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Pregnancy after bariatric surgery
386
Abstracts/Appetite 87 (2015) 371–403
Pregnancy after bariatric surgery J. SHAWE a , D. COOKE a , K. HART a , B. MCGOWEN, C. PRING, D. SUBRAMANIAN, D. WHITE, M. WHYTE a. a University of Surrey, Guildford Surrey, UK. [email protected] Half of all bariatric surgical procedures are in women of childbearing age. Surgery may improve fertility yet exacerbate nutritional deficiencies that may be disadvantageous to the fetus. The infant and maternal health risks of obesity in pregnancy are well described. What is not clear is whether bariatric surgery mitigates or complicates health consequences of obesity in pregnancy, the influence of surgery type and the optimal interval between surgery and conception. This study builds on pilot data and using both quantitative and qualitative methods aims to understand the optimal psychological, behavioural and nutritional conditions necessary to ensure healthy pregnancies and children in women who have undergone bariatric surgery. A retrospective cohort study using NHS patient databases (HES, CPRD, National Bariatric Surgery Register) will compare women aged 18–45 stratified by type of surgery, matched to obese controls for BMI pre and post-surgery at antenatal booking in order to examine pregnancy outcomes independent of the effect of weight. A sub group of women with antecedent type 2 diabetes will be examined. In-depth interviews with 20 women will explore psychological issues, attitudes, health beliefs and behaviour regarding contraception, preconception care, pregnancy risks and dietary regimes post-surgery. Interviews with a broad range of clinical professionals will explore views and decisionmaking processes on pregnancy and patient management for these women. Initial database analysis suggests pregnancy is a frequent desire and/or occurrence after bariatric surgery with variable outcomes. Interviews with clinicians have highlighted the lack of evidence and guidelines available to manage care. Study findings will advance understanding of maternal and fetal outcomes of such pregnancies and the factors involved to inform optimal management of this patient population. http://dx.doi.org/10.1016/j.appet.2014.12.147
Using fMRI to assess the impact of Mandolean training on the neural control of obesity in young people J. HAMILTON-SHIELD a , E. HINTON a , L. BIRCH a , J. BARTON a . a University of Bristol, Bristol, UK. [email protected] Evidence for interventions to treat childhood obesity is limited. A trial of a new device, the Mandolean, demonstrated a reduction in body mass index (BMI) in children when used with a weightmanagement programme. The Mandolean is a weighing scale that measures rate of eating and satiety, and provides feedback to help children change their eating behaviours. The objective of this pilot study is to investigate the underlying physiological basis of the Mandolean intervention by using functional Magnetic Resonance Imaging (fMRI). We hypothesise that weight reduction, changes in eating rate and perception of satiety are associated with longterm changes in brain activity in satiety-related regions, such as the hypothalamus and prefrontal cortex. The target population are obese adolescents (age 11–18 years), referred to the Care of Childhood Obesity clinic at Bristol Royal Hospital for Children. Participants are
randomly allocated to receive either: a weight-management programme alone, or a weight-management programme plus the Mandolean intervention. Obese participants undergo two neuroimaging sessions: at baseline and after the six-month programme. A normal-weight control group, recruited from a local school, undergo one neuroimaging session. To assess changes in food cue-reactivity and to replicate previous studies, food pictures are presented during fMRI pre- and post-consumption of a glucose drink. Preliminary results from this work-in-progress study will be presented. Comparisons between changes in BMI standard deviation score between Mandolean and standard care arms at six months will be reported. The neural response to food pictures will be compared (a) pre and post consumption of glucose, (b) pre and post weight-management programme, and (c) between groups. http://dx.doi.org/10.1016/j.appet.2014.12.148
