Remission of Diabetes Following Bariatric Surgery: Plasma Proteomic Profiles

Bariatric surgery restores glucose tolerance in many, but not all, severely obese subjects with type 2 diabetes (T2D). We aimed to evaluate the plasma protein profiles associated with the T2D remission after obesity surgery. We recruited seventeen women with severe obesity submitted to bariatric procedures, including six non-diabetic patients and eleven patients with T2D. After surgery, diabetes remitted in 7 of the 11 patients with T2D. Plasma protein profiles at baseline and 6 months after bariatric surgery were analyzed by two-dimensional differential gel electrophoresis (2D-DIGE) and matrix-assisted laser desorption/ionization-time-of-flight/time-of-flight coupled to mass spectrometry (MALDI-TOF/TOF MS). Remission of T2D following bariatric procedures was associated with changes in alpha-1-antichymotrypsin (SERPINA 3, p < 0.05), alpha-2-macroglobulin (A2M, p < 0.005), ceruloplasmin (CP, p < 0.05), fibrinogen beta chain (FBG, p < 0.05), fibrinogen gamma chain (FGG, p < 0.05), gelsolin (GSN, p < 0.05), prothrombin (F2, p < 0.05), and serum amyloid p-component (APCS, p < 0.05). The resolution of diabetes after bariatric surgery is associated with specific changes in the plasma proteomic profiles of proteins involved in acute-phase response, fibrinolysis, platelet degranulation, and blood coagulation, providing a pathophysiological basis for the study of their potential use as biomarkers of the surgical remission of T2D in a larger series of severely obese patients.

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Major microbiota dysbiosis in severe obesity: fate after bariatric surgery

Gut ◽

10.1136/gutjnl-2018-316103 ◽

2018 ◽

Vol 68 (1) ◽

pp. 70-82 ◽

Cited By ~ 105

Author(s):

Judith Aron-Wisnewsky ◽

Edi Prifti ◽

Eugeni Belda ◽

Farid Ichou ◽

Brandon D Kayser ◽

...

Keyword(s):

Bariatric Surgery ◽

Gut Microbiota ◽

Severe Obesity ◽

Shotgun Metagenomics ◽

Host Interactions ◽

Registration Number ◽

Severely Obese ◽

Obese Subjects ◽

Gene Richness

ObjectivesDecreased gut microbial gene richness (MGR) and compositional changes are associated with adverse metabolism in overweight or moderate obesity, but lack characterisation in severe obesity. Bariatric surgery (BS) improves metabolism and inflammation in severe obesity and is associated with gut microbiota modifications. Here, we characterised severe obesity-associated dysbiosis (ie, MGR, microbiota composition and functional characteristics) and assessed whether BS would rescue these changes.DesignSixty-one severely obese subjects, candidates for adjustable gastric banding (AGB, n=20) or Roux-en-Y-gastric bypass (RYGB, n=41), were enrolled. Twenty-four subjects were followed at 1, 3 and 12 months post-BS. Gut microbiota and serum metabolome were analysed using shotgun metagenomics and liquid chromatography mass spectrometry (LC-MS). Confirmation groups were included.ResultsLow gene richness (LGC) was present in 75% of patients and correlated with increased trunk-fat mass and comorbidities (type 2 diabetes, hypertension and severity). Seventy-eight metagenomic species were altered with LGC, among which 50% were associated with adverse body composition and metabolic phenotypes. Nine serum metabolites (including glutarate, 3-methoxyphenylacetic acid and L-histidine) and functional modules containing protein families involved in their metabolism were strongly associated with low MGR. BS increased MGR 1 year postsurgery, but most RYGB patients remained with low MGR 1 year post-BS, despite greater metabolic improvement than AGB patients.ConclusionsWe identified major gut microbiota alterations in severe obesity, which include decreased MGR and related functional pathways linked with metabolic deteriorations. The lack of full rescue post-BS calls for additional strategies to improve the gut microbiota ecosystem and microbiome–host interactions in severe obesity.Trial registration numberNCT01454232.

