Metabolic benefits of gastric bypass surgery in the mouse: The role of fecal losses

Aude Barataud, Justine Vily-Petit, Daisy Goncalves, Carine Zitoun, Adeline Duchampt, Erwann Philippe, Amandine Gautier-Stein, Gilles Mithieux

The Roux-en-Y gastric bypass (RYGB) procedure is one of the most efficient bariatric surgeries, inducing rapid weight loss and improvements in comorbidities of obesity. Barataud et al. performed duodenal-jejunal bypass (DJB), which is equivalent to RYGB without size restriction of the stomach, in mice and found that DJB induces dramatic loss of fecal matter in obese mice fed a high fat, high sugar diet. In obese mice, this could be sufficient to explain the lasting weight loss and associated improvements in glucose control associated with DJB. Fecal energy loss should no longer be underestimated in bypass surgery studies in the mouse.

Objective: Roux-en-Y gastric surgery (RYGB) promotes a rapid and sustained weight loss and amelioration of glucose control in obese patients. A high number of molecular hypotheses were previously tested using duodenal-jejunal bypass (DJB) performed in various genetic models of mice with knockouts for various hormones or receptors. The data were globally negative or inconsistent. Therefore, the mechanisms remained elusive. Intestinal gluconeogenesis is a gut function that has been suggested to contribute to the metabolic benefits of RYGB in obese patients.

Methods: We studied the effects of DJB on body weight and glucose control in obese mice fed a high fat-high sucrose diet. Wild type mice and mice with a genetic suppression of intestinal gluconeogenesis were studied in parallel using glucose- and insulin-tolerance tests. Fecal losses, including excretion of lipids, were studied from the feces recovered in metabolic cages.

Results: DJB induced a dramatic decrease in body weight and improvement in glucose control (glucose- and insulin-tolerance) in obese wild type mice fed a high calorie diet, for 25 days after the surgery. The DJB-induced decrease in food intake was transient and resumed to normal in 7–8 days, suggesting that decreased food intake could not account for the benefits. Total fecal losses were about 5 times and lipid losses 7 times higher in DJB-mice than in control (sham-operated and pair-fed) mice, and could account for the weight loss of mice. The results were comparable in mice with suppression of intestinal gluconeogenesis. There was no effect of DJB on food intake, body weight or fecal loss in lean mice fed a normal chow diet.

Conclusions: DJB in obese mice fed a high calorie diet promotes dramatic fecal loss, which could account for the dramatic weight loss and metabolic benefits observed. This could dominate the effects of the mouse genotype/phenotype. Thus, fecal energy loss should be considered as an essential process contributing to the metabolic benefits of DJB in obese mice.