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.

抽象的该项目的广泛目标是确定食物摄入量的日常摄入方式是否可以改善增强减肥手术的有益作用。减肥手术目前是最有效，最耐用的肥胖个体的减肥治疗，具有明显的长期益处，可为心脏代谢健康带来明显的益处。尽管减肥手术的原始设计旨在引起机械和热量限制，这似乎不是成为减肥的主要机制。这是因为首先，损失了大量数量的患者体重的体重没有过多的饥饿，通常遵循热量限制，其次，个体之间的体重减轻量差异很大，并且与手术后胃袋无关尺寸。实际上，手术后体重减轻的个体差异很大，约有25％患者可以认为减轻体重响应不良，他们不会减轻大量体重（即BMI损失<7 kg/m2）或以后恢复体重减轻。感兴趣的是，食物摄入的日常模式改变，例如跳过早餐和夜间零食，有一半以上的减肥手术候选人经历提出一个问题，个人饮食时机之间的个体差异是否有助于个体间差异减肥成功。确实，有累积的动物实验和人类证据表明这种改变了食物摄入的每日模式实际上有助于肥胖（背景中详细介绍）。但是，没有已发表的人类减肥手术研究已经测试了膳食时间和有益的因果关系减肥手术对能量平衡，葡萄糖控制和心血管危险因素的影响。在该提议，我们旨在检验以下假设：1）早期食客在SG之后1年的BMI损失较高与晚食者相比； 2）手术后体重减轻差的患者与反应的患者相比成功地，在当天晚些时候采取了更高的饥饿相关措施； 3）实验限制食物摄入量减肥较差的减肥手术患者的白天可以改善能量平衡的措施，葡萄糖耐受性和心血管功能。第一个假设将在观察性中进行检验前瞻性研究（一年后的基线加上基线加），监测门诊粉状模式和BMI损失领域。第二个假设将评估24小时的饥饿和食欲调节肽的特征实验室。第三个假设将在一项平行的随机对照试验中进行检验减肥反应不佳将接受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的24小时生理结局将在实验室内测量状况。这项研究将提供有关有效性的个体差异的机械洞察力减肥手术，可能有助于设计循证饮食干预措施，包括进餐时间优化外科后结果。