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Alabdulkader S, Al-Alsheikh AS, Miras AD, Goldstone AP. Obesity surgery and neural correlates of human eating behaviour: A systematic review of functional MRI studies. Neuroimage Clin 2024; 41:103563. [PMID: 38237270 PMCID: PMC10828606 DOI: 10.1016/j.nicl.2024.103563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 02/03/2024]
Abstract
Changes in eating behaviour including reductions in appetite and food intake, and healthier food cue reactivity, reward, hedonics and potentially also preference, contribute to weight loss and its health benefits after obesity surgery. Functional magnetic resonance imaging (fMRI) has been increasingly used to interrogate the neural correlates of eating behaviour in obesity, including brain reward-cognitive systems, changes after obesity surgery, and links with alterations in the gut-hormone-brain axis. Neural responses to food cues can be measured by changes in blood oxygen level dependent (BOLD) signal in brain regions involved in reward processing, including caudate, putamen, nucleus accumbens, insula, amygdala, orbitofrontal cortex, and top-down inhibitory control, including dorsolateral prefrontal cortex (dlPFC). This systematic review aimed to examine: (i) results of human fMRI studies involving obesity surgery, (ii) important methodological differences in study design across studies, and (iii) correlations and associations of fMRI findings with clinical outcomes, other eating behaviour measures and mechanistic measures. Of 741 articles identified, 23 were eligible for inclusion: 16 (69.6%) longitudinal, two (8.7%) predictive, and five (21.7%) cross-sectional studies. Seventeen studies (77.3%) included patients having Roux-en-Y gastric bypass (RYGB) surgery, six (26.1%) vertical sleeve gastrectomy (VSG), and five (21.7%) laparoscopic adjustable gastric banding (LAGB). The majority of studies (86.0%) were identified as having a very low risk of bias, though only six (27.3%) were controlled interventional studies, with none including randomisation to surgical and control interventions. The remaining studies (14.0%) had a low risk of bias driven by their control groups not having an active treatment. After RYGB surgery, food cue reactivity often decreased or was unchanged in brain reward systems, and there were inconsistent findings as to whether reductions in food cue reactivity was greater for high-energy than low-energy foods. There was minimal evidence from studies of VSG and LAGB surgeries for changes in food cue reactivity in brain reward systems, though effects of VSG surgery on food cue reactivity in the dlPFC were more consistently found. There was consistent evidence for post-operative increases in satiety gut hormones glucagon-like-peptide 1 (GLP-1) and peptide YY (PYY) mediating reduced food cue reactivity after RYGB surgery, including two interventional studies. Methodological heterogeneity across studies, including nutritional state, nature of food cues, post-operative timing, lack of control groups for order effects and weight loss or dietary/psychological advice, and often small sample sizes, limited the conclusions that could be drawn, especially for correlational analyses with clinical outcomes, other eating behaviour measures and potential mediators. This systematic review provides a detailed data resource for those performing or analysing fMRI studies of obesity surgery and makes suggestions to help improve reporting and design of such studies, as well as future directions.
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Affiliation(s)
- Shahd Alabdulkader
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, PO Box 84428, Riyadh 11671, Saudi Arabia; Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London W12 0NN, UK.
| | - Alhanouf S Al-Alsheikh
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London W12 0NN, UK; Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Alexander D Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London W12 0NN, UK; Ulster University, School of Medicine, Faculty of Life & Health Sciences, Londonderry, Northern Ireland BT48 7JL, UK.
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London W12 0NN, UK.
