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Role of Meal Timing in Efficacy of Bariatric Surgery in Obese Individuals

进餐时间对肥胖个体减肥手术疗效的影响

基本信息

批准号：
9963357
负责人：
FRANK A SCHEER
金额：
$ 86.82万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9963357
关键词：
Address Affect Ambulatory Monitoring Animals Autonomic nervous system Bariatrics Blood Pressure Body Weight Body Weight decreased Body mass index Caloric Restriction Calories Carbohydrates Cardiovascular Physiology Clinical Consumption Cross-Over Trials Data Desire for food Development Dietary Intervention Drops Eating Economic Burden Effectiveness Energy Intake Energy Metabolism Etiology Fasting Food Patterns Gastrectomy Glucose Intolerance Goals Health Health Benefit High Fat Diet Home Homeostasis Hormones Human Hunger Individual Individual Differences Intake Intervention Laboratories Lead Leptin Measures Mechanics Mediating Metabolic Obesity Obesity Epidemic Operative Surgical Procedures Outcome Overweight Participant Pathway interactions Patients Pattern Peptides Phase Physiological Play Procedures Prospective Studies Protocols documentation Public Health Publishing Randomized Randomized Controlled Trials Research Research Design Rest Risk Marker Rodent Role Satiation Stomach Testing Time Variant Weight Work bariatric surgery base blood glucose regulation cardiometabolism cardiovascular risk factor design diet-induced obesity dietary control energy balance evidence base experience feeding follow-up ghrelin glucagon-like peptide 1 glucose metabolism glucose tolerance high body mass index improved inflammatory marker insight interest novel novel therapeutic intervention obese person obesity treatment oxidation post intervention prevent response success surgery outcome weight loss intervention

项目摘要

Abstract The broad goal of this project is to determine whether improvements in the daily pattern of food intake can enhance the beneficial effects of bariatric surgery. Bariatric surgery is currently the most effective and durable weight loss treatment for obese individuals, with clear long-term benefit for cardiometabolic health. Though bariatric surgery was original designed to cause mechanical and consequently caloric restriction, this seems not to be the primary mechanism for weight loss. This is because, first, patients who lose a substantial amount of body weight do not experience excessive hunger which normally follows caloric restriction and, second, the amount of weight loss varies widely between individuals and is not correlated with post-surgical gastric pouch size. Indeed, the interindividual difference in post-surgical weight loss is large and approximately 25% of patients can be considered poor weight-loss responders who either do not lose a substantial amount of weight (i.e., BMI loss < 7 kg/m2) or regain the lost weight afterwards. Of interest, altered daily patterns of food intake, such as skipping breakfast and night snacking, is experienced by over half of the bariatric surgery candidates, raising the question whether interindividual differences in meal timing contribute to interindividual differences in weight loss success. Indeed, there is accumulating animal experimental and human evidence that such altered daily patterns of food intake actually contribute to obesity (detailed in the Background). However, none of the published human bariatric surgery studies have tested the causality between meal timing and the beneficial effects of bariatric surgery on measures of energy balance, glucose control, and cardiovascular risk factors. In this proposal, we aim to test the hypotheses that: 1) Early Eaters have a higher BMI loss 1 year after SG as compared to Late Eaters; 2) patients with poor post-surgical weight loss, as compared to those who respond successfully, have higher hunger-related measures late in the day; and 3) experimentally restricting food intake to the daytime in bariatric surgery patients with poor weight loss improves measures of energy balance, glucose tolerance and cardiovascular function. The first hypothesis will be tested in an observational prospective study (baseline plus after 1 year follow up), monitoring ambulatory meal patterns and BMI loss in the field. The second hypothesis will assess 24-h profiles of hunger and appetite-regulatory peptides in the laboratory. The third hypothesis will be tested in a parallel, randomized controlled trial in which patients with poor weight loss response will undergo a 12-week meal timing intervention or a control dietary intervention, and their baseline and post-intervention 24-h physiological outcomes will be measured under the in-laboratory conditions. This research will provide mechanistic insight into the interindividual differences in the effectiveness of bariatric surgery and may help in designing evidence-based dietary interventions incorporating meal timing to optimize post-surgical outcomes.

摘要该项目的主要目标是确定日常食物摄入模式的改善是否可以增强减肥手术的有益效果。减肥手术是目前最有效和持久的肥胖者的减肥治疗，对心脏代谢健康有明显的长期益处。虽然减肥手术最初的设计似乎是为了引起机械性限制，从而限制热量，不是减肥的主要机制。这是因为，首先，患者失去了大量的体重的10%不会经历过度饥饿，这通常是在热量限制之后，第二，体重减轻量在个体之间差异很大，与术后胃袋无关尺寸事实上，手术后体重减轻的个体间差异很大，大约25%的患者患者可以被认为是体重减轻反应差的患者， (i.e., BMI降低< 7 kg/m2）或之后体重恢复。有趣的是，每天的食物摄入模式改变了，例如不吃早餐和晚上吃零食，超过一半的减肥手术候选人都经历过，这就提出了一个问题，即进餐时间的个体间差异是否会导致减肥成功事实上，有越来越多的动物实验和人类证据表明，这种改变日常食物摄入模式实际上会导致肥胖（详见背景技术）。却没有一已发表的人类减肥手术研究已经测试了进餐时间和有益的饮食之间的因果关系。减肥手术对能量平衡、血糖控制和心血管危险因素的影响。在我们的目的是检验以下假设：1）早食者在SG后1年的BMI下降更高，与晚食者相比; 2）与有反应的患者相比，术后体重减轻较差的患者成功地，在一天的晚些时候有更高的饥饿相关措施; 3）实验性地限制食物摄入量到白天在减肥手术中体重减轻不佳的患者改善了能量平衡的措施，葡萄糖耐量和心血管功能。第一个假设将在一个观察性的前瞻性研究（基线加1年随访后），监测非卧床膳食模式和BMI下降，外地第二个假设将评估饥饿和食欲调节肽的24小时概况，实验室第三个假设将在一项平行随机对照试验中进行检验，减肥反应差的患者将接受12周的进餐时间干预或对照饮食干预，他们的基线和干预后24小时生理结果将在实验室内测量条件本研究将为有效性的个体间差异提供机制性的见解并可能有助于设计以证据为基础的饮食干预措施，来优化术后效果