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Understanding the impact of radical changes in diet and the gut microbiota on brain function and structure: Rationale and design of the EMBRACE study

  • Tair Ben-Porat
    Affiliations
    Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada

    Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada
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  • Angela Alberga
    Affiliations
    Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
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  • Marie-Claude Audet
    Affiliations
    School of Nutrition Sciences, University of Ottawa, Ontario, Canada

    The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
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  • Sylvie Belleville
    Affiliations
    Research centre of the Institut Universitaire de Gériatrie de Montréal (CRIUGM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal (CIUSSS-CSMTL), Montreal, QC, Canada

    Department of Psychology, University of Montreal, Montreal, QC, Canada
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  • Tamara Cohen
    Affiliations
    Faculty of Land and Food Systems, University of British Columbia (UBC), Vancouver, British Columbia, Canada
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  • Pierre Y. Garneau
    Affiliations
    Division of Bariatric Surgery, CIUSSS-NIM, Montreal, Canada

    Department of Surgery, Université de Montréal, Montréal, Canada
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  • Kim L Lavoie
    Affiliations
    Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada

    Department of Psychology, Université du Québec a Montréal (UQAM), Montreal, QC, Canada
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  • Patrick Marion
    Affiliations
    Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada
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  • Samira Mellah
    Affiliations
    Research centre of the Institut Universitaire de Gériatrie de Montréal (CRIUGM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal (CIUSSS-CSMTL), Montreal, QC, Canada
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  • Radu Pescarus
    Affiliations
    Division of Bariatric Surgery, CIUSSS-NIM, Montreal, Canada

    Department of Surgery, Université de Montréal, Montréal, Canada
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  • Elham Rahme
    Affiliations
    Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre (MUHC), Montreal, QC, Canada
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  • Sylvia Santosa
    Affiliations
    Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada

    Metabolism, Obesity and Nutrition Lab, PERFORM Centre, Concordia University, Montreal, QC, Canada

    Research Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada
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  • Anne-Sophie Studer
    Affiliations
    Division of Bariatric Surgery, CIUSSS-NIM, Montreal, Canada

    Department of Surgery, Université de Montréal, Montréal, Canada
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  • Dajana Vuckovic
    Affiliations
    Department of Chemistry and Biochemistry, Concordia University, Montreal, QC, Canada
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  • Robbie Woods
    Affiliations
    Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada

    Department of Psychology, Concordia University, Montreal, QC, Canada
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  • Reyhaneh Yousefi
    Affiliations
    Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada

    Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada
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  • Simon L. Bacon
    Correspondence
    Correspondence to: Simon L. Bacon (PhD), Concordia University, Department of Health, Kinesiology, and Applied Physiology. Montreal, QC, Canada, and the Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada. Tel +1-514-848-2424;
    Affiliations
    Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada

    Montreal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada
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  • for the
    Affiliations
    Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada

      Highlights

      • This prospective, 15-month longitudinal study, aims to elucidate the associations between bariatric-induced changes in dietary and gut microbiota patterns with post-surgical cognition and brain structure.
      • The project uses varied and comprehensive evaluations including standardized questionnaires, physiological assessments (anthropometrics, blood, urine, and fecal samples), neuropsychological tests, and structural MRI.
      • This innovative project could provide information about potential individually-targeted diet-based preventative strategies to reduce the development of neurodegenerative disorders, and will be able to explore biological mediators related to improvements in cognition and brain health.
      • Extensive collaboration with stakeholders (including patient-investigators) has streamlined as much as possible this novel but burdensome protocol to optimize participant engagement, minimize participant impact, and enhance retention.

      Abstract

      Background

      Bariatric surgery leads to profound changes in gut microbiota and dietary patterns, both of which may interact to impact gut-brain communication. Though cognitive function improves post-surgery, there is a large variability in outcomes. How bariatric surgery-induced modifications in the gut microbiota and dietary patterns influence the variability in cognitive function is still unclear.

      Objectives

      To elucidate the associations between bariatric surgery-induced changes in dietary and gut microbiota patterns with cognition and brain structure.

      Setting

      University hospital.

      Methods

      A total of 120 adult patients (≥30 years) scheduled to undergo a primary bariatric surgery along with 60 age-, sex-, and body mass index (BMI)-matched patients on the surgery waitlist will undergo assessments 3-months pre-surgery and 6- and 12-months post-surgery (or an equivalent time for the waitlist group). Additionally, 60 age-and sex-matched non-bariatric surgery eligible individuals will complete the pre-surgical assessments only. Evaluations will include sociodemographic and health behavior questionnaires, physiological assessments (anthropometrics, blood-, urine-, and fecal-based measures), neuropsychological cognitive tests, and structural magnetic resonance imaging (MRI). Cluster analyses of the dietary and gut microbiota changes will define the various dietary patterns and microbiota profiles, then using repeated measures mixed models, their associations with global cognitive and structural brain alterations will be explored.

      Ethics and dissemination

      The coordinating study site (Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), QC, Canada), provided the primary ethical approval (REB#: MP-32-2022-2412). The insights generated from this study can be used to develop individually-targeted neurodegenerative disease prevention strategies, as well as providing critical mechanistic information.

      Keywords

      Abbreviations:

      BIA (bioelectrical impedance analysis), BMI (Body mass index), CRP (C-reactive protein), EWL (Excess weight loss), GI (Gastrointestinal), GLP-1 (Glucagon-like peptide), GM (Grey matter), HbA1c (Hemoglobin A1c), IL-6 (Interleukin 6), IL-10 (Interleukin 10), MRI (Magnetic resonance imaging), NTB (Neuropsychological test battery), PYY (Peptide YY), SAA (Serum amyloid A), SCFA (Short chain fatty acids), SG (Sleeve gastrectomy), TBWL (Total body weight loss), TNF- α (Tumor necrosis factor alpha), TSH (Thyroid-Stimulating Hormone), WC (Waist circumference), WM (White matter)
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