Abstract
Background/objectives
Obesity is associated with reduced neurocognitive performance. Individuals with obesity show decreased activation in the left dorsolateral prefrontal cortex (DLPFC), a key brain region relevant to the regulation of eating behavior. Transcranial direct current stimulation (tDCS) has emerged as a potential technique to correct these abnormalities. However, there is limited information to date, particularly in clinical settings and regarding long-term effects of tDCS. This study aimed to investigate the effects of DLPFC-targeted tDCS in young women with obesity.
Subject/methods
Randomized, double-blind, sham-controlled parallel-design clinical trial conducted in 38 women, aged 20–40 years, with BMI 30–35 kg/m2. Study design: Phase I: target engagement (immediate effects of tDCS on working memory performance), Phase II: tDCS only (ten sessions, 2 weeks), Phase III: tDCS + hypocaloric diet (six sessions, 30% energy intake reduction, 2 weeks, inpatient), Phase IV: follow-up at 1, 3, and 6 months. Primary outcome: change in body weight. Secondary outcomes: change in eating behavior and appetite. Additional analyses: effect of Catechol-O-methyl transferase (COMT) gene variability. Data were analyzed as linear mixed models.
Results
There was no group difference in change in body weight during the tDCS intervention. At follow-up, the active group lost less weight than the sham group. In addition, the active group regained weight at 6-month follow-up, compared with sham. Genetic analysis indicated that COMT Met noncarriers were the subgroup that accounted for this paradoxical response in the active group.
Conclusion
Our results suggest that in young women with class I obesity, tDCS targeted to the DLPFC does not facilitate weight loss. Indeed, we found indications that tDCS could have a paradoxical effect in this population, possibly connected with individual differences in dopamine availability. Future studies are needed to confirm these findings.
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Acknowledgements
This study was funded by a research grant from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo); São Paulo Research Foundation (Funding reference 2016/04766-6, 2016/10785-3, 2016/14592-5); and FAEPA (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto—USP, Funding reference 27/2018). Additional support came from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR002541), and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.
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PGF and MAA had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: MAA, PGF, SKD, VMMS, and GM. Acquisition, analysis, or interpretation of data: PGF and MAA. Drafting of the paper: PGF and MAA. Critical revision of the paper for important intellectual content: PGF, MAA, SKD, VMMS and GM. Statistical analysis: PGF and MAA. Obtained funding: VMMS and PGF. Administrative, technical, or material support: PGF, MAA, SKD, VMMS, GM, JSM, WAS, IRS, RSRS, and CDM. Study supervision: MAA and VMMS.
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Fassini, P.G., Das, S.K., Magerowski, G. et al. Noninvasive neuromodulation of the prefrontal cortex in young women with obesity: a randomized clinical trial. Int J Obes 44, 1279–1290 (2020). https://doi.org/10.1038/s41366-020-0545-3
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DOI: https://doi.org/10.1038/s41366-020-0545-3
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