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Mattelaer N, Van der Schueren B, Van Oudenhove L, Weltens N, Vangoitsenhoven R. The circulating and central endocannabinoid system in obesity and weight loss. Int J Obes (Lond) 2024:10.1038/s41366-024-01553-z. [PMID: 38834796 DOI: 10.1038/s41366-024-01553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
Major advances have been made in obesity treatment, focusing on restoring disturbances along the gut-brain axis. The endocannabinoid system (ECS) is a neuromodulatory signaling system, present along the entire gut-brain axis, that plays a critical role in central and peripheral regulation of food intake and body weight. Evidence on the impact of weight loss on the ECS is, however, more limited. Therefore, we set out to review the existing literature for changes in central and circulating endocannabinoid levels after bariatric surgery and other weight loss strategies in humans. The PubMed, Embase and Web of Science databases were searched for relevant articles. Fifty-six human studies were identified. Most studies measuring circulating 2-arachidonoylglycerol (2-AG) found no difference between normal weight and obesity, or no correlation with BMI. In contrast, studies measuring circulating arachidonoylethanolamine (AEA) found an increase or positive correlation with BMI. Two studies found a negative correlation between BMI and cannabinoid receptor type 1 (CB1) receptor availability in the brain. Only one study investigated the effect of pharmacological weight management on circulating endocannabinoid concentrations and found no effect on AEA concentrations. So far, six studies investigated potential changes in circulating endocannabinoids after bariatric surgery and reported conflicting results. Available evidence does not univocally support that circulating endocannabinoids are upregulated in individuals with obesity, which may be explained by variability across studies in several potential confounding factors (e.g. age and sex) as well as heterogeneity within the obesity population (e.g. BMI only vs. intra-abdominal adiposity). While several studies investigated the effect of lifestyle interventions on the circulating ECS, more studies are warranted that focus on pharmacologically and surgically induced weight loss. In addition, we identified several research needs which should be fulfilled to better understand the role of the ECS in obesity and its treatments.
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Affiliation(s)
- Nele Mattelaer
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Laboratory for Brain-Gut Axis Studies, Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies, Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Nathalie Weltens
- Laboratory for Brain-Gut Axis Studies, Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Roman Vangoitsenhoven
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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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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Association Between Gut Hormones and Weight Change After Bariatric Arterial Embolization: Results from the BEAT Obesity Trial. Cardiovasc Intervent Radiol 2023; 46:220-228. [PMID: 36138191 DOI: 10.1007/s00270-022-03280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate associations of ghrelin, glucagon-like peptide 1 (GLP-1), and peptide YY 3-36 (PYY3-36) with weight change after bariatric arterial embolization (BAE). MATERIALS AND METHODS Subgroup analysis of data collected during the BEAT Obesity Trial involving 7 participants with BMI > 40 who were embolized with 300- to 500-μm Embosphere Microspheres. Three participants were characterized as "responders" (top tertile of weight loss at each visit) and 4 as "non-responders" (bottom tertile of weight loss at each visit). Mean ± standard deviation participant age was 44 ± 11 years, and 6 of 7 participants were women. Participants were evaluated at baseline, 2 weeks, and 1, 3, 6, and 12 months after BAE. After fasting, participants consumed a mixed meal test at each visit; blood samples were collected at 0, 15, 30, 60, 120, 180, and 240 min. Study outcome measures were changes in weight from baseline and plasma serum hormone levels. RESULTS Percentage change in ghrelin decreased significantly in non-responders at 60 and 120 min at 1 and 12 months (estimated difference between 60 vs. 0 min at 1 month: 69% [95% CI - 126%, - 13%]; estimated difference between 120 vs. 0 min at 12 months: - 131% (95% CI - 239%, - 23%]). Responders had significantly lower ghrelin and greater weight loss than non-responders at 6 and 12 months. GLP-1 and PYY3-36 levels did not differ between groups. CONCLUSION Participants with consistent weight loss throughout follow-up had lower ghrelin than non-responders, supporting decreased ghrelin as a mechanism underlying BAE-induced weight loss. LEVEL OF EVIDENCE I High-quality randomized trial or prospective study; testing of previously developed diagnostic criteria on consecutive patients; sensible costs and alternatives; values obtained from many studies with multiway sensitivity analyses; systematic review of Level I RCTs and Level I studies.
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Bernard A, Radoi L, Christensen J, Servant F, Blasco-Blaque V, Ledoux S, Collet X, Besnard P. A specific tongue microbiota signature is found in patients displaying an improvement of orosensory lipid perception after a sleeve gastrectomy. Front Nutr 2023; 9:1046454. [PMID: 36712531 PMCID: PMC9874242 DOI: 10.3389/fnut.2022.1046454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/29/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction A preferential consumption of low-fat foods is reported by most of the patients after a vertical sleeve gastrectomy (VSG). The fact that a recent study shed light on a relationship between oral microbiota and fat taste sensitivity in obese patients prompted us to explore whether such a connection also exists in the context of a VSG. Methods Thirty-two adult female patients with a severe obesity (BMI = 43.1 ± 0.7 kg/m2) and candidates for a VSG were selected. Oral microbiota composition surrounding the gustatory circumvallate papillae (CVP) and the lipid perception thresholds were explored before and 6 months after surgery. Results VSG was found to be associated both with a qualitative (compositional changes) and quantitative (lower gene richness) remodeling of the peri-CVP microbiota. Analysis of the lipid perception allowed us to distinguish two subgroups: patients with a post-operative improvement of the fat taste sensitivity (i.e., with a lower threshold, n = 14) and unimproved patients (n = 18). Specific peri-CVP microbiota signatures also discriminated these two subgroups, unimproved patient being characterized by higher levels of Porphyromonas, Fusobacterium, and Haemophilus genera associated with lower levels of Atopobium and Prevotella genera as compared to the lipid-improved patients. Conclusion Collectively, these data raise the possibility that the microbial environment surrounding gustatory papillae might play a role in the positive changes of fat taste sensitivity observed in some patients after VSG.