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-Cell Function in Severely Obese Type 2 Diabetic Patients: Long-term effects of bariatric surgery

Diabetes Care ◽

10.2337/dc06-1845 ◽

2007 ◽

Vol 30 (4) ◽

pp. 1002-1004 ◽

Cited By ~ 35

Author(s):

S. Camastra ◽

M. Manco ◽

A. Mari ◽

A. V. Greco ◽

S. Frascerra ◽

...

Keyword(s):

Bariatric Surgery ◽

Cell Function ◽

Diabetic Patients ◽

Long Term Effects ◽

Type 2 Diabetic Patients ◽

Severely Obese ◽

Type 2 Diabetic

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Abstract #724: Bariatric Surgery Restores Both Cardiac and Sudomotor Autonomic C-Fiber Dysfunction Towards Normal in Obese Subjects with Type 2 Diabetes

Endocrine Practice ◽

10.1016/s1530-891x(20)45133-x ◽

2016 ◽

Vol 22 ◽

pp. 159

Author(s):

Carolina Casellini ◽

Joshua Edwards ◽

Henri Parson ◽

Kim Hodges ◽

David Lieb ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

C Fiber ◽

Obese Subjects

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Comparative evaluation the effects of bariatric surgery and exenatide treatment on the clinical and laboratory parameters in obese type 2 diabetic patients

Endocrine Abstracts ◽

10.1530/endoabs.49.ep608 ◽

2017 ◽

Author(s):

Onur Elbasan ◽

Pinar Sisman ◽

Hande Peynirci ◽

Gul Ozen Oz ◽

Soner Cander ◽

...

Keyword(s):

Bariatric Surgery ◽

Comparative Evaluation ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Laboratory Parameters ◽

Type 2 Diabetic

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Early Improvement of Postprandial Lipemia After Bariatric Surgery in Obese Type 2 Diabetic Patients

Obesity Surgery ◽

10.1007/s11695-013-1148-z ◽

2013 ◽

Vol 24 (5) ◽

pp. 765-770 ◽

Cited By ~ 18

Author(s):

E. Griffo ◽

G. Nosso ◽

R. Lupoli ◽

M. Cotugno ◽

G. Saldalamacchia ◽

...

Keyword(s):

Bariatric Surgery ◽

Postprandial Lipemia ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Early Improvement ◽

Type 2 Diabetic

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Randomized Pilot Trial of Bariatric Surgery Versus Intensive Medical Weight Management on Diabetes Remission in Type 2 Diabetic Patients Who Do NOT Meet NIH Criteria for Surgery and the Role of Soluble RAGE as a Novel Biomarker of Success

Annals of Surgery ◽

10.1097/sla.0000000000000919 ◽

2014 ◽

Vol 260 (4) ◽

pp. 617-624 ◽

Cited By ~ 60

Author(s):

Manish Parikh ◽

Mimi Chung ◽

Sheetal Sheth ◽

Michelle McMacken ◽

Tasneem Zahra ◽

...

Keyword(s):

Bariatric Surgery ◽

Pilot Trial ◽

Diabetes Remission ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Soluble Rage ◽

Medical Weight Management ◽

Type 2 Diabetic

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Abstract 018: Two-year Changes of Adiponectin after Bariatric Surgery and Their Association with Incident Type 2 Diabetes, Cardiovascular Disease, Cancer and Mortality: Results from the Swedish Obese Subjects Study

Circulation ◽

10.1161/circ.125.suppl_10.a018 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Christian Herder ◽

Markku Peltonen ◽

Per-Arne Svensson ◽

Maren Carstensen ◽

Peter Jacobson ◽

...

