Metabolic improvement in obese patients after duodenal-jejunal exclusion is associated with intestinal microbiota composition changes

C. de Jonge; S. Fuentes; E. G. Zoetendal; N. D. Bouvy; R. Nelissen; W. A. Buurman; J. W. Greve; W. M. de Vos; S. S. Rensen

doi:10.1038/s41366-019-0336-x

Metabolic improvement in obese patients after duodenal-jejunal exclusion is associated with intestinal microbiota composition changes

C. de Jonge, S. Fuentes, E. G. Zoetendal, N. D. Bouvy, R. Nelissen, W. A. Buurman, J. W. Greve, W. M. de Vos, S. S. Rensen^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

209 Downloads (Pure)

Abstract

Background Intestinal microbiota have been suggested to play an important role in the pathogenesis of obesity and type 2 diabetes. Bariatric surgery improves both conditions and has been associated with changes in intestinal microbiota composition. We investigated the effect of a nonsurgical bariatric technique on intestinal microbiota composition in relation to metabolic improvement.

Methods Seventeen patients with obesity and type 2 diabetes were treated with the nonsurgical duodenal-jejunal bypass liner, which excludes the proximal 60 cm small intestine from food. Fecal samples as well as metabolic parameters reflecting obesity and type 2 diabetes were obtained from the patients at baseline, after 6 months with the device in situ, and 6 months after explantation.

Results After 6 months of treatment, both obesity and type 2 diabetes had improved with a decrease in weight from 106.1 [99.4-123.5] to 97.4 [89.4-114.0] kg and a decrease in HbA(1c) from 8.5% [7.6-9.2] to 7.2% [6.3-8.1] (both p <0.05). This was paralleled by an increased abundance of typical small intestinal bacteria such as Proteobacteria, Veillonella, and Lactobacillus spp. in feces. After removal of the duodenal-jejunal bypass liner, fecal microbiota composition was similar to that observed at baseline, despite persistent weight loss.

Conclusion Improvement of obesity and type 2 diabetes after exclusion of the proximal 60 cm small intestine by treatment with a nonsurgical duodenal-jejunal bypass liner may be promoted by changes in fecal microbiota composition.

Original language	English
Pages (from-to)	2509-2517
Number of pages	9
Journal	International Journal of Obesity
Volume	43
Issue number	12
DOIs	https://doi.org/10.1038/s41366-019-0336-x
Publication status	Published - Dec 2019

Keywords

HUMAN GUT MICROBIOTA
WEIGHT-LOSS
GASTRIC BYPASS
BIFIDOBACTERIUM-ANIMALIS
LACTOBACILLUS-REUTERI
INSULIN SENSITIVITY
DIET
INFLAMMATION
BACTERIAL
RICHNESS

Access to Document

10.1038/s41366-019-0336-x

Full TextFinal published version, 687 KBLicence: Taverne

Cite this

de Jonge, C., Fuentes, S., Zoetendal, E. G., Bouvy, N. D., Nelissen, R., Buurman, W. A., Greve, J. W., de Vos, W. M., & Rensen, S. S. (2019). Metabolic improvement in obese patients after duodenal-jejunal exclusion is associated with intestinal microbiota composition changes. International Journal of Obesity, 43(12), 2509-2517. https://doi.org/10.1038/s41366-019-0336-x

@article{3d5d7af997b14cc4afc09c5fda2f3ba7,

title = "Metabolic improvement in obese patients after duodenal-jejunal exclusion is associated with intestinal microbiota composition changes",

abstract = "Background Intestinal microbiota have been suggested to play an important role in the pathogenesis of obesity and type 2 diabetes. Bariatric surgery improves both conditions and has been associated with changes in intestinal microbiota composition. We investigated the effect of a nonsurgical bariatric technique on intestinal microbiota composition in relation to metabolic improvement.Methods Seventeen patients with obesity and type 2 diabetes were treated with the nonsurgical duodenal-jejunal bypass liner, which excludes the proximal 60 cm small intestine from food. Fecal samples as well as metabolic parameters reflecting obesity and type 2 diabetes were obtained from the patients at baseline, after 6 months with the device in situ, and 6 months after explantation.Results After 6 months of treatment, both obesity and type 2 diabetes had improved with a decrease in weight from 106.1 [99.4-123.5] to 97.4 [89.4-114.0] kg and a decrease in HbA(1c) from 8.5% [7.6-9.2] to 7.2% [6.3-8.1] (both p <0.05). This was paralleled by an increased abundance of typical small intestinal bacteria such as Proteobacteria, Veillonella, and Lactobacillus spp. in feces. After removal of the duodenal-jejunal bypass liner, fecal microbiota composition was similar to that observed at baseline, despite persistent weight loss.Conclusion Improvement of obesity and type 2 diabetes after exclusion of the proximal 60 cm small intestine by treatment with a nonsurgical duodenal-jejunal bypass liner may be promoted by changes in fecal microbiota composition.",

keywords = "HUMAN GUT MICROBIOTA, WEIGHT-LOSS, GASTRIC BYPASS, BIFIDOBACTERIUM-ANIMALIS, LACTOBACILLUS-REUTERI, INSULIN SENSITIVITY, DIET, INFLAMMATION, BACTERIAL, RICHNESS",

