Increased hepatic synthesis of cholesterol following jejunoileal bypass

Jay L. Grosfeld, Robert A. Harris, John F. Csicsko, Donald R. Cooney, James A. Madura

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7 Scopus citations

Abstract

Fatty infiltration of liver and formation of cholesterol stones are significant problems following jejunoileal bypass for morbid obesity. This report evaluates hepatic lipid metabolism and fat absorption in genetically obese, bypassed, and lean Zucker rats. Ninety percent jejunoileal bypass was performed in 12 (500 grams) obese rats (BP). Similar numbers of unoperated "fat rats" (FR) and lean litter mates (LR) were controls. Food consumption, weight gain or loss, and fecal fat were evaluated. At 4 weeks serum triglycerides, hepatic cholesterol, total lipids, triglycerides, and hepatic synthesis of fatty acids and cholesterol were measured in vivo. Food intake was excessive in FR's (23.8 ± 0.7 gm/day), decreased in BP (18.3 ± 2.3 gm/day), and lowest in LR's (16.5 ± 0.5 gm/day) (p < 0.05). Bypassed rates showed a 20% weight loss (p < 0.05) and excessive fecal fat excretion (p < 0.05). Serum triglycerides were elevated in FR's (284 ± 32 mg/dl), reduced in BP rats (148 ± 20 mg/dl) (p < 0.05), and low in LR's (86 ± 16 mg/dl). Total hepatic lipids, triglycerides, and hepatic synthesis of fatty acids were elevated in FR's (p < 0.05) and were unchanged by bypass. Hepatic cholesterol was similar in all groups. Hepatic synthesis of cholesterol, however, was increased significantly in bypassed rats (p < 0.05), (BP-102 ± 22 μnmole/ "C2"/minute/gm, FR-39 ± 6.0, LR-30 ± 4.0). Jejunoileal bypass in FR's results in weight loss, decreased food intake, increased fecal fat, decreased serum triglycerides, and increased hepatic synthesis of cholesterol. Bypass had little effect on reducing elevated hepatic lipids, triglycerides, or fatty acid synthesis in FR's. These data suggest that following bypass increased hepatic cholesterol synthesis (as a precursor for bile acids) is related to interruption of the enterohepatic circulation and bile salt pool depletion. This implies that excess synthesis of hepatic cholesterol results in supersaturation of bile which is cholelithogenic and may explain in part the increased incidence of gall stones observed following jejunoileal bypass.

Original languageEnglish (US)
Pages (from-to)701-707
Number of pages7
JournalSurgery
Volume81
Issue number6
StatePublished - Jun 1977

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ASJC Scopus subject areas

  • Surgery

Cite this

Grosfeld, J. L., Harris, R. A., Csicsko, J. F., Cooney, D. R., & Madura, J. A. (1977). Increased hepatic synthesis of cholesterol following jejunoileal bypass. Surgery, 81(6), 701-707.