651
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Weygandt M, Spranger J, Leupelt V, Maurer L, Bobbert T, Mai K, Haynes JD. Interactions between neural decision-making circuits predict long-term dietary treatment success in obesity. Neuroimage 2018; 184:520-534. [PMID: 30253206 DOI: 10.1016/j.neuroimage.2018.09.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022] Open
Abstract
Although dietary decision-making is regulated by multiple interacting neural controllers, their impact on dietary treatment success in obesity has only been investigated individually. Here, we used fMRI to test how well interactions between the Pavlovian system (automatically triggering urges of consumption after food cue exposure) and the goal-directed system (considering long-term consequences of food decisions) predict future dietary success achieved in 39 months. Activity of the Pavlovian system was measured with a cue-reactivity task by comparing perception of food versus control pictures, activity of the goal-directed system with a food-specific delay discounting paradigm. Both tasks were applied in 30 individuals with obesity up to five times: Before a 12-week diet, immediately thereafter, and at three annual follow-up visits. Brain activity was analyzed in two steps. In the first, we searched for areas involved in Pavlovian processes and goal-directed control across the 39-month study period with voxel-wise linear mixed-effects (LME) analyses. In the second, we computed network parameters reflecting the covariation of longitudinal voxel activity (i.e. principal components) in the regions identified in the first step and used them to predict body mass changes across the 39 months with LME models. Network analyses testing the link of dietary success with activity of the individual systems as reference found a moderate negative link to Pavlovian activity primarily in left hippocampus and a moderate positive association to goal-directed activity primarily in right inferior parietal gyrus. A cross-paradigm network analysis that integrated activity measured in both tasks revealed a strong positive link for interactions between visual Pavlovian areas and goal-directed decision-making regions mainly located in right insular cortex. We conclude that adaptation of food cue processing resources to goal-directed control activity is an important prerequisite of sustained dietary weight loss, presumably since the latter activity can modulate Pavlovian urges triggered by frequent cue exposure in everyday life.
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Affiliation(s)
- Martin Weygandt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Excellence Cluster NeuroCure, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, 10117 Berlin, Germany.
| | - Joachim Spranger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Experimental and Clinical Research Center, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité Center for Cardiovascular Research, 10117, Berlin, Germany
| | - Verena Leupelt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité Center for Cardiovascular Research, 10117, Berlin, Germany
| | - Lukas Maurer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité Center for Cardiovascular Research, 10117, Berlin, Germany
| | - Thomas Bobbert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany
| | - Knut Mai
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Clinic of Endocrinology, Diabetes and Metabolism, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Experimental and Clinical Research Center, 10117, Berlin, Germany
| | - John-Dylan Haynes
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Excellence Cluster NeuroCure, 10117, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, 10117 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Bernstein Center for Computational Neuroscience, 10117, Berlin, Germany
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652
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Work Related Stress, Well-Being and Cardiovascular Risk among Flight Logistic Workers: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091952. [PMID: 30205457 PMCID: PMC6164722 DOI: 10.3390/ijerph15091952] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/26/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Abstract
Work-related stress is a known occupational hazard, with a putative role on the development of cardiovascular diseases (CVD). Although several investigations have explored the association in various workplace scenarios, none have focused on the airport flight logistic support personnel, a transportation business of crucial importance, potentially exposed to job stress and consequently to an increase in CVD risk. We explored the relationship between work-related stress and cardiovascular risk in 568 healthy workers of a flight logistic support company using the Health and Safety Executive questionnaire, the Framingham Heart Study General Cardiovascular Disease (CVD) Risk Prediction Score, and the WHO general well-being index (WHO-5). We used univariate and multivariate statistical methods to take account of possible confounders. Our results show that a low job support significantly increases the CVD risk score and decreases the WHO well-being index with reference to subjects reporting high support on the job. In addition, the well-being index of workers with high strain jobs appears lower in respect to workers employed in low strain job. The multivariate analysis confirms a protective effect of job support, and shows a detrimental influence on CVD risk by physical inactivity, regular intake of alcohol, and a low educational level. In addition, job control, job support, low strain, and high demand coupled with high control (active job) showed a beneficial effect on psychological well-being. Our results suggest that a combination of general risk factors and organizational factors contributes to increase CVD risk and well-being, representing a crucial target for intervention strategies to promote health in the workplace.
