A manutenção da saúde, depende, dentre outros aspectos, do controle da massa corporal, uma vez que a obesidade está associada ao desenvolvimento de doenças crônicas. Sendo assim, o exercício pode ser considerado uma ferramenta eficaz nesse controle. Contudo, está evidenciado que o exercício realizado em alta intensidade pode ocasionar maior redução da gordura corporal. Dentre as hipóteses sugeridas para explicar tal fenômeno, a supressão do apetite pós-exercício foi levantada, no entanto, o efeito da intensidade sobre o apetite ainda é incipiente. Além disso, mulheres podem ter maior resposta compensatória que homens. Portanto, o objetivo do estudo foi comparar o efeito da intensidade no controle agudo do apetite, energia ingerida absoluta e relativa (energia ingerida menos o gasto calórico do exercício), percepção de fome e das concentrações sanguíneas de grelina acilada, peptídeo YY3-36, insulina, cortisol, glicose, ácidos graxos, colesterol e triacilglicerol em homens e mulheres. Para isso, 11 homens e 9 mulheres eutróficos, foram submetidos a 6 sessões, sendo a primeira destinada à determinação da potência aeróbia máxima (PAM) em cicloergômetro, e a segunda para realização do exercício intermitente de alta intensidade realizado na máxima intensidade (all out), composto por 60 x 8s:12s (EIAI-A), para determinação do trabalho total, o qual foi utilizado para equalização das demais sessões: a) EIAI-A; b) exercício intermitente de alta intensidade (EIAI) - 60s:60s a 100% da PAM; c) exercício contínuo de intensidade moderada (ECMI) a 60% da PAM; d) sessão controle (sem exercício). Cada visita teve duração de 4h, sendo que os participantes chegaram em jejum e receberam um café da manhã padrão. O exercício foi realizado 1,5h pós-café da manhã, e uma alimentação ad libitum foi servida 4h pós-café da manhã. Coletas de sangue e da percepção de fome (escala analógica visual) foram realizadas em jejum e em 2, 2,5, 3,25 e 4h de experimento e calculada a área sob a curva (ASC) para cada uma dessas variáveis. A comparação das variáveis sanguíneas e da percepção de fome foi feita através de análise de variância a três fatores (condição, sexo e momento), e das variáveis envolvendo a ASC e a energia ingerida foi conduzida através de análise a dois fatores (condição e sexo), seguida do pós-teste de Bonferroni se observada diferença significativa (P<0,05). Não houve diferença para a energia ingerida absoluta, porém, a energia ingerida relativa foi maior no controle quando comparada ao EIAI-A, EIAI, e ao ECMI, sem diferenças entre os tipos de exercício e sexos. A ASC da percepção de fome foi menor somente nos exercícios realizados em alta intensidade comparado com o controle, independentemente do sexo. O PYY3-36 foi inferior nas mulheres em relação aos homens ao passo que o cortisol foi inferior nos homens comparado com as mulheres. Houve interação entre situação e momento de coleta para o cortisol e insulina sendo os valores mais elevados no EIAI-A que no controle às 2,5 horas de experimento para o cortisol e às 3,25h para insulina. Portanto, embora não tenha havido diferença na energia ingerida relativa entre os tipos de exercícios, àqueles realizados em maior intensidade foram capazes de promover efeitos mais pronunciados na supressão do apetite, independentemente do sexo / Maintaining one\'s health depends, among other things, on controlling body weight, since obesity is associated with the development of chronic diseases. Accordingly, exercise is an effective tool in this control. It has been demonstrated that exercise performed at a high intensity can cause greater reduction in body fat. Among the hypotheses put forward of this phenomenon is the suppression of appetite. However, the understanding of the effect of the intensity on appetite is still incipient. In addition, women may have a greater compensatory response than men. Therefore, the aim of the study was to compare the effect of intensity on absolute and relative (energy intake less caloric expenditure of the exercise) energy intake, hunger and blood concentrations of acylated ghrelin, PYY3-36, insulin, cortisol, glucose, fatty acids, cholesterol and triacylglycerol in men and women. Accordingly, 11 men and 9 women, all eutrophic, underwent six sessions. The first was designed to determine their maximum aerobic power (MAP) on a cycle ergometer, and