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

TLDR

Preoperative plasma lipids are generally normal in morbidly obese patients, but ASP, insulin, and leptin are elevated while adiponectin and ghrelin are reduced. The study measured fasting plasma insulin, ASP, leptin, adiponectin, ghrelin, and metabolic/cardiovascular risk markers before and approximately 15 months after isolated Roux‑en‑Y gastric bypass in 50 morbidly obese subjects. Following gastric bypass, patients lost about 36 % of body weight, experienced marked improvements in lipids, insulin sensitivity, leptin, and ASP, increases in adiponectin, and a rise in ghrelin among those actively losing weight; preoperative adiponectin predicted weight loss, and changes in ASP and adiponectin predicted reductions in apolipoprotein B and improved insulin action.

Abstract

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.