Tammy L Kindel, MD, PhD1, Crystal Krause, PhD2, Melissa Helm1, Corrigan McBride2, Dmitry Oleynikov, MD2, R Thakare2, J Alamoudi2, Vishal Kothari, MD2, Rohit Kohli, MD3, Yazen Alnouti, MD2. 1Medical College of Wisconsin, 2University of Nebraska Medical Center, 3Keck School of Medicine of Univ of Southern California
Introduction: Bile acids (BAs) are not only enteral surfactants but also post-prandial hormones that play an important role in glucose and lipid homeostasis as well as energy expenditure. Total and glycine-conjugated BAs increase after sleeve gastrectomy (SG) and correlate to improved metabolic disease. No specific bile acid subtype has been shown clinically to mediate the early weight loss effect. Therefore, the objective of this study was to prospectively evaluate the comprehensive changes in meal-stimulated BAs after SG and determine if a specific change in the BA profile correlates to the early weight loss response.
Methods: Patients were prospectively enrolled at the University of Nebraska Medical Center who were undergoing a SG for treatment of morbid obesity. Patients consumed a liquid meal pre-operatively, and at 1.5 and 3 months post-operatively. Nine different primary and secondary plasma bile acids, their amidated (glycine or taurine), and sulfated metabolites were measured at fasting and 30 minutes. Data are presented as the mean ± SE. A repeated-measures ANOVA was performed for each variable at 0, 1.5 and 3 months. BAs that were significantly increased at 3 months were correlated to the dependent variable of 3 month BMI change. Significance was determined at p<0.05.
Results: 28 patients completed 3-month follow-up. The average patient age was 45.4 ± 12.9 years (82.1% female) and pre-operative BMI of 45.0 ± 6.8 kg/m2. The average BMI change at 1.5 and 3 months’ post-op was 4.3 ± 0.4 and 6.1 ± 0.4 kg/m2 respectively (p<0.05 compared to pre-op). At 3 months, there were significant increases in the 30-minute fasting and total BAs, 30-minute glycine-amidated BAs, fasting and 30 minute chenodeoxycholic acid (CDCA), fasting and 30-minute deoxycholic acid (DCA), fasting and 30 minute muricholic acid (MCA), and fasting and 30-minute hyocholic acid (HCA). 30-minute glycine-amidated CDCA, DCA, MCA, and HCA were all significantly increased at 1.5 and 3 months compared to pre-op (Table 1). Examining all 3 month significant variables, 30-minute glycine-amidated HCA correlated with the 3 month BMI change (Pearson correlation=0.770, p=0.009 as shown in Table 1).
Conclusions: Sleeve gastrectomy induced an early and persistent post-prandial surge in the hydrophilic, glycine-amidated HCA which significantly correlates with the 3-month weight loss response. Further studies will determine if the weight loss response correlates to post-prandial HCA at 12 months and if HCA mediates any effect of SG on glucose and lipid metabolism.
*Work supported by a SAGES Research Grant.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78852
Program Number: S130
Presentation Session: Bariatric surgery – Sleeves, Conversions and More
Presentation Type: Podium
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