Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK.
University College London Hospital (UCLH) Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK.
Curr Opin Endocrinol Diabetes Obes. 2018 Feb;25(1):3-11. doi: 10.1097/MED.0000000000000379.
Reduced energy intake, resulting from favourable changes in eating behaviour, is the predominant driver of weight loss following bariatric surgery. Here we review the most recent studies examining the impact of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy, the two most common bariatric procedures, upon eating behaviour and the suggested underlying biological mechanisms.
Following RYGB or sleeve gastrectomy, most people report subjective changes in appetite, taste and food preference, with decreased high-fat preference most commonly reported. Objective postsurgery changes in taste and olfactory acuity occur. A new phenomenon, 'meal-size aversion', may contribute to reduced postoperative energy intake. Recent studies provide evidence for peptide YY3-36, glucagon-like peptide-1, ghrelin, neurotensin and oleoylethanolamide as mediators of postoperative eating behaviour changes. Factors modulating these changes include sex, type 2 diabetes status, genetics and bariatric procedure. New studies implicate central dopaminergic and opioid receptor signalling as key neural mediators driving altered eating behaviour. Brain neuroimaging studies show that obesity-associated changes in food-cue responses, brain connectivity and structural abnormalities are normalized following bariatric surgery.
Understanding the biological mechanisms mediating the eating behaviour changes engendered by bariatric surgery may lead to the development of novel therapeutic strategies for people with obesity.
减重手术后体重减轻的主要驱动因素是饮食行为的有利改变导致的能量摄入减少。本文回顾了最近的研究，这些研究检查了两种最常见的减重手术（Roux-en-Y 胃旁路术和袖状胃切除术）对饮食行为的影响及其潜在的生物学机制。
在接受 RYGB 或袖状胃切除术之后，大多数人报告说他们的食欲、味觉和食物偏好发生了主观变化，最常见的是减少对高脂肪食物的偏好。手术后味觉和嗅觉敏锐度会发生客观变化。一种新的现象“餐量厌恶”可能导致术后能量摄入减少。最近的研究为肽 YY3-36、胰高血糖素样肽-1、胃饥饿素、神经降压素和油酰乙醇胺作为术后饮食行为变化的介质提供了证据。调节这些变化的因素包括性别、2 型糖尿病状态、遗传和减重手术类型。新的研究表明，中枢多巴胺能和阿片受体信号是驱动饮食行为改变的关键神经调节因子。脑影像学研究表明，肥胖相关的食物线索反应、大脑连通性和结构异常在减重手术后得到了正常化。
了解介导减重手术引起的饮食行为改变的生物学机制可能会为肥胖人群开发新的治疗策略。
