Long-Term Changes in Leptin, Chemerin, and Ghrelin Levels Following Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy

  • Mohamed Abdalla Salman
  • Mohamed El-ghobary
  • Ahmed Soliman
  • Mohammad El Sherbiny
  • Tarek Elsayed Abouelregal
  • Amr Albitar
  • Ahmed Abdallah
  • Hani Maurice Sabri Mikhail
  • Mohammed A Nafea
  • Ahmed Abd El Aal Sultan
  • Hossam E Elshafey
  • Hossam El-Din Shaaban
  • Ayman Azzam
  • Ghada M. K. GabAllah
  • Ahmed Abdallah SalmanEmail author
Original Contributions



Published reports showed conflicting results regarding the sustained alterations in leptin, chemerin, and ghrelin concenratios after metabolic surgery. Therefore, we performed the present work to contrast the alterations in leptin, chemerin, and ghrelin levels one year after Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG).


The present research is a prospective, comparative one that followed 100 cases for whom RYGB or LSG was done. We assessed the serum values of adiposity-associated mediators, including adipokcytokines (leptin and active chemerin) and gastrointestinal hormones (total ghrelin). The primary outcome in the present study was the alterations in leptin, chemerin, and ghrelin values at 12 months after RYGB and LSG.


The serum leptin level decreased significantly in the LSG group with a mean change of − 170.8 ± 29.4 ng/mL (p < 0.001). Similarly, the serum leptin concentration decreased significantly in the RYGB group, with a mean change of − 165.42 ± 53.4 (p < 0.001). In addition, the mean reduction in baseline chemerin levels 12 months after the operation was considerable in the LSG cohort (− 23.24 ± 9.5 ng/mL) and RYGB group (− 22.12 ± 15.9 ng/mL). The ghrelin values demonstrated a notable reduction in the LSG cohort (− 0.083 ± 0.11 pg/mL) and RYGB group (− 0.068 ± 0.097 pg/mL). However, the changes in the three hormones were not substantially different between both groups (p > 0.05).


Both RYGB and LSG result in a considerable, comparable decrease in the postoperative serum concentrations of leptin, chemerin, and ghrelin.


Bariatric operations Adipokines Leptin Ghrelin Chemerin 


Compliance with Ethical Standards

Informed consents were obtained from all patients included in the study

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

This study was approved by the institutional review board/clinical medical research ethics committee.


