Different Malabsorptive Obesity Surgery Interventions Result in Distinct Postprandial Amino Acid Metabolomic Signatures

Abstract

Purpose

Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective weight loss surgical procedure. Yet, BPD-DS is technically difficult to perform and carries a higher risk of nutrient deficiencies as compared with other surgical interventions. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modified BPD-DS procedure conceived with the aim of decreasing the technical complexity, while retaining the weight loss efficiency. Whether the two surgical procedures diverge in nutrient absorption rates and malnutrition risk is still matter of debate. Our aim was to determine if postprandial nutrient absorption rates are different in patients subjected to BPD-DS or SADI-S for weight loss.

Materials and Methods

Plasma amino acid metabolomic profiling during mixed-meal tolerance test (MMTT) was performed in subjects (N = 18) submitted to BPD-DS (n = 9) or SADI-S (n = 9) 1.6 ± 0.1 years earlier.

Results

Patients submitted to SADI-S or BPD-DS presented distinct postprandial metabolomic profiles. Postprandial excursions of total and essential amino acids—leucine, isoleucine, and valine—were higher after SADI-S as compared with BPD-DS.

Conclusion

Our study demonstrates that a simplified malabsorptive bariatric surgery procedure SADI-S results in greater essential branched-chain amino acid absorption when compared with the classical BPD-DS intervention. These findings suggest that SADI-S can potentially lower lifetime risk of postoperative protein malnutrition, as well as have a positive impact on systemic metabolism and glucose homeostasis.

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Acknowledgments

Authors would like to thank the Senior Nurse Sandra Tavares (Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal) for her technical assistance during the MMTT.

Funding

Unit for Multidisciplinary Research in Biomedicine (UMIB) is funded by Foundation for Science and Technology (FCT) Portugal (UID/Multi/00215/2019). JJH holds an unrestricted grant from the NNF Center for Basic Metabolic Research, Copenhagen, Denmark. The NNF foundation Center for Basic Metabolic Research is an independent research institution at the University of Copenhagen, Denmark.

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Correspondence to Mariana P. Monteiro.

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Pereira, S.S., Jarak, I., Carvalho, R.A. et al. Different Malabsorptive Obesity Surgery Interventions Result in Distinct Postprandial Amino Acid Metabolomic Signatures. OBES SURG (2020). https://doi.org/10.1007/s11695-020-04774-z

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Keywords

  • Malabsorptive bariatric surgeries
  • BPD-DS
  • SADI-S
  • Metabolomics
  • Amino acid absorption