ROLE OF THE GASTROINTESTINAL TRACT IN

THE CONTROL OF FOOD INTAKE

J. TACK, M.D., Ph.D.

Department of Gastroenterology
University Hospitals, K.U. Leuven
Leuven, Belgium

CONTROL OF FOOD INTAKE

Terminology - phases
Food intake

Food
intake

Hunger

Satiety

Satiation

Satiety

Satiation

CONTROL OF FOOD INTAKE

Pathways involved in hunger / satiety

Cortical
influences

PFA
PVN

ARC NPY/AGRP

LHA

NTS
POMC

Ghrelin
Obestatin

Leptin Adiponectin Insulin

Motilin
CCK
PP
NT
OXM
Orexin
PYY

Adiposity signals

GLP-1

Mechanical factors
Chemical factors

CONTROL OF FOOD INTAKE

Role of the gastrointestinal tract - phases
Perception

Fasting

Accommodation

Satiety

Satiation

Satiety

Perception

Emptying

PROXIMAL STOMACH MOTILITY

Quantification of accommodation reflex

n = 35 healthy subjects

500
400
300
200
100
0

500
Intragastric volume (ml)

Intragastric volume (ml)

600

-30 -20 -10 0

10

20

30

40

Time after the meal (min)

50

60

Relaxation

400
300
200
100
0

PreprandialPostprandial
(30 min) (60 min)
Tack et al., 1998

FOOD INTAKE
Role of gastric accommodation

Impaired accommodation

Activation of tension receptors in

the proximal stomach

Early satiety

Weight loss

ACCOMMODATION REFLEX
Pathways (based on animal studies)

Vagal
afferent
G.I. tract

CNS

NO
-

ACh
5-HT ?

Vagal
efferent

Nicotinic receptor
5-HT1 receptor

Interneur
on

Inhibitory
Motor
Neuron

CONTROL OF FOOD INTAKE

Role of the gastrointestinal tract - phases
Perception

Fasting

Accommodation
Satiation

Perception

Emptying

Satiety

Satiety

Hunger

Food
intake
orexigenic hormones:

Hormone
secretion

ghrelin, motilin?,

anorexigenic hormones:
CCK, PYY, GLP-1,

CONTROL OF FOOD INTAKE

Interdigestive motility and hunger

50
40
30

N = 11

20
10
0

-80

-60

-40

-20

20

40

60

80

100

120

140

160

Time (min)

Motility index (mm Hg*min)

Hunger

Hunger score (mm)

60

5
4
3
2
1
0

-80

-60

-40

-20

20

40

60

Time (min)

80

100

120

140

160

CONTROL OF FOOD INTAKE

Interdigestive motility and hunger
80

70

70

Hunger scores (mm)

80

60
50
40
30
20
10
0

-60

Motility index (mm Hg*min)

Small intestinal origin (n=5)

-20

20

40

60

6
5
4
3
2
1
-60

50
40
30
20
10
-60

80

Time (min)

60

0
-40

Motility index (mm Hg*min)

Hunger scores (mm)

Gastric origin (n=9)

-40

-20

20

Time (min)

40

60

80

-40

-20

20

40

60

80

Time (min)

7
6
5
4
3
2
1
0

-60

-40

-20

20

Time (min)

40

60

80

CONTROL OF FOOD INTAKE

Effect of erythromycin and octreoide

90

90

80

80

Hunger score (mm)

Hunger score (mm)

Erythromycin
40 mg i.v. (n=6)

70
60
50
40
30
20

-30

70
60
50
40
30
20
10

10
0

Octreotide
50 g s.c. (n=5)

0
-20

-10

10

20

30

40

-30

50

-20

-10

Motility index (mm Hg*min)

Motility index (mm Hg*min)

7
6
5
4
3
2
1
0

-30

-20

-10

10

Time (min)

20

30

40

50

10

20

30

20

30

40

50

Time (min)

Time (min)
7
6
5
4
3
2
1
0

-30

-20

-10

10

Time (min)

40

50

RETURN OF HUNGER
Study outline

Breath
test meal
F3

120 min

Stomach
Duodenum
Jejunum
VAS for hunger and satiety / 5 min
Motility index / 5 min
Phases of the migrating motor complex
Gastric emptying rate

Erythromycin: 40mg/20min i.v. or

Octreotide: 100 g SC
120 min

F3

120 min

RETURN OF HUNGER
Pooled hunger scores

Octreotide

Erythromycin

60

Meal

Drug

Hunger (mm VAS)

50
40
30
20
10

p < 0.05
0
-30

30

60

90

120

150

Time after the start of the meal (min)

180

210

240

CONTROL OF FOOD INTAKE

Role of the gastrointestinal tract

Mechanoreceptor activation
Chemoreceptor activation
Release of gastrointestinal hormones

Tone of the
proximal
stomach

Gastric
emptying rate?

Gastric phase
3 of the MMC

PHASES OF HUNGER AND FOOD INTAKE

Role of the gastrointestinal tract
Satiation

Satiety

Satiation

Satiety

Hunger

Accommodation

Hormone
secretion

Food
intake

Food
intake

Emptying?

Gastric phase III

orexigenic hormones:

anorexigenic hormones:

ghrelin, motilin?,

CCK, PYY, GLP-1,