author = "{de Jonge}, C. and S. Fuentes and Zoetendal, {E. G.} and Bouvy, {N. D.} and R. Nelissen and Buurman, {W. A.} and Greve, {J. W.} and {de Vos}, {W. M.} and Rensen, {S. S.}",

note = "Funding Information: Conflict of interest N.D.B. received an open research grant from GI dynamics. J.W.G. received an open research grant and support for travel to meetings for the study or other purposes from GI dynamics. W.M.d.V. received a Spinoza award and a Gravitation grant (SIAM 024.002.002) of the Netherlands organization for Scientific Research (NWO). All other authors declare that they have no conflict of interest. Publisher Copyright: {\textcopyright} 2019, Springer Nature Limited.",

year = "2019",

month = dec,

doi = "10.1038/s41366-019-0336-x",

language = "English",

volume = "43",

pages = "2509--2517",

journal = "International Journal of Obesity",

issn = "0307-0565",

publisher = "Nature Publishing Group",

number = "12",

}

TY - JOUR

T1 - Metabolic improvement in obese patients after duodenal-jejunal exclusion is associated with intestinal microbiota composition changes

AU - de Jonge, C.

AU - Fuentes, S.

AU - Zoetendal, E. G.

AU - Bouvy, N. D.

AU - Nelissen, R.

AU - Buurman, W. A.

AU - Greve, J. W.

AU - de Vos, W. M.

AU - Rensen, S. S.

N1 - Funding Information: Conflict of interest N.D.B. received an open research grant from GI dynamics. J.W.G. received an open research grant and support for travel to meetings for the study or other purposes from GI dynamics. W.M.d.V. received a Spinoza award and a Gravitation grant (SIAM 024.002.002) of the Netherlands organization for Scientific Research (NWO). All other authors declare that they have no conflict of interest. Publisher Copyright: © 2019, Springer Nature Limited.

PY - 2019/12

Y1 - 2019/12

N2 - Background Intestinal microbiota have been suggested to play an important role in the pathogenesis of obesity and type 2 diabetes. Bariatric surgery improves both conditions and has been associated with changes in intestinal microbiota composition. We investigated the effect of a nonsurgical bariatric technique on intestinal microbiota composition in relation to metabolic improvement.Methods Seventeen patients with obesity and type 2 diabetes were treated with the nonsurgical duodenal-jejunal bypass liner, which excludes the proximal 60 cm small intestine from food. Fecal samples as well as metabolic parameters reflecting obesity and type 2 diabetes were obtained from the patients at baseline, after 6 months with the device in situ, and 6 months after explantation.Results After 6 months of treatment, both obesity and type 2 diabetes had improved with a decrease in weight from 106.1 [99.4-123.5] to 97.4 [89.4-114.0] kg and a decrease in HbA(1c) from 8.5% [7.6-9.2] to 7.2% [6.3-8.1] (both p <0.05). This was paralleled by an increased abundance of typical small intestinal bacteria such as Proteobacteria, Veillonella, and Lactobacillus spp. in feces. After removal of the duodenal-jejunal bypass liner, fecal microbiota composition was similar to that observed at baseline, despite persistent weight loss.Conclusion Improvement of obesity and type 2 diabetes after exclusion of the proximal 60 cm small intestine by treatment with a nonsurgical duodenal-jejunal bypass liner may be promoted by changes in fecal microbiota composition.

AB - Background Intestinal microbiota have been suggested to play an important role in the pathogenesis of obesity and type 2 diabetes. Bariatric surgery improves both conditions and has been associated with changes in intestinal microbiota composition. We investigated the effect of a nonsurgical bariatric technique on intestinal microbiota composition in relation to metabolic improvement.Methods Seventeen patients with obesity and type 2 diabetes were treated with the nonsurgical duodenal-jejunal bypass liner, which excludes the proximal 60 cm small intestine from food. Fecal samples as well as metabolic parameters reflecting obesity and type 2 diabetes were obtained from the patients at baseline, after 6 months with the device in situ, and 6 months after explantation.Results After 6 months of treatment, both obesity and type 2 diabetes had improved with a decrease in weight from 106.1 [99.4-123.5] to 97.4 [89.4-114.0] kg and a decrease in HbA(1c) from 8.5% [7.6-9.2] to 7.2% [6.3-8.1] (both p <0.05). This was paralleled by an increased abundance of typical small intestinal bacteria such as Proteobacteria, Veillonella, and Lactobacillus spp. in feces. After removal of the duodenal-jejunal bypass liner, fecal microbiota composition was similar to that observed at baseline, despite persistent weight loss.Conclusion Improvement of obesity and type 2 diabetes after exclusion of the proximal 60 cm small intestine by treatment with a nonsurgical duodenal-jejunal bypass liner may be promoted by changes in fecal microbiota composition.

KW - HUMAN GUT MICROBIOTA

KW - WEIGHT-LOSS

KW - GASTRIC BYPASS

KW - BIFIDOBACTERIUM-ANIMALIS

KW - LACTOBACILLUS-REUTERI

KW - INSULIN SENSITIVITY

KW - DIET

KW - INFLAMMATION

KW - BACTERIAL

KW - RICHNESS

U2 - 10.1038/s41366-019-0336-x

DO - 10.1038/s41366-019-0336-x

M3 - Article

C2 - 30765893

SN - 0307-0565

VL - 43

SP - 2509

EP - 2517

JO - International Journal of Obesity

JF - International Journal of Obesity

IS - 12

ER -