Clusters of Glycemic Response to Oral Glucose Tolerance Tests Explain Multivariate Metabolic and Anthropometric Outcomes of Bariatric Surgery in Obese Patients
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Design
2.2. Study Population
2.3. Assay Protocols and Measurements
2.4. Statistical Analysis
3. Results
3.1. Study Cohort Characteristics
3.2. Baseline Glucose Response Clusters
3.3. OGTT Clustering in Response to Bariatric Surgery
3.4. Individual Parameter Responses
3.5. One Year Temporal Response pattern to Bariatric Surgery
3.6. Explanatory Power of Glucose Response Classification
3.7. Integrated Multiple Parameter Responses: Principal Responses
3.8. Diabetes Remission
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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General Metabolic | Glucose Homeostasis | Anthropometric |
---|---|---|
Total cholesterol | Glucose, OGTT | Waist-to-hip ratio |
Triglycerides | Insulin, OGTT | Total body mass |
HDL cholesterol | Glycated hemoglobin | Lean body mass |
LDL cholesterol | HOMA-β | Visceral adipose tissue mass |
Aspartate transaminase | HOMA-IR | Fat mass |
Alanine transaminase | Matsuda index | BMI |
C reactive protein | Weight |
Variable Name | Cluster 1 | Cluster 2 | Cluster 3 | Cluster 4 | p-Value |
---|---|---|---|---|---|
Cohort size, n (%) | 6 (4) | 37 (27) | 31 (22) | 64 (46) | NA |
Age, years | 45 (39–47) | 38 (31–48) | 52 (43–54) | 46 (39–57) | 0.26 |
Male sex, n (%) | 4 (66) | 14 (38) | 14 (45) | 31 (48) | NA |
Smoking, n (%) | 0 (0) | 4 (11) | 7 (23) | 9 (14) | NA |
Total body mass, kg | 146.2 (130.8–169.03) | 128.6 ( 116.33–149.18) | 133.1 (119.42–151.42) | 138.4 (117.6–148.9) | 0.39 |
Fat mass, kg | 65.06 (64.55–76.23) | 65.96 (54.75–75.79) | 62.89 (53.38–70.98) | 63.31 (53.8–70.45) | 0.31 |
Lean body mass, kg | 81.81 (64.73–88.95) | 62.49 (53.05–67.9) | 63.56 (55.37–76.76) | 68.22 (57.15–76.64) | 0.03 |
Visceral adipose tissue mass, kg | 3.71 (2.5–4.98) | 2.39 (1.98–3.55) | 3.63 (2.41–4.29) | 3.75 (2.8–4.99) | 0.14 |
BMI, kg/m2 | 46.83 (45.45–51.58) | 44.43 (40.65–49.69) | 45.54 (41.82–50.39) | 45.12 (42.37–49.44) | 0.26 |
Fasting glucose, mmol/L | 5.52 (5.31–6.10) | 5.88 (5.66–6.04) | 6.32 (5.93–6.90) | 6.90 (6.36–7.99) | <0.001 |
Fasting insulin, pmol/L | 244.45 (172.63–306.44) | 138.04 (109.70–186.04) | 210.72 (171.69–322.80) | 247.89 (174.42–354.37) | 0.002 |
HbA1c, % | 5.20 (5.03–5.30) | 5.50 (5.30–5.70) | 5.90 (5.60-6.05) | 6.15 (5.82–6.68) | <0.001 |
HbA1c, mmol/mol | 33 (31–34) | 37 (34–39) | 41 (38–43) | 44 (40–49) | <0.001 |
HOMA-beta | 301.90 (187.09–562.72) | 176.45 (122.13–269.72) | 201.08 (142.22–309.90) | 182.24 (125.88–292.69) | 0.65 |
HOMA-IR | 8.29 (6.76–10.30) | 5.20 (3.73–6.76) | 9.63 (6.06–12.76) | 11.09 (7.61–16.17) | <0.001 |
Matsuda index | 1.43 (1.22–1.78) | 2.13 (1.64–2.48) | 1.18 (0.9–1.58) | 0.95 (0.72–1.48) | <0.001 |
Glucose AUC | 231.12 (224.25–236.31) | 291.50 (276.75–298.00) | 338.00 (312.75–381.62) | 418.75 (363.69–470.00) | <0.001 |
Insulin AUC | 219.81 (209.13–277.50) | 207.73 (159.35–271.18) | 294.48 (180.43–392.15) | 269.30 (183.53–364.25) | 0.03 |
