Calorie restriction and Roux-en-Y gastric bypass have opposing effects on circulating FGF21 in morbidly obese subjects

• Published in: Clinical endocrinology (Oxford) Vol. 81; no. 6; pp. 862 - 870
• Main Authors: Lips, Mirjam A., de Groot, Gerrit H., Berends, Frits J., Wiezer, Renee, van Wagensveld, Bart A., Swank, Dingeman J., Luijten, Arijan, van Dijk, Ko Willems, Pijl, Hanno, Jansen, Peter L.M., Schaap, Frank G.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-12-2014; Blackwell; Wiley Subscription Services, Inc
• Subjects: Bariatric Surgery - methods; Biological and medical sciences; Caloric Restriction - methods; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Endocrinopathies; Female; Fibroblast Growth Factors - blood; Fundamental and applied biological sciences. Psychology; Gastric Bypass - methods; Humans; Medical sciences; Metabolic diseases; Middle Aged; Obesity; Obesity, Morbid - blood; Obesity, Morbid - complications; Obesity, Morbid - therapy; Vertebrates: endocrinology; Calorie; Human; Stomach; Obesity; Digestive system; Nutrition disorder; Roux en Y loop; Endocrinology; Nutritional status
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.12496

Summary
Objective
To study the effect of different weight loss strategies on levels of the metabolic regulator FGF21 in morbidly obese females with normal glucose tolerance (NGT) or type 2 diabetes mellitus (T2DM).
Design
Observational intervention trial.
Patients and measurements
Weight reduction was achieved by Gastric Banding (GB, n = 11) or Roux‐en‐Y Gastric Bypass (RYGB, n = 16) in subjects with NGT, and by RYGB (n = 15) or a very‐low‐calorie diet (VLCD, n = 12) in type 2 diabetics. Fasted and/or postprandial levels of FGF21, FGF19 (an FGF21‐related postprandial hormone) and bile salts (implicated in regulation of FGF21 and FGF19 expression) were measured before, and 3 and 12 weeks after intervention.
Results
Fasted FGF21 levels were elevated in T2DM subjects. Calorie restriction by either GB or VLCD lowered bile salt and FGF21 levels. In contrast, RYGB surgery was associated with elevated bile salt and FGF21 levels.
Conclusions
Calorie restriction and RYGB have opposite effects on serum bile salt and FGF21 levels. Calorie restriction results in FGF21 approaching nonobese control levels, suggesting that this intervention is effective in reducing the “nutritional crisis” that appears to underly FGF21 elevation in obesity. FGF21 elevation after RYGB may contribute to the beneficial effect of this procedure.