Changes in neural response to eating after bariatric surgery: MRI results

减肥手术后饮食神经反应的变化：MRI 结果

• 批准号: 8050147
• 负责人: Ruben C. Gur
• 金额: $ 61.35万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8050147
• 关键词: Affect; Amygdaloid structure; Area; Bariatrics; Basic Science; Blood; Blood specimen; Body Weight; Body Weight decreased; Body mass index; Brain; Brain imaging; Brain region; Cerebrovascular Circulation; Consumption; Cues; Desire for food; Eating; Endocrine; Exhibits; Fasting; Fatty acid glycerol esters; Food; Food Intake Regulation; Food Processing; Functional Magnetic Resonance Imaging; Gastric Bypass; Hormones; Hunger; Hypothalamic structure; Image; Individual; Ingestion; Insula of Reil; Investigation; Liquid substance; Literature; MRI Scans; Magnetic Resonance Imaging; Measures; Mediating; Methods; Morbid Obesity; Nucleus Accumbens; Nutrient; Obesity; Observational Study; Operative Surgical Procedures; Outcome; Participant; Patients; Peptide YY; Perfusion; Perfusion Weighted MRI; Persons; Positron; Postoperative Period; Prefrontal Cortex; Procedures; Relative (related person); Reporting; Research; Rest; Rewards; Satiation; Scanning; Spin Labels; Testing; Time; Ventral Tegmental Area; Visit; Weight; bariatric surgery; blood oxygen level dependent; cingulate cortex; clinical practice; feeding; follow-up; food consumption; ghrelin; glucagon-like peptide; glucagon-like peptide 1; hedonic; interest; mesolimbic system; neuroregulation; preference; prospective; public health relevance; relating to nervous system; response; sugar; tomography

DESCRIPTION (provided by applicant): Bariatric surgery is the most effective weight loss option for persons with extreme obesity (i.e., body mass index = 40 kg/m2). Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are the most common bariatric procedures, and they induce long-term reductions of ~25% and ~15% of initial weight, respectively. Anatomical differences resulting from the two procedures are associated with postoperative differences in endocrine functioning. In particular, the orexigenic hormone, ghrelin, is generally suppressed in RYGB and increased in LAGB patients. Furthermore, postprandial increases in the satiety factors, glucagon-like peptide 1 (GLP-1) and peptide YY (PYY3-36), are significantly increased after RYGB, compared with LAGB. Each of these appetite-regulating hormones has been found to act in brain regions related to both the homeostatic and hedonic control of food intake. A separate literature has examined neural activation in feeding centers, as measured with functional magnetic resonance imaging (fMRI) and positron emitted tomography (PET), in response to food cues. Most of these studies have compared responses to images of high-calorie vs. low-calorie foods or non-food items. Some have further compared responses in lean vs. obese individuals. Generally, high-calorie food images stimulate activation in the prefrontal cortex, mesolimbic dopamine system (e.g., ventral-tegmental area and nucleus accumbens), and other limbic areas (e.g., orbitofrontal cortex, amygdala, insula, and cingulate cortex). Furthermore, responses are greater in obese vs. lean individuals. Fewer studies have examined neural response to meal consumption; those investigations have found that many of the same regions are activated by nutrient ingestion. The proposed research is a prospective observational study that seeks to integrate two areas of inquiry: 1) endocrine effects of bariatric surgery; and 2) neural response to food cues and feeding. Patients who undergo RYGB or LAGB, and matched obese controls who do not seek weight loss, will complete assessment visits at 0, 6, and 18 months, which include: 1) a fMRI scan while viewing high- and low-calorie food images in the fasted state; 2) a perfusion MRI scan to measure cerebral blood flow in the fasted state; 3) fasting blood draw; 4) consumption of a liquid test meal; 5) serial perfusion MRI scans to assess the effects of the meal; and 5) serial blood draws to assess postprandial changes in ghrelin, GLP-1, and PYY3-36. Comparisons of changes among the three groups at 6-months and 18-months follow-up will comprise our primary analyses. The primary hypotheses are that following surgery: 1) fMRI response to high-calorie food images will be reduced in RYGB vs. LAGB patients and controls; 2) RYGB patients will show larger increases in postprandial GLP-1 and PYY3-36 (accompanied with a blunted postprandial ghrelin response) than will LAGB patients and controls; and 3) RYGB patients will demonstrate a greater postprandial increase in resting brain activity in homeostatic and hedonic feeding areas than will LAGB and control participants. PUBLIC HEALTH RELEVANCE: The proposed research is an 18-month prospective observational study of extremely obese patients who seek laparoscopic adjustable gastric banding (LAGB) or roux-en-Y gastric bypass (RYGB) surgery. Using functional and perfusion magnetic resonance imaging, we will assess changes in neural response to food cues and meal ingestion 6 and 18 months after surgery. Changes in the two surgical approaches will be compared with each other and with those in a group of extremely obese individuals who do not seek weight loss. In addition, we will serially measure postprandial changes in appetite-regulating hormones and examine the relationships between neural and endocrine response to food consumption.

