Importance of small bowel peptides for the improved glucose metabolism 20 years after jejunoileal bypass for obesity

Obes Surg. 1998 Jun;8(3):253-60. doi: 10.1381/096089298765554449.


Background: Obese patients operated with jejunoileal bypass (JIB) have reduced plasma concentrations of insulin and glucose. Gastric inhibitory peptide/glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) have been found to have a profound incretin effect in humans. The aim of the present study was to examine the long-term effect of JIB on glucose metabolism.

Methods: Four groups (lean, nonoperated obese, obese 9 months after JIB and obese 20 years after JIB) of six females each were given a mixed meal (280 kcal). Plasma samples were obtained every 10 min for 60 min postprandially and were analyzed for glucose, insulin, GIP and GLP-1.

Results: A reduction in body mass index (kg/m2) was seen for the two patient groups operated with JIB (12.1, at 9 months post-op; 13.1, at 20 years post-op). Surgery by JIB resulted in a reduction of glucose and insulin values. Concomitantly there was an elevation of postprandial GIP and GLP-1 plasma concentrations. In the obese subjects 20 years after JIB both fasting and postprandial GIP and GLP-1 values were markedly elevated compared with the other three groups; and plasma glucose and insulin concentrations were maintained at normal levels.

Conclusions: The improvement in glucose metabolism seen after JIB may be due to reduced insulin resistance after weight loss and/or increased levels of the incretin hormones GIP and GLP-1. Progressively, elevated levels of GIP and GLP-1 seem to be necessary to maintain glucose homeostasis at long-term follow-up after this procedure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • Body Mass Index
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Gastric Inhibitory Polypeptide / metabolism
  • Glucagon / metabolism
  • Glucagon-Like Peptide 1
  • Glucose / metabolism*
  • Humans
  • Insulin / metabolism
  • Intestine, Small / metabolism*
  • Jejunoileal Bypass*
  • Middle Aged
  • Peptide Fragments / metabolism
  • Postprandial Period
  • Protein Precursors / metabolism
  • Time Factors
  • Weight Loss


  • Blood Glucose
  • Insulin
  • Peptide Fragments
  • Protein Precursors
  • Gastric Inhibitory Polypeptide
  • Glucagon-Like Peptide 1
  • Glucagon
  • Glucose