Changes in neural response to eating after bariatric surgery: MRI results

减肥手术后饮食神经反应的变化：MRI 结果

• 批准号: 8607936
• 负责人: Ruben C. Gur
• 金额: $ 44.81万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8607936
• 关键词: Affect; Amygdaloid structure; Area; Bariatrics; Basic Science; Blood; Blood specimen; Body Weight; Body Weight decreased; Body mass index; Brain; Brain imaging; Brain region; Cerebrovascular Circulation; Consumption; Cues; Desire for food; Eating; Endocrine; Exhibits; Fasting; Fatty acid glycerol esters; Food; Food Intake Regulation; Food Processing; Functional Magnetic Resonance Imaging; Gastric Bypass; Hormones; Hunger; Hypothalamic structure; Image; Individual; Ingestion; Insula of Reil; Investigation; Liquid substance; Literature; MRI Scans; Magnetic Resonance Imaging; Measures; Mediating; Methods; Morbid Obesity; Nucleus Accumbens; Nutrient; Obesity; Observational Study; Operative Surgical Procedures; Outcome; Participant; Patients; Peptide YY; Perfusion; Perfusion Weighted MRI; Persons; Positron; Postoperative Period; Prefrontal Cortex; Procedures; Relative (related person); Reporting; Research; Rest; Rewards; Satiation; Scanning; Spin Labels; Testing; Time; Ventral Tegmental Area; Visit; Weight; bariatric surgery; blood oxygen level dependent; cingulate cortex; clinical practice; feeding; follow-up; food consumption; ghrelin; glucagon-like peptide; glucagon-like peptide 1; hedonic; interest; mesolimbic system; neuroregulation; preference; prospective; public health relevance; relating to nervous system; response; sugar; tomography

DESCRIPTION (provided by applicant): Bariatric surgery is the most effective weight loss option for persons with extreme obesity (i.e., body mass index = 40 kg/m2). Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are the most common bariatric procedures, and they induce long-term reductions of ~25% and ~15% of initial weight, respectively. Anatomical differences resulting from the two procedures are associated with postoperative differences in endocrine functioning. In particular, the orexigenic hormone, ghrelin, is generally suppressed in RYGB and increased in LAGB patients. Furthermore, postprandial increases in the satiety factors, glucagon-like peptide 1 (GLP-1) and peptide YY (PYY3-36), are significantly increased after RYGB, compared with LAGB. Each of these appetite-regulating hormones has been found to act in brain regions related to both the homeostatic and hedonic control of food intake. A separate literature has examined neural activation in feeding centers, as measured with functional magnetic resonance imaging (fMRI) and positron emitted tomography (PET), in response to food cues. Most of these studies have compared responses to images of high-calorie vs. low-calorie foods or non-food items. Some have further compared responses in lean vs. obese individuals. Generally, high-calorie food images stimulate activation in the prefrontal cortex, mesolimbic dopamine system (e.g., ventral-tegmental area and nucleus accumbens), and other limbic areas (e.g., orbitofrontal cortex, amygdala, insula, and cingulate cortex). Furthermore, responses are greater in obese vs. lean individuals. Fewer studies have examined neural response to meal consumption; those investigations have found that many of the same regions are activated by nutrient ingestion. The proposed research is a prospective observational study that seeks to integrate two areas of inquiry: 1) endocrine effects of bariatric surgery; and 2) neural response to food cues and feeding. Patients who undergo RYGB or LAGB, and matched obese controls who do not seek weight loss, will complete assessment visits at 0, 6, and 18 months, which include: 1) a fMRI scan while viewing high- and low-calorie food images in the fasted state; 2) a perfusion MRI scan to measure cerebral blood flow in the fasted state; 3) fasting blood draw; 4) consumption of a liquid test meal; 5) serial perfusion MRI scans to assess the effects of the meal; and 5) serial blood draws to assess postprandial changes in ghrelin, GLP-1, and PYY3-36. Comparisons of changes among the three groups at 6-months and 18-months follow-up will comprise our primary analyses. The primary hypotheses are that following surgery: 1) fMRI response to high-calorie food images will be reduced in RYGB vs. LAGB patients and controls; 2) RYGB patients will show larger increases in postprandial GLP-1 and PYY3-36 (accompanied with a blunted postprandial ghrelin response) than will LAGB patients and controls; and 3) RYGB patients will demonstrate a greater postprandial increase in resting brain activity in homeostatic and hedonic feeding areas than will LAGB and control participants.

