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Calorie restriction and Roux‐en‐Y gastric bypass have opposing effects on circulating FGF 21 in morbidly obese subjects
Author(s) -
Lips Mirjam A.,
Groot Gerrit H.,
Berends Frits J.,
Wiezer Renee,
Wagensveld Bart A.,
Swank Dingeman J.,
Luijten Arijan,
Dijk Ko Willems,
Pijl Hanno,
Jansen Peter L.M.,
Schaap Frank G.
Publication year - 2014
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12496
Subject(s) - morbidly obese , medicine , roux en y anastomosis , endocrinology , calorie restriction , gastric bypass , fibroblast growth factor , fgf21 , obesity , weight loss , receptor
Summary Objective To study the effect of different weight loss strategies on levels of the metabolic regulator FGF 21 in morbidly obese females with normal glucose tolerance ( NGT ) or type 2 diabetes mellitus (T2 DM ). Design Observational intervention trial. Patients and measurements Weight reduction was achieved by Gastric Banding ( GB , n = 11) or Roux‐en‐Y Gastric Bypass ( RYGB , n = 16) in subjects with NGT , and by RYGB ( n = 15) or a very‐low‐calorie diet ( VLCD , n = 12) in type 2 diabetics. Fasted and/or postprandial levels of FGF 21, FGF 19 (an FGF 21‐related postprandial hormone) and bile salts (implicated in regulation of FGF 21 and FGF 19 expression) were measured before, and 3 and 12 weeks after intervention. Results Fasted FGF 21 levels were elevated in T2 DM subjects. Calorie restriction by either GB or VLCD lowered bile salt and FGF 21 levels. In contrast, RYGB surgery was associated with elevated bile salt and FGF 21 levels. Conclusions Calorie restriction and RYGB have opposite effects on serum bile salt and FGF 21 levels. Calorie restriction results in FGF 21 approaching nonobese control levels, suggesting that this intervention is effective in reducing the “nutritional crisis” that appears to underly FGF 21 elevation in obesity. FGF 21 elevation after RYGB may contribute to the beneficial effect of this procedure.