Endocrinology and Metabolism

Original Article

Diabetes, Obesity and Metabolism
Association between the Blautia/Bacteroides Ratio and Altered Body Mass Index after Bariatric Surgery: Yoonhong Kim, Dooheon Son, Bu Kyung Kim, Ki Hyun Kim, Kyung Won Seo, Kyoungwon Jung, Seun Ja Park, Sanghyun Lim, Jae Hyun Kim; Endocrinol Metab. 2022;37(3):475-486. Published online June 29, 2022; DOI: https://doi.org/10.3803/EnM.2022.1481; Correction in: Endocrinol Metab 2022;37(4):701

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Background
Current evidence support that the gut microbiota plays a potential role in obesity. Bariatric surgery can reduce excess weight and decrease the risk of life-threatening weight-related health problems and may also influence gut microbiota. In this study, we aimed to investigate the changes in gut microbiota before and after bariatric surgery and evaluate the association of the gut microbial shift and altered body mass index (BMI) after bariatric surgery.
Methods
Between January 2019 and July 2020, stools from 58 patients scheduled for bariatric surgery were collected. Six months after bariatric surgery, stools from 22 of these patients were re-collected, and the changes in gut microbiota before and after bariatric surgery were evaluated. In addition, the differences in gut microbiota between patients with severe obesity (BMI >35 kg/m², n=42) and healthy volunteers with normal BMI (18.8 to 22.8 kg/m², n=41) were investigated.
Results
The gut microbiota of patients who underwent bariatric surgery showed increased α-diversity and differed β-diversity compared with those before surgery. Interestingly, Blautia was decreased and Bacteriodes was increased at the genus level after bariatric surgery. Further, the Blautia/Bacteroides ratio showed a positive correlation with BMI. To validate these results, we compared the gut microbiota from severely obese patients with high BMI with those from healthy volunteers and demonstrated that the Blautia/Bacteroides ratio correlated positively with BMI.
Conclusion
In the gut microbial analysis of patients who underwent bariatric surgery, we presented that the Blautia/Bacteroides ratio had changed after bariatric surgery and showed a positive correlation with BMI.

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Review Articles

Metabolic Surgery in Korea: What to Consider before Surgery: Mi-Kyung Kim, Yoonseok Heo; Endocrinol Metab. 2017;32(3):307-315. Published online September 18, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.3.307

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Obesity is increasing globally and represents a significant global health problem because it predisposes towards various diseases, such as type 2 diabetes mellitus, cardiovascular disease, degenerative joint disease, and certain types of cancer. Numerous studies have shown that bariatric surgery reduces body mass and ameliorates obesity-related complications, such as hypertension and hyperglycemia, suggesting that surgery is the most effective therapeutic option for severely obese and obese diabetic patients. Recent international guidelines recommend surgical treatment for diabetic patients with class III obesity (body mass index [BMI] >40 kg/m²), regardless of their level of glycemic control or the complexity of their glucose-lowering regimens, and for patients with class II obesity (BMI 35.0 to 39.9 kg/m²) and hyperglycemia that is poorly controlled despite appropriate lifestyle and pharmacological therapy. The most popular procedures are Roux-en-Y gastric bypass and sleeve gastrectomy, but new procedures with better outcomes have been reported. For optimal surgical outcome, comprehensive management including assessments of a medical condition, nutrition, mental health, and social support is needed before and after surgery. However, there is still a lack of understanding regarding metabolic surgery in Korea. Therefore, this article reviews indications for metabolic surgery in patients with a specific focus on the situation in Korea.

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Obesity and Metabolism
Current Status of Bariatric and Metabolic Surgery in Korea: Youn-Baik Choi; Endocrinol Metab. 2016;31(4):525-532. Published online November 4, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.4.525

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Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. In Korea, surgery for morbid obesity was laparoscopic sleeve gastrectomy first performed in 2003. Since 2003, the annual number of bariatric surgeries has markedly increased, including adjustable gastric banding (AGB), Roux-en-Y gastric bypass, sleeve gastrectomy, mini-gastric bypass, and others. In Korea, AGB is much more common than in others countries. A large proportion of doctors, the public, and government misunderstand the necessity and effectiveness of bariatric surgery, believing that bariatric surgery has an unacceptably high morbidity, and that it is not superior to non-surgical treatments to improve obesity and obesity-related diseases. The effectiveness, safety, and cost-effectiveness of bariatric surgery have been well demonstrated. The Korean Society of Metabolic and Bariatric Surgery recommend bariatric surgery confining to morbidly obese patients (body mass index ≥40 or >35 in the presence of significant comorbidities).

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Adrenal gland
In Vivo Models for Incretin Research: From the Intestine to the Whole Body: Tae Jung Oh; Endocrinol Metab. 2016;31(1):45-51. Published online March 16, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.1.45

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Incretin hormones are produced by enteroendocrine cells (EECs) in the intestine in response to ingested nutrient stimuli. The incretin effect is defined as the difference in the insulin secretory response between the oral glucose tolerance test and an isoglycemic intravenous glucose infusion study. The pathophysiology of the decreased incretin effect has been studied as decreased incretin sensitivity and/or β-cell dysfunction per se. Interestingly, robust increases in endogenous incretin secretion have been observed in many types of metabolic/bariatric surgery. Therefore, metabolic/bariatric surgery has been extensively studied for incretin physiology, not only the hormones themselves but also alterations in EECs distribution and genetic expression levels of gut hormones. These efforts have given us an enormous understanding of incretin biology from synthesis to in vivo behavior. Further innovative studies are needed to determine the mechanisms and targets of incretin hormones.

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