Role of Gut-Related Peptides and Other Hormones in the Amelioration of Type 2 Diabetes after Roux-en-Y Gastric Bypass Surgery

Table 1

Ghrelin and RYGB surgery.

Author/year	Type of study	Subjects	Preop BMI	% weight loss	F/U time	Change in hormone
Geloneze et al. 2003 [33]	Prospective controlled	28 RYGB surgery; 14 T2D; 14 NGT; lean group	56.3±10.2; 24.2±1.5	% EWL 67.4±13.4	1 y	Lower ghrelin levels in obese compared to lean presurgery; No difference in fasting ghrelin in T2D and NGT before surgery; Decrease in fasting ghrelin in both T2D and NGT after surgery.
Lin et al. 2004 [32]	Prospective controlled	34 RYGB; 4 VBG; 4 ARS; 4 lean ARS	47.0±0.7; 43.7±2.5; 40.0±2.0; 23.8±0.9	NA	30 min postop	Ghrelin higher in lean ARS compared to pre-RYGB; Decrease in ghrelin levels post-RYGB to levels lower that lean ARS;
Frühbeck et al. 2004 [37]	Prospective controlled	8 RYGB; 8 AGB; 8 Conv; 6 Total; gastrectomy	44.2±2.6; 44.8±1.6; 43.7±1.5; 29.9+1.1	NA	6 mo	At 6 mo, lower fasting ghrelin in RYGB and gastrectomy groups compared to AGB and conv group; No differences in fasting ghrelin at 6 mos between RYGB group and gastrectomy group.
Couce et al., 2006 [34]	Prospective controlled	49 obese (30 F); RYGB; 19 obese; (9 F) other; GI surgeries	50±5.3; 29.8±3.1	NA	2 hr; 10 d; 6 mo	Decrease in fasting ghrelin at 2 hr in both groups compared to preop; Decrease in fasting ghrelin 10 d postop in only RYGB group compared to preop; At 6 mo, no change in ghrelin levels in both groups compared to preoperative levels.
Morínigo et al. 2008 [35]	Prospective controlled	25 non diabetics; RYGB (6 F); 6 nonobese (2 F); 10 severely obese; T2D (5 F) RYGB	48.8±1.2; 49.2±2.0	43.0±2.3	6 and 52 wk	Decrease in fasting plasma ghrelin at 6 wk postop; At 52 wk, plasma ghrelin returned to baseline levels.
Karamanakos et al. 2008 [40]	Prospective controlled	16 RYGB (12 F, 2 T2D); 16 LSG (15 F, 1 IGT)	46.6±3.7; 45.1±3.6	% EWL^a; 60.5±10.7; 69.7±14.6	1, 3, 6 and; 12 mo	No significant change in fasting ghrelin RYGB group; Significant decrease in LSG.
Oliván et al. 2009 [39]	Prospective controlled	21 T2D; 10 RYGB; 11 diet; 9 obese nondiabetics	47.4±10.6; 42.8±3.8; 45.5±7.1	NA	10 Kg weight loss	No change in fasting ghrelin after RYGB
Frühbeck et al. 2004 [38]	Retrospective controlled	6 RYGB; 7 AGB; 3 BPD	42.6±1.6; 45.6±1.8; 60.5±7.3	50.1±4.4; 42.2±3.1; 54.2±4.3	6.1±0.4 mo; 7.0±0.6 mo; 4.4±0.8 mo	Significant decrease in fasting ghrelin in RYGB group compared to the other 2 groups
Foschi et al. 2008 [36]	Retrospective controlled	10 RYGB (9 F); 12 VBG (11 F)	44.1±1.8; 42.9±1.6	20	20% reduction in BMI (=131±6 d for RYGB); (119±4.2 for VBG)	Basal ghrelin plasma levels reduced after RYGBP but increased after VBG
Rodieux et al. 2008 [41]	Cross-sectional controlled	8 RYGB; 6 GB; 8 weight matched	44.9±1.8; 41.1±0.5; 29.2±0.8	47.8±3.3; 32.4±2.0	9 to 48 mo; 25 to 85 mo	No change in fasting ghrelin; Maximal PP suppression of ghrelin greatest in RYGB group

Abbreviations: ABG: adjustable gastric banding, ARS: anti-reflux surgery, Conv: conventional weight loss, GB: gastric banding, GI: gastrointestinal, IGT: impaired glucose tolerance, NA: data not available, LSG: laparoscopic sleeve gastrectomy, Postop: postoperatively, RYGB: Roux-en-y gastric bypass, T2D: type 2 diabetes, VBG: vertical banded gastroplasty.
^a% EWL: excess weight loss = [(operative weight − follow-up weight)/operative excess weight] × 100.