Effect of Bariatric Surgery in Pediatric Obesity on Brain and Cognition

小儿肥胖症减肥手术对大脑和认知的影响

• 批准号: 9111259
• 负责人: Eleanor Race Mackey
• 金额: $ 24.55万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9111259
• 关键词: 21 year old; Address; Adolescence; Adolescent; Adopted; Adult; Affect; Age; American Heart Association; Animals; Area; Association Learning; Basal Ganglia; Behavior; Blood Pressure; Body Weight decreased; Body mass index; Brain; Cardiovascular Diseases; Cardiovascular system; Categories; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Cognition; Cognitive; Cognitive deficits; Control Groups; Corpus striatum structure; Cues; Data; Decision Making; Development; Discrimination; Eating; Eating Behavior; Face; Fasting; Food; Functional Magnetic Resonance Imaging; Future; Gastrectomy; Gender; Glucose; Health; High Density Lipoproteins; Hippocampus (Brain); Homeostasis; Impaired cognition; Individual; Inflammation; Insulin; Insulin Resistance; Insurance; Intake; Intervention; Malignant Neoplasms; Measurement; Measures; Medial; Mediating; Medical center; Memory; Mental Depression; Metabolic; Metabolic Diseases; Metabolism; Modeling; Morbid Obesity; Musculoskeletal; Neurocognitive; Neurophysiology - biologic function; Non obese; Obesity; Operative Surgical Procedures; Outcome; Paper; Persons; Prefrontal Cortex; Psyche structure; Quality of life; Regulation; Relative (related person); Rest; Rewards; Risk; Short-Term Memory; Source; Stimulus; Temporal Lobe; Testing; Time; United States; Ursidae Family; Ventral Striatum; Waiting Lists; Work; Youth; aged; bariatric surgery; base; cardiovascular health; cognitive function; cognitive testing; cohort; computerized; contextual factors; critical period; disorder risk; economic cost; executive function; feeding; flexibility; frontal lobe; healthy weight; high risk; imaging probe; improved; improved functioning; indexing; lipoprotein triglyceride; long term memory; memory encoding; mortality; neural correlate; obesity in children; obesity prevention; psychologic; psychological outcomes; psychosocial; relating to nervous system; respiratory; saturated fat; self esteem; social; success; visual memory

 DESCRIPTION (provided by applicant): The purpose of this exploratory proposal is to examine effects of bariatric surgery, specifically vertical sleeve gastrectomy, on functional and structural neural and cognitive function in adolescents aged 14-21 years. While obese adults face serious risk of poor health outcomes (cardiovascular, metabolic, musculoskeletal, respiratory, cancer), obese children bear the added burden of poor academic and psychosocial functioning, setting them on maladaptive developmental trajectories resulting in high social and economic costs to the person and the nation. Adolescence is a critical period for maturation of executive and motivational functioning, and severe obesity during this period puts youth at far greater risk for poor physical and psychological outcomes. Bariatric surgery as a treatment option is increasingly being adopted, with proven weight loss (13%-68% excess weight loss in 3-12 months post-surgery in our cohort) and improved metabolic and cardiovascular health. Whether cognitive and brain health also improve is an open question. The proposal will address this gap by taking advantage of the opportunity presented by adolescents who are already undergoing bariatric surgery at Children's National Medical Center. The proposal focuses on three areas of function known to be affected in pediatric obesity: executive function that depends on prefrontal cortes, long-term memory that depends on hippocampus and surrounding regions (medial temporal lobe), and reward function associated with ventral striatum. Aim 1 will test the hypothesis that executive function, verbal and visual memory, and reward sensitivity will improve following surgery. Aim 2 will test the hypothesis that functional activation and connectivity of prefrontal, medial temporal lobe, and ventral striatal regions will improve following surgery, using functional magnetic resonance imaging (fMRI). Lastly, Aim 3 will explore whether the magnitude of weight-loss induced change in metabolic indices (e.g., insulin resistance) mediates association between changes in neural correlates and cognitive function. Fifty adolescents who are candidates for surgery will undergo testing twice, 25 at a minimum of one month before surgery and then again 4 months after surgery, and 25 who have had their surgery delayed for insurance or other reasons who will be tested twice 4-5 months apart; in addition a non-obese control group of 25 adolescents matched for age and gender will also be tested twice at the same intervals. While Aim 1 and 2 seek initial evidence for impact of rapid weight loss on brain and cognitive function, Aim 3 will generate hypotheses about potential metabolic sources of functional neural effects of weight loss to be tested in future work. These findings will further understanding of the influence of the gut on brain and cognition at a critica time in development, by providing neurocognitive markers sensitive to metabolic health that can be used to test mechanistic hypotheses in future work.

 描述（由申请人提出）：该探索性建议的目的是检查减肥手术的影响胃抗抗蛋白酶的影响不佳的健康结果（心脏，肌肉骨骼，呼吸道，癌症），肥胖儿童带来了较差和PS ps yChosocial功能的负担适应性的发展轨迹导致了人们的高度社会和经济成本。越来越多的人被证明是在我们的同龄人中进行的3-12个月的超量体重减轻，并改善了代谢和心血管健康。利用了在Cildren的国家医疗中心接受减肥手术的崇拜者，在儿科肥胖症中进行了苦难。执行功能和REWA RD敏感性将测试测试测试测试，即使用功能性磁共振成像（fMRI）（例如，体重减轻的幅度），功能激活和腹侧纹状体区域将改善手术。胰岛素抵抗）介导神经无用和认知功能的变化。手术后4个月，他们的手术延迟了，他们的保险或其他原因将在AIM 1和2寻求最初的两次公寓。快速减肥对大脑和认知功能的影响的证据将产生有关在Futun Re工作中体重减轻的功能影响的潜在代谢来源。开发，通过提供对代谢健康敏感的神经认知标志物，可用于测试未来工作中的机理假设。

项目成果

Effect of Adolescent Bariatric Surgery on the Brain and Cognition: A Pilot Study.

• DOI: 10.1002/oby.22013
• 发表时间: 2017-11
• 期刊: Obesity (Silver Spring, Md.)
• 作者: Pearce AL;Mackey E;Cherry JBC;Olson A;You X;Magge SN;Mietus-Snyder M;Nadler EP;Vaidya CJ
• 通讯作者: Vaidya CJ