The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids

MA Glaysher, J Ward, M Aldhwayan, A Ruban, CG Prechtl, HL Fisk, N Chhina, W Al-Najim, C Smith, N Klimowska-Nassar, N Johnson, E Falaschetti, AP Goldstone, AD Miras, JP Byrne, PC Calder, JP Teare

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Abstract

Background & aims: Duodenal-jejunal bypass liners (DJBLs) prevent absorption in the proximal small intestine, the site of fatty acid absorption. We sought to investigate the effects of a DJBL on blood concentrations of essential fatty acids (EFAs) and bioactive polyunsaturated fatty acids (PUFAs).

Methods: Sub-study of a multicentre, randomised, controlled trial with two treatment groups. Patients aged 18e65 years with type-2 diabetes mellitus and body mass index 30e50 kg/m2 were randomised to receive a DJBL for 12 months or best medical therapy, diet and exercise. Whole plasma PUFA concentrations were determined at baseline,10 days, 6 and 11.5 months; data were available for n ¼ 70 patients per group. Results: Weight loss was significantly greater in the DJBL group compared to controls after 11.5 months: total body weight loss 11.3 ± 5.3% versus 6.0 ± 5.7% (mean difference [95% CI] ¼ 5.27% [3.75, 6.80], p < 0.001). Absolute concentrations of both EFAs, linoleic acid and a-linolenic acid, and their bioactive derivatives, arachidonic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid, were significantly lower in the DJBL group than in the control group at 6 and 11.5 months follow-up. Total serum cholesterol, LDL-cholesterol and HDL-cholesterol were also significantly lower in the DJBL group.

Conclusion: One year of DJBL therapy is associated with superior weight loss and greater reductions in total serum cholesterol and LDL-cholesterol, but also depletion of EFAs and their longer chain derivatives. DJBL therapy may need to be offset by maintaining an adequate dietary intake of PUFAs or by supplementation.

Trial registration: ClinicalTrials.gov Identifier NCT02459561.
Original languageEnglish
Pages (from-to)2343-2354
Number of pages12
JournalClinical Nutrition
Volume40
Issue number4
Early online date22 Oct 2020
DOIs
Publication statusPublished (in print/issue) - 1 Apr 2021

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