Study of the effects of transoral gastroplasty on insulin sensitivity and secretion in obese subjects |
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| Authors: | C Chiellini A Iaconelli P Familiari ME Riccioni M Castagneto G Nanni G Costamagna G Mingrone |
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| Institution: | 1. Institute of Internal Medicine, Catholic University, School of Medicine, Largo A. Gemelli 8, 00168 Rome, Italy;2. Digestive Endoscopy Unit, Catholic University, Rome, Italy;3. Department of Surgery, Catholic University, Rome, Italy;1. Department of Surgery, University of South Alabama College of Medicine, Mobile, Alabama;2. Microbiology and Immunology, University of South Alabama College of Medicine, Mobile, Alabama;3. The Laboratory of Molecular Biology, University of South Alabama College of Medicine, Mobile, Alabama;4. The Center for Lung Biology, University of South Alabama College of Medicine, Mobile, Alabama;5. Internal Medicine, University of South Alabama College of Medicine, Mobile, Alabama;6. Pharmacology, University of South Alabama College of Medicine, Mobile, Alabama;1. Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain;2. Institut d’Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain;3. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain;1. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan;2. Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan;3. Department of Otorhinolaryngology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan;4. Department of General Practice, Ishikawa Prefectural Central Hospital, Ishikawa, Japan;1. Adiyaman University, Training and Research Hospital, Department of Cardiology, Adiyaman, Turkey;2. Elbistan State Hospital, Department of Cardiology, Kahramanmaras, Turkey;3. Kars State Hospital, Department of Cardiology, Kars, Turkey;4. 18 Mart University, Faculty of Medicine, Department of Cardiology, Çanakkale, Turkey |
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| Abstract: | Background and aimsTransoral gastroplasty (TOGA) recently emerged as a new, feasible and relatively safe technique for the surgical treatment of obesity. However, so far there are no data on the effects on insulin sensitivity in the literature. Our aim is to evaluate the effect of TOGA on insulin sensitivity and secretion.Methods and resultsNine glucose normo-tolerant obese subjects (age:41 ± 6 years; BMI:42.49 ± 1.03 kg/m2) were studied. Fat-free mass (FM) and fat mass (FM) were assessed by bioelectrical impedance; plasma glucose, insulin, and C-peptide were measured during an oral glucose tolerance test (OGTT) before and 3 months after the operation. Insulin sensitivity was calculated using the oral-glucose insulin-sensitivity index, and insulin secretion by C-peptide deconvolution.Three months after surgery, a significant (P = 0.008) reduction of BMI to 35.65 ± 0.65 kg/m2, with a decrease of FM and FFM from 57.22 ± 2.19 to 41.46 ± 3.02 kg (P = 0.008) and from 59.52 ± 1.36 to 56.67 ± 1.10 kg (P = 0.048) respectively, was observed. Insulinemia was significantly reduced at fast and at 120 min after OGTT; in contrast, no significant change in glucose concentration was observed. Insulin sensitivity significantly increased (348.45 ± 20.08 vs. 421.18 ± 20.84 ml/min/m2, P = 0.038) and the incremental area of insulin secretion rate (total ISR) significantly decreased (from 235.05 ± 27.50 to 124.77 ± 14.50 nmol/min/m2, P = 0.021). Total ISR correlated with weight, BMI and FM (r = 0.522, P = 0.028; r = 0.541, P = 0.020; r = 0.463, P = 0.049, respectively). BMI represented the most powerful predictor of ISR decrease (R2 = 0.541, P = 0.020).ConclusionTransoral gastroplasty allows a significant weight loss 3 months after the intervention as well as an amelioration of insulin sensitivity with subsequent reduction of the insulin secretion. |
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