Role of the Foregut in Nutrient Metabolism in Lean and Obese Humans

Vanderbilt University Medical Center27 enrolled

Overview

The overall hypothesis of this proposal is that nutrient sensing in the foregut regulates metabolic hormone secretion and nutrient metabolism via enteric neural signals, and these mechanisms might be defective in obesity.

The study proposes two specific aims Aim 1 will determine if blocking enteric neuronal signaling will alter: a) circulating levels of nutrient substrates and secretion of hormones that regulate nutrient metabolism; and b) glucose and fatty acid absorption, production, and utilization. Obese (BMI = 30-50 kg/m2) subjects will be studied. The topical anesthetic benzocaine will be infused into the duodenum prior to infusion of glucose and oleic acid into the duodenum. Duodenal infusions with a naso-intestinal feeding tube will circumvent the confounding effects of gastric emptying on the metabolic responses to a meal. Substrates (glucose, free fatty acids), and lipoproteins) and hormones will be measured by standard biochemical and immunological methods. Aim 2 will determine if enteric neural signals regulate appetite. The studies will be carried out in both lean and obese humans and the procedure will be performed as described above. In addition, the subjects will be asked to use a visual analog scale to estimate their level of appetite before, during and after enteral infusions.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

SINGLE

Enrollment

Conditions

Obesity

Interventions

benzocaineDRUG

0.5% benzocaine solution in saline/hydrochloric acid administered by intraduodenal infusion one time (6 ml bolus followed by 75 ml/hour for 105 minutes)

placeboOTHER

Placebo (saline) solution administered by intraduodenal infusion one time (6 ml bolus followed by 75 ml/hour for 105 minutes)

Eligibility

Sex: ALLMin age: 20 YearsMax age: 50 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * BMI 19 - 25 kg/m2 or 30 - 50 kg/m2 * Age 20 - 50 years Exclusion Criteria: * Contraindication to a nasoduodenal feeding tube (e.g., deviated nasal septum, prior upper gastrointestinal bleed, or history of easy bleeding) * Prior gastric or intestinal surgery or pancreas resection * Females with a positive pregnancy test * Known history of intestinal diseases including, but not limited to, inflammatory bowel disease (e.g. ulcerative colitis, Crohn's disease), celiac sprue * Type 1 or type 2 diabetes * Recent presence of or treatment for gastroenteritis (diarrhea and/or vomiting), constipation, or upper respiratory infection * Anemia * Abnormal electrocardiogram * Prior adverse reaction to anesthesia * Tobacco use

Locations (1)

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Outcomes

Primary Outcomes

Gastrointestinal Hormones

Plasma levels of Cholecystokinin, gastric inhibitory peptide and glucagon like peptide and Ghrelin

Time frame: 5 Hours

Pancreatic Hormones

Plasma levels of Insulin, C-peptide, Glucagon

Time frame: 5 Hours

Glucose and Free Fatty Acids

Plasma levels

Time frame: 5 Hours

Secondary Outcomes

Glucose Metabolism

Glucose tracer kinetics (\[3-tritiated\] glucose and \[U-13C-carbon\] oleate)

Time frame: 5 Hours

Fat Metabolism

Oleate tracer kinetics (\[U-13 C-carbon\] oleate)

Time frame: 5 Hours

Data from ClinicalTrials.gov

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