title: Cerebral activations during viewing of food stimuli in adult patients with acquired structural hypothalamic damage: a functional neuroimaging study.
abstract: OBJECTIVE
  Obesity is common following hypothalamic damage due to tumours. Homeostatic and non-homeostatic brain centres control appetite and energy balance but their interaction in the presence of hypothalamic damage remains unknown. We hypothesized that abnormal appetite in obese patients with hypothalamic damage results from aberrant brain processing of food stimuli. We sought to establish differences in activation of brain food motivation and reward neurocircuitry in patients with hypothalamic obesity (HO) compared with patients with hypothalamic damage whose weight had remained stable.
  
  
  METHODS
  In a cross-sectional study at a University Clinical Research Centre, we studied 9 patients with HO, 10 age-matched obese controls, 7 patients who remained weight-stable following hypothalamic insult (HWS) and 10 non-obese controls. Functional magnetic resonance imaging was performed in the fasted state, 1 h and 3 h after a test meal, while subjects were presented with images of high-calorie foods, low-calorie foods and non-food objects. Insulin, glucagon-like peptide-1, Peptide YY and ghrelin were measured throughout the experiment, and appetite ratings were recorded.
  
  
  RESULTS
  Mean neural activation in the posterior insula and lingual gyrus (brain areas linked to food motivation and reward value of food) in HWS were significantly lower than in the other three groups (P=0.001). A significant negative correlation was found between insulin levels and posterior insula activation (P=0.002).
  
  
  CONCLUSIONS
  Neural pathways associated with food motivation and reward-related behaviour, and the influence of insulin on their activation may be involved in the pathophysiology of HO.
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Steele
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, UK.|MARIARC and Department of Musculoskeletal Biology, University of Liverpool, Liverpool, UK.|Department of Psychology, Edge Hill University, Ormskirk, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Powell
authors.affiliation: MARIARC and Department of Musculoskeletal Biology, University of Liverpool, Liverpool, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Kemp
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
authors.forename: J C G
authors.initials: JC
authors.lastname: Halford
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Wilding
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Harrold
authors.affiliation: Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK.
authors.forename: S V D
authors.initials: SV
authors.lastname: Kumar
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Cuthbertson
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Cross
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
authors.forename: M
authors.initials: M
authors.lastname: Javadpour
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK.
authors.forename: I A
authors.initials: IA
authors.lastname: MacFarlane
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Stancak
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK.
authors.forename: C
authors.initials: C
authors.lastname: Daousi
mesh_terms: D001930:Brain Injuries / Q000503:physiopathology* / Q000523:psychology; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D003463:Cues; D005260:Female; D005502:Food; D059907:Functional Neuroimaging; D006801:Humans; D007031:Hypothalamus / Q000293:injuries / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000503:physiopathology*; D009765:Obesity / Q000503:physiopathology* / Q000523:psychology; D010775:Photic Stimulation; D012201:Reward; D006113:United Kingdom