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Koenis MMG, Ng J, Anderson B, Stevens MC, Tishler DS, Papasavas PK, Stone A, McLaughlin T, Verhaak A, Domakonda MJ, Pearlson GD. Food cue reactivity in successful laparoscopic gastric banding: A sham-deflation-controlled pilot study. Front Hum Neurosci 2022; 16:902192. [PMID: 36092648 PMCID: PMC9454014 DOI: 10.3389/fnhum.2022.902192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Laparoscopic adjustable gastric banding (LAGB) offers a unique opportunity to examine the underlying neuronal mechanisms of surgically assisted weight loss due to its instant, non-invasive, adjustable nature. Six participants with stable excess weight loss (%EWL ≥ 45) completed 2 days of fMRI scanning 1.5-5 years after LAGB surgery. In a within-subject randomized sham-controlled design, participants underwent (sham) removal of ∼ 50% of the band's fluid. Compared to sham-deflation (i.e., normal band constriction) of the band, in the deflation condition (i.e., decreasing restriction) participants showed significantly lower activation in the anterior (para)cingulate, angular gyrus, lateral occipital cortex, and frontal cortex in response to food images (p < 0.05, whole brain TFCE-based FWE corrected). Higher activation in the deflation condition was seen in the fusiform gyrus, inferior temporal gyrus, lingual gyrus, lateral occipital cortex. The findings of this within-subject randomized controlled pilot study suggest that constriction of the stomach through LAGB may indirectly alter brain activation in response to food cues. These neuronal changes may underlie changes in food craving and food preference that support sustained post-surgical weight-loss. Despite the small sample size, this is in agreement with and adds to the growing literature of post-bariatric surgery changes in behavior and control regions.
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Affiliation(s)
- Marinka M. G. Koenis
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, CT, United States
| | - Janet Ng
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, CT, United States
| | - Beth Anderson
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, CT, United States
| | - Michael C. Stevens
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Darren S. Tishler
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, United States
| | - Pavlos K. Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, United States
| | - Andrea Stone
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, CT, United States
| | - Tara McLaughlin
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, United States
| | - Allison Verhaak
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, United States
| | - Mirjana J. Domakonda
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Godfrey D. Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States
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Kozarzewski L, Maurer L, Mähler A, Spranger J, Weygandt M. Computational approaches to predicting treatment response to obesity using neuroimaging. Rev Endocr Metab Disord 2022; 23:773-805. [PMID: 34951003 PMCID: PMC9307532 DOI: 10.1007/s11154-021-09701-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 12/11/2022]
Abstract
Obesity is a worldwide disease associated with multiple severe adverse consequences and comorbid conditions. While an increased body weight is the defining feature in obesity, etiologies, clinical phenotypes and treatment responses vary between patients. These variations can be observed within individual treatment options which comprise lifestyle interventions, pharmacological treatment, and bariatric surgery. Bariatric surgery can be regarded as the most effective treatment method. However, long-term weight regain is comparably frequent even for this treatment and its application is not without risk. A prognostic tool that would help predict the effectivity of the individual treatment methods in the long term would be essential in a personalized medicine approach. In line with this objective, an increasing number of studies have combined neuroimaging and computational modeling to predict treatment outcome in obesity. In our review, we begin by outlining the central nervous mechanisms measured with neuroimaging in these studies. The mechanisms are primarily related to reward-processing and include "incentive salience" and psychobehavioral control. We then present the diverse neuroimaging methods and computational prediction techniques applied. The studies included in this review provide consistent support for the importance of incentive salience and psychobehavioral control for treatment outcome in obesity. Nevertheless, further studies comprising larger sample sizes and rigorous validation processes are necessary to answer the question of whether or not the approach is sufficiently accurate for clinical real-world application.
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Affiliation(s)
- Leonard Kozarzewski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Center for Cardiovascular Research, 10117, Berlin, Germany
| | - Lukas Maurer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Center for Cardiovascular Research, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Anja Mähler
- Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center (ECRC), 13125, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center, 10117, Berlin, Germany
| | - Joachim Spranger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Center for Cardiovascular Research, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Martin Weygandt
- Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center (ECRC), 13125, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center, 10117, Berlin, Germany.
