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Plasma Acylation-Stimulating Protein, Adiponectin, Leptin, and Ghrelin before and after Weight Loss Induced by Gastric Bypass Surgery in Morbidly Obese Subjects

Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University (M.F., S.P., A.D.S., K.C.), and Division of Clinical Biochemistry, Royal Victoria Hospital (D.B.), Montréal, Québec, Canada; and Department of Nutrition, University of California (P.J.H.), Davis, California 95616

Address all correspondence and requests for reprints to: Dr. Katherine Cianflone, Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montréal, Québec, Canada H3A 1A1. E-mail: Katherine.cianflone{at}staff.mcgill.ca.

We examined fasting plasma insulin, acylation-stimulating protein (ASP), leptin, adiponectin, ghrelin, and metabolic/cardiovascular risk profile before and 15 ± 6 months after isolated Roux-en-Y gastric bypass surgery in 50 morbidly obese subjects. Average preoperative plasma lipids were mostly normal, whereas ASP, insulin, and leptin were elevated, and adiponectin and ghrelin were decreased. Postoperatively, body weight decreased significantly (-36.4 ± 9.6%) and was best predicted by preoperative adiponectin concentration in weight-stable subjects (r = -0.59; P = 0.02). Plasma lipids and insulin resistance improved, leptin and ASP decreased (-76.3 ± 14.6% and -35.9 ± 52.2%; P < 0.001), and adiponectin increased (50.1 ± 47.0%; P < 0.001). The decrease in apolipoprotein B was best predicted by the decrease in ASP (r = 0.55; P = 0.009), whereas the improved postoperative insulin sensitivity was best predicted by the increase in adiponectin (r = 0.70; P = 0.01). Despite bypassing 95% of the stomach and isolating the fundus from contact with ingested nutrients, circulating ghrelin did not decrease after surgery. In fact, plasma ghrelin increased postoperatively in the subset of subjects undergoing active weight loss (+60.5 ± 23.2%; P < 0.001); ghrelin, however, remained unchanged in weight-stable subjects. In summary, 1) preoperative adiponectin concentrations may be predictive of the extent of weight loss; 2) changes in ASP and adiponectin are predictive of decreased apolipoprotein B and improved insulin action, respectively; and 3) plasma ghrelin increases after gastric bypass surgery in patients experiencing active weight loss.

This work was supported by a grant from Servier Pharmaceuticals (to A.D.S.), the Canadian Institute for Health Research (to K.C.), and NIH Grants DK-50129, DK-35747, and DK-58108, the U.S. Department of Agriculture, and the American Diabetes Association (to P.J.H.).

K.C. is a research scholar of the Fonds de Recherche en Santé du Québec.

Abbreviations: apoB, Apolipoprotein B; ASP, acylation-stimulating protein; BMI, body mass index; HDL, high density lipoprotein; HOMA-IR, homeostasis model assessment for insulin resistance; LDL, low density lipoprotein; NEFA, nonesterified fatty acids; TG, triglycerides.

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