrointestinal, pancreatic, and adipose hormone levels may have a greater role in weight loss than initially appreciated. The laparoscopic sleeve gastrectomy (LSG) operation is now the most frequently performed bariatric operation in many countries, but there are relatively few data regarding its molecular effects. We sought to characterize the effect of LSG on fasting plasma levels of selected hormones and on non-esterified fatty acids (NEFA), and to compare these to levels in non-obese control individuals.

Materials and methods: The levels of nine plasma hormones were measured using a multiplex bead-based assay at baseline and at 3 months after operation in 11 obese patients undergoing LSG. NEFA levels were also measured. The levels were compared to those for 22 age- and sex-matched non-obese individuals.

Results: At baseline, obese patients showed significantly higher expression of C-peptide, insulin, and leptin and significantly lower ghrelin, glucose-dependent insulinotropic peptide (GIP), and resistin compared to non-obese controls (p < 0.05). LSG resulted in a reduction in BMI from 42.5 ± 6.47 kg/m² at operation to 35.2 ± 5.14 kg/m² at 3 months (42 % mean excess weight loss, p < 0.001). LSG led to a significant decrease in ghrelin, glucagon-like peptide-1 (GLP-1), glucagon, leptin, plasminogen activator inhibitor-1 (PAI-1), and NEFA.

Conclusion: LSG induces marked early changes in the fasting levels of factors thought to be important regulators of obesity and metabolic health. These changes differ somewhat from the findings for operations with a malabsorptive component, suggesting that subtle differences exist in the mechanisms of weight loss between LSG and other bariatric operations.

Keywords: Bariatric surgery; C-peptide; GIP; GLP-1; Ghrelin; Glucagon; Insulin; Leptin; NEFA; PAI-1; Resistin; Sleeve gastrectomy; Weight loss.

Fig. 1

Comparison of fasting levels of 10 fasting factors between obese participants and healthy weight controls, both at baseline and 12 weeks follow-up following laparoscopic sleeve gastrectomy (LSG). a Gastrointestinal hormones ghrelin, gastric inhibitor peptide (GIP), and glucagon-like peptide-1 (GLP-1). b Pancreatic endocrine products C-peptide, insulin, and glucagon. c Adipose tissue hormones leptin, plasminogen activator inhibitor-1 (PAI-1), resistin, and non-esterified fatty acids (NEFA)