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Affiliation(s)
- Arnaud Bernard
- UMR 1231 INSERM/Univ Bourgogne Franche-Comté/AgroSup Dijon, Dijon, France
| | - Loredana Radoi
- Médecine Bucco-dentaire, Hôpital Louis Mourier (APHP-Nord), Colombes, France & Univ Paris Cité/CESP-UMR 1018 INSERM, Paris, France
| | | | | | | | - Séverine Ledoux
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP-Nord), Colombes, France
| | - Xavier Collet
- UMR 1297 INSERM/Univ Toulouse III Paul Sabatier, Toulouse, France
| | - Philippe Besnard
- UMR 1231 INSERM/Univ Bourgogne Franche-Comté/AgroSup Dijon, Dijon, France,*Correspondence: Philippe Besnard,
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Changes in Food Choice, Taste, Desire, and Enjoyment 1 Year after Sleeve Gastrectomy: A Prospective Study. Nutrients 2022; 14:nu14102060. [PMID: 35631200 PMCID: PMC9145557 DOI: 10.3390/nu14102060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 12/04/2022] Open
Abstract
Obesity is a well-recognized global health problem, and bariatric surgery (BS)-induced weight reduction has been demonstrated to improve survival and obesity-related conditions. Sleeve gastrectomy (SG) is actually one of the most performed bariatric procedures. The underlying mechanisms of weight loss and its maintenance after SG are not yet fully understood. However, changes to the taste function could be a contributing factor. Data on the extent of the phenomenon are limited. The primary objective was to assess, through validated questionnaires, the percentage of patients who report an altered perception of post-SG taste and compare the frequency of intake of the different food classes before SG and after 1 year follow-up. The secondary objective was to evaluate the total body weight change. Materials and Methods: We prospectively investigated the changes in food choice and gustatory sensitivity of 52 patients (55.8% females) 12 months after SG. The mean initial weight and body mass index (BMI) were 130.9 ± 24.7 kg and 47.4 ± 7.1 kg/m2, respectively. The frequency of food intake was assessed by food-frequency questionnaire, while changes in taste perception were assessed using the taste desire and enjoyment change questionnaire. The change in total body weight was also assessed. Results: A significant decrease in the intake frequency of bread and crackers (p < 0.001), dairy products and fats (p < 0.001), sweets and snacks (p < 0.001) and soft drinks (p < 0.001), and a significant increase in the frequency of vegetable and fruit consumption (p < 0.001) were observed at 12 months after SG in both genders. On the contrary, we found no significant changes in the frequency of meat and fish intake in females (p = 0.204), whereas a significant change was found in males (p = 0.028). Changes in perceived taste intensity of fatty foods (p = 0.021) and tart foods (p = 0.006) for females and taste of bitter foods for females and males (p = 0.002; p = 0.017) were found. Regarding the change in food desire for both genders, there was a decrease in the desire for sweet, fatty, and salty foods, whereas there was an increasing trend in the desire for tart foods, especially for females. Significant reduction in total body weight and BMI was observed in both genders at the time of follow-up. Conclusions: Based on our findings, we are able to support the evidence that changes in taste, desire, and enjoyment of taste are very common after SG, with a reduced preference for food with high sugar and fat content and an increased postoperative preference for low-sugar and -fat foods. However, further investigation is needed to clarify this issue. The molecular, hormonal, and central mechanisms underlying these changes in taste perception need to be further elucidated, as they could identify new targets able to modify obesogenic eating behavior, opening up a novel personalized therapeutic approach to obesity.
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Ismaeil A, Gero D, Boyle CN, Alceste D, Taha O, Spector AC, Lutz TA, Bueter M. Early Postoperative Exposure to High-Fat Diet Does Not Increase Long-Term Weight Loss or Fat Avoidance After Roux-en-Y Gastric Bypass in Rats. Front Nutr 2022; 9:834854. [PMID: 35495960 PMCID: PMC9044042 DOI: 10.3389/fnut.2022.834854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Bariatric surgery alters food preferences in rats and reportedly decreases desire to consume high-fat high-sugar food in humans. The aim of this study was to investigate whether early post-operative exposure to high-fat food could increase body weight loss after Roux-en-Y gastric bypass (RYGB) by triggering fat avoidance. Methods Male Wistar rats underwent either RYGB (n = 15) or sham-operations (n = 16). Preoperatively a standardized 4-choice cafeteria diet [dietary options: low-fat/low-sugar (LFLS), low-fat/high-sugar (LFHS), high-fat/low-sugar (HFLS), high-fat/high-sugar (HFHS)] was offered. First, each option was available for 4 days, thereafter rats were offered the 4 options simultaneously for 3 days preoperatively. Post-surgery, 8 rats in the RYGB- and 8 in the sham-group were exposed to a high-fat content diet (Oatmeal + 30% lard, OM+L) for 10 days, while 7 RYGB rats and 8 sham-rats received OM alone. From the 11th postoperative day, the 4-choice cafeteria diet was reintroduced for 55-days. The intake of all available food items, macronutrients and body weight changes were monitored over 8 weeks. Main outcomes were long-term body-weight and daily change in relative caloric intake during the postoperative cafeteria period compared to the preoperative cafeteria. Results During the first 12 days of postoperative cafeteria access, RYGB-rats exposed to OM+L had a higher mean caloric intake per day than RYGB rats exposed to OM alone (Δ10 kCal, Padj = 0.004), but this difference between the RYGB groups disappeared thereafter. Consequently, in the last 33 days of the postoperative cafeteria diet, the mean body weight of the RYGB+OM+L group was higher compared to RYGB+OM (Δ51 g, Padj < 0.001). RYGB rats, independently from the nutritional intervention, presented a progressive decrease in daily consumption of calories from fat and increased their daily energy intake mainly from non-sugar carbohydrates. No such differences were detected in sham-operated controls exposed to low- or high fat postoperative interventions. Conclusion A progressive decrease in daily fat intake over time was observed after RYGB, independently from the nutritional intervention. This finding confirms that macronutrient preferences undergo progressive changes over time after RYGB and supports the role of ingestive adaptation and learning. Early postoperative exposure to high-fat food failed to accentuate fat avoidance and did not lead to superior weight loss in the long-term.
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Affiliation(s)
- Aiman Ismaeil
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- Department of General Surgery, Aswan University Hospital, Aswan, Egypt
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christina N. Boyle
- Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - Daniela Alceste
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Osama Taha
- Department of Plastic Surgery, Assiut University Hospital, Asyut, Egypt
| | - Alan C. Spector
- Program in Neuroscience, Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Thomas A. Lutz
- Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: Marco Bueter,
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Al-Alsheikh AS, Alabdulkader S, Johnson B, Goldstone AP, Miras AD. Effect of Obesity Surgery on Taste. Nutrients 2022; 14:866. [PMID: 35215515 PMCID: PMC8878262 DOI: 10.3390/nu14040866] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 12/03/2022] Open
Abstract
Obesity surgery is a highly efficacious treatment for obesity and its comorbidities. The underlying mechanisms of weight loss after obesity surgery are not yet fully understood. Changes to taste function could be a contributing factor. However, the pattern of change in different taste domains and among obesity surgery operations is not consistent in the literature. A systematic search was performed to identify all articles investigating gustation in human studies following bariatric procedures. A total of 3323 articles were identified after database searches, searching references and deduplication, and 17 articles were included. These articles provided evidence of changes in the sensory and reward domains of taste following obesity procedures. No study investigated the effect of obesity surgery on the physiological domain of taste. Taste detection sensitivity for sweetness increases shortly after Roux-en-Y gastric bypass. Additionally, patients have a reduced appetitive reward value to sweet stimuli. For the subgroup of patients who experience changes in their food preferences after Roux-en-Y gastric bypass or vertical sleeve gastrectomy, changes in taste function may be underlying mechanisms for changing food preferences which may lead to weight loss and its maintenance. However, data are heterogeneous; the potential effect dilutes over time and varies significantly between different procedures.
