Habenular and mediodorsal thalamic connectivity predict persistent weight loss after laparoscopic sleeve gastrectomy

Abstract

Objective The aim of this study was to investigate laparoscopic sleeve gastrectomy (LSG)‐induced changes in connectivity between regions involved with reward/antireward and cognitive control and the extent to which these changes persist after surgery and predict sustainable weight loss. Methods Whole‐brain local functional connectivity density (lFCD) was studied in 25 participants with obesity who underwent resting‐state functional MRI before (PreLSG), 1 month after (PostLSG1), and 12 months after (PostLSG12) LSG and compared with 25 normal‐weight controls. Regions with significant time effects of LSG on functional connectivity density were identified for subsequent seed‐based connectivity analyses and to examine associations with behavior. Results LSG significantly increased lFCD in the mediodorsal thalamic nucleus (MD) and in the habenula (Hb) at PostLSG12 compared with PreLSG/PostLSG1, whereas it decreased lFCD in the posterior cingulate cortex/precuneus (PCC/PreCun) at PostLSG1/PostLSG12, and these changes were associated with reduction in BMI. In contrast, controls had no significant lFCD differences between baseline and repeated measures. MD had stronger connectivity with PreCun and Hb at PostLSG12 compared with PreLSG/PostLSG1, and the increased MD‐left PreCun and Hb‐MD connectivity correlated with decreases in hunger and BMI, respectively. PCC/PreCun had stronger connectivity with the insula at PostLSG1‐12. Conclusions The findings highlight the importance of reward and interoceptive regions as well as that of regions mediating negative emotions in the long‐term therapeutic benefits of LSG.

Brain functional and structural magnetic resonance imaging of obesity and weight loss interventions

“…After surgery, obese participants showed increased resting-state activity in the DLPFC, SFG, ITG, visual cortex, PCC; and decreased activity in the claustrum, precentral gyrus, putamen, insula, thalamus, and HIPP [ 127 , 183 – 185 ]. BS also increased RSFC of VMPFC-DLPFC, PCC/precuneus-caudate/DLPFC, HIPP-insula which is affected by ghrelin, reward network-MPFC, mediodorsal thalamic nucleus (MD)-precuneus/habenular; and decreased RSFC of VMPFC-HIPP/PHIPP, putamen-lateral hypothalamus, between regions involved in food-related saliency attribution and reward-driven eating behavior, and the nodes within and between DMN, SN, and FPN [ 127 , 186 – 192 ]. These latter RSFC patterns appear to be normalizing a pre-BS hyperconnected state, which might alter control of eating behavior.…”

“…These latter RSFC patterns appear to be normalizing a pre-BS hyperconnected state, which might alter control of eating behavior. Interestingly, baseline activity within the mesolimbic pathway [ 180 ], RSFC of NAc-insula, hypothalamus-precentral gyrus, habenular-MD, regions linked to emotional control and social interaction, as well as brain networks related to salience, reward, self-referential, and cognitive processing are associated with reduced BMI [ 186 , 187 , 192 , 193 ], providing evidence that specific resting-state activity and/or RSFC patterns might be useful as neuroimaging biomarkers to predict individual weight loss.…”