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Small intestinal alterations in severely obese hyperglycemic subjects
Froukje J Verdam1, Jan Willem M Greve, Sedigheh Roosta
1Department of General Surgery, School for Nutrition, Toxicology, and Metabolism Research Institute Maastricht, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands.
The Journal of Clinical Endocrinology and Metabolism
|November 19, 2010
Summary
Chronic hyperglycemia in obese individuals is linked to increased small intestinal enterocyte mass and loss. These findings highlight the small intestine's role in type 2 diabetes mellitus (DM2) pathophysiology.
Area of Science:
- Endocrinology
- Gastroenterology
- Metabolic Diseases
Background:
- Type 2 diabetes mellitus (DM2) is associated with small intestinal changes in rodents.
- The small intestine's role in DM2 pathophysiology is increasingly recognized.
Purpose of the Study:
- To investigate the relationship between plasma markers of small intestinal function and chronic hyperglycemia in humans.
- To assess small intestinal enterocyte mass, loss, and intestinotrophic factors in relation to glycated hemoglobin (HbA1c) levels.
Main Methods:
- Cross-sectional observational study of 70 severely obese subjects (40 with chronic hyperglycemia, 30 without).
- Assessed plasma levels of citrulline (enterocyte mass), intestinal fatty acid binding protein (I-FABP; enterocyte loss), and glucagon-like peptide-2 (intestinotrophic factor).
- Related plasma markers to glycated hemoglobin (HbA1c) levels.
Main Results:
- Plasma citrulline and I-FABP levels were significantly elevated in subjects with chronic hyperglycemia (HbA1c > 6.0%) compared to those with normal HbA1c (≤ 6.0%).
- Plasma citrulline and I-FABP levels positively correlated with HbA1c levels.
- The I-FABP to citrulline ratio was higher in subjects with elevated HbA1c, indicating increased enterocyte loss relative to mass.
Conclusions:
- Chronically elevated glucose levels in obese individuals are associated with increased small intestinal enterocyte mass and enterocyte loss.
- These findings support further investigation into the small intestine's role in the pathophysiology of type 2 diabetes mellitus.
- Plasma citrulline and I-FABP may serve as potential biomarkers for intestinal dysfunction in hyperglycemia.
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