Plasma FGF21 levels in obese patients undergoing energy-restricted diets or bariatric surgery: a marker of metabolic stress?

• Published in: International Journal of Obesity Vol. 41; no. 10; pp. 1570 - 1578
• Main Authors: Crujeiras, A B, Gomez-Arbelaez, D, Zulet, M A, Carreira, M C, Sajoux, I, de Luis, D, Castro, A I, Baltar, J, Baamonde, I, Sueiro, A, Macias-Gonzalez, M, Bellido, D, Tinahones, F J, Martinez, J A, Casanueva, F F
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-10-2017; Nature Publishing Group
• Subjects: 631/443/319/1557; 692/163/2743/393; 692/308/575; Adipose tissue; Adult; Bariatric Surgery; Biomarkers - blood; Body Composition; Body weight; Body weight loss; Caloric Restriction; Care and treatment; Diet; Diet therapy; Dietary restrictions; Energy; Epidemiology; Female; Fibroblast growth factors; Fibroblast Growth Factors - blood; Follow-Up Studies; Gastrointestinal surgery; Growth factors; Health aspects; Health Promotion and Disease Prevention; Humans; Hypocaloric diet; Insulin; Insulin Resistance; Internal Medicine; Ketosis; Male; Markers; Measurement; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolism; Nutrient deficiency; Nutritional status; Nutritional Status - physiology; Obesity; Obesity, Morbid - blood; Obesity, Morbid - complications; Obesity, Morbid - surgery; Obesity, Morbid - therapy; original-article; Patient outcomes; Patients; Physiological aspects; Public Health; Reducing diets; Sensitivity analysis; Spain; Stress, Physiological; Surgery; Weight Loss; Weight reduction; Spain
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/ijo.2017.138

Background:
Fibroblast growth factor 21 (FGF21) has been suggested to be an endocrine signal of nutritional status and an active regulator of metabolism. However, there is no agreement on the effect of weight-loss therapies on circulating levels of FGF21 in humans.
Objective:
To assess FGF21 circulating levels in adiposity excess and after different weight-loss strategies prescribed in five different groups from four independent centers.
Subjects and methods:
Body composition, ketosis, insulin sensitivity and FGF21 were evaluated in 181 excess body weight and 14 normal-weight subjects. From the excess body weight patients, two independent groups (discovery cohort;
n
=20 and validation cohort;
n
=28) undertook a very low-calorie ketogenic (VLCK) diet, a third group followed a low-calorie (LC) diet (
n
=84) and other two groups underwent bariatric surgery (discovery cohort;
n
=24 and validation cohort;
n
=25). The follow-up was 4 to 6 or 12 months, respectively.
Results:
FGF21 levels were higher in excess body weight patients than in normal-weight subjects. The energy-restriction therapy to lose weight induced a significant decrease, with respect to baseline, in circulating levels of FGF21 (VLCK: −62.5 pg ml
−1
or −14.8 pg ml
−1
and LC diet: −67.9 pg ml
−1
). There were no differences in FGF21 levels between both energy-restriction treatments. On the contrary, after bariatric surgery morbidly obese patients showed a significant increase in FGF21, especially 1 month after surgery (148.8 pg ml
−1
higher than baseline). The FGF21 differential changes occur concomitantly with a non-induced ketosis situation (0.66±0.56 m
m
) in bariatric surgery, and an improvement in adiposity and insulin sensitivity induced by the three therapies.
Conclusions:
FGF21 levels were reduced after energy-restricted treatments and severely increased after bariatric surgery, independently of the weight reduction magnitude, insulin sensitivity or ketosis. Therefore, FGF21 appears to be a marker of severe nutritional stress.