Diet-induced thermogenesis and respiratory quotient after Roux-en-Y gastric bypass

Background: Roux-en-Y gastric bypass (RYGB) surgery is an effective tool for long-term weight loss. Mechanisms underlying the effectiveness of such surgery might result not only from the anatomic changes due to the procedure, but also from favorable changes in energy metabolism. Our objective was to evaluate the respiratory quotient (RQ), resting metabolic rate (RMR), and diet-induced thermogenesis (DIT) among clinically severe obese patients (control group) and patients who had undergone RYGB >= 1 year previously. The setting was Gastrocirurgia de Brasilia (Brasilia, Brazil). Methods: The present study was cross-sectional and involved 35 clinically severe obese patients (body mass index >= 40 kg/m(2) or body mass index >= 35 kg/m(2) with co-morbidities) as the control group and 34 RYGB patients who had undergone the procedure >= 12 months previously (RYGB group). The anthropometric data (height and weight) were determined for both groups, and the RMR and RQ were measured using indirect calorimetry after a 12-hour fast. Patients then received a standard meal, and DIT was determined. The RMR and DIT were also adjusted per kilogram of body weight (BW), i.e BW-adjusted RMR and BW-adjusted DI. Results: The BW-adjusted RMR and RQ did not differ between the 2 groups in the fasting period. However, the DIT of the RYGB group, whether absolute or BW-adjusted, was >200% that of the control group (P < .0001). The BW-adjusted DIT of the RYGB group correlated significantly with the percentage of excess weight loss (P = .0097). The postprandial RQ value among the RYGB group was also significantly (P < .0001) greater than that of the control group, suggesting an increased use of carbohydrates. Conclusion: Postprandial changes in energy expenditure and fuel use might contribute, in part, to the effectiveness of weight loss as a result of the RYGB procedure. (Surg Obes Relat Dis 2012;8: 797-802.) (C) 2012 American Society for Metabolic and Bariatric Surgery. All rights reserved.