the second involved performing high-intensity intermittent exercise at maximum intensity (all out) for 60 x 8s: 12s (HIIE-A) in order to determine the total work, which was used for the equalization of the other sessions: a) HIIE-A; b) high intensity intermittent exercise (HIIE) - 60s: 60s at 100% of MAP; c) steady-state exercise (SSE) at 60% of the MAP; d) a control session. Each session lasted a total of 4 hours. The participants arrived in fasting and received a standard breakfast upon arrival. The exercise session was performed 1.5 h after breakfast, and an ad libitum meal was served 4 hours post-breakfast. Blood sample collection and perception of hunger were collected when fasting and at 2, 2.5, 3.25 and 4 hours into the experiment and the area under the curve (AUC) for each of these variables was calculated. A comparison of the blood sample variables and rating of hunger was performed by analyzing the variance of three factors (condition, sex, and time) and the analysis of the variables involving the AUC and energy intake was conducted through examination of two factors (sex and condition) followed by a Bonferroni post-test if significant differences (P<0.05) were observed. There was no difference for the absolute energy intake, however, relative energy intake was higher in the control compared to HIIE-A, HIIE, and SSE, with no differences between the types of exercise and sex. The AUC of hunger was lower in exercises performed at high intensity when compared to the control, regardless of sex. There was interaction between condition and time for cortisol and insulin, with higher levels in the HIIE-A than in the control at 2.5 hours for cortisol and 3.25 hours for insulin. Therefore, although there were no differences in energy intake relative to the types of exercises, those performed at a higher intensity promoted more pronounced effects on appetite suppression, regardless of sex

Recent years have witnessed significant research into the acute effects of exercise on appetite, energy intake and gut hormone responses. The experiments in this thesis have further investigated this topic by examining the appetite, acylated ghrelin, peptide YY and energy intake responses to energy deficits induced via different exercise protocols and food restriction. To achieve this, 48 young healthy males (mean (SD): age 23 (3) years, body mass index 23.7 (2.7) kg.m-2, maximum oxygen uptake 52.9 (9.8) mL.kg 1.min-1) were recruited into four studies. In study one, 60 min of treadmill running at 70% of VO2 max did not stimulate any increases in appetite or daily energy intake regardless of whether the exercise was performed after breakfast or in the fasted state. In study two, six 30 s Wingate tests stimulated increases in appetite during the subsequent hours compared with 60 min of cycling at 68% of VO2 max. Differences in appetite appeared to be unrelated to changes in plasma acylated ghrelin concentrations and did not influence ad libitum energy intake. Subsequently, endurance exercise resulted in a significantly greater negative daily energy balance than sprint exercise due to a larger exercise energy expenditure. Study three revealed that appetite and energy intake did not differ from a resting control trial after either ten, 4 min cycling bouts at 85 90% of VO2 max separated by 2 min of rest or 60 min of constant cycling at 60% of VO2 max. This occurred despite elevated PYY3-36 concentrations during the hours after exercise. Finally, study four showed that an energy deficit of ~1475 kJ stimulated increases in appetite when induced via food restriction but not when achieved by an acute bout of exercise. This was associated with differences in plasma PYY3-36 concentrations but did not appear to be related to changes in circulating levels of acylated ghrelin and did not influence energy intake. This thesis has shown that appetite perceptions do not differ from a resting control trial during the hours after continuous endurance exercise. Alternatively, supramaximal cycling exercise and subtle reductions in food intake stimulated increases in appetite during the subsequent hours. Such increases in appetite do not appear to be related to changes in acylated ghrelin but may be influenced by plasma PYY3-36 concentrations. Despite differences in appetite, daily energy intake was unaffected by all interventions.

