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首页> 外文期刊>Gut: Journal of the British Society of Gastroenterology >Obese patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding
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Obese patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding

机译：胃旁路手术后的肥胖患者对食物的脑享乐反应较胃束扎后低

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摘要

Objectives: Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations. Design: We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity. Results: Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients. Conclusions: The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gut-brain axis in the control of reward-based eating behaviour.
机译：目的：Roux-en-Y胃旁路术（RYGB）对肥胖患者的减肥作用比胃束带术（BAND）手术更大。我们假设这可能是由于继不同肠道解剖学操作后发生的生理变化对食物享乐的不同影响所致。设计：我们使用功能性MRI，进食行为和激素表型来比较体重指数（BMI）匹配的未手术对照以及RYGB和BAND手术后肥胖的患者。结果：RYGB后的肥胖患者对食物的脑享乐反应低于BAND手术后的患者。在大脑奖励系统中，RYGB患者的激活率低于BAND患者，特别是对于高热量食物，包括眶额皮质，杏仁核，尾状核，伏隔核和海马体。与BAND患者和/或BMI匹配的未手术对照相比，RYGB与RYGB的适口性和低热量，高热量食品的吸引力以及更健康的饮食行为（包括更少的脂肪摄入）相关。这些差异不能通过手术组之间的饥饿或心理特征差异来解释，但RYGB患者的食欲异常血浆肠道激素（GLP-1和PYY），血浆胆汁酸和倾倒综合征症状增加。结论：鉴定出由于肠道解剖结构/生理改变而导致的食物享乐反应的这些差异，为RYGB术后较BAND术后长期体重减轻提供了新的解释，突显了肠脑轴的重要性控制基于奖励的饮食行为。

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