  1. 1.
    Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA - J. Am. Med. Assoc. 2016. p. 2284–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA - J. Am. Med. Assoc. 2016. p. 2292–9.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    World Health Organization. Global status report 2014. Health statistics and information systems. Geneva WHO. 2011.Google Scholar
  4. 4.
    Abdelaal M, le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Ann Transl Med. 2017;Google Scholar
  5. 5.
    Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med. 2007;356:213–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Rajan T, Menon V. Psychiatric disorders and obesity: a review of association studies. J Postgrad Med. 2017;63:182.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Caudwell P, Hopkins M, King NA, Stubbs RJ, Blundell JE. Exercise alone is not enough: weight loss also needs a healthy (Mediterranean) diet? Public Health Nutr [Internet]. 2009 [cited 2019 Aug 2];12:1663–6. Available from:
  8. 8.
    Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. Obstet. Gynecol. Surv. 2009. p. 460–2.CrossRefGoogle Scholar
  9. 9.
    Velazquez A, Apovian CM. Pharmacological management of obesity. Minerva Endocrinol. 2018. p. 356–66.Google Scholar
  10. 10.
    Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat. Rev. Gastroenterol. Hepatol. 2017. p. 160–9.CrossRefGoogle Scholar
  11. 11.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg. 2019;29(3):782–95.PubMedCrossRefGoogle Scholar
  13. 13.
    Ouchi N, Kihara S, Funahashi T, Matsuzawa Y, Walsh K. Obesity, adiponectin and vascular inflammatory disease. Curr. Opin. Lipidol. 2003. p. 561–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Berg AH, Scherer PE. Adipose tissue, inflammation, and cardiovascular disease. Circ. Res. 2005. p. 939–49.PubMedCrossRefGoogle Scholar
  15. 15.
    Cao H. Adipocytokines in obesity and metabolic disease. J. Endocrinol. 2014.Google Scholar
  16. 16.
    Trujillo ME, Scherer PE. Adipose tissue-derived factors: impact on health and disease. Endocr Rev. 2006;27:762–78.PubMedCrossRefGoogle Scholar
  17. 17.
    Lord GM, Matarese G, Howard JK, et al. Leptin modulates the T-cell immune response and reverses starvation-induced immunosuppression. Nature. 1998;394:897–901.PubMedCrossRefGoogle Scholar
  18. 18.
    Wallace AM, McMahon AD, Packard CJ, et al. Plasma leptin and the risk of cardiovascular disease in the West of Scotland Coronary Prevention Study (WOSCOPS). Circulation. 2001;104:3052–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Bozaoglu K, Segal D, Shields KA, et al. Chemerin is associated with metabolic syndrome phenotypes in a Mexican-American population. J Clin Endocrinol Metab. 2009;94:3085–8.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Monteleone P, Maj M. Dysfunctions of leptin, ghrelin, BDNF and endocannabinoids in eating disorders: beyond the homeostatic control of food intake. Psychoneuroendocrinology. 2013. p. 312–30.PubMedCrossRefGoogle Scholar
  21. 21.
    Dimitriadis E, Daskalakis M, Kampa M, et al. Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study. Ann Surg. 2013;257:647–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Makris MC, Alexandrou A, Papatsoutsos EG, Malietzis G, Tsilimigras DI, Guerron AD, et al. Ghrelin and obesity: identifying gaps and dispelling myths. A reappraisal. In Vivo (Brooklyn). 2017. p. 1047–50.Google Scholar
  23. 23.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;Google Scholar
  24. 24.
    Ahima RS, Saper CB, Flier JS, et al. Leptin regulation of neuroendocrine systems. Front Neuroendocrinol. 2000;21:263–307.PubMedCrossRefGoogle Scholar
  25. 25.
    Wu N, Tan HR. Leptin receptor and its relations with obesity. Chinese Pharmacol Bull. 2004;20:1334–6.Google Scholar
  26. 26.
    Gruzdeva O, Borodkina D, Uchasova E, Dyleva Y, Barbarash O. Leptin resistance: underlying mechanisms and diagnosis. Diabetes, Metab. Syndr. Obes. Targets Ther. 2019.Google Scholar
  27. 27.
    Holtkamp K, Hebebrand J, Mika C, et al. High serum leptin levels subsequent to weight gain predict renewed weight loss in patients with anorexia nervosa. Psychoneuroendocrinology. 2004;29:791–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Matarese G, La Cava A, Sanna V, Lord GM, Lechler RI, Fontana S, et al. Balancing susceptibility to infection and autoimmunity: a role for leptin? Trends Immunol. 2002. p. 182–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Montani JP, Antic V, Yang Z, et al. Pathways from obesity to hypertension: from the perspective of a vicious triangle. Int J Obes. 2002;26:S28–38.CrossRefGoogle Scholar
  30. 30.
    Ren J. Leptin and hyperleptinemia-from friend to foe for cardiovascular function. J. Endocrinol. 2004. p. 1–10.PubMedCrossRefGoogle Scholar
  31. 31.
    Forny-Germano L, De Felice FG, Do Nascimento Vieira MN. The role of leptin and adiponectin in obesity-associated cognitive decline and Alzheimer’s disease. Front Neurosci. 2019;Google Scholar
  32. 32.
