Surgery for Diabetes at Lower BMI: Some Caution

摘要: Many thousands of years ago, our ancestors were hunter– gatherers and performed arduous labor. They hunted animals also ate some fibrous roots, berries, nuts—a diet high in protein with complex carbohydrates [1–3]. This coincides a low glycemic index [4, 5]. These meals irregular sometimes infrequent, when there was “kill”, the entire clan would share meal. Through natural selection, early man developed “thrifty” genes for times famine [6]. However, past 8,000 years, farming indigenous wild grains commenced. Frequent carbohydrate higher became available, frequent stimulation insulin secretion from pancreas. High plasma levels resistance developed, impaired glucose tolerance. progressed to modern era where fast foods (containing particularly simple sugars), affluence, sedentary lifestyle have led an “obesity pandemic”. The so-called metabolic syndrome, resistance, type 2 diabetes, hypertension, dyslipidemia, atherosclerosis, coronary artery disease, fatty liver are now prevalent [7]. prior thrifty contribute obesity. We increasing incidence diabetes. handling is associated elevated down-regulation receptors [8]. circulating inhibit lipolysis promote lipogenesis. Immediately following all types bariatric operations, rapid improvement handling, before significant weight loss often patient even discharged hospital [9, 10]. After old jejuno-ileal bypass, oral tolerance curves markedly flattened—glucose bypassed its absorptive area intestine [11]. Shortly after gastric restrictive or bypass operations channel stomal edema, only able consume 575±146 kcal/day at time discharge [12–14] up-regulation [15, 16] located on cell membranes muscle adipose tissue. Later, improved metabolism [17] [18] procedures loss, greater which followed by more decrease fat mass [9]. Originally, hormones foregut postulated as reason processing [19, 20]. More recently, incretins (intestinal that stimulate secretion) distal small bowel due expedited nutrient delivery, been confirmed be [21]. most interest has glucagon-like peptide-1 (GLP-1) secreted into bloodstream L-cells hindgut [22, 23]. GLP-1 (7-36) amide found postprandial OBES SURG (2008) 18:1211–1214 DOI 10.1007/s11695-008-9674-9