Mean insulin concentration during OGTT, pmol/L | 711.18 (692.38–920.26) | 614.89 (479.00–801.80) | 883.67 (563.16–1145.77) | 844.49 (588.70–1142.40) | 0.01 |
Mean glucose concentration during OGTT, mmol/L | 6.27 (6.11–6.54) | 7.63 (7.27–7.92) | 8.76 (8.11–9.83) | 10.81 (9.44–12.11) | <0.001 |
Total cholesterol, mmol/L | 4.18 (4.12–5.01) | 5.10 (4.19–5.77) | 5.20 (4.46–6.28) | 4.79 (4.13–5.60) | 0.37 |
Triglycerides, mmol/L | 1.08 (0.83–1.37) | 1.35 (0.98–1.78) | 1.68 (1.27–2.00) | 1.61 (1.2–2.54) | 0.02 |
HDL-cholesterol, mmol/L | 1.08 (0.95–1.2) | 1.24 (1.01–1.45) | 1.1 (0.91–1.45) | 1.08 (0.95–1.37) | 0.57 |
LDL-cholesterol, mmol/L | 2.75 (2.64–2.95) | 3.15 (2.69–3.87) | 3.42 (2.73–4.00) | 3.10 (2.38–3.63) | 0.31 |
Aspartate transaminase, ukat/L | 0.43 (0.34–0.45) | 0.38 (0.29–0.45) | 0.34 (0.29–0.42) | 0.42 (0.32–0.56) | 0.04 |
Alanine transaminase, ukat/L | 0.54 (0.39–0.69) | 0.47 (0.35–0.78) | 0.47 (0.36–0.61) | 0.56 (0.40–0.93) | 0.56 |
C Reactive Protein, nmol/L | 30.19 (15.04–32.47) | 49.90 (30.19–75.99) | 44.28 (26.76–81.61) | 59.8 (33.23–107.23) | 0.26 |
Physical activity, METs-minutes/week | 3586 (3067–8899) | 5937 (2046–12546) | 5364 (2820–8773) | 4513 (2355–13598) | 0.71 |
Daily kcal intake, kcal/day | 1309 (1079–1469) | 1788 (1431–2209) | 1578 (1284–2284) | 1724 (1347–2334) | 0.14 |
Response Type | Model Terms | N | μR2 | lwr | upr |
---|---|---|---|---|---|
Anthropometric | diagnosis | 12 | 0.483 | 0.39 | 0.57 |
OGTT cluster | 12 | 0.482 | 0.39 | 0.57 | |
diagnosis + OGTT cluster | 12 | 0.492 | 0.40 | 0.58 | |
Glucose homeostasis | diagnosis | 11 | 0.319 | 0.22 | 0.49 |
OGTT cluster | 11 | 0.326 | 0.23 | 0.42 | |
diagnosis + OGTT cluster | 11 | 0.411 | 0.30 | 0.52 | |
General metabolic | diagnosis | 11 | 0.185 | 0.12 | 0.25 |
OGTT cluster | 11 | 0.171 | 0.10 | 0.24 | |
diagnosis + OGTT cluster | 11 | 0.208 | 0.14 | 0.28 |
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Szczerbinski, L.; Taylor, M.A.; Citko, A.; Gorska, M.; Larsen, S.; Hady, H.R.; Kretowski, A. Clusters of Glycemic Response to Oral Glucose Tolerance Tests Explain Multivariate Metabolic and Anthropometric Outcomes of Bariatric Surgery in Obese Patients. J. Clin. Med. 2019, 8, 1091. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm8081091
Szczerbinski L, Taylor MA, Citko A, Gorska M, Larsen S, Hady HR, Kretowski A. Clusters of Glycemic Response to Oral Glucose Tolerance Tests Explain Multivariate Metabolic and Anthropometric Outcomes of Bariatric Surgery in Obese Patients. Journal of Clinical Medicine. 2019; 8(8):1091. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm8081091
Chicago/Turabian StyleSzczerbinski, Lukasz, Mark A. Taylor, Anna Citko, Maria Gorska, Steen Larsen, Hady Razak Hady, and Adam Kretowski. 2019. "Clusters of Glycemic Response to Oral Glucose Tolerance Tests Explain Multivariate Metabolic and Anthropometric Outcomes of Bariatric Surgery in Obese Patients" Journal of Clinical Medicine 8, no. 8: 1091. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm8081091