Ghrelin and Leptin Changes Post-Sleeve Gastrectomy
DOI:
https://doi.org/10.59675/U214Keywords:
Bariatric surgery, laparoscopic sleeve gastrectomy, leptin, ghrelin, appetite.Abstract
Background: Ghrelin and leptin may regulate metabolism and appetite. Ghrelin, a newly discovered orexigenic gastric hormone, is produced when the stomach is empty. This may explain why morbidly obese people fail to diet, hence the recommendation for bariatric surgery. Leptin, a well-known adipokine, inhibits food intake and circulates at fat-mass-related levels.
Aim of the study:
To evaluate changes in the ghrelin and leptin level post-laparoscopic sleeve gastrectomy. And their relation to changes in appetite and weight loss.
Methods: This prospective study examines adult patients' clinical and lab data for pre- and post-sleeve gastrectomy at Al-Hussain Medical City and Al-Kafeel Hospital in Karbala. The study included 48 obese individuals (36 females and 12 males) with a mean age of 35.5 ± 8.9 years and a BMI of 42.4 ± 5.6 kg/m2. Clinical data comprised pre-surgery body weight, height, hunger, and ghrelin and leptin levels. Patients were seen 2–5 months following surgery for follow-up.
Results: Significant decreases in plasma ghrelin (p<0.0001) and leptin (p<0.0001) were detected. Patients reported a considerable appetite reduction post-surgery (p <0.0001). Serum ghrelin (p = 0.0004) and leptin (p = 0.003) decreased significantly compared to hunger fluctuations following surgery. The average patient weight loss was 20.2 kg, and excess weight loss was 36.4 ± 10.8%. All patients achieved an 8 kg/m2 weight loss and a 46 ±16.6% excess weight loss while controlling comorbidities such as diabetes, hypertension, and sleep apnea.
Conclusion: Significant reduction in ghrelin and leptin levels post-surgery. Significant correlation between decrease in ghrelin and leptin concentrations and decrease in appetite post sleeve gastrectomy.
Downloads
References
WHO. Obesity and overweight. Fact sheet N 311. [Online] WHO, 2011. from: http://www.who.int/mediacentre/factsheets/fs311/en/index.html
Dadan J, Iwacewicz P, Hady HR. New approaches in bariatric surgery. Videosurgery Miniinv 2008; 3: 66-70.
Stanowski E, Pasnik K. Bariatric surgery – the current state of knowledge [Polish]. Videosurgery Miniinv 2008; 3: 71-86.
Fried M, Ribaric G, Buchwald JN, et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/ m2: an integrative review of early studies. Obes Surg 2010; 20:776-90.
Olbers T, Björkman S, Lindroos A, et al. Body composition, dietary intake, and energy expenditure after laparoscopic Roux- en-Y gastric bypass and laparoscopic vertical banded gastroplasty. Ann Surg 2006; 244: 715-22.
Ponce J, DeMaria EJ, Nguyen NT, et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis 2016; 12:1637.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013; 23:427.
Abdemur A, Slone J, Berho M, et al. Morphology, localization, and patterns of ghrelin-producing cells in stomachs of a morbidly obese population. Surg Laparosc Endosc Percutan Tech 2014; 24:122.
Ashrafian H, le Roux CW. Metabolic surgery and gut hormones - areview of bariatric entero-humoral modulation. Physiol Behav.2009;97:620–31.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: asystematic review and meta-analysis. JAMA. 2004;292:1724–37.
Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 2008; 247: 401-7.
Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrecto my and gastric banding: effects on plasma ghrelin levels. ObesSurg 2005; 15: 1024-9.
Procaccini C, Jirillo E, Matarese G. Leptin as an immunomodulator. Mol Aspects Med 2012; 33:35.
Gambino YP, Maymó JL, Pérez-Pérez A, et al. 17Beta-estradiol enhances leptin expression in human placental cells through genomic and nongenomic actions. Biol Reprod 2010; 83:42.
Hellstrom PM, Geliebter A, Naslund E et al. Peripheral and central signals in the control of eating in normal, obese and binge-eating human subjects. Br J Nutr 2004; 92: 47-57.
Korbonits M, Goldstone AP, Gueorguiev M et al. Ghrelin – a hormone with multiple functions. Front Neuroendocrinol 2004; 25: 27-68.
Meier U, Gressner AM. Endocrine regulation of energy metabolism: review of pathobiochemical and clinical chemical aspects of leptin, ghrelin, adiponectin, and resistin. Clin Chem 2004; 50:1511.
Dardeno TA, Chou SH, Moon HS, et al. Leptin in human physiology and therapeutics. Front Neuroendocrinol 2010; 31:377.
Weigle DS, Duell PB, Connor WE, et al. Effect of fasting, refeeding, and dietary fat restriction on plasma leptin levels. J Clin Endocrinol Metab 1997; 82:561.
Kelesidis T, Kelesidis I, Chou S, Mantzoros CS. Narrative review: the role of leptin in human physiology: emerging clinical applications. Ann Intern Med 2010; 152:93.
Heymsfield SB, Greenberg AS, Fujioka K, Dixon RM, Kushner R, Hunt T, et al. Recombinant leptin for weight loss in obese and lean adults: a randomized, controlled, dose-escalation trial. JAMA 1999;282(16):1568–75. [PubMed: 10546697].
