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Clinical Studies and Practice

Plasma FGF21 levels in obese patients undergoing energy-restricted diets or bariatric surgery: a marker of metabolic stress?

International Journal of Obesity volume 41, pages 1570–1578 (2017)Cite this article

Subjects

Abstract

Background:

Fibroblast growth factor 21 (FGF21) has been suggested to be an endocrine signal of nutritional status and an active regulator of metabolism. However, there is no agreement on the effect of weight-loss therapies on circulating levels of FGF21 in humans.

Objective:

To assess FGF21 circulating levels in adiposity excess and after different weight-loss strategies prescribed in five different groups from four independent centers.

Subjects and methods:

Body composition, ketosis, insulin sensitivity and FGF21 were evaluated in 181 excess body weight and 14 normal-weight subjects. From the excess body weight patients, two independent groups (discovery cohort; n=20 and validation cohort; n=28) undertook a very low-calorie ketogenic (VLCK) diet, a third group followed a low-calorie (LC) diet (n=84) and other two groups underwent bariatric surgery (discovery cohort; n=24 and validation cohort; n=25). The follow-up was 4 to 6 or 12 months, respectively.

Results:

FGF21 levels were higher in excess body weight patients than in normal-weight subjects. The energy-restriction therapy to lose weight induced a significant decrease, with respect to baseline, in circulating levels of FGF21 (VLCK: −62.5 pg ml−1 or −14.8 pg ml−1 and LC diet: −67.9 pg ml−1). There were no differences in FGF21 levels between both energy-restriction treatments. On the contrary, after bariatric surgery morbidly obese patients showed a significant increase in FGF21, especially 1 month after surgery (148.8 pg ml−1 higher than baseline). The FGF21 differential changes occur concomitantly with a non-induced ketosis situation (0.66±0.56 mm) in bariatric surgery, and an improvement in adiposity and insulin sensitivity induced by the three therapies.

Conclusions:

FGF21 levels were reduced after energy-restricted treatments and severely increased after bariatric surgery, independently of the weight reduction magnitude, insulin sensitivity or ketosis. Therefore, FGF21 appears to be a marker of severe nutritional stress.

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Acknowledgements

We thank all the subjects who participated in this study and the research group implicated in the project, especially the people who performed the field work (I Abete, R de la Iglesia, P Lopez-Legarrea, S Perez and BE Martinez de Morentin) as well as technical assistance (M Amil and V Ciaurriz). We also thank Prof Francesc Villarroya for his advice and encouragement. This work was supported by the PronoKal Group and grants from the Fondo de Investigacion Sanitaria, PE13/00024 and PI14/01012 research projects and CIBERobn (CB06/003) from the Instituto de Salud Carlos III (ISCIII)-Subdireccion General de Evaluacion y Fomento de la Investigación; Fondo Europeo de Desarrollo Regional (FEDER), the Health Department of the Xunta de Galicia (GRC2014/034), and the Health Department of the Government of Navarra (48/2009), Spain and Linea Especial ‘Nutrition, Obesity and Health’ (University of Navarra LE/97). DGA is grateful to the Colombian Department of Science, Technology and Innovation (COLCIENCIAS) as a recipient of their pre-doctoral scholarship to support his work.

Disclaimer

The funding source had no involvement in the study design, recruitment of patients, study interventions, data collection or interpretation of the results. The Pronokal personnel (IS) was involved in the study design and revised the final version of the manuscript, without intervention in the analysis of data, statistical evaluation and final interpretation of the results of this study.

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Author notes

  1. A B Crujeiras and D Gomez-Arbelaez: These authors contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS) and Santiago de Compostela University (USC), Santiago de Compostela, La Coruña, Spain

    A B Crujeiras, D Gomez-Arbelaez, M C Carreira, A I Castro, A Sueiro & F F Casanueva

  2. CIBER de Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Santiago de Compostela, Spain

    A B Crujeiras, M A Zulet, M C Carreira, A I Castro, M Macias-Gonzalez, F J Tinahones, J A Martinez & F F Casanueva

  3. Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, University of Navarra (UNAV) and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    M A Zulet & J A Martinez

  4. Medical Department Pronokal, Protein Supplies SL, Barcelona, Spain

    I Sajoux

  5. Department of Endocrinology and Nutrition, School of Medicine, Center of Investigation of Endocrinology and Nutrition, Hospital Clinico Universitario Valladolid, University of Valladolid, Valladolid, Spain

    D de Luis

  6. Division of General Surgery, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain

    J Baltar & I Baamonde

  7. Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria), University of Málaga, Málaga, Spain

    M Macias-Gonzalez & F J Tinahones

  8. Division of Endocrinology, Complejo Hospitalario Universitario de Ferrol and Coruña University, Ferrol, Spain

    D Bellido

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  1. A B Crujeiras
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Correspondence to F F Casanueva.

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ABC, DB and FFC received advisory board fees and or research grants from Pronokal Protein Supplies Spain. IS is Medical Director of Pronokal Spain. The remaining authors declare no conflict of interest.

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Crujeiras, A., Gomez-Arbelaez, D., Zulet, M. et al. Plasma FGF21 levels in obese patients undergoing energy-restricted diets or bariatric surgery: a marker of metabolic stress?. Int J Obes 41, 1570–1578 (2017). https://doi.org/10.1038/ijo.2017.138

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