Gut microbiota and bariatric surgery
DOI:
https://doi.org/10.47196/diab.v49i1.195Keywords:
obesity, bariatric surgery, type 2 diabetes, microbiotaAbstract
In the last years, the study of gut microbiota has emerged as a new environmental factor in obesity and type 2 diabetes pathogeny, complex, heterogeneous, chronic and progressive diseases. Conventional treatments fail in morbid obesity, and bariatric surgery is considered at present as the only effective treatment in severe obesity, defined as BMI>40, or BMI>35 associated with comorbidities. The malabsorption and restriction mechanisms, initially proposed as the responsible for the weight loss and metabolic amelioration observed after bariatric surgery, do not adequately explain the quick remission of type 2 diabetes seen with the surgical procedure. The causal mechanisms are not exactly known, in spite of the profuse research on the matter. The following factors have been postulated: neuro-endocrine changes associated with the re-direction of the flow of nutrients, changes in gastric emptying and intestinal motility, changes in feeding behavior, remodeling of Roux loop, changes in the enterohepatic circulation of bile acids, intestinal gluconeogenesis, and alterations in gut microbiota. Gut microbiota is seen as a link between dietary intake, systemic inflammation, and glucose homeostasis. Some studies in animal models and in humans suggest that microbiota composition modification may contribute to the metabolic benefits observed after the Roux-en-Y gastric bypass.
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