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Roux-en-Y gastric bypass with a long versus a short biliopancreatic limb improves weight loss and glycemic control in obese mice

  • Author Footnotes
    † Contributed equally and share first authorship.
    Romano Schneider
    Footnotes
    † Contributed equally and share first authorship.
    Affiliations
    Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
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  • Author Footnotes
    † Contributed equally and share first authorship.
    Marko Kraljević
    Footnotes
    † Contributed equally and share first authorship.
    Affiliations
    Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
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  • Ralph Peterli
    Affiliations
    Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland

    Department of Clinical Research, University of Basel, Basel, Switzerland
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  • Theresa V. Rohm
    Affiliations
    Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Biomedicine (DBM), University of Basel, University Hospital Basel, Basel, Switzerland
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  • Angela J.T. Bosch
    Affiliations
    Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Biomedicine (DBM), University of Basel, University Hospital Basel, Basel, Switzerland
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  • Andy J.Y. Low
    Affiliations
    Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Biomedicine (DBM), University of Basel, University Hospital Basel, Basel, Switzerland
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  • Lena Keller
    Affiliations
    Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Biomedicine (DBM), University of Basel, University Hospital Basel, Basel, Switzerland
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  • Shefaa AlAsfoor
    Affiliations
    Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Biomedicine (DBM), University of Basel, University Hospital Basel, Basel, Switzerland
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  • Simon Häfliger
    Affiliations
    Institute for Pathology, University Hospital Basel, Basel, Switzerland
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  • Bahtiyar Yilmaz
    Affiliations
    Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland

    Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
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  • Caspar J. Peterson
    Affiliations
    Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
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  • Ioannis I. Lazaridis
    Affiliations
    Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
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  • Pascale Vonaesch
    Affiliations
    Swiss Tropical Medicine and Public Health Institute, Basel, Switzerland
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  • Author Footnotes
    †† Contributed equally and share last authorship.
    Tarik Delko
    Footnotes
    †† Contributed equally and share last authorship.
    Affiliations
    Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
    Search for articles by this author
  • Author Footnotes
    †† Contributed equally and share last authorship.
    Claudia Cavelti-Weder
    Correspondence
    Correspondence: Claudia Cavelti-Weder, M.D., M.P.H., Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ), Rämistrasse 100, 8091 Zurich, Switzerland.
    Footnotes
    †† Contributed equally and share last authorship.
    Affiliations
    Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland

    Department of Biomedicine (DBM), University of Basel, University Hospital Basel, Basel, Switzerland

    Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
    Search for articles by this author
  • Author Footnotes
    † Contributed equally and share first authorship.
    †† Contributed equally and share last authorship.

      Abstract

      Background

      Roux-en-Y gastric bypass (RYGB) results in long-term weight loss and reduced obesity related co-morbidities. However, little is known about how the lengths of the biliopancreatic limb (BPL), the alimentary limb (AL), and the common limb (CL) affect weight loss and glucose metabolism.

      Objectives

      Our aim was to establish a RYGB obese mouse model with defined proportions of the AL and BPL and a constant CL to assess the effects on weight loss,glucose metabolism, and obesity-related co-morbidities.

      Setting

      In vivo mouse study.

      Methods

      Six-week-old male C57BL/6J mice fed with a high-fat diet (HFD) underwent bariatric surgery with defined BPL lengths: a very long, long, and short BPL (35%, 25%, and 15% of total bowel length), or sham surgery. The length of the AL was adjusted to achieve the same CL length. Mice were analyzed for weight loss, glycemic control, and obesity-related co-morbidities.

      Results

      Mice undergoing RYGB surgery with a very long BPL had excessive weight loss and mortality and were therefore not further analyzed. Mice with a long BPL showed a significantly increased total weight loss when compared with mice with a short BPL. In addition, a long BPL improved glucose tolerance, particularly early after surgery. A long BPL was also associated with lower triglyceride levels. Resolution of hepatic steatosis and adipose tissue inflammation was, however, not statistically significant. Of note, bariatric surgery dramatically changed gut microbiota, regardless of limb length.

      Conclusion

      In obese mice, a long BPL results in enhanced weight loss and improved glucose tolerance. These findings could potentially be translated to humans by tailoring the BPL length according to body weight, obesity-related co-morbidities, and total bowel length of an individual patient.

      Keywords

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