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Koenis MMG, Papasavas PK, Janssen RJ, Tishler DS, Pearlson GD. Brain responses to anticipatory cues and milkshake taste in obesity, and their relationship to bariatric surgery outcome. Neuroimage 2021; 245:118623. [PMID: 34627978 PMCID: PMC10947342 DOI: 10.1016/j.neuroimage.2021.118623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
There is substantial variability in percent total weight loss (%TWL) following bariatric surgery. Functional brain imaging may explain more variance in post-surgical weight loss than psychological or metabolic information. Here we examined the neuronal responses during anticipatory cues and receipt of drops of milkshake in 52 pre-bariatric surgery men and women with severe obesity (OW, BMI = 35-60 kg/m2) (23 sleeve gastrectomy (SG), 24 Roux-en-Y gastric bypass (RYGB), 3 laparoscopic adjustable gastric banding (LAGB), 2 did not undergo surgery) and 21 healthy-weight (HW) controls (BMI = 19-27 kg/m2). One-year post-surgery weight loss ranged from 3.1 to 44.0 TWL%. Compared to HW, OW had a stronger response to milkshake cues (compared to water) in frontal and motor, somatosensory, occipital, and cerebellar regions. Responses to milkshake taste receipt (compared to water) differed from HW in frontal, motor, and supramarginal regions where OW showed more similar response to water. One year post-surgery, responses to high-fat milkshake cues normalized in frontal, motor, and somatosensory regions. This change in brain response was related to scores on a composite health index. We found no correlation between baseline response to milkshake cues or tastes and%TWL at 1-yr post-surgery. In RYGB participants only, a stronger response to low-fat milkshake and water cues (compared to high-fat) in supramarginal and cuneal regions respectively was associated with more weight loss. A stronger cerebellar response to high-fat vs low-fat milkshake receipt was also associated with more weight loss. We confirm differential responses to anticipatory milkshake cues in participants with severe obesity and HW in the largest adult cohort to date. Our brain wide results emphasizes the need to look beyond reward and cognitive control regions. Despite the lack of a correlation with post-surgical weight loss in the entire surgical group, participants who underwent RYGB showed predictive power in several regions and contrasts. Our findings may help in understanding the neuronal mechanisms associated with obesity.
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Affiliation(s)
- Marinka M G Koenis
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06102, United States.
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, United States
| | - Ronald J Janssen
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06102, United States
| | - Darren S Tishler
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, United States
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06102, United States; Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States
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5
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Hwang JJ. Food for Thought. J Nutr 2021; 151:2089-2091. [PMID: 34195820 DOI: 10.1093/jn/nxab210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Janice J Hwang
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
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Bariatric surgery restores visual cortical plasticity in nondiabetic subjects with obesity. Int J Obes (Lond) 2021; 45:1821-1829. [PMID: 34002040 DOI: 10.1038/s41366-021-00851-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity leads to changes in synaptic plasticity. We aimed at investigating the impact of bariatric surgery (RYGB) on visual neural plasticity (NP) and its relationship with the main gut peptides, leptin, and brain-derived neurotrophic factor (BDNF). SUBJECTS/METHODS NP was assessed testing binocular rivalry before and after 2 h of monocular deprivation (index of visual brain plasticity) in 15 subjects with obesity (age 42.3 ± 9.8 years; BMI 46.1 ± 4.9 kg/m2) before and after RYGB. Gut peptides, leptin, and BDNF were obtained at baseline and 6 months after surgery in 13 subjects. RESULTS A significant reduction in BMI (p < 0.001 vs. baseline) and a significant increase of disposition index (DI, p = 0.02 vs baseline) were observed after RYGB. Total and active GLP-1 release in response to glucose ingestion significantly increased after RYGB, while no changes occurred in VIP, GIP, and BDNF levels. Fasting leptin concentration was lower after RYGB (p = 0.001 vs. baseline). Following RYGB, NP was progressively restored (p < 0.002). NP was correlated with DI and fasting glucose at baseline (r = 0.75, p = 0.01; r = -0.7, p = 0.02; respectively), but not with BMI. A positive correlation between post-pre-RYGB changes in AUCactive GLP-1 and NP was observed (r = 0.70, p < 0.01). Leptin was inversely correlated with NP 6 months after surgery (r = -0.63, p = 0.02). No correlation was observed between GIP, VIP, BDNF, and NP. CONCLUSIONS Visual plasticity is altered in subjects with obesity, and it can be restored after RYGB. The improvement may be mediated by amelioration of insulin sensitivity, increased GLP-1 levels, and reduced leptin levels.
