Eact Carolina Univ. Bariatric Surgery Clinical Center

描述(由申请人提供)： 肥胖症是21世纪最普遍、最致命的慢性病，它正在以以前只有传染病的速度增长。病态肥胖是最严重的形式，困扰着2300万美国人。这些个体不仅受到其体型的限制，而且还受到危及生命的共病的严重危害。手术已被证明是一种有效的治疗方法。该机构开发的格林维尔胃分流手术(GGB)不仅能使体重持续减轻100磅以上，还能使83%的2型糖尿病患者完全缓解，一半以上的高血压得到控制，以及哮喘、匹克威克综合征、压力性尿失禁和大脑假瘤等并存疾病的完全逆转。GGB患者2型糖尿病的可重复性逆转是一个具有挑衅性的发现，需要进一步的基础研究。 然而，与其他减肥手术一样，GGB与严重的长期营养缺乏有关，在脆弱的人中，还与情绪障碍有关。一般来说，对于应该使用七种常见的减肥手术中的哪一种，还没有达成共识。由于手术护理缺乏标准化，同一手术在美国各地的手术结果也有相当大的差异。因此，减肥外科采用协作的方法来回答临床和基础研究问题的时机已经成熟。 我们目前的中心工作包括三个主要领域：1.促进减肥外科社区内的合作，以促进病态肥胖及其并存的临床、行为和基础研究；2.两种类型胃分流手术的有效性、效率和安全性的临床研究，重点是非裔美国人和高加索女性之间的结果差异。3.减肥手术前后受试者胰岛素作用和敏感性的基础科学研究。此外，这份申请还包括三个机构间项目的建议：1.最常用的减肥手术的比较；2.胃旁路手术后胰岛素敏感性增加的机制；3.减肥手术中知情同意的伦理问题。由于东卡罗来纳大学在病态肥胖的跨学科临床、基础科学和行为研究方面拥有多产的传统，以及在全国处于领先地位的记录，我们提交这份申请，以成为NIDDK的减肥外科临床中心之一。

DESCRIPTION (provided by applicant): Obesity, the most prevalent, fatal, chronic disease of the 21st Century, is increasing at a rate seen before only with infectious diseases. Morbid obesity, the most severe form, afflicts 23 million Americans. These individuals are not only limited by their bulk but are sharply compromised by life-endangering co-morbidities. Surgery has proven to be an effective therapy. The Greenville gastric bypass operation (GGB), developed at this institution, produces not only durable weight loss greater than 100 Ibs but also induces full remission of type 2 diabetes in 83 percent of patients, control of hypertension in over half, as well as full reversal of such co-morbidities as asthma, Pickwickian syndrome, stress incontinence, and pseudotumor cerebri. The reproducible reversal of type 2 diabetes in GGB patients is a provocative finding and requires further basic research. However, the GGB, like other bariatric procedures, is associated with serious long-term nutritional deficiencies and, in vulnerable individuals, emotional disorders. Generally, there is no consensus about which of the seven common bariatric procedures should be used. There is also considerable variation in surgical outcomes across the US for the same operation due to a lack of standardization of the surgical care. Thus, bariatric surgery is ripe for a collaborative approach to answering both clinical and basic research issues. Our current center efforts include three major areas: 1. Fostering collaboration within the bariatric surgical community to promote clinical, behavioral, and basic research in morbid obesity and its co-morbidities; 2. Clinical studies of the efficacy, efficiency, and safety of two types of gastric bypass operations with an emphasis on differences in outcomes between African-American and Caucasian women. 3. Basic science studies of insulin action and sensitivity in human subjects prior to and after bariatric surgery. In addition, this application includes three proposals for inter-institutional projects: 1. Comparison of the most commonly performed bariatric operations; 2. the mechanism for increased insulin sensitivity after gastric bypass surgery; and 3. the ethics of the informed consent in bariatric surgery. Because East Carolina University has a productive tradition of interdisciplinary clinical, basic science, and behavioral research in morbid obesity as well as a record of national leadership, we submit this application to become one of the Bariatric Surgery Clinical Centers of the NIDDK.