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Plasma Ghrelin in Obesity before and after Weight Loss after Laparoscopical Adjustable Gastric Banding

Department of Internal Medicine V (U.H.-E., E.C., A.D.), Wilhelminenspital, A-1160 Vienna, Austria; Division of Clinical Endocrinology (G.B.), Hannover Medical School, D-30623 Hannover, Germany; Department of Surgery (H.R.), Sozial-Medizinisches Zentrum Ost, A-1220 Vienna, Austria; Metabolic Unit (G.P.), Institute of Biomedical Engineering, ISIB-CNR, I-35127 Padova, Italy; Ludwig Boltzmann Institute for Leukemia (H.T.), Hanusch Hospital, A-1140 Vienna, Austria; Ludwig Boltzmann Institute for Nutrition and Metabolism (R.P.), Hospital Lainz, A-1130 Vienna, Austria; and 1. Medical Department (M.R.), Hanusch Hospital, A-1140 Vienna, Austria

Address all correspondence and requests for reprints to: Michael Roden, M.D., 1. Medical Department, Hanusch Hospital, A-1140 Vienna, Austria. E-mail: michael.roden{at}akh-wien.ac.at.

Weight reduction after gastric bypass surgery has been attributed to a decrease of the orexigenic peptide ghrelin, which may be regulated by insulin and leptin. This study examined effects of long-term weight loss after laparoscopical adjustable gastric banding on plasma ghrelin and leptin concentrations and their relationship with insulin action. Severely obese patients (15 women, three men, 36 ± 12 yr) underwent clinical examinations every 3 months and modified oral glucose tolerance tests to assess parameters of insulin sensitivity and secretion every 6 months. After surgery, body mass index fell from 45.3 ± 5.3 to 37.2 ± 5.3 and 33.6 ± 5.5 kg/m² at 6 and 12 months, respectively (P < 0.0001). This was associated with lower (P < 0.0001) plasma glucose, insulin, insulin resistance, waist circumference, and blood pressure. Plasma leptin decreased from 27.6 ± 9.5 to 17.7 ± 9.8 (P = 0.0005) and 12.7 ± 5.1 ng/ml (P < 0.0001). Plasma ghrelin was comparable before and at 6 months (234 ± 53; 232 ± 53 pmol/liter) but increased at 12 months (261 ± 72 pmol/liter; P = 0.05 vs. 6 months). At 6 and 12 months, ghrelin levels correlated negatively with fasting plasma insulin levels and hepatic insulin extraction but not with body mass or insulin action.

In conclusion, prolonged weight loss results in a rise of fasting ghrelin concentrations that correlates with fasting insulin concentrations but not improvement of insulin sensitivity.

This work was supported by grants from the Austrian Science Foundation (P15656) and the European Foundation for the Study of Diabetes (EFSD Novo-Nordisk Type 2 Focused Research Program) to M.R.

Abbreviations: AUC, Area under the concentration-time curve; BMI, body mass index; BSR, basal fasting prehepatic insulin secretion rate per unit volume; DM, diabetes mellitus; ghrelin, changes in plasma ghrelin; HIE, hepatic insulin extraction; IGT, impaired glucose tolerance; LAGB, laparoscopical adjustable gastric banding; NGT, normal glucose tolerance; OGIS, OGTT-based index of insulin sensitivity; OGTT, oral glucose tolerance test; RYGB, Roux-en-Y gastric bypass; TIS, total amount of secreted insulin per unit volume.

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