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. 2014 Sep-Oct;10(5):780-6.
doi: 10.1016/j.soard.2014.01.032. Epub 2014 Feb 17.

Effects on GLP-1, PYY, and leptin by direct stimulation of terminal ileum and cecum in humans: implications for ileal transposition

Henry Buchwald  1 , Robert B Dorman  2 , Nikolaus F Rasmus  2 , Van N Michalek  2 , Nichol M Landvik  2 , Sayeed Ikramuddin  2
Affiliations

Effects on GLP-1, PYY, and leptin by direct stimulation of terminal ileum and cecum in humans: implications for ileal transposition

Henry Buchwald et al. Surg Obes Relat Dis. 2014 Sep-Oct.

Abstract

Background: We do not have a unified, scientifically tested theory of causation for obesity and its co-morbidities, nor do we have explanations for the mechanics of the metabolic/bariatric surgery procedures. Integral to proffered hypotheses are the actions of the hormones glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and leptin. The objective of this study was to obtain blood levels of GLP-1, PYY, and leptin after stimulation of the terminal ileum and cecum by a static infusion of a food hydrolysate in morbidly obese patients undergoing a duodenal switch procedure.

Setting: University Hospital.

Methods: Plasma levels of GLP-1, PYY, and leptin were obtained at 0, 30, 60, 90, and 120 minutes after instillation of 240 mL of a food hydrolysate into the ileum or cecum.

Results: The mean±SD GLP-1 values by cecal stimulation for 0, 30, 60, 90, and 120 minutes were: 41.3±23.2; 39.6±21.8; 38.9±19.1; 47.4±22.3; 51.7±27.3 pM, and by ileal stimulation: 55.0±32.8; 83.4±16.1; 78.7±23.8; 84.7±23.5; 76.4±25.6. The mean±SD PYY values by cecal stimulation were: 62.1±24.8; 91.1±32.8; 102.1±39.6; 119.6±37.5; 130.3±36.7, and by ileal stimulation: 73.8±41.6; 138.1±17.7; 149.5±23.3; 165.7±24.3; 155.5±29.1. Percent change in PYY levels increased ~150%, GLP-1 increased ~50%, and leptin decreased ~20%.

Conclusion: Direct stimulation of the human terminal ileum and cecum by a food hydrolysate elicits significant plasma GLP-1 and PYY elevations and leptin decreases, peaking at 90-120 minutes. The ileal GLP-1 and PYY responses exceed those of the cecum, and the PYY effect is about 3-fold that of GLP-1. The results of this study question the satiety premise for ileal transposition.

Keywords: Duodenal switch; GLP-1; Leptin; PYY.

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Conflict of interest statement

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

Figures

Fig. 1
Fig. 1
Comparison of GLP-1, PYY, and leptin changes from baseline between cecum and ileum. All values compared using repeated measures ANOVA. Data represented as mean ± SE. *P < .05 for ileum compared to baseline; ‡P < .05 for cecum compared to baseline.
See this image and copyright information in PMC

Comment in

  • Is Glucagon-like peptide-1 for real?
    Murr MM. Murr MM. Surg Obes Relat Dis. 2014 Sep-Oct;10(5):786. doi: 10.1016/j.soard.2014.02.006. Epub 2014 Feb 12. Surg Obes Relat Dis. 2014. PMID: 24935178 No abstract available.

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