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  Distinct adaptations of endocrine and cognitive functions may contribute to high variability in long-term weight loss outcome after bariatric surgery

Lammert, M., Medawar, E., Hartmann, H., Grasser, L., Dietrich, A., Fenske, W., et al. (2023). Distinct adaptations of endocrine and cognitive functions may contribute to high variability in long-term weight loss outcome after bariatric surgery. Physiology & Behavior, 269: 114279. doi:10.1016/j.physbeh.2023.114279.

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Lammert, Mathis1, 2, 3, Author
Medawar, Evelyn1, Author                 
Hartmann, Hendrik1, 3, 4, Author                 
Grasser, Linda1, 2, Author
Dietrich, Arne5, Author
Fenske, Wiebke6, Author
Horstmann, Annette1, 2, 3, 4, Author                 
1Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_634549              
2Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Germany, ou_persistent22              
3Collaborative Research Center Obesity Mechanisms, Institute of Biochemistry, University of Leipzig, Germany, ou_persistent22              
4Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland, ou_persistent22              
5Department of Obesity, Metabolic and Endocrine Surgery, University Hospital Leipzig, Germany, ou_persistent22              
6Department of Endocrinology, Diabetes and Metabolism, University Hospital Bonn, Germany, ou_persistent22              


Free keywords: Bariatric surgery; Gut hormones; Postprandial release; Working memory function
 Abstract: Background: Bariatric surgery has been widely recognized as the most efficient long-term treatment method in severe obesity, yet therapy success shows considerable interindividual variability. Postoperative metabolic adaptations, including improved gut hormone secretion (GLP-1, PYY and ghrelin), and restored executive function may play an explanatory role in weight loss, yet causes for poor success in individual patients remain unknown. This study investigates gut-hormonal and cognitive characteristics in extreme weight loss responders to bariatric surgery. Methods: Patients (n=47) with high or low excessive weight loss (EWL) at least 2 years after Roux-en-Y-gastric bypass or sleeve gastrectomy were allocated into good responders (GR, EWL 82.4 ± 11.6%) and poor responders (PR, EWL 24.0 ± SD 12.8%) to study differences in postprandial secretion of GLP-1, PYY, ghrelin and in working memory (WM). Results: Mean BMI was 47.1 ± 6.2 kg/m² in PR (n=21) and 28.9 ± 3.1 kg/m² in GR (n=26, p < 0.001). Fasted GLP-1 and PYY were comparable for GR and PR (p > 0.2) and increased strongly after a standardized test meal (300 kcal liquid meal) with a peak at 15 to 30 minutes. The increase was stronger in GR compared to PR (GLP-1, PYY: Time x Group p < 0.05). Plasma ghrelin levels already differed between groups at fasted state, showing significantly higher levels for GR (p < 0.05). Postprandially, ghrelin secretion was suppressed in both groups, but suppression was higher in GR (Time x Group p < 0.05). GR showed significantly higher WM scores than PR (p < 0.05). Postprandial ghrelin (iAUC), but not GLP-1 or PYY plasma levels, significantly mediated the relationship between EWL and a WM subscore (IS score, CI = 0.07 - 1.68), but not WM main score (MIS score, CI = -0.07 - 1.54), in mediation analyses. Conclusion: Excess weight loss success after bariatric surgical procedures is associated with distinct profiles of gut-hormones at fasted and postprandial state, and differences in working memory. Better working memory performance in GR might be mediated by higher postprandial reduction in ghrelin plasma levels. Future studies need to integrate longitudinal data, larger samples and more sensitive cognitive tests.


Language(s): eng - English
 Dates: 2023-05-082022-12-012023-06-202023-06-242023-10-01
 Publication Status: Issued
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.1016/j.physbeh.2023.114279
Other: epub 2023
PMID: 37356514
 Degree: -



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Project name : -
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Funding program : (209933838 – SFB 1052)
Funding organization : German Research Foundation (DFG)
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Grant ID : 01E01501
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Funding organization : Federal Ministry of Education and Research (BMBF)
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Funding organization : Projekt DEAL

Source 1

Title: Physiology & Behavior
Source Genre: Journal
Publ. Info: New York [etc.] : Elsevier
Pages: - Volume / Issue: 269 Sequence Number: 114279 Start / End Page: - Identifier: ISSN: 0031-9384
CoNE: https://pure.mpg.de/cone/journals/resource/954925433415