150-cm Versus 200-cm Biliopancreatic Limb One-Anastomosis Gastric Bypass: Propensity Score-Matched Analysis.

BACKGROUND: It has been suggested that shortening the length of the biliopancreatic limb (BPL) to 150 cm in one anastomosis gastric bypass (OAGB) would reduce nutritional complication rates without impairing weight loss outcomes. The aim of this study is to compare patients who underwent OAGB with a 200-cm BPL (OAGB-200) to patients with OAGB with a 150-cm BPL (OAGB-150) in terms of weight loss and late morbidity. METHODS: This is a monocentric retrospective matched cohort study including patients with a body mass index between 35 and 50 kg/m2 who underwent an OAGB-150 or an OAGB-200. Patients were matched 1:1 based on age, sex, and body mass index, prior to bariatric surgery. RESULTS: In total, 784 patients who underwent OAGB were included (OAGB-150 n = 392 and OAGB-200 (n = 392). There was no significant difference in terms of early morbidity. Regarding late morbidity in patients with an OAGB-150, significantly lower rates for marginal ulcer (OR = 0.4, CI 95% [0.2; 0.8], p = 0.006), incisional hernia (OR = 0.5, CI 95% [0.3; 1], p = 0.041), and bowel obstruction (OR = 0.3, CI 95% [0.1; 0.9], p = 0.039) were reported. Likewise, regarding late nutritional deficiencies, post-OAGB-150, a significantly lower number of patients with hypoalbuminemia (OR = 0.3, CI 95% [0.2; 0.7], p = 0.006), low vitamin B9 (OR = 0.5, CI 95% [0.2; 1], p = 0.044), and low ferritin (OR = 0.5, CI 95% [0.3; 0.8], p = 0.005) were observed. There was no significant difference in the percentage of excess BMI loss at 1, 2, 3, 4, and 5 years. CONCLUSION: Compared to OAGB-200 in patients with BMI ≤ 50 kg/m2, OAGB-150 results in fewer nutritional deficiency rates long term, without impairing weight loss.

Gastric bypass specifically impairs liver parameters as compared with sleeve gastrectomy, independently of evolution of metabolic disorders.

BACKGROUND: Numerous studies have shown that Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differently affect metabolic disorders associated with obesity. While bariatric surgery has been shown to improve nonalcoholic fatty liver disease, very few studies have compared liver parameters after both procedures. OBJECTIVES: To compare the evolution of liver parameters after SG and RYGB and their relationships with improvement of metabolic disorders. METHODS: Metabolic parameters and abdominal ultrasonography were recorded before and 1 year after bariatric surgery in all patients who underwent SG or RYGB between 2004 and 2016 in our institution. SETTING: University hospital, Colombes, France. RESULTS: Five hundred thirty-three patients (15% men, age 43 ± 11 yr) were analyzed, including 326 who underwent RYGB and 207 who underwent SG. Before surgery, body mass index (44.7 ± 5.7 versus 44.4 ± 7.4 kg/m²) and metabolic parameters were not significantly different. One year after surgery, RYGB induced greater weight loss (31.9 ± 7.7 versus 28.6 ± 8.3 %, P < .001). Metabolic parameters improved in both groups, but fasting insulin, low-density lipoprotein cholesterol, C-reactive protein, and ferritin were lower after RYGB (P < .001). In contrast, transaminases were higher after RYGB compared with SG (alanine aminotransferase: 31.6 ± 18.7 versus 22.6 ± 7.7 IU/L; P < .001). The persistence of alanine aminotransferase >34 IU/L (27% versus 7% of patients, P < .001) was independent of the persistence of steatosis on ultrasonography (39% versus 37% of patients) 1 year after RYGB and SG, respectively. CONCLUSION: Despite a greater improvement of metabolic disorders, RYGB has less beneficial effect on liver parameters compared with SG. Further studies are required to define the mechanisms explaining these differences between both procedures.

Feeding behaviour and pre-prandial status affect post-prandial plasma energy metabolites and insulin kinetics in growing pigs fed diets differing in fibre concentration.