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Bach P, Grosshans M, Koopmann A, Kienle P, Vassilev G, Otto M, Bumb JM, Kiefer F. Reliability of neural food cue-reactivity in participants with obesity undergoing bariatric surgery: a 26-week longitudinal fMRI study. Eur Arch Psychiatry Clin Neurosci 2021; 271:951-962. [PMID: 33331960 PMCID: PMC8236041 DOI: 10.1007/s00406-020-01218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
Obesity is highly prevalent worldwide and results in a high disease burden. The efforts to monitor and predict treatment outcome in participants with obesity using functional magnetic resonance imaging (fMRI) depends on the reliability of the investigated task-fMRI brain activation. To date, no study has investigated whole-brain reliability of neural food cue-reactivity. To close this gap, we analyzed the longitudinal reliability of an established food cue-reactivity task. Longitudinal reliability of neural food-cue-induced brain activation and subjective food craving ratings over three fMRI sessions (T0: 2 weeks before surgery, T1: 8 weeks and T2: 24 weeks after surgery) were investigated in N = 11 participants with obesity. We computed an array of established reliability estimates, including the intraclass correlation (ICC), the Dice and Jaccard coefficients and similarity of brain activation maps. The data indicated good reliability (ICC > 0.6) of subjective food craving ratings over 26 weeks and excellent reliability (ICC > 0.75) of brain activation signals for the contrast of interest (food > neutral) in the caudate, putamen, thalamus, middle cingulum, inferior, middle and superior occipital gyri, and middle and superior temporal gyri and cunei. Using similarity estimates, it was possible to re-identify individuals based on their neural activation maps (73%) with a fading degree of accuracy, when comparing fMRI sessions further apart. The results show excellent reliability of task-fMRI neural brain activation in several brain regions. Current data suggest that fMRI-based measures might indeed be suitable to monitor and predict treatment outcome in participants with obesity undergoing bariatric surgery.
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Affiliation(s)
- Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5/68159, Mannheim, Germany. .,Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany.
| | - Martin Grosshans
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5/68159 Mannheim, Germany
| | - Anne Koopmann
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5/68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Peter Kienle
- Department of Surgery, Theresienkrankenhaus, Mannheim, Germany
| | - Georgi Vassilev
- grid.411778.c0000 0001 2162 1728Department of Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Otto
- grid.411778.c0000 0001 2162 1728Department of Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - J. Malte Bumb
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5/68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Falk Kiefer
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5/68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
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Li P, Shan H, Nie B, Liu H, Dong G, Guo Y, Du J, Gao H, Ma L, Li D, Shan B. Sleeve Gastrectomy Rescuing the Altered Functional Connectivity of Lateral but Not Medial Hypothalamus in Subjects with Obesity. Obes Surg 2020; 29:2191-2199. [PMID: 30895508 DOI: 10.1007/s11695-019-03822-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral and medial hypothalamus (LH and MH) play important roles in energy balance. Changed hypothalamic function has been found in subjects with obesity. However, the effect of bariatric surgery on the function of the two sub-regions has been poorly investigated. METHODS Thirty-eight subjects with obesity and 34 age- and sex-matched normal-weight controls were included. Seventeen of the 38 subjects underwent laparoscopic sleeve gastrectomy. Functional magnetic resonance imaging data and metabolic parameters were collected to investigate functional connectivity networks of the two hypothalamic sub-regions as well as the influence of sleeve gastrectomy on the two networks in subjects with obesity. RESULTS Compared to normal-weight controls, pre-surgical subjects had increased functional connectivity (FC) in the reward region (putamen) within the LH network, and increased FC in somatosensory cortical area (insula), as well as decreased FC in the cognitive control regions (prefrontal regions) within the MH network. After the surgery, post-surgical FC of the putamen within the LH network changed towards the patterns found in the control group. Furthermore, the changes in fasting glucose before and after the surgery were associated with the changes in FC of the putamen within the LH network. CONCLUSIONS The FC within the LH and MH networks were changed in subjects with obesity. Part of these altered FC was rescued after the surgery.
