Impact of gastric emptying and small intestinal transit on blood glucose, intestinal hormones, glucose absorption in the morbidly obese

• Published in: International Journal of Obesity Vol. 42; no. 9; pp. 1556 - 1564
• Main Authors: Nguyen, Nam Q, Debreceni, Tamara L, Burgess, Jenna E, Bellon, Max, Wishart, Judith, Standfield, Scott, Malbert, Charles-Henri, Horowitz, Michael
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2018; Nature Publishing Group
• Subjects: 101/47; 631/45/776/198; 692/699/1503/1702/393; 82/16; 9/10; Absorption; Adult; Blood; Blood glucose; Blood Glucose - metabolism; Emptying; Epidemiology; Female; Gastric emptying; Gastric Emptying - physiology; Gastrointestinal Hormones - metabolism; Gastrointestinal Transit - physiology; GIP protein; Glucagon; Glucagon-like peptide 1; Glucose; Health Promotion and Disease Prevention; Hormones; Humans; Insulin; Internal Medicine; Intestine; Intestine, Small - metabolism; Life Sciences; Male; Medical imaging; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Obesity; Obesity, Morbid - metabolism; Obesity, Morbid - physiopathology; Public Health; Radionuclide Imaging; Scintigraphy; Transit; insulin sensitivity; weight-loss; glp-1 secretion; bariatric surgery; liqutest meal; high-fat; glucagon receptor; incretin hormones; type-2 diabetes-mellitus; gastrointestinal symptoms
• ISSN: 0307-0565; 1476-5497; 1476-5497; 0307-0565
• DOI: 10.1038/s41366-018-0012-6

Objective: This study evaluated gastric emptying (GE) and small intestinal (SI) transit in people with morbid obesity and their relationships to glycaemia, incretin hormones, and glucose absorption Methods: GE and caecal arrival time (CAT) of a mixed meal were assessed in 22 morbidly obese (50.2 ± 2.5 years; 13 F:9 M; BMI: 48.6 ± 1.8 kg/m 2 ) and 10 lean (38.6 ± 8.4 years; 5 F:5 M; BMI: 23.9 ± 0.7 kg/m 2 ) subjects, using scintigraphy. Blood glucose, plasma 3-O-methylglucose, insulin, glucagon, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) were measured. Insulin sensitivity and resistance were also quantified Results: When compared with lean subjects, GE (t50: 60.7 ± 6.5 vs. 41.1 ± 7.3 min; P   = 0.04) and CAT (221.5 ± 9.8 vs. 148.0 ± 7.1 min; P  =  0.001) of solids were prolonged in morbid obesity. Postprandial rises in GIP ( P  = 0.001), insulin ( P   = 0.02), glucose ( P  = 0.03) and 3-O-methylglucose ( P  = 0.001) were less. Whereas GLP-1 increased at 45 mins post-prandially in lean subjects, there was no increase in the obese ( P   = 0.04). Both fasting ( P  = 0.045) and postprandial ( P  = 0.012) plasma glucagon concentrations were higher in the obese Conclusions: GE and SI transit are slower in the morbidly obese, and associated with reductions in postprandial glucose absorption, and glycaemic excursions, as well as plasma GIP and GLP-1