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Weight loss by low calorie diet versus gastric bypass surgery in people with diabetes results in divergent brain activation patterns: an functional MRI study

Title: Weight loss by low calorie diet versus gastric bypass surgery in people with diabetes results in divergent brain activation patterns: an functional MRI study
Authors: Salem, V
Demetriou, L
Behary, P
Alexiadou, K
Scholtz, S
Tharakan, G
Miras, A
Purkayastha, S
Ahmed, A
Bloom, S
Wall, M
Dhillo, W
Tan, T
Item Type: Journal Article
Abstract: OBJECTIVE: Weight loss achieved with very-low-calorie diets (VLCDs) can produce remission of type 2 diabetes (T2D), but weight regain very often occurs with reintroduction of higher calorie intakes. In contrast, bariatric surgery produces clinically significant and durable weight loss, with diabetes remission that translates into reductions in mortality. We hypothesized that in patients living with obesity and prediabetes/T2D, longitudinal changes in brain activity in response to food cues as measured using functional MRI would explain this difference. RESEARCH DESIGN AND METHODS: Sixteen participants underwent gastric bypass surgery, and 19 matched participants undertook a VLCD (meal replacement) for 4 weeks. Brain responses to food cues and resting-state functional connectivity were assessed with functional MRI pre- and postintervention and compared across groups. RESULTS: We show that Roux-en-Y gastric bypass surgery (RYGB) results in three divergent brain responses compared with VLCD-induced weight loss: 1) VLCD resulted in increased brain reward center food cue responsiveness, whereas in RYGB, this was reduced; 2) VLCD resulted in higher neural activation of cognitive control regions in response to food cues associated with exercising increased cognitive restraint over eating, whereas RYGB did not; and 3) a homeostatic appetitive system (centered on the hypothalamus) is better engaged following RYGB-induced weight loss than VLCD. CONCLUSIONS: Taken together, these findings point to divergent brain responses to different methods of weight loss in patients with diabetes, which may explain weight regain after a short-term VLCD in contrast to enduring weight loss after RYGB.
Issue Date: 22-Jun-2021
Date of Acceptance: 18-May-2021
URI: http://hdl.handle.net/10044/1/90292
DOI: 10.2337/dc20-2641
ISSN: 0149-5992
Publisher: American Diabetes Association
Start Page: 1842
End Page: 1851
Journal / Book Title: Diabetes Care
Volume: 44
Issue: 8
Copyright Statement: © 2021 by the American Diabetes Association https://www.diabetesjournals.org/content/license Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.
Sponsor/Funder: Medical Research Council (MRC)
National Institute for Health Research
Imperial College Healthcare NHS Trust
National Institute for Health Research
Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Trust - CLRN Funding
Imperial College Healthcare NHS Trust - CLRN Funding
Funder's Grant Number: MR/K02115X/1
RDA11 79560
RDC06 79560
NIHR130639
RDC06 79560
RDC06 79560
RDC06
Keywords: Endocrinology & Metabolism
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2021-06-22
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Bioengineering
Department of Surgery and Cancer
Faculty of Medicine
Faculty of Engineering