Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
Case Comprehensive Cancer Center, Cleveland, OH, USA.
Nutr Diabetes. 2020 Jun 15;10(1):21. doi: 10.1038/s41387-020-0124-7.
The rates of severe or Class III obesity (BMI ≥ 40.0 kg/m) and endometrial cancer (EC) incidence and mortality have been increasing significantly in the United States. Adults with severe obesity are more likely to die and women with severe obesity have a higher risk of EC development and mortality than those with Class I/II obesity (BMI: 30-<40 kg/m). However, no prior studies have evaluated the neural response to food cues by obesity severity/class in adults with or without cancer.
We conducted a functional magnetic resonance imaging visual food cue task in 85 obese Stage I EC survivors who were seeking weight loss in a lifestyle intervention at baseline. We evaluated the neural response to high-calorie vs. non-food images after an overnight fast (fasted state) and after eating a standardized meal (fed state), and grouped patients by obesity class (Class I/II: n = 38; Class III: n = 47).
In the fasted state, we found increased activation in several regions including the dorsolateral prefrontal cortex (DLPFC) in Class III and Class I/II patients (whole brain cluster corrected (WBCC), p < 0.05), which was significantly higher in Class III vs. Class I/II (p < 0.05). We found decreased activation in the insula in the fasted state, which was significantly lower in Class I/II vs. Class III (p = 0.03). In the fed state, we found increased activation in the DLPFC in Class III and Class I/II (WBCC, p < 0.05). The increased activation in cognitive control/inhibition regions (DLPFC) is consistent with the summative literature; however, the decreased activation in taste information processing regions (insula) was unexpected.
Our results provide novel insights on food cue response between different classes of obesity and highlight the importance of targeting the DLPFC in weight loss interventions, particularly in severely obese patients. Additional studies examining food-related neural circuitry between different classes of obesity are needed.
在美国，严重或 III 类肥胖（BMI≥40.0kg/m）和子宫内膜癌（EC）的发病率和死亡率一直在显著上升。与 I/II 类肥胖（BMI：30-<40kg/m）相比，严重肥胖的成年人更有可能死亡，而严重肥胖的女性患 EC 发展和死亡的风险更高。然而，以前没有研究评估过肥胖严重程度/类别的成年人是否存在与癌症相关的食物线索的神经反应。
我们对 85 名肥胖的 I 期 EC 幸存者进行了功能性磁共振成像视觉食物线索任务，这些患者在基线时正在进行生活方式干预以寻求减肥。我们评估了禁食状态下（空腹状态）和进食标准餐后（进食状态）对高热量与非食物图像的神经反应，并根据肥胖类别（I/II 类：n=38；III 类：n=47）对患者进行分组。
在空腹状态下，我们发现 Class III 和 Class I/II 患者的多个区域（包括背外侧前额叶皮层（DLPFC））的激活增加（全脑聚类校正（WBCC），p<0.05），且 Class III 患者的激活程度明显高于 Class I/II 患者（p<0.05）。我们还发现，在空腹状态下，岛叶的激活减少，Class I/II 患者的激活明显低于 Class III 患者（p=0.03）。在进食状态下，我们发现 Class III 和 Class I/II 患者的 DLPFC 激活增加（WBCC，p<0.05）。认知控制/抑制区域（DLPFC）的激活增加与综合文献一致；然而，味觉信息处理区域（岛叶）的激活减少则出人意料。
我们的研究结果提供了不同肥胖类别的食物线索反应之间的新见解，并强调了在减肥干预中靶向 DLPFC 的重要性，尤其是在严重肥胖的患者中。需要开展更多研究来检验不同肥胖类别的肥胖与食物相关的神经回路。
Zotero 插件