Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany.
Department of Internal Medicine IV, University Hospital, Tübingen, Germany German Center for Diabetes Research, München-Neuherberg, Germany.
Diabetes Care. 2016 Aug;39(8):1311-7. doi: 10.2337/dc16-0094. Epub 2016 Jun 12.
Obesity and type 2 diabetes mellitus (T2DM) are associated with altered food-related neuronal functions. Besides weight loss, substantial improvement of glucose metabolism in patients with T2DM can be achieved by bariatric surgery. We aimed to target the neuronal and behavioral correlates of improved glycemic control after bariatric surgery.
Two patient groups with T2DM were recruited. The treatment group (n = 12) consisted of patients who had undergone Roux-en-Y gastric bypass (RYGB) surgery, and a control group consisted of patients who did not undergo surgery (n = 12). The groups were matched for age and current BMI. HbA1c was matched by using the presurgical HbA1c of the RYGB group and the current HbA1c of the nonsurgical group. Neuronal activation during a food reward task was measured using functional MRI (fMRI). Behavioral data were assessed through questionnaires.
RYGB improved HbA1c from 7.07 ± 0.50 to 5.70 ± 0.16% (P < 0.05) and BMI from 52.21 ± 1.90 to 35.71 ± 0.84 kg/m(2) (P < 0.001). Behavioral results showed lower wanting and liking scores as well as lower eating behavior-related pathologies for the patients after RYGB than for similar obese subjects without surgery but with impaired glycemic control. The fMRI analysis showed higher activation for the nonsurgical group in areas associated with inhibition and reward as well as in the precuneus, a major connectivity hub in the brain. By contrast, patients after RYGB showed higher activation in the visual, motor, cognitive control, memory, and gustatory regions.
In obese patients with diabetes, RYGB normalizes glycemic control and leads to food reward-related brain activation patterns that are different from those of obese patients with less-well-controlled T2DM and without bariatric surgery. The differences in food reward processing might be one factor in determining the outcome of bariatric surgery in patients with T2DM.
肥胖和 2 型糖尿病（T2DM）与改变与食物相关的神经元功能有关。除了体重减轻外，减重手术还可以显著改善 T2DM 患者的葡萄糖代谢。我们旨在针对减重手术后血糖控制改善的神经元和行为相关性进行研究。
招募了两组 T2DM 患者。治疗组（n=12）由接受 Roux-en-Y 胃旁路术（RYGB）的患者组成，对照组由未接受手术的患者组成（n=12）。两组在年龄和当前 BMI 方面相匹配。通过使用 RYGB 组的术前 HbA1c 和非手术组的当前 HbA1c 来匹配 HbA1c。使用功能磁共振成像（fMRI）测量食物奖励任务期间的神经元激活。通过问卷评估行为数据。
RYGB 将 HbA1c 从 7.07±0.50 降至 5.70±0.16%（P<0.05），BMI 从 52.21±1.90 降至 35.71±0.84kg/m2（P<0.001）。行为结果表明，与类似的肥胖但血糖控制不佳且无手术的患者相比，RYGB 后的患者的欲望和喜好评分以及与饮食行为相关的病理表现较低。fMRI 分析显示，非手术组在与抑制和奖励相关的区域以及在大脑的主要连接枢纽扣带回后部表现出更高的激活。相比之下，RYGB 后的患者在视觉、运动、认知控制、记忆和味觉区域表现出更高的激活。
在患有糖尿病的肥胖患者中，RYGB 使血糖控制正常化，并导致与食物奖励相关的大脑激活模式与血糖控制不佳且未接受减重手术的肥胖患者不同。食物奖励处理的差异可能是决定 T2DM 患者减重手术结果的因素之一。
