Skeletal health in obesity and after bariatric surgery

肥胖症和减肥手术后的骨骼健康

• 批准号: 8461677
• 负责人: Elaine Wei-Yin Yu
• 金额: $ 15.76万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8461677
• 关键词: Adipose tissue; Adrenal Glands; Adult; Affect; Age; Anatomy; Androgens; Biochemical Markers; Body Composition; Body Weight decreased; Bone Density; Bone Resorption; Bone Tissue; Bone remodeling; Clinical Investigator; Complex; Complication; Defect; Development Plans; Duodenum; Estradiol; Etiology; Evaluation; Fasting; Fatty acid glycerol esters; Finite Element Analysis; Fracture; Gastric Bypass; Gastrointestinal Hormones; Gender; Goals; Health; High Resolution Computed Tomography; Hormones; Image; Imaging Techniques; Imaging technology; Impairment; Insulin-Like Growth Factor I; Knowledge; Lead; Light; Measurement; Measures; Mechanics; Mediating; Mentors; Metabolic; Metabolic Bone Diseases; Morbid Obesity; Obesity; Operative Surgical Procedures; Osteoblasts; Osteogenesis; Patients; Peripheral; Physiological; Physiology; Procedures; Public Health; Race; Recruitment Activity; Research; Research Training; Resolution; Risk; Scientist; Serum; Site; Skeleton; Structure; Techniques; Technology; Testing; Thick; Three-Dimensional Imaging; Training; Visceral; Weight; Weight maintenance regimen; Weight-Bearing state; X-Ray Computed Tomography; bariatric surgery; base; body system; bone; bone health; bone loss; bone quality; bone strength; bone turnover; career development; clinical care; cohort; density; design; epidemiologic data; ghrelin; improved; innovation; insight; novel; obesity treatment; paracrine; programs; prospective; response; skeletal; subcutaneous; substantia spongiosa

DESCRIPTION (provided by applicant): Morbid obesity is an important public health problem, but the complex relationship between obesity and the skeleton is poorly understood. This proposal has been designed to examine the impact of obesity and obesity treatments on skeletal health, and to facilitate my long-term goal of becoming an independent clinical investigator. Recent epidemiologic data suggest that fracture rates in morbidly obese adults are higher than is commonly believed, and may equal or surpass rates in normal-weight adults at certain skeletal sites. Furthermore, Roux-en-Y gastric bypass surgery is becoming increasingly popular as a treatment for morbid obesity, but there is growing concern that the surgery results in accelerated bone loss and increased risk of fractures. Our knowledge in this field has been complicated by known limitations in dual-energy x-ray absorptiometry in obesity and during weight loss. This proposal seeks to provide a more complete and accurate evaluation of bone density, microarchitecture, and strength in both obesity and after gastric bypass surgery using advanced imaging techniques. A prospective, longitudinal cohort of morbidly obese adults will be studied before and for 2 years after gastric bypass surgery using quantitative computed tomography and high- resolution non-invasive imaging. Normal-weight and non-surgical obese controls will be recruited for cross-sectional and longitudinal comparisons. We will also examine the complex physiology connecting adipose tissue and the skeleton, and evaluate potential mechanisms of accelerated bone loss after gastric bypass. The career development plan consists of a five year mentored program that will incorporate didactic and research training and will be guided by well-established scientists who have been selected based upon their expertise in obesity and metabolic bone disease. In summary, the proposed research will test innovative hypotheses about the skeletal consequences of obesity and gastric bypass surgery, while providing a training platform and investigational niche for the candidate to establish independence as a clinical investigator. Characterization of obesity's effects on bone may yield insights on how to optimize skeletal health in obese patients, uncover ways to minimize fracture risk for patients undergoing gastric bypass surgery, and shed light on the complex interactions between adipose tissue and bone.

描述（由申请人提供）：病态肥胖是一个重要的公共卫生问题，但肥胖和骨骼之间的复杂关系知之甚少。这项提案旨在研究肥胖和肥胖治疗对骨骼健康的影响，并促进我成为独立临床研究者的长期目标。最近的流行病学数据表明，病态肥胖成年人的骨折率高于通常认为的，在某些骨骼部位可能等于或超过正常体重成年人的骨折率。此外，Roux-en-Y胃旁路手术作为病态肥胖的治疗方法越来越受欢迎，但人们越来越担心手术会导致骨丢失加速和骨折风险增加。我们在这一领域的知识已经复杂的双能x射线吸收测量法在肥胖和减肥过程中已知的局限性。该提案旨在使用先进的成像技术对肥胖患者和胃旁路手术后的骨密度、微结构和强度进行更完整和准确的评估。将使用定量计算机断层扫描和高分辨率非侵入性成像，在胃旁路手术之前和之后2年对病态肥胖成年人的前瞻性纵向队列进行研究。将招募正常体重和非手术肥胖对照进行横截面和纵向比较。我们还将研究连接脂肪组织和骨骼的复杂生理学，并评估胃旁路术后加速骨丢失的潜在机制。职业发展计划包括一个为期五年的指导计划，该计划将结合教学和研究培训，并将由根据其在肥胖和代谢性骨病方面的专业知识选择的知名科学家指导。总之，拟议的研究将测试有关肥胖和胃旁路手术的骨骼后果的创新假设，同时为候选人提供培训平台和研究利基，以建立作为临床研究者的独立性。肥胖对骨骼影响的表征可能会产生关于如何优化肥胖患者骨骼健康的见解，揭示如何最大限度地降低胃旁路手术患者骨折风险的方法，并揭示脂肪组织和骨骼之间复杂的相互作用。