    Geloneze B, Tambascia MA, Pareja JC, et al. Serum leptin levels after bariatric surgery across a range of glucose tolerance from normal to diabetes. Obes Surg. 2001;11:693–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Kalinowski P, Paluszkiewicz R, Wróblewski T, et al. Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass—results of a randomized clinical trial. Surg Obes Relat Dis. 2017;13:181–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Terra X, Auguet T, Guiu-Jurado E, et al. Long-term changes in leptin, chemerin and ghrelin levels following different bariatric surgery procedures: Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23:1790–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Woelnerhanssen B, Peterli R, Steinert RE, Peters T, Borbély Y, Beglinger C. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy--a prospective randomized trial. Surg Obes Relat Dis [Internet]. [cited 2019 Aug 8];7:561–8. Available from: PubMedCrossRefGoogle Scholar
  36. 36.
    Rourke JL, Dranse HJ, Sinal CJ. Towards an integrative approach to understanding the role of chemerin in human health and disease. Obes. Rev. 2013. p. 245–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Bozaoglu K, Curran JE, Stocker CJ, et al. Chemerin, a novel adipokine in the regulation of angiogenesis. J Clin Endocrinol Metab. 2010;95:2476–85.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Lumeng CN, Saltiel AR. Inflammatory links between obesity and metabolic disease. J. Clin. Invest. 2011. p. 2111–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Sell H, Divoux A, Poitou C, et al. Chemerin correlates with markers for fatty liver in morbidly obese patients and strongly decreases after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2010;95:2892–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Ress C, Tschoner A, Engl J, et al. Effect of bariatric surgery on circulating chemerin levels. Eur J Clin Invest. 2010;40:277–80.PubMedCrossRefGoogle Scholar
  41. 41.
    Wren AM, Seal LJ, Cohen MA, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:5992–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Callahan HS, Cummings DE, Pepe MS, et al. Postprandial suppression of plasma ghrelin level is proportional to ingested caloric load but does not predict intermeal interval in humans. J Clin Endocrinol Metab. 2004;89:1319–24.PubMedCrossRefGoogle Scholar
  43. 43.
    Piche T. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. Nutr. Clin. Metab. 2002. p. 219–20.Google Scholar
  44. 44.
    Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30.PubMedCrossRefGoogle Scholar
  45. 45.
    Erol V, Aydın C, Uğurlu L, Turgut E, Yalçın H, Demet İnce F. Changes in ghrelin, leptin and insulin levels after laparoscopic sleeve gastrectomy Laparoskopik sleeve gastrektomi sonrası grelin, leptin ve insülin düzeylerindeki değişiklikler. Res. Artic. / Araştırma Makal. Ege J. Med. / Ege Tıp Derg. 2019.Google Scholar
  46. 46.
    Tritos NA, Mun E, Bertkau A, et al. Serum ghrelin levels in response to glucose load in obese subjects post-gastric bypass surgery. Obes Res. 2003;11:919–24.PubMedCrossRefGoogle Scholar
  47. 47.
    Geloneze B, Tambascia MA, Pilla VF, et al. Ghrelin: A gut-brain hormone. Effect of gastric bypass surgery. Obes Surg. 2003;13:17–22.PubMedCrossRefGoogle Scholar
  48. 48.
    Pournaras DJ, Le Roux CW. Ghrelin and metabolic surgery. Int. J. Pept. 2010.Google Scholar
  49. 49.
    Santiago-Fernández C, García-Serrano S, Tome M, Valdes S, Ocaña-Wilhelmi L, Rodríguez-Cañete A, et al. Ghrelin levels could be involved in the improvement of insulin resistance after bariatric surgery. Endocrinol diabetes y Nutr [Internet]. [cited 2019 Aug 8];64:355–62. Available from: PubMedCrossRefGoogle Scholar
  50. 50.
    Stoeckli R, Clianda R, Langer I, et al. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res. 2004;12:346–50.PubMedCrossRefGoogle Scholar
  51. 51.
    Korner J, Bessler M, Cirilo LJ, et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab. 2005;90:359–65.PubMedCrossRefGoogle Scholar
  52. 52.
    Le Roux CW, Aylwin SJB, Batterham RL, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006;243:108–14.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Frühbeck G, Rotellar F, Hernández-Lizoain JL, et al. Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia. Obes Surg. 2004;14:1208–15.PubMedCrossRefGoogle Scholar
  54. 54.
    Faraj M, Havel PJ, Phélis S, et al. Plasma acylation-stimulating protein, adiponectin, leptin, and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2003;88:1594–602.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.General Surgery Department, Faculty of MedicineCairo UniversityGizaEgypt
  2. 2.Internal Medicine Department, Faculty of MedicineCairo UniversityGizaEgypt
  3. 3.General Surgery Department, Faculty of MedicineAl Azhar UniversityCairoEgypt
  4. 4.General Surgery Department, Faculty of MedicineHelwan UniversityHelwanEgypt
  5. 5.National Hepatology and Tropical Medicine Research InstituteCairoEgypt
  6. 6.Clinical Biochemistry Department, National Liver InstituteMenoufia UniversityShibin el KomEgypt
  7. 7.Medical Biochemistry Department, Faculty of MedicineMenoufia UniversityShibin el KomEgypt

Personalised recommendations