Bariatric Surgery, Gastric Stimulation: Metabolic Effects

描述（由申请人提供）：本提案的长期目标是研究可能调节减肥手术和植入式胃刺激（IGS）引起的体重减轻和体重维持的激素机制。特别关注肠道中枢神经系统轴的激素，这些激素参与食欲调节、肠道运动、能量分配和能量ZV消耗。Aim 1的目的是：a)在一项长期前瞻性研究中，比较Roux-en-Y胃旁路（GBP）和胃束带（BND）前后空腹和餐后胃饥饿素（总胃饥饿素和辛烷化胃饥饿素）和肽YY （PYY）浓度的变化，并确定这些变化是否与饥饿、饱腹感、体重减轻和体重维持程度相关；B)描述和；使用高效液相色谱法测定PYY的两种分子形式PYY（l-36）和PYY（3-36）的空腹和餐后浓度与GBP和BND后体重和体重减轻的关系；c)确定在GBP和BND手术后体重减轻的个体中，使用核磁共振成像确定单位脂肪质量和身体组成，特别是内脏脂肪质量的血浆瘦素是否存在差异。目的二比较GBP和END患者的代谢和神经内分泌变化。本研究的目的是：通过静脉内葡萄糖耐量试验和频繁采血，确定前肠在调节胰岛素敏感性中的作用；b)比较这三种减肥方式对甲状腺和生长激素轴的影响。Aim 3的重点是阐明IGS系统诱导体重减轻的可能激素机制，这是目前正在研究的一种新的减肥治疗方式。最终目标是利用这些研究的信息来开发比减肥手术侵入性更小、比目前药物治疗更有效的肥胖治疗方法。

DESCRIPTION (provided by applicant): The long-term objectives of this proposal are to examine hormonal mechanisms that may regulate weight loss and weight maintenance induced by bariatric surgery and implantable gastric stimulation (IGS). Particular focus is on hormones of the gut-central nervous system axis that are involved in appetite regulation, gut motility, energy partitioning and energy ZV expenditure. The objectives of Aim One are: a) to compare the changes in both fasting and post-prandial concentrations of ghrelin (total and octanoylated) and peptide YY (PYY) before and after Roux-en-Y gastric bypass (GBP) and gastric banding (BND) in a long-term prospective study and determine if these changes correlate with hunger, satiety, degree of weight loss weight maintenance; b) to characterize and; the fasting and post-prandial concentrations using high performance liquid chromatography of the two molecular forms of PYY, PYY(l-36) and PYY(3-36), in relation to body weight and weight reduction after GBP and BND; and c) to determine if there are differences in plasma leptin per unit fat mass and body composition, particularly visceral fat mass, using nuclear magnetic resonance imaging in weight-reduced individuals after GBP and BND procedures. Aim Two compares metabolic and neuroendocrine changes in individuals GBP and END. The purposes of this who have lost an equivalent amount of weight by calorie restriction, Aim are: a) to determine the role of the foregut in mediating insulin sensitivity through the use of intravenous glucose tolerance tests with frequent blood sampling; and b) compare the effects on thyroid and growth hormone axes with these three weight loss modalities. The focus of Aim Three is to elucidate possible hormonal mechanisms for weight loss induced by the IGS system, a new modality of weight loss therapy currently under investigation. The ultimate goal is to use information from these studies for the development of obesity treatments that are less invasive than bariatric surgery and more effective than current pharmacotherapy.