Katie Robinson1, Sharon M. Donovan2, Blaire Rowitz3, and Margarita Teran-Garcia2
1Division of Nutritional Sciences, University of Illinois at Urbana-Champaign
2Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign
3Department of Bariatric Surgery, Carle Foundation Hospital, Urbana, IL
Introduction: Bariatric surgery is an effective treatment for both obesity and T2DM. Glucose homeostasis is restored within days of surgery independent of weight loss. The hepatokine, Fetuin-A, has been suggested to play a role in diabetes remission since it dramatically decreases following bariatric surgery. Fetuin-A (FetA) inhibits autophosphorylation of insulin receptor therefore limiting uptake of glucose in the cell. FetA binds saturated fatty acids and signals the inflammatory cascade of toll-like receptor 4, thus promoting insulin resistance. Accordingly, circulating FetA is increased in individuals with obesity and T2DM. Although previous studies show FetA decreases following bariatric surgery, control for presence of preoperative diet is not mentioned.
Methods: To determine the effect of the preoperative diet of FetA, plasma was collected from forty sleeve gastrectomy patients prior to preoperative diet, on the day of surgery and approximately 6 weeks after surgery once the patient finished the postoperative diet. At each visit, three-day food logs and body composition using bioelectrical impedance were collected.
Results: Baseline FetA was 606.0±170.0 μg/mL and was positively associated with BMI (p=0.0149) and negatively associated with age (p=0.0026). Following the preoperative diet FetA significantly decreased 12% to an average of 533.3±98.8 μg/mL (p=0.010). Average FetA was 35% lower following the postoperative diet than at baseline (392.4±82.94 μg/mL)(p<0.0001).
Conclusion: Our results show the reduction in FetA following bariatric surgery actually begins during the preoperative diet. Therefore, immediate improvements in glucose homeostasis may be partly explained by preoperative calorie restriction. Studies of short-term improvements should disclose whether patients were or were not advised to complete a preoperative.