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Affiliation(s)
- Alhanouf S. Al-Alsheikh
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London W12 0NN, UK; (A.S.A.-A.); (S.A.); (B.J.); (A.D.M.)
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Shahd Alabdulkader
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London W12 0NN, UK; (A.S.A.-A.); (S.A.); (B.J.); (A.D.M.)
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia
| | - Brett Johnson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London W12 0NN, UK; (A.S.A.-A.); (S.A.); (B.J.); (A.D.M.)
| | - Anthony P. Goldstone
- PsychoNeuroEndocrinology Research Group, Division of Psychiatry, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Alexander Dimitri Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London W12 0NN, UK; (A.S.A.-A.); (S.A.); (B.J.); (A.D.M.)
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The Effects of Roux-en-Y Gastric Bypass on Glucose- vs. Fructose-Associated Conditioned Flavor Preference. Physiol Behav 2022; 248:113730. [PMID: 35149056 PMCID: PMC8901435 DOI: 10.1016/j.physbeh.2022.113730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 11/23/2022]
Abstract
In rodents, repeated single-bottle exposures to distinctly flavored isocaloric glucose and fructose solutions, two sugars with different metabolic pathways, eventually lead to a preference for the former. Because Roux-en-Y gastric bypass (RYGB) surgery decreases preference for and intake of sugar solutions in rats, we tested whether RYGB would curtail the conditioning of a preference for a glucose-paired vs. fructose-paired flavor. RYGB (♂ n=11; ♀ n=10) and sham-operated (SHAM; ♂ n=9; ♀ n=10) rats were trained with a single bottle (30 min/day) containing 8% glucose solution flavored with either 0.05% grape or cherry Kool-Aid (Glu/CSG) or 8% fructose solution with the alternative Kool-Aid flavor (Fru/CSF) in an alternating fashion for 8 days. To determine baseline preferences, a 4-day 30-min two-bottle test was used to assess preference for Glu/CSG vs. Fru/CSF before training. After training, 2-day 30-min two-bottle tests assessed preference for the a) Glu/CSG (CSG-flavored 8% glucose solution) vs Fru/CSF (CSF-flavored 8% fructose solution), b) CSG- vs. CSF-flavored mixture of 4% glucose & 4% fructose (isocaloric), c) CSG- vs. CSF-flavored 0.2% saccharin ("sweet", no calories), and d) CSG- vs. CSF-flavored water. During training, only male SHAM rats demonstrated progressively increased intake of Glu/CSG over Fru/CSF, and female SHAM rats displayed a trend. RYGB eliminated any difference in single-bottle intake of these solutions during training, regardless of sex. Like their male and female SHAM counterparts, male RYGB rats displayed a conditioned preference for the CSG-associated stimulus in Tests 1-3. Although female RYGB rats displayed acquisition of the conditioned flavor preference in Test 1, unlike the other groups, when the differential sugar cue between the two solutions was removed in Tests 2 and 3, female rats did not display a CSG preference. When the sugar and sweetener cues were both removed on Test 4, all groups displayed some generalization decrement. Thus, RYGB does not compromise the ability of rats to learn and express a glucose- vs. fructose-associated conditioned flavor preference when the exact CS used in training is presented in testing. The mechanistic basis for the sex difference in the effect of RYGB on the generalization decrement observed in this type of flavor preference learning warrants further study.
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Luna M, Pereira S, Saboya C, Cruz S, Matos A, Ramalho A. Body Composition, Basal Metabolic Rate and Leptin in Long-Term Weight Regain After Roux-en-Y Gastric Bypass Are Similar to Pre-surgical Obesity. Obes Surg 2021; 32:302-310. [PMID: 34787767 DOI: 10.1007/s11695-021-05780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the relationship between body composition, basal metabolic rate (BMR), and serum concentrations of leptin with long-term weight regain after Roux-en-Y gastric bypass (RYGB) and compare it with obesity before surgery. MATERIALS AND METHODS Prospective longitudinal analytical study. Three groups were formed: individuals 60 months post RYGB, with weight regain (G1) and without it (G2), and individuals with obesity who had not undergone bariatric surgery (G3). Body fat (BF), body fat mass (BFM), visceral fat (VF), fat-free mass (FFM), skeletal muscle mass (SMM), and BMR were assessed by octapolar and multi-frequency electrical bioimpedance. Fasting serum concentrations of leptin were measured. RESULTS Seventy-two individuals were included, 24 in each group. Higher means of BF, BFM, VF, and leptin levels were observed in G1, when compared to G2 (BF: 47.5 ± 5.6 vs. 32.0 ± 8.0, p < 0.05; FBM: 47.8 ± 11.6 vs. 23.9 ± 7.0, p < 0.05; VF: 156.8 ± 30.2 vs. 96.1 ± 23.8, p < 0.05; leptin: 45,251.2 pg/mL ± 20,071.8 vs. 11,525.7 pg/mL ± 9177.5, p < 0.000). G1 and G2 did not differ in FFM, SMM, and BMR. G1 and G3 were similar according to BF, FFM, BMR, and leptin levels. Body composition, but not leptin, was correlated with %weight regain in G1 (FBM: r = 0.666, p < 0.000; BF: r = 0.428, p = 0.037; VF: r = 0.544, p = 0.006). CONCLUSION Long-term weight regain after RYGB is similar to pre-surgical obesity in body composition, BMR, and leptin concentrations, indicating relapse of metabolic and hormonal impairments associated with excessive body fat.
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Affiliation(s)
- Mariana Luna
- Postgraduate Program in Internal Medicine, Medical School, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321044-020, Brazil. .,Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil.
| | - Silvia Pereira
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Carlos Saboya
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Sabrina Cruz
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Andrea Matos
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Andrea Ramalho
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil.,Social Applied Nutrition Department, Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, 373 - Cidade, Rio de Janeiro, RJ, 21941-902, Brazil
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10
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Lampropoulos C, Alexandrides T, Tsochatzis S, Kehagias D, Kehagias I. Are the Changes in Gastrointestinal Hormone Secretion Necessary for the Success of Bariatric Surgery? A Critical Review of the Literature. Obes Surg 2021; 31:4575-4584. [PMID: 34304379 DOI: 10.1007/s11695-021-05568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
Ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) are involved in energy balance regulation and glucose homeostasis. Obesity is characterized by lower fasting levels and blunted postprandial responses of ghrelin, GLP-1, and possibly PYY. Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been shown to increase postprandial GLP-1 and PYY levels. Human studies have shown that enhanced postprandial GLP-1 and PYY release are associated with favorable weight loss outcomes after RYGB. However, studies in knockout mice have shown that GI hormones are not required for the primary metabolic effects of bariatric surgery. Here, we summarize the complex interaction between obesity, bariatric surgery, and GI hormones in order to determine the exact role of GI hormones in the success of bariatric surgery.
