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Glucagon-Like Peptide-1, Peptide YY, Hunger, and Satiety after Gastric Bypass Surgery in Morbidly Obese Subjects

Obesity Unit (R.M., V.M., A.M.L., S.D., J.V.) and Departments of Biological Diagnostics (M.M., J.L.M., R.C.) and Gastroenterology (S.N.), Hospital Clínic Universitari, 08036 Barcelona, Spain

Address all correspondence and requests for reprints to: Dr. Josep Vidal, Obesity Unit, Endocrinology and Diabetes Department, Hospital Clínic Universitari, Villarroel 170, 08036 Barcelona, Spain. E-mail: jovidal{at}clinic.ub.es.

Context: The mechanisms underlying weight loss after Roux-en-Y gastric bypass (RYGBP) are not well understood.

Objective: The objective of the study was to assess the changes in active glucagon-like peptide 1 (GLP-1) and total peptide YY (PYY) after RYGBP and examine their relationship with changes in hunger and satiety.

Design: This was a prospective study on the changes in active GLP-1, PYY, hunger, and satiety in response to a standardized test meal in nine normal-glucose-tolerant obese subjects [body mass index (BMI) 47.4 ± 6.1 kg/m²] before and 6 wk after RYGBP.

Results: Before surgery, meal ingestion failed to stimulate GLP-1 and PYY secretion. Six weeks after surgery, despite subjects still being markedly obese (BMI 43.6 ± 7.8 kg/m²), the area under the curve_0–120' of GLP-1 and of PYY in response to the standardized test meal were significantly elevated (P < 0.05 and P < 0.01, respectively). These hormonal responses were significantly larger (P < 0.01) than those observed in a group matched for the BMI attained 6 wk after surgery. The 2.9 ± 1.2- and 1.6 ± 1.9-fold increase, respectively, in the area under the curve_0–120' of GLP-1 and PYY were accompanied by a significant decrease in fasting (P < 0.05) and postprandial hunger (P = 0.05) and a significant increase in satiety (P < 0.05) after meal intake. Nevertheless, a significant correlation between changes in the hormonal and eating behavior parameters was not found.

Conclusion: Our data show that RYGBP is associated with an improvement in the active GLP-1 and total PYY response to a liquid-meal intake. Moreover, we provide circumstantial evidence for a potential role of these gastrointestinal hormones on the decreased appetite after RYGBP.

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