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Affiliation(s)
- Panlong Li
- Department of Physics, Zhengzhou University, Zhengzhou, 450001, Henan, China.,Division of Nuclear Technology and Applications, Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Han Shan
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Binbin Nie
- Division of Nuclear Technology and Applications, Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Hua Liu
- Division of Nuclear Technology and Applications, Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Guanglong Dong
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yulin Guo
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jin Du
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongkai Gao
- Department of General Surgery, The General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
| | - Lin Ma
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Demin Li
- Department of Physics, Zhengzhou University, Zhengzhou, 450001, Henan, China.
| | - Baoci Shan
- Division of Nuclear Technology and Applications, Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China. .,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, 100049, China. .,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
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Moore JM, Haemer MA, Fox CK. Lifestyle and pharmacologic management before and after bariatric surgery. Semin Pediatr Surg 2020; 29:150889. [PMID: 32238284 PMCID: PMC8456424 DOI: 10.1016/j.sempedsurg.2020.150889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As metabolic and bariatric surgery (MBS) increasingly becomes a treatment of choice for adolescents with severe obesity, there is a need to understand how to deliver pre- and postoperative care in ways that maximize long-term safety and efficacy. This article describes major pre- and postoperative goals, lifestyle modification targets, and, when necessary, pharmacologic management strategies for adolescents undergoing MBS. Three categories of evidence were used-studies of pre- and postoperative interventions and factors influencing MBS outcomes in adolescents, studies of pre- and postoperative associations and interventions in adults, and studies of non-surgical weight management applicable to adolescents pursuing MBS. Finally, priority areas for future research within this topic are identified.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Matthew A Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN 55455, United States
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10
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Cerit H, Davidson P, Hye T, Moondra P, Haimovici F, Sogg S, Shikora S, Goldstein JM, Evins AE, Whitfield-Gabrieli S, Stoeckel LE, Holsen LM. Resting-State Brain Connectivity Predicts Weight Loss and Cognitive Control of Eating Behavior After Vertical Sleeve Gastrectomy. Obesity (Silver Spring) 2019; 27:1846-1855. [PMID: 31689011 PMCID: PMC6839788 DOI: 10.1002/oby.22607] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/09/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The effects of sleeve gastrectomy (SG) on functional connectivity (FC) and associations with weight loss and eating-related cognitive control were investigated. METHODS In a longitudinal study, 14 SG patients (13 female; 42.1 presurgery BMI) completed study visits 1 month pre surgery and 12 months post surgery. Patients completed the Dutch Eating Behavior Questionnaire and resting-state functional magnetic resonance imaging scanning to measure FC. Data were analyzed using a seed-to-voxel approach in the CONN Toolbox to investigate pre-/postsurgery changes (n = 12) and to conduct predictive analysis (n = 14). RESULTS Seed-to-voxel analysis revealed changes in magnitude (decreases) and directionality (positively correlated to anticorrelated) of FC pre to post surgery within and between default mode network, salience network, and frontoparietal network nodes [Family-Wise Error (FWE) corrected at P < 0.05]. Baseline FC of the nucleus accumbens (with insula) and hypothalamus (with precentral gyrus) predicted 12-month post-SG % total weight loss (FWE-P < 0.05). Baseline FC of the hippocampus, frontoparietal network, and default mode network nodes predicted improvement in cognitive control of eating behavior 12 months after SG (FWE-P < 0.05). CONCLUSIONS Our findings demonstrate changes in FC magnitude and directionality post versus pre surgery within and between resting-state networks and frontal, paralimbic, and visual areas in SG patients. Baseline FC predicted weight loss and changes in cognitive control of food intake behavior at 12 months. These could serve as predictive biomarkers for bariatric surgery.
