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Saavedra JM, Lefferts EC, Song BK, Lee DC. The associations of daily steps and body mass index with incident gastroesophageal reflux disease in older adults. Front Sports Act Living 2024; 6:1384845. [PMID: 38645729 PMCID: PMC11026570 DOI: 10.3389/fspor.2024.1384845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Background High body mass index (BMI) is a major risk factor of gastroesophageal reflux disease (GERD), a prevalent morbidity of older adulthood linked to lower quality of life and an increased risk of esophageal cancers. Daily stepping behavior, the most common physical activity of older adulthood, is associated with an array of favorable health outcomes, sometimes independent of high BMI. Whether stepping behavior is associated with the incidence of GERD independently or in combination with BMI is currently unclear. Materials and methods We followed 442 individuals (58.4% female) aged 65-91 years enrolled in the Physical Activity and Aging Study. Baseline steps were obtained by pedometer and categorized by tertiles (lower, middle, upper), while BMI was categorized into normal weight, overweight, and obesity. To explore joint associations, daily steps were dichotomized into "high steps" (middle/upper tertiles) and "low steps" (lower tertile), while BMI was dichotomized into normal weight and overweight/obesity. The joint exposure categories included "low steps and overweight/obesity," "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight." Results We identified 35 (7.9%) cases of GERD over a mean follow-up of 2.5 years. Compared to the lower tertile of steps, the hazard ratios (HRs) [95% confidence intervals (95% CIs)] of GERD were 0.44 (0.20-0.96) and 0.17 (0.05-0.54) for the middle and upper tertiles, respectively, after adjusting for confounders (including BMI). Compared to normal weight, the HRs (95% CIs) of GERD were 1.35 (0.54-3.37) and 3.00 (1.19-7.55) for overweight and obesity, respectively, after adjusting for confounders (including steps). In a joint analysis, compared to "low steps and overweight/obesity," the HRs (95% CIs) of GERD were 0.32 (0.10-1.00), 0.23 (0.10-0.54), and 0.20 (0.07-0.58) for "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight," respectively. Conclusion Higher daily steps were associated with a lower risk of GERD in older adults, independent of BMI. Since accumulating steps through walking is an achievable and acceptable modality of physical activity in older adulthood, future lifestyle interventions designed to achieve high daily steps counts may have favorable implications for the development of GERD in older adults of any BMI status.
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Affiliation(s)
- Joey M. Saavedra
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | | | - Bong Kil Song
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Duck-chul Lee
- Department of Kinesiology, Iowa State University, Ames, IA, United States
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2
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Alemany M. The Metabolic Syndrome, a Human Disease. Int J Mol Sci 2024; 25:2251. [PMID: 38396928 PMCID: PMC10888680 DOI: 10.3390/ijms25042251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
This review focuses on the question of metabolic syndrome (MS) being a complex, but essentially monophyletic, galaxy of associated diseases/disorders, or just a syndrome of related but rather independent pathologies. The human nature of MS (its exceptionality in Nature and its close interdependence with human action and evolution) is presented and discussed. The text also describes the close interdependence of its components, with special emphasis on the description of their interrelations (including their syndromic development and recruitment), as well as their consequences upon energy handling and partition. The main theories on MS's origin and development are presented in relation to hepatic steatosis, type 2 diabetes, and obesity, but encompass most of the MS components described so far. The differential effects of sex and its biological consequences are considered under the light of human social needs and evolution, which are also directly related to MS epidemiology, severity, and relations with senescence. The triggering and maintenance factors of MS are discussed, with especial emphasis on inflammation, a complex process affecting different levels of organization and which is a critical element for MS development. Inflammation is also related to the operation of connective tissue (including the adipose organ) and the widely studied and acknowledged influence of diet. The role of diet composition, including the transcendence of the anaplerotic maintenance of the Krebs cycle from dietary amino acid supply (and its timing), is developed in the context of testosterone and β-estradiol control of the insulin-glycaemia hepatic core system of carbohydrate-triacylglycerol energy handling. The high probability of MS acting as a unique complex biological control system (essentially monophyletic) is presented, together with additional perspectives/considerations on the treatment of this 'very' human disease.