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Affiliation(s)
| | - Theodoros Alexandrides
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rio, Greece
| | - Stylianos Tsochatzis
- Department of General Surgery, Saint Andrew's General Hospital, 26335, Patras, Greece
| | - Dimitrios Kehagias
- Department of General Surgery, General University Hospital of Patras, 26504, Rio, Greece
| | - Ioannis Kehagias
- Division of Bariatric and Metabolic Surgery, Department of Surgery, General University Hospital of Patras, 26504, Rio, Greece
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11
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Bernard A, Le May C, Dastugue A, Ayer A, Blanchard C, Martin JC, Pais de Barros JP, Delaby P, Le Bourgot C, Ledoux S, Besnard P. The Tryptophan/Kynurenine Pathway: A Novel Cross-Talk between Nutritional Obesity, Bariatric Surgery and Taste of Fat. Nutrients 2021; 13:nu13041366. [PMID: 33921805 PMCID: PMC8073116 DOI: 10.3390/nu13041366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
Diet-induced obesity (DIO) reduces the orosensory perception of lipids in rodents and in some humans. Although bariatric surgery partially corrects this alteration, underlying mechanisms remain poorly understood. To explore whether metabolic changes might explain this fat taste disturbance, plasma metabolome analyses, two-bottle choice tests and fungiform papillae (Fun) counting were performed in vertical sleeve gastrectomized (VSG) mice and sham-operated controls. An exploratory clinic study was also carried out in adult patients undergone a VSG. In mice, we found that (i) the VSG reduces both the plasma neurotoxic signature due to the tryptophan/kynurenine (Trp/Kyn) pathway overactivation and the failure of fat preference found in sham-operated DIO mice, (ii) the activity of Trp/Kyn pathway is negatively correlated to the density of Fun, and (iii) the pharmacological inhibition of the Kyn synthesis mimics in non-operated DIO mice the positive effects of VSG (i.e., decrease of Kyn synthesis, increase of Fun number, improvement of the fat taste perception). In humans, a reduction of the plasma Kyn level is only found in patients displaying a post-surgery improvement of their fat taste sensitivity. Altogether these data provide a plausible metabolic explanation to the degradation of the orosensory lipid perception observed in obesity.
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Affiliation(s)
- Arnaud Bernard
- UMR 1231 Lipides/Nutrition/Cancer INSERM/Univ Bourgogne-Franche-Comté/AgroSupDijon, 21000 Dijon, France; (A.B.); (A.D.); (J.-P.P.d.B.)
| | - Cédric Le May
- UMR 1087 INSERM/6291 CNRS Université de Nantes, l’Institut du Thorax, 44000 Nantes, France; (C.L.M.); (A.A.); (C.B.)
| | - Aurélie Dastugue
- UMR 1231 Lipides/Nutrition/Cancer INSERM/Univ Bourgogne-Franche-Comté/AgroSupDijon, 21000 Dijon, France; (A.B.); (A.D.); (J.-P.P.d.B.)
| | - Audrey Ayer
- UMR 1087 INSERM/6291 CNRS Université de Nantes, l’Institut du Thorax, 44000 Nantes, France; (C.L.M.); (A.A.); (C.B.)
| | - Claire Blanchard
- UMR 1087 INSERM/6291 CNRS Université de Nantes, l’Institut du Thorax, 44000 Nantes, France; (C.L.M.); (A.A.); (C.B.)
| | | | - Jean-Paul Pais de Barros
- UMR 1231 Lipides/Nutrition/Cancer INSERM/Univ Bourgogne-Franche-Comté/AgroSupDijon, 21000 Dijon, France; (A.B.); (A.D.); (J.-P.P.d.B.)
| | | | | | - Séverine Ledoux
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Colombes and Université de Paris, 92700 Nanterre, France;
- Fonctions Gastro-Intestinales, Métaboliques et Physiopathologies Nutritionnelles INSERM UMR1149, CEDEX 18, 75890 Paris, France
| | - Philippe Besnard
- UMR 1231 Lipides/Nutrition/Cancer INSERM/Univ Bourgogne-Franche-Comté/AgroSupDijon, 21000 Dijon, France; (A.B.); (A.D.); (J.-P.P.d.B.)
- Physiologie de la Nutrition, AgroSup Dijon, 26 Bd Dr Petitjean, 21000 Dijon, France
- Correspondence:
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12
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Bernard A, Le Beyec-Le Bihan J, Radoi L, Coupaye M, Sami O, Casanova N, Le May C, Collet X, Delaby P, Le Bourgot C, Besnard P, Ledoux S. Orosensory Perception of Fat/Sweet Stimuli and Appetite-Regulating Peptides before and after Sleeve Gastrectomy or Gastric Bypass in Adult Women with Obesity. Nutrients 2021; 13:878. [PMID: 33800516 PMCID: PMC8000537 DOI: 10.3390/nu13030878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to explore the impact of bariatric surgery on fat and sweet taste perceptions and to determine the possible correlations with gut appetite-regulating peptides and subjective food sensations. Women suffering from severe obesity (BMI > 35 kg/m2) were studied 2 weeks before and 6 months after a vertical sleeve gastrectomy (VSG, n = 32) or a Roux-en-Y gastric bypass (RYGB, n = 12). Linoleic acid (LA) and sucrose perception thresholds were determined using the three-alternative forced-choice procedure, gut hormones were assayed before and after a test meal and subjective changes in oral food sensations were self-reported using a standardized questionnaire. Despite a global positive effect of both surgeries on the reported gustatory sensations, a change in the taste sensitivity was only found after RYGB for LA. However, the fat and sweet taste perceptions were not homogenous between patients who underwent the same surgery procedure, suggesting the existence of two subgroups: patients with and without taste improvement. These gustatory changes were not correlated to the surgery-mediated modifications of the main gut appetite-regulating hormones. Collectively these data highlight the complexity of relationships between bariatric surgery and taste sensitivity and suggest that VSG and RYGB might impact the fatty taste perception differently.
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Affiliation(s)
- Arnaud Bernard
- UMR Lipides/Nutrition/Cancer 1231 INSERM/AgroSup Dijon/Univ. Bourgogne-Franche Comté, 21000 Dijon, France;
| | - Johanne Le Beyec-Le Bihan
- UF de Génétique de l’Obésité et des Dyslipidémies, Service de Biochimie Endocrinienne et Oncologique, Centre de Génétique Moléculaire et Chromosomique, Groupe Hospitalier Pitié-Salpêtrière (APHP), 75013 Paris, France;
- Fonctions Gastro-Intestinales, Métaboliques et Physiopathologies Nutritionnelles Inserm UMR1149, Centre de Recherche sur l’Inflammation Paris Montmartre, 75018 Paris, France
| | - Loredana Radoi
- Service d’odontologie, Hôpital Louis Mourier (APHP), 92700 Colombes, France;
| | - Muriel Coupaye
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
| | - Ouidad Sami
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
| | - Nathalie Casanova
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
| | | | - Xavier Collet
- UMR 1048 INSERM/Toulouse III, 31400 Toulouse, France;
| | | | | | - Philippe Besnard
- UMR Lipides/Nutrition/Cancer 1231 INSERM/AgroSup Dijon/Univ. Bourgogne-Franche Comté, 21000 Dijon, France;
- Physiologie de la Nutrition, Agrosup Dijon, 26, Bd Dr Petitjean, 21000 Dijon, France
| | - Séverine Ledoux
- Fonctions Gastro-Intestinales, Métaboliques et Physiopathologies Nutritionnelles Inserm UMR1149, Centre de Recherche sur l’Inflammation Paris Montmartre, 75018 Paris, France
- Explorations Fonctionnelles, Hôpital Louis Mourier (APHP), Université de Paris, 92700 Colombes, France; (M.C.); (O.S.); (N.C.)
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13
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Stefura T, Zapała B, Stój A, Gosiewski T, Skomarovska O, Krzysztofik M, Pędziwiatr M, Major P. Does Postoperative Oral and Intestinal Microbiota Correlate with the Weight-Loss Following Bariatric Surgery?-A Cohort Study. J Clin Med 2020; 9:jcm9123863. [PMID: 33261125 PMCID: PMC7761068 DOI: 10.3390/jcm9123863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 12/23/2022] Open
Abstract
The composition of the gastrointestinal microbiota is associated with obesity. The aim of this study was to verify if, six months after bariatric surgery, patients who achieve satisfying weight-loss after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have a different composition of oral and intestinal microbiota in comparison with those who do not. This prospective cohort study was conducted between November 2018 and November 2020. Participants underwent either SG or RYGB and were allocated into: Group 1—participants who achieved a percentage of excess weight loss (%EWL) of ≥ 50%, and Group 2—patients with %EWL of < 50%. The %EWL was measured 6 months following surgery. At this time, oral swabs were obtained and stool samples were provided. The endpoint was the composition of the gut microbiota. Group 1 comprised 20 participants and Group 2 comprised 11 participants. Group 1 had oral microbiota more abundant in phylum Fusobacteria and intestinal microbiota more abundant in phylum Firmicutes. Group 2 had oral microbiota was more enriched in phylum Actinobacteria and intestinal microbiota was more enriched in phylum Bacteroidetes. The compositions of the microbiota of the oral cavity and large intestine 6 months after bariatric surgery are related to the weight-loss.
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Affiliation(s)
- Tomasz Stefura
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland; (T.S.); (O.S.); (M.K.); (M.P.)
| | - Barbara Zapała
- Department of Clinical Biochemistry, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Cracow, Poland;
| | - Anastazja Stój
- Department of Hematology Diagnostics, The University Hospital, 30-688 Cracow, Poland;
| | - Tomasz Gosiewski
- Department of Microbiology, Faculty of Medicine, Division of Molecular Medical Microbiology, Jagiellonian University Medical College, 33-332 Cracow, Poland;
| | - Oksana Skomarovska
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland; (T.S.); (O.S.); (M.K.); (M.P.)
| | - Marta Krzysztofik
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland; (T.S.); (O.S.); (M.K.); (M.P.)
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland; (T.S.); (O.S.); (M.K.); (M.P.)
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 30-688 Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland; (T.S.); (O.S.); (M.K.); (M.P.)
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 30-688 Cracow, Poland
- Correspondence: ; Tel.: +48-12-400-26-01
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14
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Koliaki C, Liatis S, Dalamaga M, Kokkinos A. The Implication of Gut Hormones in the Regulation of Energy Homeostasis and Their Role in the Pathophysiology of Obesity. Curr Obes Rep 2020; 9:255-271. [PMID: 32647952 DOI: 10.1007/s13679-020-00396-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review provides an update on the role of gut hormones and their interactions in the regulation of energy homeostasis, describes gut hormone adaptations in obesity and in response to weight loss, and summarizes the current evidence on the role of gut hormone-based therapies for obesity treatment. RECENT FINDINGS Gut hormones play a key role in regulating eating behaviour, energy and glucose homeostasis. Dysregulated gut hormone responses have been proposed to be pathogenetically involved in the development and perpetuation of obesity. Summarizing the major gut hormone changes in obesity, obese individuals are characterized by blunted postprandial ghrelin suppression, loss of premeal ghrelin peaks, impaired diurnal ghrelin variability and reduced fasting and postprandial levels of anorexigenic peptides. Adaptive alterations of gut hormone levels are implicated in weight regain, thus complicating hypocaloric dietary interventions, and can further explain the profound weight loss and metabolic improvement following bariatric surgery. A plethora of compounds mimicking gut hormone changes after bariatric surgery are currently under investigation, introducing a new era in the pharmacotherapy of obesity. The current trend is to combine different gut hormone receptor agonists and target multiple systems simultaneously, in order to replicate as closely as possible the gut hormone milieu after bariatric surgery and circumvent the counter-regulatory adaptive changes associated with dietary energy restriction. An increasing number of preclinical and early-phase clinical trials reveal the additive benefits obtained with dual or triple gut peptide receptor agonists in reducing body weight and improving glycaemia. Gut hormones act as potent regulators of energy and glucose homeostasis. Therapeutic strategies targeting their levels or receptors emerge as a promising approach to treat patients with obesity and hyperglycaemia.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece.
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
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15
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Rohde K, Schamarek I, Blüher M. Consequences of Obesity on the Sense of Taste: Taste Buds as Treatment Targets? Diabetes Metab J 2020; 44:509-528. [PMID: 32431111 PMCID: PMC7453985 DOI: 10.4093/dmj.2020.0058] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Premature obesity-related mortality is caused by cardiovascular and pulmonary diseases, type 2 diabetes mellitus, physical disabilities, osteoarthritis, and certain types of cancer. Obesity is caused by a positive energy balance due to hyper-caloric nutrition, low physical activity, and energy expenditure. Overeating is partially driven by impaired homeostatic feedback of the peripheral energy status in obesity. However, food with its different qualities is a key driver for the reward driven hedonic feeding with tremendous consequences on calorie consumption. In addition to visual and olfactory cues, taste buds of the oral cavity process the earliest signals which affect the regulation of food intake, appetite and satiety. Therefore, taste buds may play a crucial role how food related signals are transmitted to the brain, particularly in priming the body for digestion during the cephalic phase. Indeed, obesity development is associated with a significant reduction in taste buds. Impaired taste bud sensitivity may play a causal role in the pathophysiology of obesity in children and adolescents. In addition, genetic variation in taste receptors has been linked to body weight regulation. This review discusses the importance of taste buds as contributing factors in the development of obesity and how obesity may affect the sense of taste, alterations in food preferences and eating behavior.
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Affiliation(s)
- Kerstin Rohde
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany.
| | - Imke Schamarek
- Medical Department III (Endocrinology, Nephrology and Rheumatology), University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany.
- Medical Department III (Endocrinology, Nephrology and Rheumatology), University of Leipzig, Leipzig, Germany
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16
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Paulus GF, van Avesaat M, Crijnen JAW, Ernest van Heurn LW, Westerterp-Plantenga MS, Bouvy ND. Preliminary evidence that endoscopic gastroplication reduces food reward. Appetite 2020; 150:104632. [PMID: 32070711 DOI: 10.1016/j.appet.2020.104632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 01/13/2023]
Abstract
Morbidly obese patients are most successfully treated with bariatric surgery. Although restrictive gastric surgery physically limits food intake, it is also suggested that eating behavior and food-reward mechanisms are affected. Therefore, eating behavior and food-reward were assessed in ten patients that underwent gastric volume reduction by endoscopic gastroplication. Patients participated in test days before and one, three and twelve months after the procedure. Weight loss, food intake, appetite, gastric emptying rate, food-reward (i.e. liking and wanting) and eating behavior were assessed. Body mass index decreased from 38.3 (37.6-42.6) to 33.9 (31.0-35.9) kg/m2 after one year. Ad libitum food intake decreased significantly after one month, but not after one year. Gastric emptying rate did not change. AUC of VAS scores for desire to eat, quantity, fullness, hunger, snacking and satiety changed after one month, but not all remained significantly changed after one year. Thirst did not change. Liking scores of food items decreased significantly in the fasted as well as the satiated state after the procedure. Wanting scores did not change. Uncontrolled eating decreased significantly after three and twelve months; emotional eating was only significantly decreased after three months. The results show that food intake decreases, while VAS scores for appetite and eating behavior change accordingly. Liking, but not wanting of food items changed to benefit the weight losing patient. The effects were stronger at one-month follow-up than at 12 months, which may be a risk of relapse after initial successful weight loss. The effects of new bariatric procedures on food-reward should be studied in future randomized trials to further elucidate their impact. REGISTERED AT CLINICALTRIALS. GOV: NCT02381340.
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Affiliation(s)
- Givan F Paulus
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, the Netherlands.
| | - Mark van Avesaat
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, the Netherlands; TIFN, Maastricht University, the Netherlands
| | - Jasper A W Crijnen
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, the Netherlands
| | - L W Ernest van Heurn
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, the Netherlands
| | | | - Nicole D Bouvy
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, the Netherlands
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17
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Neuroimaging of Sex/Gender Differences in Obesity: A Review of Structure, Function, and Neurotransmission. Nutrients 2020; 12:nu12071942. [PMID: 32629783 PMCID: PMC7400469 DOI: 10.3390/nu12071942] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
While the global prevalence of obesity has risen among both men and women over the past 40 years, obesity has consistently been more prevalent among women relative to men. Neuroimaging studies have highlighted several potential mechanisms underlying an individual’s propensity to become obese, including sex/gender differences. Obesity has been associated with structural, functional, and chemical alterations throughout the brain. Whereas changes in somatosensory regions appear to be associated with obesity in men, reward regions appear to have greater involvement in obesity among women than men. Sex/gender differences have also been observed in the neural response to taste among people with obesity. A more thorough understanding of these neural and behavioral differences will allow for more tailored interventions, including diet suggestions, for the prevention and treatment of obesity.
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18
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Makaronidis JM, Batterham RL. The role of gut hormones in the pathogenesis and management of obesity. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Wallenius V, Dirinck E, Fändriks L, Maleckas A, le Roux CW, Thorell A. Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus. Obes Surg 2019; 28:1461-1472. [PMID: 29264780 PMCID: PMC5973990 DOI: 10.1007/s11695-017-3061-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG. Methods Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery. Results Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline—8.1 ± 0.6 vs. 8.2 ± 0.4 mmol/l, 2 days—7.8 ± 0.5 vs. 7.4 ± 0.3 mmol/l, 3 weeks—6.6 ± 0.4 vs. 6.6 ± 0.3 mmol/l, respectively, P < 0.01 vs. baseline for both groups; 12 months—6.6 ± 0.4 vs. 5.9 ± 0.4, respectively, P < 0.05 for LRYGB and P < 0.001 for LSG vs. baseline, P = ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean ± SEM; LSG + 58 ± 14%, P < 0.01; LRYGB − 8 ± 17%, P = ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525 ± 1258 vs. 4779 ± 712 pmol × min, respectively, P < 0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (− 10.1 ± 0.9 vs. − 7.9 ± 0.5 kg/m2, respectively, P < 0.05). Conclusion LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG. Electronic supplementary material The online version of this article (10.1007/s11695-017-3061-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ville Wallenius
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Eveline Dirinck
- Department of Endocrinology, Diabetology, and Metabolism, University of Antwerp, Antwerp, Belgium
| | - Lars Fändriks
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Almantas Maleckas
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Carel W le Roux
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Diabetes Complications Research Centre, Conway Institute, University College of Dublin, Dublin, Ireland
| | - Anders Thorell
- Department of Clinical Science at Danderyd Hospital, Karolinska Institutet and Department of Surgery, Ersta Hospital, Stockholm, Sweden
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20
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Björklund P, Fändriks L. The pros and cons of gastric bypass surgery - The role of the Roux-limb. Best Pract Res Clin Gastroenterol 2019; 40-41:101638. [PMID: 31594646 DOI: 10.1016/j.bpg.2019.101638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/18/2019] [Indexed: 01/31/2023]
Abstract
The prevalence of overweight and obesity has exploded in the post-industrial era. Life style interventions like dieting and exercise can induce a marked weight loss, but the main problem for most patients is to maintain the reduced body weight over time. Gastric bypass surgery is a commonly performed and very effective method for achieving a pronounced and sustained weight loss including metabolic improvements in obese patients. Despite the therapeutic successfulness there are known side-effects like chronic postprandial nausea and pain that in some patients become intractable. The pathophysiology is complex and partly unexplored. The physician or surgeon handling a patient with "post-bariatric symptoms" must be aware of the risk for symptom aggravations due to iatrogenic opioid-associated intestinal dysmotility. The present paper gives a brief overview of obesity surgery and its associated postsurgical conditions with a focus on the unexplored role of the Roux-limb following gastric bypass surgery.