Variations in feeding behaviour between animals result from individual variations in their metabolism as affected by diet composition. The study aimed to link the within-day dynamics of voluntary feed intake and those of blood metabolites and insulin in growing pigs having ad libitum access to feed and receiving diets differing in dietary fibre levels and aleurone supplementation. A total of forty pigs (body weight: 35 kg) had access to diets provided ad libitum, which differed by fibre content (13 or 18 % neutral-detergent fibre) and aleurone supplementation (0, 2 or 4 g/kg). Feeding behaviour was individually recorded for 1 week. The kinetic of plasma metabolites and insulin was followed for 1 h after a voluntary test meal. Dietary fibre level did not affect the daily feed intake but increased meal size and meal duration. Aleurone supplementation (4 g/kg) decreased the daily feed intake and number of meals. Dietary fibre level only decreased insulin concentration measured 15 min after meal beginning. Aleurone supplementation (4 g/kg) decreased glycaemia in the first hour after the meal and insulinaemia 15 min after the meal. Free access to feed led to high variability in pre-prandial metabolites and insulin concentrations, resulting in different test meal size irrespective of diet composition. Animals were then spread over different profiles combining feeding behaviour and fasted status to explain different profiles of regulation of feed intake. Plasma metabolites and insulin kinetics were affected by diet composition but also by animal characteristics. Individual variability should be considered when diet composition is used to modulate feeding behaviour.

The role of whole-wheat grain and wheat and rye ingredients on the digestion and fermentation processes in the gut--a model experiment with pigs.

The effect of wheat and rye breads made from white wheat flour with added refined fibre (WFL), whole-wheat grain, wheat aleurone flour (WAF) or rye aleurone flour (RAF) on digestion and fermentation processes in the gut was studied in a model experiment with pigs. The diets were similar in dietary fibre (DF) but differed in arabinoxylan (AX) content and composition. Twenty pigs were fed the breads three times daily (08.00, 13.00 and 18.00 hours) and the digesta collected through a T-cannula for two successive periods (breakfast: 8.00-13.00; lunch: 13.00-18.00 hours). Faeces were collected for 24 h and caecal and colonic contents at slaughter. The rigid nature of the aleurone cell walls encapsulated nutrients, which resulted in reduced (P < 0.01) digestibility of protein (WAF and RAF breads) and fat (RAF bread). For the RAF bread, the digestibility of starch was also lower (P < 0.001) than of the wheat-based diets primarily due to the higher intestinal viscosity. The DF composition had an impact on (P < 0.001) the site for fibre degradation in the large intestine. Thus, AX of the WAF bread, with the lowest degree of substitution, were fermented as much in the caecum as in the colon, whereas AX of the RAF bread, with an intermediary degree of substitution, were mainly fermented in the caecum. The WFL bread, rich in cellulose, was fermented more distally. Fermentation of experimental breads in the large intestine had no effect (P>0.05) on the production of metabolites, except for butyrate which was higher (P < 0.01) after the WAF bread consumption.

Comparative effect of orally administered sodium butyrate before or after weaning on growth and several indices of gastrointestinal biology of piglets.

Sodium butyrate (SB) provided orally favours body growth and maturation of the gastrointestinal tract (GIT) in milk-fed pigs. In weaned pigs, conflicting results have been obtained. Therefore, we hypothesised that the effects of SB (3 g/kg DM intake) depend on the period (before v. after weaning) of its oral administration. From the age of 5 d, thirty-two pigs, blocked in quadruplicates within litters, were assigned to one of four treatments: no SB (control), SB before (for 24 d), or after (for 11-12 d) weaning and SB before and after weaning (for 35-36 d). Growth performance, feed intake and various end-point indices of GIT anatomy and physiology were investigated at slaughter. The pigs supplemented with SB before weaning grew faster after weaning than the controls (P < 0.05). The feed intake was higher in pigs supplemented with SB before or after weaning (P < 0.05). SB provided before weaning improved post-weaning faecal digestibility (P < 0.05) while SB after weaning decreased ileal and faecal digestibilities (P < 0.05). Gastric digesta retention was higher when SB was provided before weaning (P < 0.05). Post-weaning administration of SB decreased the activity of three pancreatic enzymes and five intestinal enzymes (P < 0.05). IL-18 gene expression tended to be lower in the mid-jejunum in SB-supplemented pigs. The small-intestinal mucosa was thinner and jejunal villous height lower in all SB groups (P < 0.05). In conclusion, the pre-weaning SB supplementation was the most efficient to stimulate body growth and feed intake after weaning, by reducing gastric emptying and intestinal mucosa weight and by increasing feed digestibility.