Kelesidis T, Kelesidis I, Chou S, Mantzoros CS. Narrative review: the role of leptin in human physiology: emerging clinical applications. Ann Intern Med. 2010;152(2):93-100. doi:10.7326/0003-4819-152-2-201001190-00008
Cummings DE, Weigle DS, Frayo RS et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002; 346: 1623-30.
Nagaya N, Uematsu M, Kojima M et al. Elevated circulating level of ghrelin in cachexia associated with chronic heart failure. Circulation 2001; 104: 2034-8.
Purnell JQ. Definitions, Classification, and Epidemiology of Obesity. [Updated 2018 Apr 12]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000
American Diabetes Association. Standards of Medical Care in Diabetes 2011. Diabetes Care 2011; 34:S11. Copyright © 2011 American Diabetes Association
Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 1999; 402:656.
Takaya K, Ariyasu H, Kanamoto N, et al. Ghrelin strongly stimulates growth hormone release in humans. J Clin Endocrinol Metab 2000;
Paolo Prolo, Ma-Li Wong, Julio Licinio * Molecules in focus Leptin Unit on Clinical Research,
Clinical Neuroendocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-1284, USA Received 15 April 1998
Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts 2008; 1: 52-9.
Dahiru T. P - value, a true test of statistical significance? A cautionary note. Ann Ib Postgrad Med.
;6(1):21-26. doi:10.4314/aipm.v6i1.64038
Aly S, Hachey K, Pernar LIM. Gender disparities in weight loss surgery. Mini-invasive Surg 2020;4:21. http://dx.doi.org/10.20517/2574-1225.2019.57
Kochkodan, J., Telem, D.A. & Ghaferi, A.A. Physiologic and psychological gender differences in bariatric surgery. Surg Endosc 32, 1382–1388 (2018). https://doi.org/10.1007/s00464-017-5819-z
Sjöström, C.D., Lissner, L., Wedel, H. and Sjöström, L. (1999), Reduction in Incidence of Diabetes, Hypertension and Lipid Disturbances after Intentional Weight Loss Induced by Bariatric Surgery: the SOS Intervention Study. Obesity Research, 7: 477-484
Ricci, C., Gaeta, M., Rausa, E. et al. Early Impact of Bariatric Surgery on Type II Diabetes, Hypertension, and Hyperlipidemia: A Systematic Review, Meta-Analysis and Meta-Regression on 6,587 Patients. OBES SURG 24, 522–528 (2014).
Wilhelm SM, Young J, Kale-Pradhan PB. Effect of Bariatric Surgery on Hypertension: A Metaanalysis. Annals of Pharmacotherapy. 2014;48(6):674-682.
Priyadarshini P, Singh VP, Aggarwal S, Garg H, Sinha S, Guleria R. Impact of bariatric surgery on obstructive sleep apnoea-hypopnea syndrome in morbidly obese patients. J Minim Access Surg. 2017;13(4):291-295. doi:10.4103/jmas.JMAS_5_17
de Aquino LA, Pereira SE, de Souza Silva J, Sobrinho CJ, Ramalho A. Bariatric surgery: impact on body composition after Roux-en-Y gastric bypass. Obesity surgery. 2012 Feb;22:195-200.
Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg 2007; 17: 565-8.
Hady, H.R., Dadan, J. & Luba, M. The Influence of Laparoscopic Sleeve Gastrectomy on Metabolic Syndrome Parameters in Obese Patients in Own Material. OBES SURG 22, 13–22 (2012).
Bužga M, Zavadilová V, Holéczy P, et al. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne. 2014;9(4):554-561. doi:10.5114/wiitm.2014.45437
Paluszkiewicz R, Kalinowski P, Wróblewski T, et al. Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity. Wideochir Inne Tech Maloinwazyjne. 2012;7(4):225-232.
Snyder-Marlow G, Taylor D, Lenhard J. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J Am Diet Assoc 2010; 110: 600-7.
Iannelli A, Dainese R, Piche T, et al. Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol 2008; 14: 821-7.
Geloneze B, Tambascia MA, Pilla VF et al. Ghrelin: a gut-brain hormone: effect of gastric bypass surgery.Obes Surg 2003; 13: 17-22.
Cummings DE, Weigle DS, Frayo RS et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002; 346: 1623-30.
Tymitz, K., Engel, A., McDonough, S. et al. Changes in Ghrelin Levels Following Bariatric Surgery: Review of the Literature. OBES SURG 21, 125–130 (2011).
Friedmann JM. The function of leptin in nutrition, weight and physiology. Nutr Rev 2002; 60: S1-14.
Major P, Matłok M, Pędziwiatr M, et al. Changes in levels of selected incretins and appetitecontrolling hormones following surgical treatment for morbid obesity. Wideochir Inne Tech Maloinwazyjne. 2015;10(3):458-465. doi:10.5114/wiitm.2015.54003
Buchwald H, Dorman RB, Rasmus NF, et al. Effects on GLP-1, PYY, and leptin by direct stimulation of terminal ileum and cecum in humans: implications for ileal transposition. Surg Obes Relat Dis 2014; 10: 780-6.
Terra X, Auguet T, Guiu-Jurado E, et al. Long-term changes in leptin, chemerin and ghrelin levels following different bariatric surgery procedures: Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg 2013; 23: 1790-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Academic International Journal of Medical Update
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.