Bile acid changes after metabolic surgery are linked to improvement in insulin sensitivity

Esmeralda Capristo, Geltrude Mingrone, I. Bondia-Pons, A. Gastaldelli, J. J. Nolan

Research output: Contribution to journalArticle

7 Citations (Scopus)


Background: Metabolic surgery is associated with a prompt improvement in insulin resistance, although the mechanism of action remains unknown. The literature on bile acid changes after metabolic surgery is conflicting, and insulin sensitivity is generally assessed by indirect methods. The aim of this study was to investigate the relationship between improvement in insulin sensitivity and concentration of circulating bile acids after biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB). Methods: This was a prospective observational study of nine patients who underwent BPD and six who had RYGB. Inclusion criteria for participation were a BMI in excess of 40 kg/m2, no previous diagnosis of type 2 diabetes and willingness to participate. Exclusion criteria were major endocrine diseases, malignancies and liver cirrhosis. Follow-up visits were carried out after a mean(s.d.) of 185·3(72·9) days. Fasting plasma bile acids were assessed by ultra-high-performance liquid chromatography coupled with a triple quadrupole mass spectrometer, and insulin sensitivity was measured by means of a hyperinsulinaemic–euglycaemic clamp. Results: A significant increase in all bile acids, as well as an amelioration of insulin sensitivity, was observed after metabolic surgery. An increase in conjugated secondary bile acids was significantly associated with an increase in insulin sensitivity. Only the increase in glycodeoxycholic acid was significantly associated with an increase in insulin sensitivity in analysis of individual conjugated secondary bile acids. Conclusion: Glycodeoxycholic acid might drive the improved insulin sensitivity after metabolic surgery.
Original languageEnglish
Pages (from-to)1178-1186
Number of pages9
JournalBritish Journal of Surgery
Publication statusPublished - 2019


  • Adult
  • Bile Acids and Salts
  • Biliopancreatic Diversion
  • Chromatography, High Pressure Liquid
  • Female
  • Gas Chromatography-Mass Spectrometry
  • Gastric Bypass
  • Glucose Clamp Technique
  • Glycodeoxycholic Acid
  • Humans
  • Insulin Resistance
  • Male
  • Middle Aged
  • Prospective Studies


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