This thesis examines the effect of surgical weight loss on gut and adipose tissue peptides involved in appetite regulation and energy homeostasis in morbidly obese humans. Roux-en-Y gastric bypass (RYGBP) is the gold standard operation used for effective long-term weight loss and improved health. The exact mechanisms for this outcome are under investigation. We measured ghrelin, a recently discovered hunger hormone, insulin, adiponectin and leptin along with anthropometry measures in 66 morbidly obese patients prior to and 6 and 12 months after RYGBP. Impressive weight loss occurred postoperatively as did alterations in the peptides. Consistent correlations were found between weight, leptin, ghrelin and insulin. The main findings were low ghrelin concentrations in obesity and an increase after RYGBP. We explored inflammatory proteins C-reactive protein (CRP), serum amyloid A and interleukin-6 before and during massive weight loss 6 and 12 months after RYGBP in morbidly obese subjects. The studied proteins declined after surgery and a correlation between CRP and homeostatic model of assessment for insulin resistance, independent of BMI, strongly linked insulin resistance and inflammation. CRP declined most in insulin-sensitive subjects. We examined the excluded stomach mucosa and vagus nerve by measuring gastrin, pepsinogen I (PGI), pancreatic polypeptide (PP) and ghrelin levels during week 1 and year after RYGBP. Ghrelin levels rose with weight loss but declined 24-hours after surgery, like PP, indicating transient vagal nerve damage. Low levels of gastrin and PGI suggest a resting mucosa. We evaluated gut peptides: peptide YY (PYY), glucaogon like peptide-1 (GLP-1), pro-neurotensin (pro-NT) and PP, in lean (young and middle-aged), obese and postoperative RYGBP subjects pre- and postprandially. RYGBP subjects had exaggerated levels of PYY and GLP-1 postprandially and higher basal proNT levels, implying a ‘satiety peptide tone’ that may contribute to the maintenance of weight loss. In summary, RYGBP results in marked weight loss and alterations in gut and adipose tissue peptides involved in appetite regulation and energy homeostasis. These postoperative peptide changes may contribute to impressive weight loss observed after RYGBP.

The acute effects of exercise on appetite, ad libitum energy intake and gut hormone responses have received much attention over the past two decades. The experiments in this thesis have contributed to this research by examining appetite, acylated ghrelin, peptide-YY (PYY), leptin and ad libitum energy intake responses to two consecutive days of moderate-high intensity running. To achieve this 15 individuals aged 21 (2) y, with a BMI of 23.0 (1.9) kg·m-2 were recruited. Additionally, appetite, acylated ghrelin, PYY, glucagon-like peptide-1 (GLP-1), and ad libitum energy intake responses to an acute bout of moderate intensity treadmill exercise were compared in lean and overweight/obese (ow/ob) males and females. Two separate cohorts of individuals were recruited; 22 lean individuals and 25 ow/ob individuals (aged 38 (15) and 45 (12) y, with a BMI of 22 (2) and 29 (3) kg·m 2, for lean and ow/ob individuals, respectively). In Chapter 4, two consecutive days of 60 min treadmill running at 70% VO₂ peak did not produce compensatory changes in appetite or energy intake over two days. There were no main effects of trial for acylated ghrelin or leptin. However a main effect of trial for PYY indicated higher concentrations on the exercise than control trial. A meta-analysis was completed in Chapter 5, suggesting further research in the effects of acute exercise on appetite regulatory hormones in individuals who are ow/ob was necessary. In Chapter 6, 60 min of treadmill exercise at 60% VO₂ peak did not alter appetite sensations or energy intake in the 7 h after exercise in lean and ow/ob males and females. There were no main effects of sex, BMI or trial for acylated ghrelin; however, PYY and GLP-1 concentrations were higher in exercise than control trials. This thesis has demonstrated that over two days, high volume exercise does not stimulate compensatory appetite regulatory changes, in lean healthy males. In the short term, lean and ow/ob males and females respond similarly to acute exercise, showing no alterations in appetite or food intake responses, whilst PYY and GLP-1 concentrations are higher in exercise than control trials.

