Session: SAT 660-676-Clinical Obesity Treatment
Poster Board SAT-674
Aim. The aim of this study was to investigate whether: A) N&V symptoms are related to elevated GLP-1 levels, and, B) whether treatment to reduce systemic GLP-1 ameliorates these symptoms. The study also aimed to ascertain whether GLP-1 is either, directly or indirectly, associated with leptin levels.
Methods. Forty two female, non-diabetic subjects were studied in 5 groups. Group (1): patients with N&V after RYGB surgery (n=10). Group (2): patients with no symptoms after RYGB surgery (n=10). Group (3): morbidly obese patients (n=7). Group (4): obese/overweight subjects (n=6). Group (5): lean healthy subjects (n=8). Blood was collected in the fasting and post-prandial states. Plasma concentrations of insulin, glucose, GLP-1 and adipokines were measured. A sub-set of symptomatic patients were treated with Octreotide (somatostatin analogue) and GLP-1 measured. Subcutaneous (SC) and omental (OM) adipose tissue were collected from morbidly obese patients during bariatric surgery. Adipose tissue was treated with recombinant GLP-1 for 16 hours and the media assayed for leptin.
Results. Subjects with N&V post RYGB had significantly elevated fasting GLP-1 levels (p=0.03) compared to all other groups. Weight loss, glucose, insulin, and GLP-1 responses to an 180Kcal meal were similar in subjects with and without N&V. Patients treated with Octreotide showed reduced GLP-1 levels and improvements in their symptoms. Fasting plasma leptin was significantly lower in subjects with N&V compared to those without (p=0.04) and leptin secretion from adipose explants was inhibited by GLP-1 treatment.
Conclusion. The persistent N&V post RYGB surgery appears to be mediated by elevated fasting GLP-1 levels, as inhibition with Octreotide helps both lower GLP-1 and ameliorate symptoms. However, potential detrimental effects on weight maintenance and insulin sensitivity need to be considered. GLP-1 also has a direct inhibitory effect on leptin secretion, so decreased leptin levels early after RYGB might be explained by elevated GLP-1 levels.
Nothing to Disclose: NA, RG, PS, EA
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