Neuroimaging predictors of bariatric surgical outcomes

减肥手术结果的神经影像预测因素

• 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
• 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

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.

项目摘要/摘要 减肥手术是病态肥胖患者的重要治疗选择，这些患者未通过 饮食和运动。尽管有干预，但有20-50％的患者未能失去目标体重或 重复体重最初会失去。尝试预测减肥程度的尝试只有适中 成功，没有长期（> 2年）的可靠性。而且，严重缺乏研究 预测手术后第一年或第二年的体重减轻，以及减肥以外的结果 在减肥人群中常见的合并症。我们45名患者的试点数据表明个人 用功能MRI（fMRI）测量的手术前神经活动的差异可靠地解释了33％ 手术后1年的体重减轻差异，超过50％的多方面结局指标 超过许多其他指标。这些大脑激活预测因素暗示着密切符合的区域 要强调两种迫切冲动（现在的神经回路）与渴望调节的理论模型 和自我控制（“后来”电路）。我们的中心假设是这些中立的个体差异 途径对维持体重减轻并实现其他关键健康成果的能力产生了强大的影响。 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 与关键体重相关的健康结果。 我们建议复制从我们的fMRI试验数据中得出的模型，以预测体重减轻，其次是 探索其对卡路里摄入量，活性水平，肝脂肪，血红蛋白A1C，血浆脂质的变化的预测效用 血压和禁食葡萄糖在n = 150的新独立队列中成功同意，预先 在研究1-3年中，手术套筒淋巴形切除术（SG）患者。我们将跟随飞行员队列长达7年 以及三年或更长时间的新队列，以确定AIM 1中复制的预测因子是否保留其长期 预测能力，尤其是在补充非脑成像变量并使用较大的时 纵向数据集。我们将使用成像和非成像数据来开发多元统计模型 将能源平衡，fMRI和实验室值与AIM 1中描述的变量结合在一起，以帮助 单独的预测因素与外科后结果的后果。帮助单独的扫描到扫描可变性 从真正的术后，轨迹相关的大脑变化中，我们将注册n = 20个肥胖受试者 接受减肥手术，并与上述SG受试者单独匹配。最后，就 翻译潜力，我们将评估几种相关的非FMRI认知测试是否探测为“ VS。 后来“我们的MRI范式的功能域可能有可能充当临床的替代测试 在手术前患者评估期间，有助于预测成功SG结局的可能性的实践。 这些研究在理解神经模式在体重中的作用方面都非常重要 调节并帮助患者获得特定于减肥人群的健康结果。