A manutenção da saúde, depende, dentre outros aspectos, do controle da massa corporal, uma vez que a obesidade está associada ao desenvolvimento de doenças crônicas. Sendo assim, o exercício pode ser considerado uma ferramenta eficaz nesse controle. Contudo, está evidenciado que o exercício realizado em alta intensidade pode ocasionar maior redução da gordura corporal. Dentre as hipóteses sugeridas para explicar tal fenômeno, a supressão do apetite pós-exercício foi levantada, no entanto, o efeito da intensidade sobre o apetite ainda é incipiente. Além disso, mulheres podem ter maior resposta compensatória que homens. Portanto, o objetivo do estudo foi comparar o efeito da intensidade no controle agudo do apetite, energia ingerida absoluta e relativa (energia ingerida menos o gasto calórico do exercício), percepção de fome e das concentrações sanguíneas de grelina acilada, peptídeo YY3-36, insulina, cortisol, glicose, ácidos graxos, colesterol e triacilglicerol em homens e mulheres. Para isso, 11 homens e 9 mulheres eutróficos, foram submetidos a 6 sessões, sendo a primeira destinada à determinação da potência aeróbia máxima (PAM) em cicloergômetro, e a segunda para realização do exercício intermitente de alta intensidade realizado na máxima intensidade (all out), composto por 60 x 8s:12s (EIAI-A), para determinação do trabalho total, o qual foi utilizado para equalização das demais sessões: a) EIAI-A; b) exercício intermitente de alta intensidade (EIAI) - 60s:60s a 100% da PAM; c) exercício contínuo de intensidade moderada (ECMI) a 60% da PAM; d) sessão controle (sem exercício). Cada visita teve duração de 4h, sendo que os participantes chegaram em jejum e receberam um café da manhã padrão. O exercício foi realizado 1,5h pós-café da manhã, e uma alimentação ad libitum foi servida 4h pós-café da manhã. Coletas de sangue e da percepção de fome (escala analógica visual) foram realizadas em jejum e em 2, 2,5, 3,25 e 4h de experimento e calculada a área sob a curva (ASC) para cada uma dessas variáveis. A comparação das variáveis sanguíneas e da percepção de fome foi feita através de análise de variância a três fatores (condição, sexo e momento), e das variáveis envolvendo a ASC e a energia ingerida foi conduzida através de análise a dois fatores (condição e sexo), seguida do pós-teste de Bonferroni se observada diferença significativa (P<0,05). Não houve diferença para a energia ingerida absoluta, porém, a energia ingerida relativa foi maior no controle quando comparada ao EIAI-A, EIAI, e ao ECMI, sem diferenças entre os tipos de exercício e sexos. A ASC da percepção de fome foi menor somente nos exercícios realizados em alta intensidade comparado com o controle, independentemente do sexo. O PYY3-36 foi inferior nas mulheres em relação aos homens ao passo que o cortisol foi inferior nos homens comparado com as mulheres. Houve interação entre situação e momento de coleta para o cortisol e insulina sendo os valores mais elevados no EIAI-A que no controle às 2,5 horas de experimento para o cortisol e às 3,25h para insulina. Portanto, embora não tenha havido diferença na energia ingerida relativa entre os tipos de exercícios, àqueles realizados em maior intensidade foram capazes de promover efeitos mais pronunciados na supressão do apetite, independentemente do sexo / Maintaining one\'s health depends, among other things, on controlling body weight, since obesity is associated with the development of chronic diseases. Accordingly, exercise is an effective tool in this control. It has been demonstrated that exercise performed at a high intensity can cause greater reduction in body fat. Among the hypotheses put forward of this phenomenon is the suppression of appetite. However, the understanding of the effect of the intensity on appetite is still incipient. In addition, women may have a greater compensatory response than men. Therefore, the aim of the study was to compare the effect of intensity on absolute and relative (energy intake less caloric expenditure of the exercise) energy intake, hunger and blood concentrations of acylated ghrelin, PYY3-36, insulin, cortisol, glucose, fatty acids, cholesterol and triacylglycerol in men and women. Accordingly, 11 men and 9 women, all eutrophic, underwent six sessions. The first was designed to determine their maximum aerobic power (MAP) on a cycle ergometer, and the second involved performing high-intensity intermittent exercise at maximum intensity (all out) for 60 