Study of the effects of transoral gastroplasty on insulin sensitivity and secretion in obese subjects

Chiellini, C.; Iaconelli, A.; Familiari, P.; Riccioni, M.E.; Castagneto, M.; Nanni, G.; Costamagna, G.; Mingrone, G.

doi:10.1016/j.numecd.2009.03.012

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 20, Issue 3 , Pages 202-207, March 2010

Study of the effects of transoral gastroplasty on insulin sensitivity and secretion in obese subjects

C. Chiellini
- Institute of Internal Medicine, Catholic University, School of Medicine, Largo A. Gemelli 8, 00168 Rome, Italy
A. Iaconelli
- Institute of Internal Medicine, Catholic University, School of Medicine, Largo A. Gemelli 8, 00168 Rome, Italy
P. Familiari
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
M.E. Riccioni
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
M. Castagneto
- Department of Surgery, Catholic University, Rome, Italy
G. Nanni
- Department of Surgery, Catholic University, Rome, Italy
G. Costamagna
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
G. Mingrone
- Institute of Internal Medicine, Catholic University, School of Medicine, Largo A. Gemelli 8, 00168 Rome, Italy
- Corresponding author. Tel.: +39 06 3015 4395; fax: +39 06 3054 392.

Received 20 January 2009; received in revised form 6 March 2009; accepted 16 March 2009. published online 08 June 2009.

Abstract

Background and aims

Transoral gastroplasty (TOGA) recently emerged as a new, feasible and relatively safe technique for the surgical treatment of obesity. However, so far there are no data on the effects on insulin sensitivity in the literature. Our aim is to evaluate the effect of TOGA on insulin sensitivity and secretion.

Methods and results

Nine glucose normo-tolerant obese subjects (age:41±6years; BMI:42.49±1.03kg/m²) were studied. Fat-free mass (FM) and fat mass (FM) were assessed by bioelectrical impedance; plasma glucose, insulin, and C-peptide were measured during an oral glucose tolerance test (OGTT) before and 3months after the operation. Insulin sensitivity was calculated using the oral-glucose insulin-sensitivity index, and insulin secretion by C-peptide deconvolution.

Three months after surgery, a significant (P=0.008) reduction of BMI to 35.65±0.65kg/m², with a decrease of FM and FFM from 57.22±2.19 to 41.46±3.02kg (P=0.008) and from 59.52±1.36 to 56.67±1.10kg (P=0.048) respectively, was observed. Insulinemia was significantly reduced at fast and at 120min after OGTT; in contrast, no significant change in glucose concentration was observed. Insulin sensitivity significantly increased (348.45±20.08 vs. 421.18±20.84ml/min/m², P=0.038) and the incremental area of insulin secretion rate (total ISR) significantly decreased (from 235.05±27.50 to 124.77±14.50nmol/min/m², P=0.021). Total ISR correlated with weight, BMI and FM (r=0.522, P=0.028; r=0.541, P=0.020; r=0.463, P=0.049, respectively). BMI represented the most powerful predictor of ISR decrease (R²=0.541, P=0.020).

Conclusion

Transoral gastroplasty allows a significant weight loss 3months after the intervention as well as an amelioration of insulin sensitivity with subsequent reduction of the insulin secretion.

Keywords: Transoral gastroplasty, Obesity, Insulin resistance, Insulin sensitivity, Insulin secretion