Supplemental sodium butyrate stimulates different gastric cells in weaned pigs.

Sodium butyrate (SB) is used as an acidifier in animal feed. We hypothesized that supplemental SB impacts gastric morphology and function, depending on the period of SB provision. The effect of SB on the oxyntic and pyloric mucosa was studied in 4 groups of 8 pigs, each supplemented with SB either during the suckling period (d 4-28 of age), after weaning (d 29 to 39-40 of age) or both, or never. We assessed the number of parietal cells immunostained for H+/K+-ATPase, gastric endocrine cells immunostained for chromogranin A and somatostatin (SST) in the oxyntic mucosa, and gastrin-secreting cells in the pyloric mucosa. Gastric muscularis and mucosa thickness were measured. Expressions of the H+/K+-ATPase and SST type 2 receptor (SSTR2) genes in the oxyntic mucosa and of the gastrin gene in the pyloric mucosa were evaluated by real-time RT-PCR. SB increased the number of parietal cells per gland regardless of the period of administration (P < 0.05). SB addition after, but not before, weaning increased the number of enteroendocrine and SST-positive cells (P < 0.01) and tended to increase gastrin mRNA (P = 0.09). There was an interaction between the 2 periods of SB treatment for the expression of H/K-ATPase and SSTR2 genes (P < 0.05). Butyrate intake after weaning increased gastric mucosa thickness (P < 0.05) but not muscularis. SB used orally at a low dose affected gastric morphology and function, presumably in relationship with its action on mucosal maturation and differentiation.

Identification of dietary and endogenous ileal protein losses in pigs by immunoblotting and mass spectrometry.

Ileal flows and the endogenous or dietary origin of soluble proteins present in ileal digesta were determined in pigs fed diets containing different pea cultivars (Solara, Madria and Eiffel) and micro-ground peas (c.v. Solara). Ileal digesta proteins were analyzed by electrophoresis and densitometry analysis and were identified by LC-MS-MS spectrometry and immunoblotting. The ileal flows of proteins differed (P < 0.1) among the 3 pea cultivars; the flow in pigs fed the Madria-containing diet was higher than that of pigs fed the Eiffel- and Solara-containing diets. The flow was reduced by micro-grinding the peas. The true digestibility of pea proteins and the endogenous losses were not correlated. However, at this intestinal level, protein losses were essentially of endogenous origin (enzymes, antibodies), and from the partly digested pea albumin fraction. Pea lectin and albumin PA1b were totally resistant to gastric and small intestinal digestion and a minor resistant peptide from pea albumin PA2 was detectable. In contrast, the storage proteins, legumin and vicilin, were not detectable by antibodies or by LC-MS-MS.

Effects of grinding and thermal treatments on hydrolysis susceptibility of pea proteins (Pisum sativum L.).

The effects of three particle sizes with two types of grindings and two thermal treatments on pea protein extraction (PE) and susceptibility to in vitro enzymatic hydrolysis (pepsin plus trypsin) were studied. Degrees of hydrolysis (DH) were calculated. Remaining peptides were detected by SDS-PAGE and identified by immunoblotting and MS/MS spectrometry. The increase in particle size decreased PE and DH due to a restricted access of solvents and enzymes to proteins. The thermal treatment induced a decrease in PE but did not modify DH. Heating improved legumin (alphaM) and convicilin pepsin hydrolyses but reduced the pea albumin 2 (PA2) hydrolysis. After pepsin and trypsin hydrolysis, only peptides from vicilin and lectin were identified by LC-MS/MS analyses, whatever the treatment.