Abstract
BackgroundThe rates of severe or Class III obesity (BMI ≥ 40.0 kg/m2) 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/m2). However, no prior studies have evaluated the neural response to food cues by obesity severity/class in adults with or without cancer.MethodsWe 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).ResultsIn 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.ConclusionsOur 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.
Highlights
Introduction Severe or ClassIII obesity (body mass index (BMI) ≥40 kg/m2)[1,2] is increasing in several developed nationsNutrition and DiabetesNock et al Nutrition and Diabetes (2020)10:215 unit increase in BMI5
In a small pilot study of endometrial cancer patients enrolled in a larger behavioral lifestyle intervention, which aimed to improve diet quality by increasing the intake of low-calorie/nutrient-rich foods and decreasing the intake of high-calorie/nutrient-weak foods[39], we found that endometrial cancer survivors with Class II obesity, on average, generally had similar responses to visual food cues as the wider population of obese adults without cancer but we observed some unanticipated findings[40]
When comparing high-calorie vs. non-food images in the postmeal state, we found significant increased activation in several regions including the precuneus (Bilateral; BA = 39; 30, −66, 32), dorsolateral prefrontal cortex (DLPFC) (BA = 46; −42, 17, 25), and medial frontal gyrus (MFG) (BA = 6; −4, 13, 46) (Fig. 1, right panel)
Summary
Introduction Severe or ClassIII obesity (body mass index (BMI) ≥40 kg/m2)[1,2] is increasing in several developed nationsNutrition and DiabetesNock et al Nutrition and Diabetes (2020)10:215 unit increase in BMI5. Cancer is the second leading cause of death in the United States[6] and there are currently more than 15.5 million cancer survivors living in the United States, with a projected estimate of 20 million by 20267. There are ~757,190 uterine cancer survivors and by 2026 it is projected that 942,670 uterine cancer survivors will be living in the United States[7]. The rates of severe or Class III obesity (BMI ≥ 40.0 kg/m2) 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–
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