Association between gastrointestinal phenotypes and weight gain in younger adults: a prospective 4-year cohort study

Abstract

Background/Objectives: Gastrointestinal phenotypes have previously been associated with obesity, however it is unknown if these phenotypes are a cause or a consequence of obesity and weight gain. Our aim was to assess whether these gastrointestinal phenotypes are associated with future weight gain in younger adults. Subjects/Methods: At baseline, 126 adult participants under the age of 35 were weighed and underwent measurement of gastrointestinal phenotypes including gastric emptying (GE), gastric volume, satiation, satiety and gastrointestinal hormones. Patients were re-appraised after median 4.4 years unless, during the period of follow up, they participated in a formal weight loss program, received obesity-weight loss interventions, or developed a health condition likely to affect weight. Participants were dichotomized into two groups for each phenotype at the median of each phenotype. Results: In total, 60 participants met criteria for inclusion and were evaluated after a median of 4.4 years [IQR: 3.5 to 5],36 participants were excluded due to conditions that would abnormally affect weight during study period including pregnancy and weight loss treatment, and 30 participants were lost to prospective follow-up. Faster GE was significantly associated with weight gain. Those with faster GE at baseline (n=30) gained a median of 9.6 kg [3.1 to 14.9] compared to those with slower GE at baseline (n=30) who gained a median of 2.8 kg [−4.6 to 9.2] (p=0.03), over the follow-up period. There was no association between the other phenotypes and weight gain. Conclusions: In adults ≤35 years old, faster gastric emptying is associated with significantly increased weight gain over the medium term. This provides supportive evidence for the role of gastric emptying in weight gain and development of obesity.

Gastric Sensory and Motor Functions and Energy Intake in Health and Obesity—Therapeutic Implications

“…There is also evidence in normal and overweight patients that there is a relationship between weight and gastric emptying [ 14 , 137 ]. Furthermore, young adults with more rapid gastric emptying were shown to be more likely to gain weight [ 138 ].A larger gastric capacity has also been reported in patients with obesity based on maximum tolerated volume during a nutrient drink test or as measured by an intragastric latex balloon [ 139 , 140 , 141 ]. SPECT showed increased fasting gastric volume in participants who were overweight or obese [ 14 , 142 , 143 ].…”

Selection of Antiobesity Medications Based on Phenotypes Enhances Weight Loss: A Pragmatic Trial in an Obesity Clinic

“… Hunger, defined as desire to eat (23), studied by visual analog scale for hunger and desire to eat (100‐mm scale) at baseline before breakfast and lunch. Satiation, defined as calories consumed to reach fullness and terminate meal (23), studied by ad libitum buffet meal (kilocalories consumed to reach maximal fullness) (24). Satiety, defined as duration of fullness or return of hunger (23), studied by visual analog scale for appetite (100‐mm scale) at baseline and postprandially every 15 minutes for 2 hours after a standard 320‐kcal meal (23,25) and by a quantifiable variable gastric emptying of solids that could impact both magnitude of postprandial fullness and time to return of hunger (26‐28). Gastric emptying is summarized by the half‐emptying time, T 1/2 , in minutes. Hedonic eating behavior (18) was assessed by the Hospital Anxiety and Depression Score (HADS) (26) and Three Factor Eating Questionnaire (TFEQ‐21) (29); there is significant correlation between HADS and the emotional eating domain of the TFEQ‐21 (30).…”

“…b Satiation, defined as calories consumed to reach fullness and terminate meal (23), studied by ad libitum buffet meal (kilocalories consumed to reach maximal fullness) (24). c Satiety, defined as duration of fullness or return of hunger (23), studied by visual analog scale for appetite (100-mm scale) at baseline and postprandially every 15 minutes for 2 hours after a standard 320-kcal meal (23,25) and by a quantifiable variable gastric emptying of solids that could impact both magnitude of postprandial fullness and time to return of hunger (26)(27)(28). Gastric emptying is summarized by the half-emptying time, T 1/2 , in minutes.…”

Association of gastric emptying with postprandial appetite and satiety sensations in obesity

“…GE correlates with hunger hormones like ghrelin (40) and satiety hormones like glucagon-like peptide 1 (GLP-1) and peptide YY (PYY), all of which influence GE (41). Furthermore, rapid GE is associated with more weight gain in 4 years compared with normal GE in young adults (30), and physical activity accelerates GE and The reported study strengths are the large sample size, the tests performed simultaneously on the same day, in participants with obesity who had minimal or no comorbidities that may influence the GE or VAS, such as advanced diabetes, or binge eating disorders.…”

“…The gold-standard test for measuring GE is scintigraphy with a standard radiolabeled meal, which is reproducible (coefficient of variation 9% to 25%) over short-, intermediate-, and long-term in healthy volunteers (29). Furthermore, GE is accelerated in obesity when compared with healthy weight controls (20), and patients with faster GE gain more weight than those with normal GE when followed prospectively for 4 years (30).…”