Keyword(s):

Myocardial Infarction ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Bariatric Surgery ◽

Weight Loss ◽

Control Group ◽

Incident Type ◽

Surgery Group ◽

Obese Subjects

Introduction: Adiponectin has anti-inflammatory, insulin-sensitising and atheroprotective effects in rodents. Although serum adiponectin is uniformly downregulated in obesity, its clinical relevance in humans seems more complex. It is not known whether changes in circulating adiponectin predict type 2 diabetes, cardiovascular disease, cancer and mortality in an obese population. Hypothesis: We hypothesised that adiponectin levels are upregulated substantially after weight loss following bariatric surgery and that pronounced increases of adiponectin should offer better protection for individuals against type 2 diabetes. In addition, findings for type 2 diabetes should be compared to associations with cardiovascular disease, myocardial infarction, stroke, cancer and mortality. Methods: Serum concentrations of total adiponectin were measured in 3,223 participants of the Swedish Obese Subjects (SOS) Study (1,533 in the bariatric surgery group: 229 with gastric bypass, 1056 with vertical banded gastroplasty, 248 with adjustable gastric banding; 1,690 in the control group without surgery) at study baseline and after 2 years. Hazard ratios (HR) and 95% confidence intervals (CI) per 1 standard deviation (SD) of 2-year changes (concentration at year 2 - concentration at baseline) in adiponectin were calculated for incident type 2 diabetes, cardiovascular disease, myocardial infarction, stroke, cancer and mortality in the combined surgery group. Numbers of cases were 93, 122, 78, 55, 82 and 179, respectively. Median follow-up times ranged from 10 years for diabetes up to 16 years for mortality. Results: Mean (SD) levels of adiponectin at baseline were 7,453 (4,150) ng/ml in the combined surgery group and 8,247 (4,846) ng/ml in the control group. During the first 2 years of follow-up, adiponectin levels increased in the surgery group by 4,850 (5,387) ng/ml (parallel to a loss of 24% of body weight) and decreased slightly by 270 (2,650) ng/ml in the control group (parallel to a slight gain of 0.1% body weight). The degree of correlation between changes in adiponectin and weight loss in kg was more pronounced in the surgery groups compared with the control group (p=0.001 for interaction). Two-year increases in adiponectin in the surgery group were associated with decreased risk of type 2 diabetes (HR [95% CI] 0.61 [0.38-0.98], adjusted for baseline data for age, sex, BMI, lipids, blood pressure, alcohol consumption, smoking, anti-hypertensive drugs, glucose, insulin), but not with cardiovascular disease, myocardial infarction, stroke, cancer and mortality (adjusted HR between 0.89 and 1.05). Conclusions: Weight loss after bariatric surgery is paralleled by a substantial increase in circulating adiponectin. The degree of upregulation of adiponectin is associated with protection against future type 2 diabetes, but not with the incidence of cardiovascular outcomes, cancer or mortality.

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Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

10.2337/figshare.16903630 ◽

2021 ◽

Author(s):

Kajsa Sjöholm ◽

Lena MS Carlsson ◽

Per-Arne Svensson ◽

Johanna C. Andersson-Assarsson ◽

Felipe Kristensson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Cancer Risk ◽

Cancer Incidence ◽

Diabetes Remission ◽

Obesity And Diabetes ◽

Obese Subjects

OBJECTIVE Obesity and type 2 diabetes are associated with serious, adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. RESEARCH DESIGN AND METHODS The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of which underwent bariatric surgery, and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years). RESULTS During follow-up, the incidence rate for first-time cancer was 9.1 per 1000-person-years (95% CI, 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1000-person-years (95% CI, 11.2-17.7) in patients treated with usual obesity care (HRadj=0.63; 95% CI 0.44-0.89, p=0.008). Moreover, surgery was associated with reduced cancer incidence in women (HRadj=0.58; 0.38-0.90, p=0.016), although the sex-treatment interaction was non-significant (p=0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (HRadj=0.40; 95% CI 0.22-0.74, p=0.003). CONCLUSIONS These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes, and that durable diabetes remission is associated with reduced cancer risk.

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