Gut-brain interactions affecting metabolic health and central appetite regulation in diabetes, obesity and aging

The central aim of this thesis was to study the effects of gut microbiota on host energy metabolism and central regulation of appetite. We specifically studied the interaction between gut microbiota-derived short-chain fatty acids (SCFAs), postprandial glucose metabolism and central regulation of appetite. In addition, we studied probable determinants that affect this interaction, specifically: host genetics, bariatric surgery, dietary intake and hypoglycemic medication.
First, we studied the involvement of microbiota-derived short-chain fatty acids in glucose tolerance. In an observational study we found an association of intestinal availability of SCFAs acetate and butyrate with postprandial insulin and glucose responses. Hereafter, we performed a clinical trial, administering acetate intravenously at a constant rate and studied the effects on glucose tolerance and central regulation of appetite. The acetate intervention did not have a significant effect on these outcome measures, suggesting the association between increased gastrointestinal SCFAs and metabolic health, as observed in the observational study, is not paralleled when inducing acute plasma elevations.
Second, we looked at other determinants affecting gut-brain interactions in metabolic health and central appetite signaling. Therefore, we studied the relation between the microbiota and central appetite regulation in identical twin pairs discordant for BMI. Second, we studied the relation between microbial composition and post-surgery gastrointestinal symptoms upon bariatric surgery. Third, we report the effects of increased protein intake on host microbiota composition and central regulation of appetite. Finally, we explored the effects of combination therapy with GLP-1 agonist exenatide and SGLT2 inhibitor dapagliflozin on brain responses to food stimuli.