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653
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Zago M, Capodaglio P, Ferrario C, Tarabini M, Galli M. Whole-body vibration training in obese subjects: A systematic review. PLoS One 2018; 13:e0202866. [PMID: 30183742 PMCID: PMC6124767 DOI: 10.1371/journal.pone.0202866] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/12/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE (i) to determine the outcomes of whole-body vibration training (WBVT) on obese individuals, and the intervention settings producing such effects; (ii) identify potential improper or harmful use of WBVT. DESIGN Systematic review. DATA SOURCES Medline, Scopus, Web of Science, PEDro and Scielo until July 2018. ELIGIBILITY CRITERIA Full papers evaluating the effect of WBVT on body composition, cardiovascular status and functional performance in obese adults. Papers with PEDro score<4 were excluded. STUDY APPRAISAL AND SYNTHESIS Risk of bias and quality of WBVT reporting were assessed with PEDro scale (randomized controlled trials) or TREND checklist (non-randomized studies) and a 14-items checklist, respectively. Weighted acceleration, daily exposure and Hedges' adjusted g were computed. RESULTS We included 18 papers published 2010-2017. Typical interventions consisted in three sessions/week of exercises (squats, calf-raises) performed on platforms vibrating at 25-40 Hz (amplitude: 1-2 mm); according to ISO 2631-1:1997, daily exposure was "unsafe" in 7/18 studies. Interventions lasting ≥6 weeks improved cardiac autonomic function and reduced central/peripheral arterial stiffness in obese women; 10 weeks of WBVT produced significant weight/fat mass reduction, leg strength improvements as resistance training, and enhanced glucose regulation when added to hypocaloric diet. No paper evidenced losses of lean mass. Isolated cases of adverse effects were reported. SUMMARY To date, WBVT is a promising adjuvant intervention therapy for obese women; long-term studies involving larger cohorts and male participants are required to demonstrate the associated safety and health benefits. The therapeutic use of WBVT in the management of obese patients is still not standardised and should be supported by an extensive knowledge on the causality between vibration parameters and outcomes.
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Affiliation(s)
- Matteo Zago
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano–Italy
- Fondazione Istituto Farmacologico “Filippo Serpero”, Milano–Italy
- * E-mail:
| | - Paolo Capodaglio
- Research Laboratory in Biomechanics and Rehabilitation, Orthopedic Rehabilitation Unit, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Cristina Ferrario
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano–Italy
- Dipartimento di Meccanica, Politecnico di Milano, Milano–Italy
| | - Marco Tarabini
- Dipartimento di Meccanica, Politecnico di Milano, Milano–Italy
| | - Manuela Galli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano–Italy
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654
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Raveendran AV, Chacko EC, Pappachan JM. Non-pharmacological Treatment Options in the Management of Diabetes Mellitus. EUROPEAN ENDOCRINOLOGY 2018; 14:31-39. [PMID: 30349592 PMCID: PMC6182920 DOI: 10.17925/ee.2018.14.2.31] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 02/05/2023]
Abstract
The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.
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Affiliation(s)
| | - Elias C Chacko
- Department of Endocrinology, Jersey General Hospital, Jersey
| | - Joseph M Pappachan
- Department of Endocrinology, Diabetes & Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, UK
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655
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Adrenergically and non-adrenergically mediated human adipose tissue lipolysis during acute exercise and exercise training. Clin Sci (Lond) 2018; 132:1685-1698. [PMID: 29980605 DOI: 10.1042/cs20180453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 02/07/2023]
Abstract
Obesity-related adipose tissue (AT) dysfunction, in particular subcutaneous AT (SCAT) lipolysis, is characterized by catecholamine resistance and impaired atrial natriuretic peptide (ANP) responsiveness. It remains unknown whether exercise training improves (non-)adrenergically mediated lipolysis in metabolically compromised conditions. We investigated the effects of local combined α-/β-adrenoceptor blockade on abdominal SCAT lipolysis in lean insulin sensitive (IS) (n=10), obese IS (n=10), and obese insulin resistant (IR) (n=10) men. Obese men participated in a 12-week exercise training intervention to determine the effects on SCAT lipolysis. Abdominal SCAT extracellular glycerol concentration and blood flow (ATBF) were investigated using microdialysis, with/without locally combined α-/β-adrenoceptor blockade at rest, during low-intensity endurance-type exercise and post-exercise recovery. In obese IR men, microdialysis was repeated after exercise intervention. The exercise-induced increase in SCAT extracellular glycerol was more pronounced in obese IS compared with lean IS men, possibly resulting from lower ATBF in obese IS men. The exercise-induced increase in extracellular glycerol was blunted in obese IR compared with obese IS men, despite comparable local ATBF. Abdominal SCAT extracellular glycerol was markedly reduced (remaining ~60% of exercise-induced SCAT extracellular glycerol) following the local α-/β-adrenoceptor blockade in obese IS but not in IR men, suggesting reduced catecholamine-mediated lipolysis during exercise in obese IR men. Exercise training did not affect (non-)adrenergically mediated lipolysis in obese IR men. Our findings showed a major contribution of non-adrenergically-mediated lipolysis during exercise in male abdominal SCAT. Furthermore, catecholamine-mediated lipolysis may be blunted during exercise in obese IR men but could not be improved by exercise intervention, despite an improved metabolic profile and body composition.