x 8s: 12s (HIIE-A) in order to determine the total work, which was used for the equalization of the other sessions: a) HIIE-A; b) high intensity intermittent exercise (HIIE) - 60s: 60s at 100% of MAP; c) steady-state exercise (SSE) at 60% of the MAP; d) a control session. Each session lasted a total of 4 hours. The participants arrived in fasting and received a standard breakfast upon arrival. The exercise session was performed 1.5 h after breakfast, and an ad libitum meal was served 4 hours post-breakfast. Blood sample collection and perception of hunger were collected when fasting and at 2, 2.5, 3.25 and 4 hours into the experiment and the area under the curve (AUC) for each of these variables was calculated. A comparison of the blood sample variables and rating of hunger was performed by analyzing the variance of three factors (condition, sex, and time) and the analysis of the variables involving the AUC and energy intake was conducted through examination of two factors (sex and condition) followed by a Bonferroni post-test if significant differences (P<0.05) were observed. There was no difference for the absolute energy intake, however, relative energy intake was higher in the control compared to HIIE-A, HIIE, and SSE, with no differences between the types of exercise and sex. The AUC of hunger was lower in exercises performed at high intensity when compared to the control, regardless of sex. There was interaction between condition and time for cortisol and insulin, with higher levels in the HIIE-A than in the control at 2.5 hours for cortisol and 3.25 hours for insulin. Therefore, although there were no differences in energy intake relative to the types of exercises, those performed at a higher intensity promoted more pronounced effects on appetite suppression, regardless of sex

INTRODUÇÃO: A obesidade é uma doença crônica que tem se tornado um dos maiores problemas de saúde das últimas décadas. A etiologia da obesidade é multifatorial, o que dificulta seu tratamento. O balão intragástrico (BIG) constitui um método pouco invasivo, reversível, de curto prazo para a perda de peso, além de auxiliar na mudança de hábitos alimentares e comportamentais. Promove distensão gástrica, acarretando na diminuição da ingestão alimentar, atrasa o esvaziamento gástrico e causa sensação de saciedade. O objetivo deste trabalho foi avaliar os efeitos do BIG em pacientes com diabetes mellitus tipo 2 (DM2) e sobrepeso ou obesidade grau I, através da análise da perda de peso, composição corporal, metabolismos glicêmico e lipídico, produção de enterohormônios e qualidade de vida. MÉTODOS: realizou-se ensaio clínico, incluindo 40 pacientes com DM2 e (IMC de 27 a 34,9 kg/m2), os quais foram submetidos à colocação do BIG, mantido por 6 meses, e com seguimento por mais 6 meses após sua retirada. Um teste de refeição com dieta padronizada foi realizado nos tempos 0 e 6 meses, com dosagens de glicose, insulina, triglicérides, GLP-1 ativo e PYY total nos tempos 0, 30, 60, 120 e 180 minutos. RESULTADOS: O peso absoluto diminuiu em 15,6 +- 7,23 kg após 6 meses do uso do BIG, o que corresponde à perda de 17,1% do peso total. Após os 6 meses de seguimento, a média de perda de peso foi mantida em 13,89 kg (15,2%). Houve redução significativa na massa de gordura corporal e da área da curva de glicose, insulina e triglicérides (p variou de < 0,001 a 0,003). Dos 24 pacientes (60%) portadores de hipertensão arterial sistêmica no início do estudo, apenas 3 (7,5%) mantiveram-se hipertensos após o uso do BIG. Os níveis séricos de GLP-1 ativo e PYY total diminuíram com o uso do BIG. A qualidade de vida melhorou em todos os domínios analisados (p < 0,001 a 0,041): capacidade funcional, aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais, aspectos emocionais e saúde mental. CONCLUSÃO: o BIG foi eficaz para perda de peso e controle do DM2 com melhora na qualidade de vida. Não há correlação positiva com a produção de enterohormônios / INTRODUCTION: Obesity is a chronic disease that has become one of the biggest health problems on the last decades. The etiology of obesity is multifactorial, which makes the success of treatment more difficult. Intragastric balloon (BIB) is a short term, reversible, minimally invasive method for weight loss. Furthermore, it helps changing eating habits and behavior. It promotes gastric distension, resulting in decreased intake of food, potentially delays gastric emptying and enhances the feeling of