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Affiliation(s)
- Marià Alemany
- Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain
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3
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Portincasa P, Bonfrate L, Wang DQH, Frühbeck G, Garruti G, Di Ciaula A. Novel insights into the pathogenic impact of diabetes on the gastrointestinal tract. Eur J Clin Invest 2022; 52:e13846. [PMID: 35904418 DOI: 10.1111/eci.13846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
Type 2 and type 1 diabetes are common endocrine disorders with a progressively increasing incidence worldwide. These chronic, systemic diseases have multiorgan implications, and the whole gastrointestinal (GI) tract represents a frequent target in terms of symptom appearance and interdependent pathophysiological mechanisms. Metabolic alterations linked with diabetic complications, neuropathy and disrupted hormone homeostasis can lead to upper and/or lower GI symptoms in up to 75% of diabetic patients, with multifactorial involvement of the oesophagus, stomach, upper and lower intestine, and of the gallbladder. On the other hand, altered gastrointestinal motility and/or secretions are able to affect glucose and lipid homeostasis in the short and long term. Finally, diabetes has been linked with increased cancer risk at different levels of the GI tract. The presence of GI symptoms and a comprehensive assessment of GI function should be carefully considered in the management of diabetic patients to avoid further complications and to ameliorate the quality of life. Additionally, the presence of gastrointestinal dysfunction should be adequately managed to improve metabolic homeostasis, the efficacy of antidiabetic treatments and secondary prevention strategies.
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Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - David Q-H Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gema Frühbeck
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Gabriella Garruti
- Department of Emergency and Organ Transplants, Unit of Endocrinology, University of Bari Medical School, Bari, Italy
| | - Agostino Di Ciaula
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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4
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Molecular Mechanisms and Health Benefits of Ghrelin: A Narrative Review. Nutrients 2022; 14:nu14194191. [PMID: 36235843 PMCID: PMC9572668 DOI: 10.3390/nu14194191] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
Ghrelin, an endogenous brain-gut peptide, is secreted in large quantities, mainly from the stomach, in humans and rodents. It can perform the biological function of activating the growth hormone secretagogue receptor (GHSR). Since its discovery in 1999, ample research has focused on promoting its effects on the human appetite and pleasure-reward eating. Extensive, in-depth studies have shown that ghrelin is widely secreted and distributed in tissues. Its role in neurohumoral regulation, such as metabolic homeostasis, inflammation, cardiovascular regulation, anxiety and depression, and advanced cancer cachexia, has attracted increasing attention. However, the effects and regulatory mechanisms of ghrelin on obesity, gastrointestinal (GI) inflammation, cardiovascular disease, stress regulation, cachexia treatment, and the prognosis of advanced cancer have not been fully summarized. This review summarizes ghrelin's numerous effects in participating in a variety of biochemical pathways and the clinical significance of ghrelin in the regulation of the homeostasis of organisms. In addition, potential mechanisms are also introduced.
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von Gerichten J, Elnesr MH, Prollins JE, De Mel IA, Flanagan A, Johnston JD, Fielding BA, Short M. The [ 13 C]octanoic acid breath test for gastric emptying quantification: A focus on nutrition and modeling. Lipids 2022; 57:205-219. [PMID: 35799422 PMCID: PMC9546385 DOI: 10.1002/lipd.12352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Gastric emptying (GE) is the process of food being processed by the stomach and delivered to the small intestine where nutrients such as lipids are absorbed into the blood circulation. The combination of an easy and inexpensive method to measure GE such as the CO2 breath test using the stable isotope [13C]octanoic acid with semi‐mechanistic modeling could foster a wider application in nutritional studies to further understand the metabolic response to food. Here, we discuss the use of the [13C]octanoic acid breath test to label the solid phase of a meal, and the factors that influence GE to support mechanistic studies. Furthermore, we give an overview of existing mathematical models for the interpretation of the breath test data and how much nutritional studies could benefit from a physiological based pharmacokinetic model approach.
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Affiliation(s)
- Johanna von Gerichten
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Marwan H Elnesr
- Department of Chemical and Process Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Joe E Prollins
- Department of Chemical and Process Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Ishanki A De Mel
- Department of Chemical and Process Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Alan Flanagan
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.,Section of Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Jonathan D Johnston
- Section of Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Barbara A Fielding
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Michael Short
- Department of Chemical and Process Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
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Gonzalez-Izundegui D, Campos A, Calderon G, Ricardo-Silgado ML, Cifuentes L, Decker PA, Vargas EJ, Tran L, Burton D, Dayyeh BA, Camilleri M, Eckel-Passow JE, Acosta A. Association of gastric emptying with postprandial appetite and satiety sensations in obesity. Obesity (Silver Spring) 2021; 29:1497-1507. [PMID: 34313001 PMCID: PMC8722357 DOI: 10.1002/oby.23204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Satiety, defined as the duration of the sensation of fullness, is usually measured by validated visual analog scales (VAS) for appetite. Gastric function plays a key role in food intake regulation. However, the association between gastric emptying (GE) and VAS appetite is unknown. METHODS In this cross-sectional study, 134 participants (mean [SEM] age = 39 [0.8] years, mean [SEM] BMI = 38 [0.5] kg/m2 , 67% females) completed simultaneous measurements of GE and VAS appetite. After a 320-kcal meal, GE was measured by scintigraphy and appetite by validated 100-mm VAS for 240 minutes. Satiation was defined as calories consumed to terminate meal and was measured by an ad libitum meal. GE, VAS, and ad libitum meal tests were measured on the same day. Percent of meal retention in the stomach, VAS area under curve (AUC0-240 min ), and overall appetite score (OAS) were calculated. Pearson correlation (ρ) determined the association of GE with VAS appetite and satiation. Appetite components were also analyzed by quartiles based on GE120 min . RESULTS GE120 min was correlated with sensation of VAS hungerAUC(0-240 min) (ρ = 0.24, p = 0.004), fullnessAUC(0-240 min) (ρ = 0.16, p = 0.05), and OASAUC(0-240 min) (ρ = 0.20, p = 0.02). Patients with rapid GE120 min had a mean increase in VAS hungerAUC(0-240 min) by 32 mm/min (15.62%, p = 0.03) compared with normal/slow GE120 min . CONCLUSIONS GE is associated with the sensations of appetite, and rapid GE is associated with increased appetite, which may contribute to weight gain.
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Affiliation(s)
- Daniel Gonzalez-Izundegui
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alejandro Campos
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Gerardo Calderon
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Maria L Ricardo-Silgado
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Paul A. Decker
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Eric J. Vargas
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Linh Tran
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Duane Burton
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Barham Abu Dayyeh
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael Camilleri
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jeanette E. Eckel-Passow
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Andres Acosta
- Precision Medicine for Obesity Program, and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
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Horner KM, Byrne NM, King NA. Effect of Combined Interval and Continuous Exercise Training on Gastric Emptying, Appetite, and Adaptive Responses in Men With Overweight and Obesity. Front Nutr 2021; 8:654902. [PMID: 34124120 PMCID: PMC8192796 DOI: 10.3389/fnut.2021.654902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background/Objectives: Characterizing compensatory and adaptive responses to exercise assists in understanding changes in energy balance and health outcomes with exercise interventions. This study investigated the effects of a short-term exercise intervention (combining high intensity interval (HII) and continuous exercise) on (1) gastric emptying, appetite and energy intake; and (2) other adaptive responses including cardiorespiratory fitness, in inactive men with overweight/obesity. Methods: Fifteen men (BMI: 29.7 ± 3.3 kg/m-2) completed a 4-wk supervised exercise intervention, consisting of 5 exercise sessions per week alternating between HII (30 s at 100% VO2max followed by 30 s recovery) and continuous (at 50% VO2max) training on a cycle ergometer, progressing from 30 to 45 min session duration. Gastric emptying (13C-octanoic acid breath test), appetite (visual analog scale), energy intake (ad libitum lunch meal), body composition (air displacement plethysmography), non-exercise activity (accelerometery) VO2max, blood pressure, and fasting concentrations of glucose, insulin, and ghrelin were measured before and after (≥48 h) the intervention. Results: Gastric emptying, glucose, insulin and ghrelin were unchanged, but energy intake at the ad libitum lunch test meal significantly increased at post-intervention (+171 ± 116 kcal, p < 0.01). Body weight (-0.9 ± 1.1 kg), waist circumference (-2.3 ± 3.5 cm) and percent body fat (-0.9 ± 1.1%) were modestly reduced (P < 0.05). VO2max increased (+4.4 ± 2.1 ml.kg.min-1) by 13% and systolic (-6.2 ± 8.4 mmHg) and diastolic (-5.8 ± 2.2 mmHg) blood pressure were significantly reduced (P ≤ 0.01 for all). Conclusions: Four weeks of exercise training did not alter gastric emptying, indicating gastric emptying may only adapt to a higher volume/longer duration of exercise or changes in other characteristics associated with regular exercise. The combination of HII and continuous exercise training had beneficial effects on body composition, cardiorespiratory fitness, and blood pressure and warrants further investigation in larger randomized controlled trials.
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Affiliation(s)
- Katy M. Horner
- School of Public Health, Physiotherapy and Sport Sciences, Institute for Sport and Health and Institute of Food and Health, University College Dublin, Dublin, Ireland
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nuala M. Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Neil A. King
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Gastric Sensory and Motor Functions and Energy Intake in Health and Obesity-Therapeutic Implications. Nutrients 2021; 13:nu13041158. [PMID: 33915747 PMCID: PMC8065811 DOI: 10.3390/nu13041158] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 01/19/2023] Open
Abstract
Sensory and motor functions of the stomach, including gastric emptying and accommodation, have significant effects on energy consumption and appetite. Obesity is characterized by energy imbalance; altered gastric functions, such as rapid gastric emptying and large fasting gastric volume in obesity, may result in increased food intake prior to reaching usual fullness and increased appetite. Thus, many different interventions for obesity, including different diets, anti-obesity medications, bariatric endoscopy, and surgery, alter gastric functions and gastrointestinal motility. In this review, we focus on the role of the gastric and intestinal functions in food intake, pathophysiology of obesity, and obesity management.
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Acosta A, Camilleri M, Abu Dayyeh B, Calderon G, Gonzalez D, McRae A, Rossini W, Singh S, Burton D, Clark MM. Selection of Antiobesity Medications Based on Phenotypes Enhances Weight Loss: A Pragmatic Trial in an Obesity Clinic. Obesity (Silver Spring) 2021; 29:662-671. [PMID: 33759389 PMCID: PMC8168710 DOI: 10.1002/oby.23120] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Little is known about the predictors of response to obesity interventions. METHODS In 450 participants with obesity, body composition, resting energy expenditure, satiety, satiation, eating behavior, affect, and physical activity were measured by validated studies and questionnaires. These variables were used to classify obesity phenotypes. Subsequently, in a 12-month, pragmatic, real-world trial performed in a weight management center, 312 patients were randomly assigned to phenotype-guided treatment or non-phenotype-guided treatment with antiobesity medications: phentermine, phentermine/topiramate, bupropion/naltrexone, lorcaserin, and liraglutide. The primary outcome was weight loss at 12 months. RESULTS Four phenotypes of obesity were identified in 383 of 450 participants (85%): hungry brain (abnormal satiation), emotional hunger (hedonic eating), hungry gut (abnormal satiety), and slow burn (decreased metabolic rate). In 15% of participants, no phenotype was identified. Two or more phenotypes were identified in 27% of patients. In the pragmatic clinical trial, the phenotype-guided approach was associated with 1.75-fold greater weight loss after 12 months with mean weight loss of 15.9% compared with 9.0% in the non-phenotype-guided group (difference -6.9% [95% CI -9.4% to -4.5%], P < 0.001), and the proportion of patients who lost >10% at 12 months was 79% in the phenotype-guided group compared with 34% with non-phenotype-guided treatment group. CONCLUSIONS Biological and behavioral phenotypes elucidate human obesity heterogeneity and can be targeted pharmacologically to enhance weight loss.
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Affiliation(s)
- Andres Acosta
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Michael Camilleri
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Barham Abu Dayyeh
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Gerardo Calderon
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Daniel Gonzalez
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Alison McRae
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - William Rossini
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Sneha Singh
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Duane Burton
- Precision Medicine for Obesity ProgramDivision of Gastroenterology and HepatologyDepartment of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Matthew M. Clark
- Department of Psychology and PsychiatryMayo ClinicRochesterMinnesotaUSA
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