Effect of Gastric Bypass Surgery on Energy Metabolism

NCT ID: NCT00939679

Last Updated: 2013-08-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

32 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-09-30

Study Completion Date

2013-04-30

Brief Summary

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The purpose of this study is to investigate the short term and long term effects of Roux-en-Y gastric bypass (RYGB) surgery on energy expenditure, gastrointestinal and appetite regulating hormone levels, and appetite sensation. We hypothesize that following RYGB surgery, metabolism will be elevated in comparison to patients who have not yet had RYGB but who are losing weight simultaneously using a low calorie diet. We further hypothesize that this higher metabolism will be associated with alterations in fasting and postmeal levels of gastrointestinal and appetite regulating hormones. Long term (1.5 years after RYGB), we hypothesize that differences in metabolism, body composition, and hormone levels will distinguish between patients who have maintained their weight loss after RYGB vs those who have regained weight.

Detailed Description

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Conditions

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Obesity

Keywords

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obesity bariatric surgery energy expenditure incretins appetite regulation body composition GLP-1

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Earlier gastric bypass surgery (7 weeks)

These patients will undergo gastric bypass surgery 7 weeks after starting a low calorie diet, and will continue the low calorie diet for 3 weeks following surgery.

Group Type EXPERIMENTAL

Roux-en-Y gastric bypass surgery

Intervention Type PROCEDURE

Briefly, RYGB is characterized first by creation of a small stomach pouch. The small intestine is then divided approximately 75 cm distal to the ligament of Treitz, creating a proximal intestinal limb that transports the secretions from the stomach remnant, liver, and pancreas, and a 'Roux' limb, that is attached to the new stomach pouch to drain consumed food. The distal end of the proximal limb is then reattached approximately 100 cm distal to the new stomach drainage site, creating a common channel where digestive enzymes mix with ingested food.

low calorie diet (1,000 kcal/day)

Intervention Type DIETARY_SUPPLEMENT

Patients will consume a daily diet composed of:

* 4 powder diet portions (Cambridge Diets, UK)
* plain yogurt (100-125g)
* skim milk (1L)
* a limited variety of vegetables

The diet will be consumed by both groups for a 10 week period.

Later gastric bypass surgery (10 weeks)

These patients will undergo gastric bypass surgery 10 weeks after starting a low calorie diet.

Group Type ACTIVE_COMPARATOR

Roux-en-Y gastric bypass surgery

Intervention Type PROCEDURE

Briefly, RYGB is characterized first by creation of a small stomach pouch. The small intestine is then divided approximately 75 cm distal to the ligament of Treitz, creating a proximal intestinal limb that transports the secretions from the stomach remnant, liver, and pancreas, and a 'Roux' limb, that is attached to the new stomach pouch to drain consumed food. The distal end of the proximal limb is then reattached approximately 100 cm distal to the new stomach drainage site, creating a common channel where digestive enzymes mix with ingested food.

low calorie diet (1,000 kcal/day)

Intervention Type DIETARY_SUPPLEMENT

Patients will consume a daily diet composed of:

* 4 powder diet portions (Cambridge Diets, UK)
* plain yogurt (100-125g)
* skim milk (1L)
* a limited variety of vegetables

The diet will be consumed by both groups for a 10 week period.

Interventions

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Roux-en-Y gastric bypass surgery

Briefly, RYGB is characterized first by creation of a small stomach pouch. The small intestine is then divided approximately 75 cm distal to the ligament of Treitz, creating a proximal intestinal limb that transports the secretions from the stomach remnant, liver, and pancreas, and a 'Roux' limb, that is attached to the new stomach pouch to drain consumed food. The distal end of the proximal limb is then reattached approximately 100 cm distal to the new stomach drainage site, creating a common channel where digestive enzymes mix with ingested food.

Intervention Type PROCEDURE

low calorie diet (1,000 kcal/day)

Patients will consume a daily diet composed of:

* 4 powder diet portions (Cambridge Diets, UK)
* plain yogurt (100-125g)
* skim milk (1L)
* a limited variety of vegetables

The diet will be consumed by both groups for a 10 week period.

Intervention Type DIETARY_SUPPLEMENT

Other Intervention Names

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Cambridge Weight Plan, Northants, UK.

Eligibility Criteria

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Inclusion Criteria

* Age 18-65
* BMI ≥40, or ≥35 with concomitant obstructive sleep apnea, or hypertension
* scheduled for RYGB surgery at Hvidovre Hospital, Copenhagen, Denmark
* Must have lost between 1-4% body weight after 3 months of dietary counselling

Exclusion Criteria

* Deemed ineligible for RYGB surgery by patient's own physician(s)
* Diabetes Mellitus
* Non Caucasian
* Weight \>160kg (due to DEXA scanner limitations), or morphologically unable to accommodate in DEXA scanner (\>40cm in maximum supine anterior-posterior dimension, or \>60cm in maximum supine body width)
* Hemoglobin \<7.0 mmol/L
* Psychiatric illness under the care of a psychiatrist
* Eating disorder such as bulimia
* Patients on special diets (eg vegetarian, Atkins)
* Any history of thyroid dysfunction, or use of thyroid medication (with the exception of transient thyroiditis)
* Hypothalamic or genetic etiology of obesity
* A current diagnosis of cancer
* Any surgery other than RYGB planned in the ensuing 3 months
* Substance abuse or smoking
* Use of prescription medications or over-the-counter drugs affecting metabolism
* Excessive intake of alcohol (\>7 drinks/week)
* Excessive intake of caffeine (\>300 mg/day)
* Presence of any contraindication to use of a low calorie powder diet, including:

* Past history of ventricular arrhythmias (even if treated)
* Renal dysfunction (creatinine clearance \<60 mL/min)
* Liver enzymes (ALT or AST) \>3x upper limit of normal
* Milk protein allergy, or lactose intolerance
* Porphyria or phenylketonuria
* History of gout
* Breastfeeding
* Concomitant use of monoamine oxidase inhibitors or non potassium sparing diuretics
* Inability or unwillingness to comply with a low calorie diet protocol
* Patients who find the powder diet products to be unpalatable
* Do not enjoy yogurt, carrots, or milk (as these are essential elements of the low calorie diet)
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cambridge Weight Plan Limited

INDUSTRY

Sponsor Role collaborator

University of Copenhagen

OTHER

Sponsor Role lead

Responsible Party

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AAstrup

Head of Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Julie B Schmidt, MSc

Role: PRINCIPAL_INVESTIGATOR

University of Copenhagen

Locations

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Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen

Copenhagen, , Denmark

Site Status

Hvidovre Hospital

Copenhagen, , Denmark

Site Status

Countries

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Denmark

Other Identifiers

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B263

Identifier Type: -

Identifier Source: org_study_id