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Affiliation(s)
- Per Björklund
- Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
| | - Lars Fändriks
- Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
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Abstract
Bariatric surgery candidates often report problematic and/or eating disordered behaviors. For most patients, these eating behaviors improve after surgery. A subset, however, experience a recurrence or new onset of problematic eating behaviors as early as 2 months to 18 months after surgery, which can result in compromised weight loss/excessive weight regain. Those most at risk are individuals with comorbid psychopathology (ie, loss-of-control eating or depression) after surgery. For some, such problems are present before surgery. Therefore, it is critical to monitor patients closely after surgery so that appropriate psychiatric treatments can be provided if indicated.
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Affiliation(s)
- Cassie S Brode
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV 26505, USA.
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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Yan Y, Sha Y, Huang X, Yuan W, Wu F, Hong J, Fang S, Huang B, Hu C, Wang B, Zhang X. Roux-en-Y Gastric Bypass Improves Metabolic Conditions in Association with Increased Serum Bile Acids Level and Hepatic Farnesoid X Receptor Expression in a T2DM Rat Model. Obes Surg 2019; 29:2912-2922. [DOI: 10.1007/s11695-019-03918-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Associations between Weight Loss, Food Likes, Dietary Behaviors, and Chemosensory Function in Bariatric Surgery: A Case-Control Analysis in Women. Nutrients 2019; 11:nu11040804. [PMID: 30970617 PMCID: PMC6521240 DOI: 10.3390/nu11040804] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022] Open
Abstract
We tested the hypothesis that successful weight loss post-bariatric surgery would be associated with healthier chemosensory function, food likes, and dietary behaviors than either unsuccessful weight loss or pre-surgery morbid obesity. In a case-control design, pre-surgical women with morbid obesity (n = 49) were compared with those 1-year post-surgery (24 Roux-en-Y Bypass, 24 Sleeve Gastrectomy) and defined by excess or percent weight loss as successful/unsuccessful. For self-reported smell/taste perception, more post-surgery than pre-surgery reported improved/distorted perception, especially if weight loss successful. Measured taste function (perceived quinine and NaCl intensity) was lower among weight loss unsuccessful versus pre-surgery patients, yet a genetic variation in taste probe (propylthiouracil bitterness) matched expected frequencies without significant pre/post-surgery difference. Regarding survey-reported liking, higher diet quality was seen in the weight loss successful (independent of surgery type) versus pre-surgical patients, with differences driven by lower sweet and refined carbohydrate liking. The post versus pre-surgical patients had greater restraint but less hunger and disinhibition. Patients reporting both higher diet quality and lower hunger showed greater % weight loss, independent of surgery type. Thus, successful weight loss 1-year post-bariatric surgery was associated with improved or distorted chemosensation and patterns of liking associated with healthier diets, especially if coupled with less hunger.
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Zoghbi M, Stone A, Papsavas P, Swede H, Hubert P, Tisher D, Duffy VB. Evaluating Taste Preferences and Dietary Quality with a Simple Liking Survey: Application in Bariatric Treatment Settings. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2017.0049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marina Zoghbi
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Andrea Stone
- Department of Surgery, Hartford Hospital, Hartford, Connecticut
| | - Pavlos Papsavas
- Department of Surgery, Hartford Hospital, Hartford, Connecticut
| | - Helen Swede
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington, Connecticut
| | - Patrice Hubert
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Darren Tisher
- Department of Surgery, Hartford Hospital, Hartford, Connecticut
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
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Flølo TN, Tell GS, Kolotkin RL, Aasprang A, Norekvål TM, Våge V, Andersen JR. Eating self-efficacy as predictor of long-term weight loss and obesity-specific quality of life after sleeve gastrectomy: A prospective cohort study. Surg Obes Relat Dis 2019; 15:161-167. [PMID: 30709748 DOI: 10.1016/j.soard.2018.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND A person's confidence to control eating, eating self-efficacy (ESE), has been identified as a target for long-term weight management in nonsurgical weight loss interventions, but has to a limited extent been studied after bariatric surgery. OBJECTIVE We investigated the association between ESE, weight loss, and obesity-specific quality of life (QOL) after sleeve gastrectomy (SG). SETTING A single-center longitudinal study. METHODS Data from adult patients were collected before SG, and at mean 16 months (±standard deviation 4 mo) and 55 (±4) months postoperatively. ESE was measured by the Weight Efficacy Lifestyle Questionnaire Short-Form. Multiple regression analyses were performed with excess body mass index loss (%EBMIL) and obesity-specific QOL as dependent variables. Age, sex, and other preoperative values were covariates in all models. RESULTS Of 114 preoperative patients, 91 (80%) and 84 (74%) were available for follow-up 16 and 55 months after SG, respectively. Mean %EBMIL from baseline to 16 and 55 months was 76% (95% confidence interval: 71.9, 79.6) and 67% (95% confidence interval: 61.9, 72.2), respectively. Preoperative ESE scores improved significantly at both 16 and 55 months (P = .002) but did not predict postoperative %EBMIL or QOL at 55 months (β = -.08, P = .485). Greater change in ESE from 0 to 16 months predicted higher %EBMIL (β = .34, P = .013) at 55 months, and improvements in ESE from 0 to 55 months were significantly associated with higher %EBMIL (β = .46, P = .001) and obesity-specific QOL (β = .50, P < .001) 55 months after SG. CONCLUSION Significant improvements in ESE were seen at 16 months, and remained high at 55 months after SG in this cohort. Patients who improved their ESE the most also experienced the highest weight loss and obesity-specific QOL 5 years postoperatively. Future research should address whether enhancement of ESE corresponds to sustained improvements in eating behavior after bariatric surgery.