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Affiliation(s)
- Hilâl Cerit
- Division of Women’s Health, Department of Medicine, Boston, Massachusetts, United Stated of America
- Harvard Medical School, Boston, Massachusetts, United Stated of America
| | - Paul Davidson
- Department of Psychiatry, Boston, Massachusetts, United Stated of America
- Center for Metabolic and Bariatric Surgery, Department of Surgery; Brigham & Women’s Hospital, Boston, Massachusetts, United Stated of America
- Harvard Medical School, Boston, Massachusetts, United Stated of America
| | - Taryn Hye
- Division of Women’s Health, Department of Medicine, Boston, Massachusetts, United Stated of America
| | - Priyanka Moondra
- Division of Women’s Health, Department of Medicine, Boston, Massachusetts, United Stated of America
| | - Florina Haimovici
- Department of Psychiatry, Boston, Massachusetts, United Stated of America
- Harvard Medical School, Boston, Massachusetts, United Stated of America
| | - Stephanie Sogg
- Harvard Medical School, Boston, Massachusetts, United Stated of America
- MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
| | - Scott Shikora
- Center for Metabolic and Bariatric Surgery, Department of Surgery; Brigham & Women’s Hospital, Boston, Massachusetts, United Stated of America
- Harvard Medical School, Boston, Massachusetts, United Stated of America
| | - Jill M. Goldstein
- Division of Women’s Health, Department of Medicine, Boston, Massachusetts, United Stated of America
- Harvard Medical School, Boston, Massachusetts, United Stated of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
- Division of Psychiatric Neuroscience, Athinoula A. Martinos Center, Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
- Department of Obstetrics & Gynecology; Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
| | - A. Eden Evins
- Harvard Medical School, Boston, Massachusetts, United Stated of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
- Division of Psychiatric Neuroscience, Athinoula A. Martinos Center, Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
| | - Susan Whitfield-Gabrieli
- Northeastern University Biomedical Imaging Center, College of Science, Northeastern University, Boston Massachusetts, United Stated of America
| | - Luke E. Stoeckel
- Harvard Medical School, Boston, Massachusetts, United Stated of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United Stated of America
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United Stated of America
| | - Laura M. Holsen
- Division of Women’s Health, Department of Medicine, Boston, Massachusetts, United Stated of America
- Department of Psychiatry, Boston, Massachusetts, United Stated of America
- Harvard Medical School, Boston, Massachusetts, United Stated of America
- Corresponding author: Laura M. Holsen, Ph.D., Division of Women’s Health, BC-3, 1620 Tremont St. Boston, MA 02120, Office: (617) 525-8772, Fax: (617) 525-7900,
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11
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Li P, Shan H, Liang S, Nie B, Liu H, Duan S, Huang Q, Zhang T, Dong G, Guo Y, Du J, Gao H, Ma L, Li D, Shan B. Sleeve Gastrectomy Recovering Disordered Brain Function in Subjects with Obesity: a Longitudinal fMRI Study. Obes Surg 2019; 28:2421-2428. [PMID: 29500671 DOI: 10.1007/s11695-018-3178-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Bariatric surgery could recover regional dysfunction of cerebral cortex. However, it is unknown whether bariatric surgery could recover the global-level dysfunction in subjects with obesity. The aim of this study was to investigate the effect of bariatric surgery on global-level dysfunction in subjects with obesity by resting-state functional magnetic resonance imaging (fMRI). METHODS Resting-state fMRI was used to investigate dysfunction of whole-brain in 34 subjects with obesity and 34 age-and gender-matched normal-weight subjects, in which 17 subjects with obesity received sleeve gastrectomy. Fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) among the whole brain were used to estimate the brain functional differences among the preoperative subjects, postoperative subjects, and the controls. RESULTS The preoperative subjects compared to controls had decreased resting-state activities in reward processing and cognitive control regions such as orbitofrontal cortex, middle frontal gyrus, superior frontal gyrus, and gyrus rectus. It was important that increased FC was also found in these regions. Correlation analysis showed that body mass index (BMI) was associated with these decreased activity and increased FC. More importantly, the dysfunction in these regions was recovered by the bariatric surgery. CONCLUSIONS These results suggest that bariatric surgery-induced weight loss could reverse the global-level dysfunction in subjects with obesity. The dysfunction in these regions might play a key role in the development of obesity, which might serve as a biomarker in the treatment of obesity.