satiety. The objective of this study was to evaluate the effects of BIB in patients with type 2 diabetes mellitus (T2DM) and overweight or with grade I obesity, by analyzing the weight loss, body composition, glucose and lipid metabolism, production of enterohormones and quality of life. METHODS: Clinical trial including 40 patients with T2DM and BMI 27-34.9 kg/m2, which underwent placement of BIB, kept for 6 months, and follow-up for another 6 months after withdrawn. A standardized meal test diet was carried out at 0 and 6 months. Glucose, insulin, triglycerides, GLP-1 active and total PYY were measured at times 0, 30, 60, 120 and 180 minutes. RESULTS: The total weight decreased by 15.6 +- 7.23 kg after 6 months of use of BIB, which corresponds to loss of 17.1% of the total weight. After 6 months of follow-up, mean weight loss was maintained at 13.89 kg (15.2%). There was a significant reduction in body fat mass and area of the glucose curve, insulin and triglycerides (p ranged from < 0.001 to 0.003). Of the 24 patients (60%) patients with hypertension at baseline, only 3 (7.5%) remained hypertensive after using the BIB. Serum levels of active GLP-1 and total PYY decreased with BIB. The quality of life improved in all domains analyzed (p < 0.001 to 0.041): physical functioning, physical function, pain, general health, vitality, social functioning, emotional aspects and mental health. CONCLUSION: BIB is effective for weight loss and control of DM2 with quality of life improvement. There is no positive correlation with the production of enterohormones

INTRODUÇÃO: A obesidade é uma doença crônica que tem se tornado um dos maiores problemas de saúde das últimas décadas. A etiologia da obesidade é multifatorial, o que dificulta seu tratamento. O balão intragástrico (BIG) constitui um método pouco invasivo, reversível, de curto prazo para a perda de peso, além de auxiliar na mudança de hábitos alimentares e comportamentais. Promove distensão gástrica, acarretando na diminuição da ingestão alimentar, atrasa o esvaziamento gástrico e causa sensação de saciedade. O objetivo deste trabalho foi avaliar os efeitos do BIG em pacientes com diabetes mellitus tipo 2 (DM2) e sobrepeso ou obesidade grau I, através da análise da perda de peso, composição corporal, metabolismos glicêmico e lipídico, produção de enterohormônios e qualidade de vida. MÉTODOS: realizou-se ensaio clínico, incluindo 40 pacientes com DM2 e (IMC de 27 a 34,9 kg/m2), os quais foram submetidos à colocação do BIG, mantido por 6 meses, e com seguimento por mais 6 meses após sua retirada. Um teste de refeição com dieta padronizada foi realizado nos tempos 0 e 6 meses, com dosagens de glicose, insulina, triglicérides, GLP-1 ativo e PYY total nos tempos 0, 30, 60, 120 e 180 minutos. RESULTADOS: O peso absoluto diminuiu em 15,6 +- 7,23 kg após 6 meses do uso do BIG, o que corresponde à perda de 17,1% do peso total. Após os 6 meses de seguimento, a média de perda de peso foi mantida em 13,89 kg (15,2%). Houve redução significativa na massa de gordura corporal e da área da curva de glicose, insulina e triglicérides (p variou de < 0,001 a 0,003). Dos 24 pacientes (60%) portadores de hipertensão arterial sistêmica no início do estudo, apenas 3 (7,5%) mantiveram-se hipertensos após o uso do BIG. Os níveis séricos de GLP-1 ativo e PYY total diminuíram com o uso do BIG. A qualidade de vida melhorou em todos os domínios analisados (p < 0,001 a 0,041): capacidade funcional, aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais, aspectos emocionais e saúde mental. CONCLUSÃO: o BIG foi eficaz para perda de peso e controle do DM2 com melhora na qualidade de vida. Não há correlação positiva com a produção de enterohormônios / INTRODUCTION: Obesity is a chronic disease that has become one of the biggest health problems on the last decades. The etiology of obesity is multifactorial, which makes the success of treatment more difficult. Intragastric balloon (BIB) is a short term, reversible, minimally invasive method for weight loss. Furthermore, it helps changing eating habits and behavior. It promotes gastric distension, resulting in decreased intake of food, potentially delays gastric emptying and enhances the feeling of satiety. The objective of this study was to evaluate the effects of BIB in patients with type 2 diabetes mellitus (T2DM) and overweight or with grade I obesity, by analyzing the weight loss, body composition, glucose and lipid metabolism, production