Abstract
Background
We hypothesized that laparoscopic adjustable gastric banding (LAGB) reduces weight and modulates ghrelin production, but largely spares gastrointestinal endocrine function. To examine this hypothesis, we determined plasma concentrations of appetite-control, insulinotropic, and digestive hormones in relation to LAGB.
Methods
Twenty-four patients undergoing LAGB were prospectively enrolled. Body mass index (BMI) was measured and blood samples obtained at baseline and 6 and 12 months post-surgery. Plasma concentrations of leptin, acylated and total ghrelin, pancreatic polypeptide (PP), insulin, glucose-dependent insulinotropic peptide (GIP), active glucagon-like peptide-1 (GLP-1), gastrin, and pepsinogens I and II were measured using enzyme-linked immunoassays.
Results
Median percent excess weight loss (%EWL) over 12 months was 45.7% with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery (p < 0.001). Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery (p < 0.001). In contrast, plasma levels of acylated and total ghrelin, PP, insulin, GIP, GLP-1, gastrin, and pepsinogen I did not change in relation to surgery (p > 0.05). Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months.
Conclusions
LAGB yielded substantial %EWL and a proportional decrease in plasma leptin. Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss. Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term.
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Acknowledgments
This study is supported in part by RR00096, K23CA107123 from the National Institute of Health, the Diane Belfer Program for Human Microbial Ecology, and the Michael Saperstein Medical Scholars Program. The authors thank Drs. Frank Martiniuk and Maryann Huie for performing the Lincoplex assay.
Disclosures
GAF and CR are consultants for Inamed, Inc. (Irvine, CA), the manufacturer of the Lap-Band device. The other authors have no conflicts of interest.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s11695-008-9562-3
Electronic Supplementary Material
Supplemental Fig. 1
Ghrelin dynamics in subjects stratified by amount of weight loss after LAGB. Subjects were divided into two groups, based on their %EWL over 12 months. Group I (blue diamonds): %EWL = 14.4 to 43.2 (n = 11); Group II (green circles): %EWL = 48.1 to 62.3 (n = 11). Panels show values at baseline, 6 and 12 months for: mean BMI (a), plasma concentrations of total ghrelin (b) and acylated ghrelin (c), and the acylated/total ghrelin ratio (d). Statistical significance assessed at each time point for each variable using unpaired Wilcoxon signed rank tests, *p < 0.05 (EPS 300 kb)
Supplemental Table 1
BMI and fasting serum peptide levels before and 6 and 12 month after LAGB (EPS 406 kb)
Supplemental Table 2
Medium BMI and peptide concentrations by H. pylori status (EPS 417 kb)
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Shak, J.R., Roper, J., Perez-Perez, G.I. et al. The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones. OBES SURG 18, 1089–1096 (2008). https://doi.org/10.1007/s11695-008-9454-6
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DOI: https://doi.org/10.1007/s11695-008-9454-6