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: 8662763
• 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/8662763
• 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; 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; non-invasive imaging; 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，但是肥胖与骨骼之间的复杂关系知之甚少。该建议旨在检查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，并且在某些骨骼部位的正常体重成年人中可能等于或超过率。此外，作为病态肥胖症的治疗方法，rou​​x-en-y胃旁路手术越来越流行，但是人们越来越担心手术会导致骨质流失和骨折风险增加。我们在这一领域的知识使肥胖和体重减轻期间双能X射线吸收法的已知局限性变得复杂。该提案旨在使用先进的成像技术对肥胖症和胃搭桥手术后的骨密度，微体系结构和强度进行更完整和准确的评估。使用定量计算机断层扫描和高分辨率的非侵入性成像，将在胃旁路手术后和两年内研究病态肥胖成年人的前瞻性纵向队列。正常体重和非手术肥胖对照将被招募进行横断面和纵向比较。我们还将检查连接脂肪组织和骨骼的复杂生理，并评估胃搭桥后加速骨质流失的潜在机制。职业发展计划由一个为期五年的指导计划组成，该计划将纳入教学培训和研究培训，并将受到成熟的科学家的指导，这些科学家是根据肥胖和代谢骨病方面的专业知识而选择的。总而言之，拟议的研究将检验有关肥胖和胃搭桥手术骨骼后果的创新假设，同时为候选人提供培训平台和研究的利基市场，以建立独立性作为临床研究者。肥胖对骨骼的影响的表征可能会产生有关如何优化肥胖患者骨骼健康的见解，发现方法以最大程度地减少接受胃搭桥手术的患者的断裂风险，并阐明脂肪组织与骨骼之间的复杂相互作用。