Neuroimaging predictors of bariatric surgical outcomes

减肥手术结果的神经影像预测因素

基本信息

批准号：
9981729
负责人：
GODFREY D PEARLSON
金额：
$ 67.92万
依托单位：
HARTFORD HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-25 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9981729
关键词：
Affect Age Anxiety Bariatrics Blood Pressure Body Weight Changes Body Weight decreased Body mass index Brain Calories Characteristics Clinical Consent Data Dietary Practices Disease remission Enrollment Evolution Fatty acid glycerol esters Food Functional Magnetic Resonance Imaging Future Gastrectomy Glycosylated hemoglobin A Health Hormones Image Impulsivity Individual Individual Differences Insulin Intake Intervention Laboratories Lipids Literature Liver Magnetic Resonance Imaging Measures Mental Depression Modeling Morbid Obesity Motivation Neural Pathways Neurobiology Neuropsychological Tests Obesity Operative Surgical Procedures Outcome Outcome Measure Patients Pattern Pilot Projects Plasma Population Quality of life Regulation Research Role Scanning Secondary to Self-control as a personality trait Statistical Models Testing Theoretical model Time Weight bariatric surgery base clinical practice cognitive testing cohort comorbidity craving diet and exercise energy balance fasting glucose financial incentive follow-up functional MRI scan gut-brain axis insight instrument longitudinal dataset microbiota neural circuit neural patterning neurobiological mechanism neurocognitive test neuroimaging predictive modeling prospective recruit relating to nervous system secondary outcome sex success surgery outcome

项目摘要

PROJECT SUMMARY/ABSTRACT Bariatric surgery is an important treatment option for morbidly obese patients who fail to lose weight through diet and exercise. Despite intervention, 20-50% of patients either fail to lose targeted amounts of weight or regain weight that was lost initially. Attempts at predicting the degree of weight loss have had only modest success and none have long term (>2 year) reliability. Moreover, there is a serious absence of research to predict weight loss beyond the 1st or 2nd year post-surgery and for outcomes other than weight loss including comorbidities common in the bariatric population. Our pilot data in 45 patients suggest that individual differences on pre-surgical neural activity measured with functional MRI (fMRI) reliably explains s 33% of the variance in weight loss up to 1 year post surgery, and over 50% of a multifaceted outcome measure, far outperforming many other indicators. These brain activation predictors implicate regions that closely conform to a theoretical model emphasizing both consummatory urges (a “Now” neural circuit) vs. regulation of craving and self-control (a “Later” circuit). Our central hypothesis is that individual differences in these neural pathways exert a powerful effect on the ability to sustain weight loss and achieve other key health outcomes. This project seeks to replicate and refine this model over a longer timeframe and to assess its predictive utility for key weight-related health outcomes. We propose to replicate the model derived from our fMRI pilot data predicting weight loss and secondarily to explore its predictive utility for changes in calorie intake, activity levels, liver fat, hemoglobin A1c, plasma lipids, blood pressure, and fasting glucose in a new, independent cohort of N=150 successively consenting, pre- surgical sleeve gastrectomy (SG) patients in study years 1-3. We will follow the pilot cohort for up to 7 years and the new cohort for 3 or more years to determine if predictors replicated in Aim 1 retain their long-term predictive power, particularly when supplemented with non-brain imaging variables and using a larger longitudinal dataset. We will use imaging and non-imaging data to develop multivariate statistical models incorporating energy balance, fMRI, and laboratory values with the variables described in Aim 1 to help to separate predictors vs. consequences of post-surgical outcomes. To help separate scan-to-scan variability from true post-surgical, trajectory-related brain changes, we will enroll N=20 obese subjects who will not undergo bariatric surgery, and are individually matched with our above SG subjects. Finally, in terms of translational potential, we will evaluate whether several related, non-fMRI cognitive tests that probe "Now vs. Later" functional domains to our MRI paradigms might have the potential to act as surrogate tests in clinical practice that help predict the likelihood of successful SG outcome during pre-surgical patient assessment. These studies are highly significant both in terms of understanding the role of neural patterns in weight regulation and in helping patients achieve bariatric population-specific health outcomes.

项目概要/摘要对于通过减肥失败的病态肥胖患者来说，减肥手术是一种重要的治疗选择尽管进行了干预，20-50% 的患者还是未能减掉目标体重，或者无法达到目标体重。预测体重减轻程度的尝试收效甚微。但没有一个具有长期（>2 年）可靠性。此外，严重缺乏相关研究。预测术后第一年或第二年的体重减轻以及体重减轻以外的结果，包括我们对 45 名患者的试点数据表明，肥胖人群中常见的合并症。通过功能性 MRI (fMRI) 测量的术前神经活动差异可靠地解释了 33% 术后 1 年内体重减轻的差异，以及超过 50% 的多方面结果指标，到目前为止这些大脑激活预测指标的表现优于许多其他指标。理论模型强调追求的冲动（“现在”的神经回路）与渴望的调节和自我控制（“后来的”回路）。我们的中心假设是这些神经的个体差异。途径对维持体重减轻和实现其他关键健康成果的能力产生强大影响。该项目旨在在更长的时间内复制和完善该模型，并评估其预测效用与体重相关的关键健康结果。我们建议复制从功能磁共振成像试点数据中得出的模型来预测体重减轻，其次是探索其对卡路里摄入量、活动水平、肝脏脂肪、血红蛋白 A1c、血浆脂质变化的预测效用，血压和空腹血糖在一个新的、独立的队列中进行，N = 150 成功同意，预先研究第 1-3 年的袖状胃切除术 (SG) 患者我们将跟踪试点队列长达 7 年。和新队列 3 年或更长时间，以确定目标 1 中复制的预测因子是否保留其长期预测能力，特别是当补充非脑成像变量并使用更大的我们将使用成像和非成像数据来开发多元统计模型。将能量平衡、功能磁共振成像和实验室值与目标 1 中描述的变量结合起来，以帮助分离预测因素与术后结果的后果，以帮助分离扫描之间的变异性。根据真实的术后、与轨迹相关的大脑变化，我们将招募 N=20 名肥胖受试者，他们不会接受减肥手术，并与我们上述的 SG 受试者进行单独匹配。转化潜力，我们将评估是否有一些相关的、非功能磁共振成像认知测试来探讨“现在与未来”。我们的 MRI 范式的“后来的”功能域可能有潜力充当临床中的替代测试有助于在术前患者评估期间预测 SG 结果成功可能性的实践。这些研究对于理解神经模式在体重中的作用都非常重要监管并帮助患者实现肥胖人群特定的健康结果。