How are gastrointestinal peptides related to satiety? C. GIBBONS a , G. FINLAYSON a , P. CAUDWELL a , P. HELLSTRÖM, D. WEBB, E. NÄSLUND, J. BLUNDELL a. a University of Leeds, Leeds, UK. [email protected] The function of gastrointestinal peptides is to organise the intestinal response to different macronutrients consumed. In the field of obesity, peptides are thought to play a major role in satiety and/ or satiation. We compared responses of glucose, insulin, ghrelin (total and acylated), CCK, GLP-1 and PYY with profiles of subjective appetite (hunger/fullness) and ad libitum eating behaviour after consumption of normal iso-energetic meals varying in fat content. Overweight/obese participants were studied (Age: 46 years; BMI: 29.8 kg/m2). Peptides and subjective appetite were measured fasted and postprandially for 180 min after consuming high fat (HF- >50% fat) or high carbohydrate (HCHO- <3% fat) meals of equal palatability, energy and weight (590 kcal; 685 g). Ad-libitum eating was also measured. The pattern of peptide release was quite different after the two meals indicating selectivity in response to macronutrients – glucose and insulin release was higher after HCHO (F(1,15) = 6.200, p < 0.05; F(1,15) = 32.688, p < 0.001), but CCK, GLP-1 and PYY responded more to HF (F(1,15) = 11.178, p < 0.01; F(1,15) = 5.099 and F(1,14) = 5.226, p < 0.05); ghrelin was the same after both meals (F(1,12) = 0.658, p = 0.433). Profiles of hunger and fullness were similar and ad libitum energy intake did not differ after the two meals (p > 0.05). Ghrelin, GLP-1 and insulin (only after HCHO) showed significant relationships with appetite measures and energy intake, but CCK and PYY did not. This outcome demonstrated that the same degree of satiety and satiation can be mediated by distinctly different peptide profiles implying that no single peptide can be regarded as the sole biomarker of appetite. This has implications for understanding the physiological basis of appetite control. This research was funded by Biotechnology and Biological Sciences Research Council (BB/G530141/1BBSRC) and European Union Seventh Framework Programme (FP7/2007–2013) grant agreement number 266408. http://dx.doi.org/10.1016/j.appet.2014.12.149
Abstracts/Appetite 87 (2015) 371–403
Pregnancy after bariatric surgery J. SHAWE a , D. COOKE a , K. HART a , B. MCGOWEN, C. PRING, D. SUBRAMANIAN, D. WHITE, M. WHYTE a. a University of Surrey, Guildford Surrey, UK. [email protected] Half of all bariatric surgical procedures are in women of childbearing age. Surgery may improve fertility yet exacerbate nutritional deficiencies that may be disadvantageous to the fetus. The infant and maternal health risks of obesity in pregnancy are well described. What is not clear is whether bariatric surgery mitigates or complicates health consequences of obesity in pregnancy, the influence of surgery type and the optimal interval between surgery and conception. This study builds on pilot data and using both quantitative and qualitative methods aims to understand the optimal psychological, behavioural and nutritional conditions necessary to ensure healthy pregnancies and children in women who have undergone bariatric surgery. A retrospective cohort study using NHS patient databases (HES, CPRD, National Bariatric Surgery Register) will compare women aged 18–45 stratified by type of surgery, matched to obese controls for BMI pre and post-surgery at antenatal booking in order to examine pregnancy outcomes independent of the effect of weight. A sub group of women with antecedent type 2 diabetes will be examined. In-depth interviews with 20 women will explore psychological issues, attitudes, health beliefs and behaviour regarding contraception, preconception care, pregnancy risks and dietary regimes post-surgery. Interviews with a broad range of clinical professionals will explore views and decisionmaking processes on pregnancy and patient management for these women. Initial database analysis suggests pregnancy is a frequent desire and/or occurrence after bariatric surgery with variable outcomes. Interviews with clinicians have highlighted the lack of evidence and guidelines available to manage care. Study findings will advance understanding of maternal and fetal outcomes of such pregnancies and the factors involved to inform optimal management of this patient population. http://dx.doi.org/10.1016/j.appet.2014.12.147