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Affiliation(s)
- Panlong Li
- Department of Physics, Zhengzhou University, Zhengzhou, Henan, 450001, China.,Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China
| | - Han Shan
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Shengxiang Liang
- Department of Physics, Zhengzhou University, Zhengzhou, Henan, 450001, China.,Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China
| | - Binbin Nie
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China
| | - Hua Liu
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China
| | - Shaofeng Duan
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China
| | - Qi Huang
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China
| | - Tianhao Zhang
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China
| | - Guanglong Dong
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yulin Guo
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jin Du
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongkai Gao
- Department of General Surgery, the General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
| | - Lin Ma
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Demin Li
- Department of Physics, Zhengzhou University, Zhengzhou, Henan, 450001, China.
| | - Baoci Shan
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China. .,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing, 100049, China. .,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China. .,Department of Physics, University of Chinese Academy of Sciences, Beijing, 100049, China.
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12
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Smeets PAM, Dagher A, Hare TA, Kullmann S, van der Laan LN, Poldrack RA, Preissl H, Small D, Stice E, Veldhuizen MG. Good practice in food-related neuroimaging. Am J Clin Nutr 2019; 109:491-503. [PMID: 30834431 PMCID: PMC7945961 DOI: 10.1093/ajcn/nqy344] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/22/2017] [Accepted: 11/05/2018] [Indexed: 12/17/2022] Open
Abstract
The use of neuroimaging tools, especially functional magnetic resonance imaging, in nutritional research has increased substantially over the past 2 decades. Neuroimaging is a research tool with great potential impact on the field of nutrition, but to achieve that potential, appropriate use of techniques and interpretation of neuroimaging results is necessary. In this article, we present guidelines for good methodological practice in functional magnetic resonance imaging studies and flag specific limitations in the hope of helping researchers to make the most of neuroimaging tools and avoid potential pitfalls. We highlight specific considerations for food-related studies, such as how to adjust statistically for common confounders, like, for example, hunger state, menstrual phase, and BMI, as well as how to optimally match different types of food stimuli. Finally, we summarize current research needs and future directions, such as the use of prospective designs and more realistic paradigms for studying eating behavior.
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Affiliation(s)
- Paul A M Smeets
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, NL,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands,Address correspondence to PAMS (e-mail: )
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Todd A Hare
- Zurich Center for Neuroeconomics, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research, Tübingen, Germany
| | - Laura N van der Laan
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research, Tübingen, Germany
| | - Dana Small
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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13
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Zoon H, de Bruijn S, Jager G, Smeets P, de Graaf C, Janssen I, Schijns W, Deden L, Boesveldt S. Altered neural inhibition responses to food cues after Roux-en-Y Gastric Bypass. Biol Psychol 2018; 137:34-41. [DOI: 10.1016/j.biopsycho.2018.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/22/2018] [Accepted: 06/18/2018] [Indexed: 12/23/2022]
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14
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Gastric-bypass surgery induced widespread neural plasticity of the obese human brain. Neuroimage 2018; 172:853-863. [DOI: 10.1016/j.neuroimage.2017.10.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/11/2017] [Accepted: 10/27/2017] [Indexed: 11/23/2022] Open
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15
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Olivo G, Zhou W, Sundbom M, Zhukovsky C, Hogenkamp P, Nikontovic L, Stark J, Wiemerslage L, Larsson EM, Benedict C, Schiöth HB. Resting-state brain connectivity changes in obese women after Roux-en-Y gastric bypass surgery: A longitudinal study. Sci Rep 2017; 7:6616. [PMID: 28747648 PMCID: PMC5529553 DOI: 10.1038/s41598-017-06663-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/07/2017] [Indexed: 12/21/2022] Open
Abstract
Bariatric surgery is an effective method to rapidly induce weight loss in severely obese people, however its impact on brain functional connectivity after longer periods of follow-up is yet to be assessed. We investigated changes in connectivity in 16 severely obese women one month before, one month after and one year after Roux-en-Y gastric bypass surgery (RYGB). 12 lean controls were also enrolled. Resting-state fMRI was acquired for all participants following an overnight fast and after a 260 kcal load. Connectivity between regions involved in food-related saliency attribution and reward-driven eating behavior was stronger in presurgery patients compared to controls, but progressively weakened after follow-up. At one year, changes in networks related to cognitive control over eating and bodily perception also occurred. Connectivity between regions involved in emotional control and social cognition had a temporary reduction early after treatment but had increased again after one year of follow-up. Furthermore, we could predict the BMI loss by presurgery connectivity in areas linked to emotional control and social interaction. RYGBP seems to reshape brain functional connectivity, early affecting cognitive control over eating, and these changes could be an important part of the therapeutic effect of bariatric surgery.
