Chenodeoxycholic acid as a potential prognostic marker for Roux-en-Y gastric bypass in Chinese obese patients

Abstract

Context: Bile acids (BAs) have been suggested as key mediators of the improvements in glucose metabolism after Roux-en-Y gastric bypass (RYGB). Objective: The objective of the study was to test whether the individual or a group of BAs have potential value to predict diabetes remission after RYGB. Design and Patients: A retrospective cohort of 38 Chinese obese patients with type 2 diabetes mellitus (T2DM) who had undergone RYGB and a cross-sectional cohort of 327 subjects from the Shanghai Obesity Study were involved in the study. Main Outcome and Measures: We applied a targeted metabolomics approach to quantitatively measure 26 serum BAs. The relative proportion of each BA in total BAs was calculated. Results: In the metabolic surgery study, RYGB was effective in the reduction of body weight in both remission and nonremission groups. The reductions of body mass index (BMI) in both groups were 7.34±2.10 kg/m2 and 6.31±2.38 kg/m2, respectively (P=.14). Patients in the remission group had a shorter duration of diabetes, lower glycated hemoglobin, and higher C-peptide and chenodeoxycholic acid (CDCA) proportion at baseline compared with the nonremission group. Multiple logistic regression indicated that a higher level of CDCA relative to total BA (CDCA%) and shorter duration of diabetes at baseline were associated with a greater chance of diabetes remission. The odd ratios were 0.19 (95% confidence interval 0.05-0.74) and 1.77 (95% confidence interval 1.13-2.76), respectively, after adjustment for age, gender, and BMI. In the cross-sectional study,CDCA% was significantly higher in obese individuals with T2DM than the normal glucose tolerance group. Correlation analysis showed CDCA% was positively correlated with BMI, glycated hemoglobin, triglycerides, and low-density lipoprotein cholesterol and negatively correlated with high-density lipoprotein cholesterol and diabetes duration. Conclusion: Increased CDCA, a major primary BA, was correlated with a shorter duration of T2DM, which was associated with a higher possibility of remission after surgery. CDCA% might act as a potential prognostic marker of RYGB.