| Obesity is mainly due to excess energy intake caused by food intake greater than consumption.The increasingly serious obesity problem not only brings detrimental complications and high mortality to patients themselves,but also greatly increases the burden of public medical expenditure.Among various therapies of weight-loss,acupuncture,as an effective weight-loss therapy,has many advantages such as safety,low cost,wide applicability and convenient implementation.Clinical studies have shown that acupuncture significantly reduces the appetite and anxiety of overweight/obese individuals and improves their eating behavior while reducing weight loss,suggesting that central changes caused by acupuncture play an important role in regulating feeding behavior and body weight.However,the central mechanism of acupuncture weight loss remains unclear.As a non-invasive imaging method that can quantitatively measure brain function and structure,magnetic resonance imaging(MRI)has been widely used in devising the mechanism of the acupuncture regulation center.In this paper,overweight/obese people were selected as the research subjects,and they were randomly divided into an electroacupuncture(EA)group and sham needle(Sham)control group.The MRI of the resting state/task state stimulated by food pictures/T1 structure/Diffusion tensor imaging(DTI)and repeated measures two-factor analysis of variance methods was used to explore the changes of brain function and structure in overweight/obese patients caused by acupuncture acute effects(first treatment)and long-term effects(one course of treatment)to provide scientific and reliable imaging evidence for weight-loss caused by acupuncture.First,26 overweight/obese patients receiving true acupuncture treatment were recruited as the true needle group(EA)and 19 overweight/obese patients receiving sham acupuncture were classified as the sham needle group(Sham).For resting state image data,the amplitude of low-frequency fluctuation(ALFF)and functional connectivity(FC)analysis methods were used to study the acute effects of acupuncture.The results showed that EA and Sham decreased ALFF in the right insula(INS)related to visceral sensation,and increased ALFF in the left Dorsolateral prefrontal cortex(DLPFC)related to cognitive control.Functional connectivity revealed that EA and Sham decreased FC strength in INS-SMA(Supplementary motor area),INS-DLPFC_R(cognitive control)and DLPFC_L-DMPFC(Dorsal medial prefrontal cortex,emotional control),and increased FC strength in INS-PCUN(Precuneus,self-referential processing).Subsequently,17 EA group subjects and 15 Sham group subjects who completed a course of long-term treatment were included in this study.The same method was used to analyze the long-term effects of acupuncture.Behavioral data showed that both EA and Sham reduced BMI,body weight and waist circumference in overweight/obese patients,and the reduction in the EA group was significantly greater than that in the Sham group.Neuroimaging showed that EA increased ALFF in the right ventrolateral prefrontal cortex(VLPFC).EA and Sham increased FC strength in the VLPFC-OFC(orbitofrontal cortex,reward-driven)and decreased FC strength in the VLPFC-THA(thalamus,somatosensory center).These results suggest that EA-induced weight loss may be associated with regulation of brain regions involved in executive control,gastric motility and internal sensation in overweight/obese individuals.Secondly,based on functional connectivity density mapping(FCDM)and FC methods,the resting state study was found: EA induced acute effects increased FCD in the DMPFC related to emotional control and decreased FC strength in the DMPFC-INS(related to internal sensation).EA induced long-term effects decreased FCD in the posterior cingulate cortex(PCC)/PCUN related to self-referential processing,and increased FC strength in the PCC/PCUN-CAU(Caudate,reward).These results suggest that EA-induced weight loss may be associated with regulation of brain regions involved in emotional control and internal sensation in overweight/obese individuals.Then,EA reduced the craving for high-calorie foods in overweight/obese patients,suggesting that acupuncture may regulate reward-related areas and thus improve eating behavior.Therefore,the study included 23 EA subjects and 18 Sham subjects,using the food picture stimulation paradigm to study the acute effects of acupuncture to regulate brain responses to picture stimuli.The results showed that under food picture cues(Food)vs.neutral picture cues(NC),EA/Sham induced acute effects significantly increased the activation in the anterior cingulate cortex(ACC)/DMPFC related to emotional control and the CAU related to reward processing.Under high-calorie food cues(HC)vs.low-calorie food cues(LC),EA induced acute effects increased the activation in the DLPFC_L,and Sham induced acute effects decreased it.Subsequently,the study included 15 EA subjects and 15 Sham subjects who completed a course of long-term treatment.The same method was used to study the long-term effects of acupuncture to regulate changes in brain responses to picture stimulation.The results showed that under Food vs.NC,EA/Sham induced long-term effects significantly increased the activation of the bilateral reward area CAU and the bilateral somatosensory center THA.Under HC vs.NC,EA specifically increased the activation of the bilateral CAU.These results suggested that EA-induced weight loss,and changes in food craving and eating behavior may be associated with regulation of brain regions involved in inhibition control(emotional inhibition and cognitive depression)and reward in overweight/obese individuals.Finally,for the T1 and DTI image data,voxel-based morphometery and tract-based spatial statistics methods were used to study the gray matter and white matter structural changes in overweight/obese patients caused by long-term acupuncture treatment.The results showed that EA/Sham increased the white matter volume of the left OFC,the middle occipital gyrus(MOG)and the FA value of the right anterior limb of the internal capsule(ALIC)fiber bundle,and EA specifically increased the FA value of the body of the corpus callosum(BCC),the right external capsule(EC),the right posterior limb of the internal capsule(PLIC),and the bilateral superior longitudinal fasciculus(SLF)fiber bundle.Furthermore,the correlation analysis between clinical measurement data and structural imaging data found that the decreased BMI of overweight/obese patients was positively correlated with increased FA values of the BCC and SLF fiber bundles.These results indicated that long-term acupuncture treatment improved the damage of white matter structure caused by obesity while reducing body weight.These brain regions are closely related to reward-drive,reward adjustment,and executive control.In summary,this paper explored the central mechanism of acupuncture in regulating body weight from the perspective of function and structure through multimodal imaging methods,and found that acupuncture regulated relevant areas such as inhibition and control,inner feeling,reward,emotion and self-consciousness,providing imaging evidence for acupuncture in regulating body weight and improving dietary behavior. |
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