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The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids

The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids
The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids
Background & aims Duodenal-jejunal bypass liners (DJBLs) prevent absorption in the proximal small intestine, the site of fatty acid absorption. We sought to investigate the effects of a DJBL on blood concentrations of essential fatty acids (EFAs) and bioactive polyunsaturated fatty acids (PUFAs). Methods Sub-study of a multicentre, randomised, controlled trial with two treatment groups. Patients aged 18–65 years with type-2 diabetes mellitus and body mass index 30–50 kg/m2 were randomised to receive a DJBL for 12 months or best medical therapy, diet and exercise. Whole plasma PUFA concentrations were determined at baseline, 10 days, 6 and 11.5 months; data were available for n = 70 patients per group. Results Weight loss was significantly greater in the DJBL group compared to controls after 11.5 months: total body weight loss 11.3 ± 5.3% versus 6.0 ± 5.7% (mean difference [95% CI] = 5.27% [3.75, 6.80], p < 0.001). Absolute concentrations of both EFAs, linoleic acid and α-linolenic acid, and their bioactive derivatives, arachidonic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid, were significantly lower in the DJBL group than in the control group at 6 and 11.5 months follow-up. Total serum cholesterol, LDL-cholesterol and HDL-cholesterol were also significantly lower in the DJBL group. Conclusion One year of DJBL therapy is associated with superior weight loss and greater reductions in total serum cholesterol and LDL-cholesterol, but also depletion of EFAs and their longer chain derivatives. DJBL therapy may need to be offset by maintaining an adequate dietary intake of PUFAs or by supplementation.
Duodenal-jejunal bypass liner, Endobarrier, Endoscopic bariatric therapies, Lipids, Obesity, Polyunsaturated fatty acids
0261-5614
Glaysher, Michael
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Ward, James
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Aldhwayan, Madhawi
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Ruban, Aruchuna
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Prechtl,, Christina Gabriele
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Fisk, Helena
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Chhina, Navpreet
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Al-Najim, Werd
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Smith, Claire
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Klimowska-Nassar, Natalia
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Johnson, Nicholas
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Falaschetti, Emmanuela
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Goldstone, Anthony P.
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Miras, Alexander Dimitri
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Byrne, James
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Calder, Philip
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Teare, Julian P
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Glaysher, Michael
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Ward, James
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Aldhwayan, Madhawi
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Ruban, Aruchuna
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Prechtl,, Christina Gabriele
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Fisk, Helena
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Chhina, Navpreet
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Al-Najim, Werd
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Smith, Claire
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Klimowska-Nassar, Natalia
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Johnson, Nicholas
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Falaschetti, Emmanuela
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Goldstone, Anthony P.
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Miras, Alexander Dimitri
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Byrne, James
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Calder, Philip
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Teare, Julian P
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Glaysher, Michael, Ward, James, Aldhwayan, Madhawi, Ruban, Aruchuna, Prechtl,, Christina Gabriele, Fisk, Helena, Chhina, Navpreet, Al-Najim, Werd, Smith, Claire, Klimowska-Nassar, Natalia, Johnson, Nicholas, Falaschetti, Emmanuela, Goldstone, Anthony P., Miras, Alexander Dimitri, Byrne, James, Calder, Philip and Teare, Julian P (2020) The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids. Clinical Nutrition. (doi:10.1016/j.clnu.2020.10.026).

Record type: Article

Abstract

Background & aims Duodenal-jejunal bypass liners (DJBLs) prevent absorption in the proximal small intestine, the site of fatty acid absorption. We sought to investigate the effects of a DJBL on blood concentrations of essential fatty acids (EFAs) and bioactive polyunsaturated fatty acids (PUFAs). Methods Sub-study of a multicentre, randomised, controlled trial with two treatment groups. Patients aged 18–65 years with type-2 diabetes mellitus and body mass index 30–50 kg/m2 were randomised to receive a DJBL for 12 months or best medical therapy, diet and exercise. Whole plasma PUFA concentrations were determined at baseline, 10 days, 6 and 11.5 months; data were available for n = 70 patients per group. Results Weight loss was significantly greater in the DJBL group compared to controls after 11.5 months: total body weight loss 11.3 ± 5.3% versus 6.0 ± 5.7% (mean difference [95% CI] = 5.27% [3.75, 6.80], p < 0.001). Absolute concentrations of both EFAs, linoleic acid and α-linolenic acid, and their bioactive derivatives, arachidonic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid, were significantly lower in the DJBL group than in the control group at 6 and 11.5 months follow-up. Total serum cholesterol, LDL-cholesterol and HDL-cholesterol were also significantly lower in the DJBL group. Conclusion One year of DJBL therapy is associated with superior weight loss and greater reductions in total serum cholesterol and LDL-cholesterol, but also depletion of EFAs and their longer chain derivatives. DJBL therapy may need to be offset by maintaining an adequate dietary intake of PUFAs or by supplementation.

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Endobarrier PUFA Clin Nutr - revision 2 clean - Accepted Manuscript
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Accepted/In Press date: 16 October 2020
e-pub ahead of print date: 22 October 2020
Keywords: Duodenal-jejunal bypass liner, Endobarrier, Endoscopic bariatric therapies, Lipids, Obesity, Polyunsaturated fatty acids

Identifiers

Local EPrints ID: 444655
URI: http://eprints.soton.ac.uk/id/eprint/444655
ISSN: 0261-5614
PURE UUID: b0530b24-7ed2-4596-8441-8649ed631fa8
ORCID for Helena Fisk: ORCID iD orcid.org/0000-0002-9534-3246
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X

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Date deposited: 28 Oct 2020 18:03
Last modified: 26 Nov 2021 02:59

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Contributors

Author: Michael Glaysher
Author: James Ward
Author: Madhawi Aldhwayan
Author: Aruchuna Ruban
Author: Christina Gabriele Prechtl,
Author: Helena Fisk ORCID iD
Author: Navpreet Chhina
Author: Werd Al-Najim
Author: Claire Smith
Author: Natalia Klimowska-Nassar
Author: Nicholas Johnson
Author: Emmanuela Falaschetti
Author: Anthony P. Goldstone
Author: Alexander Dimitri Miras
Author: James Byrne
Author: Philip Calder ORCID iD
Author: Julian P Teare

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