描述（由申请人提供）：减肥手术是极端肥胖者（即体重指数= 40 kg/m2）的最有效的减肥选择。 roux-en-y胃旁路（RYGB）和可腹腔镜可调式胃体带（LAGB）是最常见的减肥手术，它们的长期降低量分别降低了约25％和约15％的初始体重。两种过程引起的解剖学差异与内分泌功能的术后差异有关。特别是，在RYGB中，甲状腺激素Ghrelin通常在LAGB患者中受到抑制。此外，与LAGB相比，RYGB后，私人饱腹感因子的饱腹感因子，胰高血糖素样肽1（GLP-1）和肽YY（PYY3-36）的增加显着增加。这些食欲调节激素中的每一个都在与食物摄入的稳态和享乐控制有关的大脑区域起作用。通过功能性磁共振成像（fMRI）和正电子发射断层扫描（PET）测量的摄食中心的神经激活（响应食物提示）。这些研究大多数都比较了对高热量与低热量食品或非食品的图像的反应。一些人进一步比较了精益与肥胖个体中的反应。通常，高热量食品图像刺激前额叶皮层，中唇胶质不同的多巴胺系统（例如，腹侧细分区域和伏和核核）以及其他边缘区域（例如甲状腺皮质，甲状腺皮质，Amygdala，Amygdala，Insula，Insula，Insula，insula，insula，in Insula，in Insula，insula，in Insula，in Insula，insula，in Insula，and in Insula，and in Insula，and insulation Cortex）。此外，肥胖与精益个人的反应更大。较少的研究检查了对食物消费的神经反应。这些调查发现，许多相同的区域都是通过营养摄入而激活的。 拟议的研究是一项前瞻性观察性研究，试图整合两个调查领域：1）减肥手术的内分泌作用； 2）对食物提示和喂养的神经反应。经历RYGB或LAGB的患者，并匹配不寻求体重减轻的肥胖对照，将在0、6和18个月的时间完成评估访问，其中包括：1）fMRI扫描，同时在禁食状态下查看高和低热量的食物图像； 2）在禁食状态下测量脑血流的灌注MRI扫描； 3）抽血； 4）食用液体测试餐； 5）连续灌注MRI扫描以评估餐的影响； 5）抽血以评估生长素素，GLP-1和PYY3-36的餐后变化。在6个月和18个月的随访中的三组变化的比较将包括我们的主要分析。主要假设是手术后：1）在RYGB与LAGB患者和对照组中，FMRI对高热量食品图像的反应将减少； 2）与LAGB患者和对照组相比，RYGB患者将显示出餐后GLP-1和PYY3-36（伴有发phe的餐后缓慢反应）的增加（伴随着发pher蛋白的钝化）； 3）RYGB患者将表现出比LAGB和控制参与者的稳定脑活动和享乐喂养区域的静止大脑活动的增加。

项目成果

Changes in neural responsivity to highly palatable foods following roux-en-Y gastric bypass, sleeve gastrectomy, or weight stability: An fMRI study.

• DOI: 10.1002/oby.21464
• 发表时间: 2016-05
• 期刊: Obesity (Silver Spring, Md.)
• 作者: Faulconbridge LF;Ruparel K;Loughead J;Allison KC;Hesson LA;Fabricatore AN;Rochette A;Ritter S;Hopson RD;Sarwer DB;Williams NN;Geliebter A;Gur RC;Wadden TA
• 通讯作者: Wadden TA