of enterohormones and quality of life. METHODS: Clinical trial including 40 patients with T2DM and BMI 27-34.9 kg/m2, which underwent placement of BIB, kept for 6 months, and follow-up for another 6 months after withdrawn. A standardized meal test diet was carried out at 0 and 6 months. Glucose, insulin, triglycerides, GLP-1 active and total PYY were measured at times 0, 30, 60, 120 and 180 minutes. RESULTS: The total weight decreased by 15.6 +- 7.23 kg after 6 months of use of BIB, which corresponds to loss of 17.1% of the total weight. After 6 months of follow-up, mean weight loss was maintained at 13.89 kg (15.2%). There was a significant reduction in body fat mass and area of the glucose curve, insulin and triglycerides (p ranged from < 0.001 to 0.003). Of the 24 patients (60%) patients with hypertension at baseline, only 3 (7.5%) remained hypertensive after using the BIB. Serum levels of active GLP-1 and total PYY decreased with BIB. The quality of life improved in all domains analyzed (p < 0.001 to 0.041): physical functioning, physical function, pain, general health, vitality, social functioning, emotional aspects and mental health. CONCLUSION: BIB is effective for weight loss and control of DM2 with quality of life improvement. There is no positive correlation with the production of enterohormones

La première cause de maigreur chez les femmes dans les pays occidentaux est l’anorexie mentale (AM). La maigreur constitutionnelle (MC) regroupe des femmes d’Indice de masse corporelle identique aux AM mais sans les anomalies psychologiques, biologiques ou hormonales (pas d’aménorrhée) rencontrées dans l’AM. Les troubles du comportement alimentaire (TCA) comprennent l’AM restrictive pure (AM-R), l’AM avec crises boulimiques (AM-BP) et la boulimie nerveuse (BN). Notre travail explore ces troubles à la lumière de la régulation de l’appétit dont le centre organique (noyau arqué) reçoit des afférences de peptides périphériques tels que la leptine, le PYY, le GLP1 , la ghréline et l’obéstatine. Nous montrons un profil orexigène dans l’AM-R, témoignant d’une intégrité du système de régulation de la prise alimentaire et adaptatif, luttant contre la restriction alimentaire. Nous avançons le concept de ghrélino-résistance dans l’AM-R dont le substratum biologique est peut-être l’obéstatine. Nous montrons une ghréline basse chez les AM-BP comme chez les BN permettant un diagnostic différentiel précis et rapide. A l’inverse, nous montrons un profil anorexigène constitutif chez les MC participant au maintien du poids bas, proposant la MC comme un modèle humain de résistance à la prise de poids. Ces hormones peuvent agir comme arbitre organique objectif entre des entités cliniques parfois à tort confondues. Une leptine basse chez une jeune fille maigre signe une AM, une ghréline basse chez une AM signe la présence de crises boulimiques. Ces éléments forts nous poussent à continuer notre travail de précision et de phénotypage de ces entités pour mieux en comprendre la physiopathologie / The commonest group of underweight young women in the developed world is restrictive anorexia nervosa (AN). However, constitutional thinness (CT) is a condition described in the same low weight range as AN. CT women display normal menstruation an do not present with psychological or hormonal features of AN. Eating disorders (EA) displays Anorexia Nervosa with restrictive food behaviour (AN-R), Anorexia Nervosa with binge purge associated (AN-BP) and bulimia Nervosa (BN ). Food intake is controlled by the arcuate nucleus through integration of peripheral hormonal signals such as leptin, ghrelin, peptide YY (PYY) and glucagon like peptide 1 (GLP-1). Our objective was to understand thinness and EA through those hormonal signals. AN-R presents an orexigenic adaptative profile contrasting with the anorexigenic constitutive one in CT, proving the integrity of the appetite regulation system. We propose the ghrelin resistance concept with the putative obestatin. AN-BP presents a very different profile of appetite regulatory peptides when compared with AN-R, with low ghrelin levels. The hormones appear to be valuable biomarkers to distinguish AN and CT in severe underweight patients and to diagnose binge purge in AN. The assessment of ghrelin (and eventually obestatin) could be of particular interest for differential diagnosis between AN-R and AN-BP. The assessment of leptin could also be useful for differential diagnosis between AN and CT