描述（由申请人提供）：对于极度肥胖者（即体重指数 = 40 kg/m2）来说，减肥手术是最有效的减肥选择。 Roux-en-Y 胃旁路术 (RYGB) 和腹腔镜可调节胃束带术 (LAGB) 是最常见的减肥手术，它们分别可使初始体重长期减少约 25% 和约 15%。两种手术产生的解剖学差异与术后内分泌功能的差异有关。特别是，促食欲激素生长素释放肽在 RYGB 患者中通常受到抑制，而在 LAGB 患者中则增加。此外，与 LAGB 相比，RYGB 后饱腹感因子、胰高血糖素样肽 1 (GLP-1) 和肽 YY (PYY3-36) 的餐后增加显着增加。人们发现，这些食欲调节激素中的每一种都在与食物摄入的稳态和享乐控制相关的大脑区域中发挥作用。另一篇文献研究了喂养中心的神经激活情况，通过功能磁共振成像（fMRI）和正电子发射断层扫描（PET）进行测量，以响应食物提示。这些研究大多数都比较了人们对高热量与低热量食品或非食品图像的反应。一些人进一步比较了瘦人和肥胖者的反应。一般来说，高热量食物图像会刺激前额皮质、中脑边缘多巴胺系统（例如腹侧被盖区和伏隔核）和其他边缘区域（例如眶额皮质、杏仁核、岛叶和扣带皮层）的激活。此外，与瘦人相比，肥胖者的反应更大。很少有研究检查对进餐的神经反应。这些调查发现，许多相同区域会因营养摄入而被激活。 拟议的研究是一项前瞻性观察研究，旨在整合两个研究领域：1）减肥手术的内分泌影响； 2）对食物提示和进食的神经反应。接受 RYGB 或 LAGB 的患者以及不寻求减肥的匹配肥胖对照患者将在 0、6 和 18 个月时完成评估访视，其中包括：1) 在查看高热量和低热量食物图像时进行功能磁共振成像扫描禁食状态； 2）灌注MRI扫描以测量禁食状态下的脑血流量； 3) 空腹抽血； 4) 消耗液体测试餐； 5) 连续灌注 MRI 扫描以评估膳食的效果； 5) 连续抽血以评估餐后 ghrelin、GLP-1 和 PYY3-36 的变化。我们的主要分析将比较 6 个月和 18 个月随访时三组之间的变化。主要假设是手术后：1）与 LAGB 患者和对照相比，RYGB 对高热量食物图像的 fMRI 反应会降低； 2) 与 LAGB 患者和对照相比，RYGB 患者餐后 GLP-1 和 PYY3-36 的增加幅度更大（伴随餐后 ghrelin 反应减弱）； 3) 与 LAGB 和对照参与者相比，RYGB 患者在稳态和享乐喂养区域的静息大脑活动会表现出更大的餐后增加。 公共健康相关性：拟议的研究是一项为期 18 个月的前瞻性观察研究，对象是寻求腹腔镜可调节胃束带 (LAGB) 或 roux-en-Y 胃绕道手术 (RYGB) 手术的极度肥胖患者。使用功能性和灌注磁共振成像，我们将评估手术后 6 个月和 18 个月对食物线索和膳食摄入的神经反应的变化。这两种手术方法的变化将相互比较，并与一组不寻求减肥的极度肥胖者进行比较。此外，我们将连续测量餐后食欲调节激素的变化，并检查神经和内分泌对食物消耗的反应之间的关系。