Roux-en-Y Gastric Bypass Improves Insulin Response and Secretion of GLP-1 and PYY in Response to Postprandial Acute Exercise

Saulo Gil; Igor Hisashi Murai; Wagner S Dantas; Carlos Alberto Abujabra Merege-Filho; Alice Erwig Leitão; Carolina Ferreira Nicoletti; Alisson Padilha de Lima; Fabiana Benatti; Roberto de Cleva; Marco Aurélio Santo; John P Kirwan; Bruno Gualano; Hamilton Roschel

doi:10.1007/s11695-025-08327-0

Roux-en-Y Gastric Bypass Improves Insulin Response and Secretion of GLP-1 and PYY in Response to Postprandial Acute Exercise

Obes Surg. 2025 Dec;35(12):4989-4999. doi: 10.1007/s11695-025-08327-0. Epub 2025 Nov 14.

Authors

Saulo Gil^{1

2

3

4}, Igor Hisashi Murai^{1

2

3}, Wagner S Dantas^{1

5}, Carlos Alberto Abujabra Merege-Filho^{1

2

3}, Alice Erwig Leitão^{1

2

3}, Carolina Ferreira Nicoletti^{1

2

3}, Alisson Padilha de Lima^{1

2

3}, Fabiana Benatti^{1

2

3}, Roberto de Cleva^{1

6}, Marco Aurélio Santo⁶, John P Kirwan⁵, Bruno Gualano^{1

2

3}, Hamilton Roschel^{7

8

9}

Affiliations

¹ Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil.
² Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Universidade de Sao Paulo, São Paulo, Brazil.
³ Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil.
⁴ Post-graduate Program in Health Sciences, Santo Amaro University, São Paulo, Brazil.
⁵ Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, USA.
⁶ Department of Digestive Surgery, School of Medicine, University of Sao Paulo, São Paulo, Brazil.
⁷ Applied Physiology and Nutrition Research Group - School of Physical Education and Sport and Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil. hars@usp.br.
⁸ Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Universidade de Sao Paulo, São Paulo, Brazil. hars@usp.br.
⁹ Laboratory of Assessment and Conditioning in Rheumatology; Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil. hars@usp.br.

PMID: 41238973
DOI: 10.1007/s11695-025-08327-0

Abstract

Background: The acute exercise-mediated changes in metabolic, immunomodulatory, and gut hormones are blunted by excessive adiposity. We investigated whether bariatric surgery improves the acute postprandial exercise response in terms of glucose metabolism, gut hormones, and inflammatory markers in women with severe obesity.

Methods: Thirteen women (age: 37 ± 7; BMI: 47.6 ± 5.6) underwent an exercise session (resistance training plus aerobic exercise) before and 3 months after surgery. Blood samples were collected at baseline, immediately and 30 min after exercise to analyze glucose, insulin, inflammatory markers, and gut hormones.

Results: Post-surgery, glucose levels decreased immediately (P = 0.0011) and 30 min after exercise (P = 0.0160), but AUC remained similar (181.0 vs. 166.8 mg/dL x min^-1, P = 0.1980) between conditions. Insulin response to postprandial exercise did not change after surgery (all P > 0.05), but AUC was reduced post-surgery (60.7 vs. 26.3 µU/mL x min^-1, P = 0.0457). No changes occurred in Glucagon-Like Peptide-1 (GLP-1) and Peptide YY (PYY) pre-surgery exercise (all P > 0.05); however, both parameters were increased immediately (P = 0.0180 and P = 0.0020, respectively) and 30 min post-exercise (P = 0.0380 and P = 0.0360, respectively) after surgery. AUC for GLP-1 (2.3 vs. 14.5 pg/mL x min^-1, P = 0.0075) and PYY (9.9 vs. 224.2 pg/mL x min^-1, P = 0.0004) were increased post-surgery. Surgery did not affect Pancreatic Polypeptide (PP) or Gastric Inhibitory Polypeptide (GIP) responses to postprandial exercise. Both parameters were elevated immediately (all P < 0.05) and 30 min post-exercise (all P < 0.05), regardless of surgery. PP (549.6 vs. 261.7 pg/mL x min^-1, P = 0.0457) and GIP (610.6 vs. 429.1 pg/mL x min^-1, P = 0.0260) AUC was lower post- vs. pre-surgery. No changes were observed for ghrelin levels and inflammatory markers (all P > 0.05).

Conclusions: Bariatric surgery improves the secretion of GLP-1 and PYY in response to postprandial acute exercise in parallel with enhanced peripheral insulin response.

Keywords: Bariatric surgery; Exercise; Metabolism.

MeSH terms

Adult
Blood Glucose / metabolism
Exercise* / physiology
Female
Gastric Bypass*
Glucagon-Like Peptide 1* / blood
Glucagon-Like Peptide 1* / metabolism
Humans
Insulin* / blood
Insulin* / metabolism
Middle Aged
Obesity, Morbid* / blood
Obesity, Morbid* / metabolism
Obesity, Morbid* / surgery
Peptide YY* / blood
Peptide YY* / metabolism
Postprandial Period
Treatment Outcome
Weight Loss

Substances

Glucagon-Like Peptide 1
Peptide YY
Insulin
Blood Glucose