Obesity Surgery

, Volume 26, Issue 8, pp 1851–1858 | Cite as

Equivalent Increases in Circulating GLP-1 Following Jejunal Delivery of Intact and Hydrolysed Casein: Relevance to Satiety Induction Following Bariatric Surgery

  • Carel W. le Roux
  • My Engström
  • Niclas Björnfot
  • Lars Fändriks
  • Neil G. Docherty
Original Contributions



Both Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) decrease the latency of food delivery to the proximal small intestine. This is implicated in exaggerated post-prandial release of glucagon-like peptide 1 (GLP-1), which provokes early satiety and reductions in food intake. Altered stomach anatomy also creates a deficit in enzymatic pre-processing. The impact of this state effect as a modulator of gut hormone responses remains underexplored.


A double-blind cross-over trial study was conducted in 13 healthy subjects assigned to receive in the fasted state and in random order at 1 week apart, a direct jejunal infusion of either intact casein or a casein hydrolysate. Downstream effects on GLP-1 release, ratings of hunger and fullness and food and water intake on each study day were recorded when an ad libitum meal was provided 30 min after the infusion.


Circulating GLP-1 was increased 25 min after infusions and peaked to a similar degree at 15 min post-meal initiation. The hormone surge had no impact on ratings of hunger and fullness ahead of the ad libitum meal. The kinetic and magnitude of satiation following each infusion was not significantly different. Food and water intake were likewise not differentially impacted by the two infusion types.


Protein macronutrient state upon arrival in the small intestine does not in isolation impact upon GLP-1 responses and subsequent onset of satiety. This potentially points to rate of delivery being the dominant factor in exaggerated post-prandial GLP-1 responses in patients post-RYGB and VSG.


Bariatric surgery GLP-1 Satiety Hormones Gut signalling 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interest.


This study was funded by Enterprise Ireland (TC20130001), Science Foundation Ireland (12/YI/B2480) and an ALF grant to LF at Sahlegrenska University Hospital, Gothenburg.

Human Rights Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Carel W. le Roux
    • 1
    • 2
    • 3
    • 4
  • My Engström
    • 2
  • Niclas Björnfot
    • 2
  • Lars Fändriks
    • 2
  • Neil G. Docherty
    • 1
    • 5
  1. 1.Molecular Medicine Laboratory, Diabetes Complications Research Centre, Conway InstituteSchool of Medicine and Medical Sciences, University College DublinDublinIreland
  2. 2.Department of Gastrosurgical Research and Education, Institute of Clinical SciencesSahlgrenska Academy, University of GothenburgGothenburgSweden
  3. 3.Investigative Science, Imperial College LondonLondonUK
  4. 4.Food for Health Ireland, University College DublinDublinIreland
  5. 5.Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical ResearchSchool of Medicine and Medical Sciences, University College DublinDublin 4Ireland

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