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Title: The effects of the Endoluminal Duodeno-Jejunal Bypass Liner on eating behaviour in humans
Author: Al Najim, Werd
ISNI:       0000 0004 7969 821X
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2017
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Background: The Endoluminal Duodeno-Jejunal Bypass Liner (DJBL) is a thin, flexible, sleeve-like device, made of a single use 60cm fluoropolymer. The DJBL is inserted endoscopically through the mouth and anchored to the proximal small intestine to acts as a physical barrier between the walls of the duodenal and the food ingested. The DJBL is currently being used for the treatment of diabetes in patients with obesity. Therefore, this device offers the unique opportunity to apply a reductionist approach and interrogates the contribution of bypassing the proximal bowel in the regulation of eating behaviour. This is the first study to assess eating behaviour in DJBL patients using direct and indirect measures of behaviour. Aims: To assess whether the DJBL affects eating behaviour 6-months post intervention compared to Best Medical Practice for the treatment of obesity and Type 2 Diabetes. Objective: To investigate the effect of DJBL on: 1. Food choices and calories intake 2.  Eating behaviour 3. The sensory domain of taste. 4. The appetitive behaviour subdomain of the hedonic ingestive motivation domain. 5. The consummatory behaviour subdomain of the hedonic ingestive motivation domain. Methods: This was a randomised controlled study of 42 subjects (23 DJBL, 19 SMT) with Type 2 Diabetes Mellitus who receive the DJBL device or standard medical therapy alone. All patients (40% female) were studied at baseline and followed up for 6-months post intervention. Food choices and calories intake were assessed using Food Diaries, Food Frequency Questionnaire, and 24hr Diet Recall. Psychology and personality traits linked to eating behaviour were assessed with questionnaires, whereas appetite and hunger scores were assessed with Visual Analogue Scales. The intensity of sweet taste stimuli was measured using (a direct behavioural technique) to determine the taste detection threshold using the method of constant stimuli. The appetitive reward of sweet taste stimuli was assessed using a progressive ratio task (a direct behavioural technique). Finally, the consummatory reward value of taste was assessed using visual analogue scales (indirect behaviour technique). Results: 1. Total food intake reduced from at 6-months reduced albeit not significantly and DJBL patients had a modest healthier shift in food preferences. 2. A shift towards healthier eating behaviour and psychological factors was found, which was specific to the treatment type. However, no change in the reported appetite ratings was found. 3. No changes in sucrose detection threshold after DJBL. 4. No change in the appetitive reward value of sweet and fatty tastant after DJBL. 5. No change in the consummatory reward value of sweet taste after DJBL. Conclusion: I conclude, that despite not adding extra benefits on total weight loss, the DJBL could potentially make weight loss an easier task due to the modest changes in food preferences and eating behaviour and psychological traits. In addition, the DJBL did not affect any of the taste dimensions. Therefore, the bypass of the proximal small bowel is not behind the changes in eating behaviour observed post RYGB or that RYGB alters eating behaviour via a combined/synergistic effect of the multiple components and the profound changes in the GI tract. This study contributes to the clinical benefits of the use of DJBL for weight loss and also to the research field on the physiological mechanisms behind RYGB operation.
Supervisor: le Roux, Carel W. ; Teare, Julian Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral