Plasma Acylation-Stimulating Protein, Adiponectin, Leptin, and Ghrelin before and after Weight Loss Induced by Gastric Bypass Surgery in Morbidly Obese Subjects

• Published in: The journal of clinical endocrinology and metabolism Vol. 88; no. 4; pp. 1594 - 1602
• Main Authors: Faraj, May, Havel, Peter J., Phélis, Steve, Blank, David, Sniderman, Allan D., Cianflone, Katherine
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Oxford University Press 01.04.2003; Copyright by The Endocrine Society; Endocrine Society
• Subjects: Acylation; Adiponectin; Adult; Apolipoprotein B; Apolipoproteins; Biological and medical sciences; Blood Glucose - analysis; Blood Proteins - analysis; Body weight loss; Cardiovascular diseases; Complement C3a - analogs & derivatives; Female; Gastric Bypass; Gastrointestinal surgery; Ghrelin; Heart surgery; Humans; Insulin - blood; Insulin resistance; Intercellular Signaling Peptides and Proteins; Leptin; Leptin - blood; Lipid metabolism; Male; Medical sciences; Metabolic diseases; Middle Aged; Obesity; Obesity, Morbid - blood; Obesity, Morbid - surgery; Peptide Hormones - blood; Plasma; Proteins - analysis; Sex Characteristics; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Human; Stomach; Obesity; Pathophysiology; Treatment efficiency; Nutrition disorder; Weight loss; Surgical anastomosis; Roux en Y loop; Protein; Blood plasma; Adiponectin; Treatment; Ghrelin; Surgery; Leptin; Orexigen hormone; Adult; Hormonal investigation; Nutritional status; Acylation
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2002-021309

We examined fasting plasma insulin, acylation-stimulating protein (ASP), leptin, adiponectin, ghrelin, and metabolic/cardiovascular risk profile before and 15 ± 6 months after isolated Roux-en-Y gastric bypass surgery in 50 morbidly obese subjects. Average preoperative plasma lipids were mostly normal, whereas ASP, insulin, and leptin were elevated, and adiponectin and ghrelin were decreased. Postoperatively, body weight decreased significantly (−36.4 ± 9.6%) and was best predicted by preoperative adiponectin concentration in weight-stable subjects (r = −0.59; P = 0.02). Plasma lipids and insulin resistance improved, leptin and ASP decreased (−76.3 ± 14.6% and −35.9 ± 52.2%; P < 0.001), and adiponectin increased (50.1 ± 47.0%; P < 0.001). The decrease in apolipoprotein B was best predicted by the decrease in ASP (r = 0.55; P = 0.009), whereas the improved postoperative insulin sensitivity was best predicted by the increase in adiponectin (r = 0.70; P = 0.01). Despite bypassing 95% of the stomach and isolating the fundus from contact with ingested nutrients, circulating ghrelin did not decrease after surgery. In fact, plasma ghrelin increased postoperatively in the subset of subjects undergoing active weight loss (+60.5 ± 23.2%; P < 0.001); ghrelin, however, remained unchanged in weight-stable subjects. In summary, 1) preoperative adiponectin concentrations may be predictive of the extent of weight loss; 2) changes in ASP and adiponectin are predictive of decreased apolipoprotein B and improved insulin action, respectively; and 3) plasma ghrelin increases after gastric bypass surgery in patients experiencing active weight loss.