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Affiliation(s)
- Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden.
| | - Wei Zhou
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden
| | - Christina Zhukovsky
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Pleunie Hogenkamp
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Lamia Nikontovic
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Julia Stark
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Lyle Wiemerslage
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Christian Benedict
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
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16
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Ahuja NK, Nimgaonkar A. Precision Bariatrics: Toward a New Paradigm of Personalized Devices in Obesity Therapeutics. Obes Surg 2016; 26:1642-5. [PMID: 27067911 DOI: 10.1007/s11695-016-2180-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The prevalence and complexity of obesity and its associated metabolic complications highlight the importance of building a rigorous investigative framework for the development of novel weight loss therapies. Device-based interventions in particular constitute a market poised for rapid expansion in the coming years. Optimizing outcomes for this new class of therapies requires attention to an evolving taxonomy of subdivisions within the broader obesity phenotype and a means for stratifying patients toward maximally effective interventions. Extant bariatric devices implicitly prioritize anatomic variables as surrogates for physiology, a somewhat arbitrary assumption that merits empiric validation. Utilizing the governing principles of systems biology and recent innovations in clinical trial design, a robust and precise research infrastructure can and should be developed to more effectively mitigate this contemporary epidemic.
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Affiliation(s)
- Nitin K Ahuja
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock Suite 412, Baltimore, MD, 21287, USA.
| | - Ashish Nimgaonkar
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 424, Baltimore, MD, 21205, USA.,Center for Bioengineering Innovation & Design, Johns Hopkins University, 3400 N. Charles Street, Clark Hall, Suite 200, Baltimore, MD, 21218, USA
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17
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18
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Hogenkamp PS, Sundbom M, Nilsson VC, Benedict C, Schiöth HB. Patients lacking sustainable long-term weight loss after gastric bypass surgery show signs of decreased inhibitory control of prepotent responses. PLoS One 2015; 10:e0119896. [PMID: 25774526 PMCID: PMC4361610 DOI: 10.1371/journal.pone.0119896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 01/09/2015] [Indexed: 01/14/2023] Open
Abstract
Background A considerable number of bariatric patients report poor long-term weight loss after Roux-en-Y gastric bypass (RYGB) surgery. One possibility for an underlying cause is an impairment of cognitive control that impedes this patient group’s dietary efforts. Objective To investigate if patients having either poor or good weight loss response, ~12 years after RYGB-surgery, differ in their ability to inhibit prepotent responses when processing food cues during attentional operations—as measure of cognitive control. Methods In terms of weight loss following RYGB-surgery, 15 ‘poor responders’ and 15 ‘good responders’, matched for gender, age, education, preoperative body mass index, and years since surgery, were administered two tasks that measure sustained attention and response control: a go/no-go task and a Stroop interference task; both of which are associated with maladaptive eating behaviours. Results The poor responders (vs. good responders) needed significantly more time when conducting a go/no-go task (603±134 vs. 519±44 msec, p = 0.03), but the number of errors did not differ between groups. When conducting a Stroop interference task, poor responders read fewer inks than good responders (68±16 vs. 85±10 words, p = 0.002). Conclusion Patients lacking sustainable weight loss after RYGB-surgery showed poorer inhibitory control than patients that successfully lost weight. In the authors’ view, these results suggest that cognitive behavioral therapies post-RYGB-surgery may represent a promising behavioral adjuvant to achieve sustainable weight loss in patients undergoing this procedure. Future studies should examine whether these control deficits in poor responders are food-specific or not.
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Affiliation(s)
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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