Using fMRI to assess the impact of Mandolean training on the neural control of obesity in young people J. HAMILTON-SHIELD a , E. HINTON a , L. BIRCH a , J. BARTON a . a University of Bristol, Bristol, UK. [email protected] Evidence for interventions to treat childhood obesity is limited. A trial of a new device, the Mandolean, demonstrated a reduction in body mass index (BMI) in children when used with a weightmanagement programme. The Mandolean is a weighing scale that measures rate of eating and satiety, and provides feedback to help children change their eating behaviours. The objective of this pilot study is to investigate the underlying physiological basis of the Mandolean intervention by using functional Magnetic Resonance Imaging (fMRI). We hypothesise that weight reduction, changes in eating rate and perception of satiety are associated with longterm changes in brain activity in satiety-related regions, such as the hypothalamus and prefrontal cortex. The target population are obese adolescents (age 11–18 years), referred to the Care of Childhood Obesity clinic at Bristol Royal Hospital for Children. Participants are
randomly allocated to receive either: a weight-management programme alone, or a weight-management programme plus the Mandolean intervention. Obese participants undergo two neuroimaging sessions: at baseline and after the six-month programme. A normal-weight control group, recruited from a local school, undergo one neuroimaging session. To assess changes in food cue-reactivity and to replicate previous studies, food pictures are presented during fMRI pre- and post-consumption of a glucose drink. Preliminary results from this work-in-progress study will be presented. Comparisons between changes in BMI standard deviation score between Mandolean and standard care arms at six months will be reported. The neural response to food pictures will be compared (a) pre and post consumption of glucose, (b) pre and post weight-management programme, and (c) between groups. http://dx.doi.org/10.1016/j.appet.2014.12.148
How are gastrointestinal peptides related to satiety? C. GIBBONS a , G. FINLAYSON a , P. CAUDWELL a , P. HELLSTRÖM, D. WEBB, E. NÄSLUND, J. BLUNDELL a. a University of Leeds, Leeds, UK. [email protected] The function of gastrointestinal peptides is to organise the intestinal response to different macronutrients consumed. In the field of obesity, peptides are thought to play a major role in satiety and/ or satiation. We compared responses of glucose, insulin, ghrelin (total and acylated), CCK, GLP-1 and PYY with profiles of subjective appetite (hunger/fullness) and ad libitum eating behaviour after consumption of normal iso-energetic meals varying in fat content. Overweight/obese participants were studied (Age: 46 years; BMI: 29.8 kg/m2). Peptides and subjective appetite were measured fasted and postprandially for 180 min after consuming high fat (HF- >50% fat) or high carbohydrate (HCHO- <3% fat) meals of equal palatability, energy and weight (590 kcal; 685 g). Ad-libitum eating was also measured. The pattern of peptide release was quite different after the two meals indicating selectivity in response to macronutrients – glucose and insulin release was higher after HCHO (F(1,15) = 6.200, p < 0.05; F(1,15) = 32.688, p < 0.001), but CCK, GLP-1 and PYY responded more to HF (F(1,15) = 11.178, p < 0.01; F(1,15) = 5.099 and F(1,14) = 5.226, p < 0.05); ghrelin was the same after both meals (F(1,12) = 0.658, p = 0.433). Profiles of hunger and fullness were similar and ad libitum energy intake did not differ after the two meals (p > 0.05). Ghrelin, GLP-1 and insulin (only after HCHO) showed significant relationships with appetite measures and energy intake, but CCK and PYY did not. This outcome demonstrated that the same degree of satiety and satiation can be mediated by distinctly different peptide profiles implying that no single peptide can be regarded as the sole biomarker of appetite. This has implications for understanding the physiological basis of appetite control. This research was funded by Biotechnology and Biological Sciences Research Council (BB/G530141/1BBSRC) and European Union Seventh Framework Programme (FP7/2007–2013) grant agreement number 266408. http://dx.doi.org/10.1016/j.appet.2014.12.149