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Affiliation(s)
- Tone Nygaard Flølo
- Department of Surgery, Voss Hospital, Haukeland University Hospital, Voss, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ronette L Kolotkin
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway; Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Anny Aasprang
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Tone M Norekvål
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway; Department of Heart Diseases, Haukeland University Hospital, Bergen, Norway
| | - Villy Våge
- Department of Surgery, Haraldsplass Diaconal Hospital, Bergen, Norway; Scandinavian Obesity Surgery Registry (SOReg-N), The Western Norway Health Region Authority, Bergen, Norway
| | - John R Andersen
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway
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Pucci A, Batterham RL. Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different. J Endocrinol Invest 2019; 42:117-128. [PMID: 29730732 PMCID: PMC6394763 DOI: 10.1007/s40618-018-0892-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 12/12/2022]
Abstract
The worldwide obesity epidemic continues unabated, adversely impacting upon global health and economies. People with severe obesity suffer the greatest adverse health consequences with reduced life expectancy. Currently, bariatric surgery is the most effective treatment for people with severe obesity, resulting in marked sustained weight loss, improved obesity-associated comorbidities and reduced mortality. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), the most common bariatric procedures undertaken globally, engender weight loss and metabolic improvements by mechanisms other than restriction and malabsorption. It is now clear that a plethora of gastrointestinal (GI) tract-derived signals plays a critical role in energy and glucose regulation. SG and RYGB, which alter GI anatomy and nutrient flow, impact upon these GI signals ultimately leading to weight loss and metabolic improvements. However, whilst highly effective overall, at individual level, post-operative outcomes are highly variable, with a proportion of patients experiencing poor long-term weight loss outcome and gaining little health benefit. RYGB and SG are markedly different anatomically and thus differentially impact upon GI signalling and bodyweight regulation. Here, we review the mechanisms proposed to cause weight loss following RYGB and SG. We highlight similarities and differences between these two procedures with a focus on gut hormones, bile acids and gut microbiota. A greater understanding of these procedure-related mechanisms will allow surgical procedure choice to be tailored to the individual to maximise post-surgery health outcomes and will facilitate the discovery of non-surgical treatments for people with obesity.
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Affiliation(s)
- A Pucci
- Centre for Obesity Research, Rayne Institute, University College London, London, UK
- Centre for Weight Management and Metabolic Surgery, University College London Hospital Bariatric, London, UK
| | - R L Batterham
- Centre for Obesity Research, Rayne Institute, University College London, London, UK.
- Centre for Weight Management and Metabolic Surgery, University College London Hospital Bariatric, London, UK.
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK.
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28
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Macumber IR. Improving kidney disease in obese adolescents: a surgical approach. Kidney Int 2018; 91:279-281. [PMID: 28087009 DOI: 10.1016/j.kint.2016.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022]
Abstract
Obesity has been associated with chronic kidney disease in adult studies, but little data exist in pediatrics. Nehus et al. offer the first study to show that bariatric surgery in severely obese adolescents is associated with improved renal outcomes. Despite limitations, this study provided compelling evidence that aggressive weight loss intervention can improve renal outcomes in young, severely obese subjects. Further investigation is required to determine mechanisms by which this may occur.
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Affiliation(s)
- Ian R Macumber
- Division of Nephrology, Children's Hospital of Los Angeles, Los Angeles, California, USA.
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29
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Lynch AI, Reznar MM, Zalesin KC, Bohn D. To Keep Myself on Track: The Impact of Dietary and Weight Monitoring Behaviors on Weight Loss After Bariatric Surgery. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amanda I. Lynch
- Department of Interdisciplinary Health Sciences, School of Health Sciences, Oakland University, Rochester, Michigan
| | - Melissa M. Reznar
- Department of Interdisciplinary Health Sciences, School of Health Sciences, Oakland University, Rochester, Michigan
| | - Kerstyn C. Zalesin
- Weight Control Center, Beaumont Health and Wellness Center, William Beaumont Hospital, Royal Oak, Michigan
| | - Danielle Bohn
- Department of Wellness and Health Promotion, School of Health Sciences, Oakland University, Rochester, Michigan
- Health Behavior and Health Education, Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan
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Brown A, Guess N, Dornhorst A, Taheri S, Frost G. Insulin-associated weight gain in obese type 2 diabetes mellitus patients: What can be done? Diabetes Obes Metab 2017; 19:1655-1668. [PMID: 28509408 DOI: 10.1111/dom.13009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
Abstract
Insulin therapy (IT) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT, which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin-associated weight gain (IAWG) is reported to occur in the first year of initiating IT, predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch-up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co-morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT, that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG, and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.
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Affiliation(s)
- Adrian Brown
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
| | - Nicola Guess
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
- Division of Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Anne Dornhorst
- Department of Metabolic Medicine, Imperial College London, London, UK
| | - Shahrad Taheri
- Department of Metabolic Medicine, Imperial College London, London, UK
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine, New York, New York
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine, Doha, Qatar
| | - Gary Frost
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
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Clemmensen C, Müller TD, Woods SC, Berthoud HR, Seeley RJ, Tschöp MH. Gut-Brain Cross-Talk in Metabolic Control. Cell 2017; 168:758-774. [PMID: 28235194 DOI: 10.1016/j.cell.2017.01.025] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/19/2016] [Accepted: 01/23/2017] [Indexed: 12/15/2022]
Abstract
Because human energy metabolism evolved to favor adiposity over leanness, the availability of palatable, easily attainable, and calorically dense foods has led to unprecedented levels of obesity and its associated metabolic co-morbidities that appear resistant to traditional lifestyle interventions. However, recent progress identifying the molecular signaling pathways through which the brain and the gastrointestinal system communicate to govern energy homeostasis, combined with emerging insights on the molecular mechanisms underlying successful bariatric surgery, gives reason to be optimistic that novel precision medicines that mimic, enhance, and/or modulate gut-brain signaling can have unprecedented potential for stopping the obesity and type 2 diabetes pandemics.
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Affiliation(s)
- Christoffer Clemmensen
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center & German Center for Diabetes Research (DZD), Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany; Division of Metabolic Diseases, Department of Medicine, Technische Universität München, 80333 Munich, Germany
| | - Timo D Müller
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center & German Center for Diabetes Research (DZD), Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany; Division of Metabolic Diseases, Department of Medicine, Technische Universität München, 80333 Munich, Germany
| | - Stephen C Woods
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH 45220, USA
| | - Hans-Rudolf Berthoud
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70803, USA
| | - Randy J Seeley
- Departments of Surgery, Internal Medicine, and Nutritional Sciences at the University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthias H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center & German Center for Diabetes Research (DZD), Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), 85764 Neuherberg, Germany; Division of Metabolic Diseases, Department of Medicine, Technische Universität München, 80333 Munich, Germany.
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Eligibility and Success Criteria for Bariatric/Metabolic Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:529-543. [PMID: 28585215 DOI: 10.1007/978-3-319-48382-5_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obesity is a worldwide main health concern, with a high treatment failure. This chapter focuses on the definition of obesity, based on excessive fat accumulation and thus underscores the importance of body composition, and the clinical tools currently used to diagnose it, mainly body mass index that is only a proxy measure of body composition. It also highlights the importance of the personal commitment to comply to a healthy diet and physical activity recommendations since surgery is most effective when accompanied by lifestyle modifications. Additionally, it addresses the description of types of patients who could benefit most from surgical management of excessive body fat percentage and metabolic derangements, as well as on the indications for surgery that are currently valid.
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Changes in Non-Diabetic Comorbid Disease Status Following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) Procedures: a Systematic Review of Randomized Controlled Trials. Obes Surg 2016; 27:1208-1221. [DOI: 10.1007/s11695-016-2469-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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