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656
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Dedov II, Melnichenko GA, Troshina EA, Mazurina NV, Galieva MO. Body Weight Reduction Associated with the Sibutramine Treatment: Overall Results of the PRIMAVERA Primary Health Care Trial. Obes Facts 2018; 11:335-343. [PMID: 30089303 PMCID: PMC6189539 DOI: 10.1159/000488880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the effectiveness and safety of long-term sibutramine therapy in routine clinical practice. METHODS In total, 98,774 patients (82.3% women, 17.7% men) from 142 cities of the Russian Federation were enrolled in the PRIMAVERA program. The mean age of the patients was 39.39 ± 10.38 years, the mean body weight was 99.1 ± 14.28 kg, and the mean BMI was 35.7 ± 4.41 kg/m2. The duration of the sibutramine therapy was determined by physicians: 59.3% of patients took the drug for 6 months, the treatment course of 37.7% of patients was 12 months, and 3% of patients had treatment for 3 months. RESULTS The BMI reduction correlated with the treatment duration: 3.4 ± 1.53 kg/m2 after 3 months of therapy, 5.4 ± 2.22 kg/m2 after 6 months, and 7.2 ± 3.07 kg/m2 after 12 months. The body weight reduction after 3, 6 and 12 months of treatment was 9.5%, 15.1%, and 19.7%, respectively. The body weight loss associated with sibutramine treatment was accompanied by a slight decrease in blood pressure and did not lead to any significant increases of the heart rate. CONCLUSIONS The results of the PRIMAVERA study confirmed the lack of increased risk of using sibutramine in routine clinical practice in patients without underlying cardiovascular disease and low rate of adverse events.
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657
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Zenténius E, Andersson-Assarsson JC, Carlsson LMS, Svensson PA, Larsson I. Self-Reported Weight-Loss Methods and Weight Change: Ten-Year Analysis in the Swedish Obese Subjects Study Control Group. Obesity (Silver Spring) 2018; 26:1137-1143. [PMID: 29873894 DOI: 10.1002/oby.22200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/21/2018] [Accepted: 03/31/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Swedish Obese Subjects (SOS) study was designed to compare outcomes in patients with obesity treated by bariatric surgery and a matched control group given usual care. The aim of this study was to analyze self-reported weight-loss methods and weight changes over 10 years in the SOS control group. METHODS Self-reported weight-loss methods in the control group (n = 2,037; 71% women; 48.7 ± 6.3 years; BMI 40.1 ± 4.7 kg/m2 ) were analyzed at baseline and after 0.5, 1, 2, 3, 4, 6, 8, and 10 years of follow-up and studied in relation to weight changes. RESULTS The average 10-year weight change was +2.1% (95% CI: 1.4%-2.8%). At every follow-up, 82.7% (95% CI: 81.3%-84.1%) of participants reported weight-loss attempts. At 10 years, 12.5% of the participants had ≥ 10% weight loss and 22.3% had ≥ 10% weight gain. Participants who lost or gained weight reported similar usage of weight-loss methods. CONCLUSIONS Over 10 years, the majority of the participants of the SOS control group reported continuous efforts to lose weight. These results illustrate the constant struggle individuals with severe obesity are facing and that, on average, the results of long-term weight loss and weight maintenance were discouraging.
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Affiliation(s)
- Edit Zenténius
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johanna C Andersson-Assarsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena M S Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Per-Arne Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- The Unit of Clinical Nutrition and The Regional Obesity Center of Västra Götaland, Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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658
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Gómez-Martin JM, Balsa JA, Aracil E, Cuadrado-Ayuso M, Rosillo M, De la Peña G, Lasunción MA, Escobar-Morreale HF, Botella-Carretero JI. Beneficial changes on plasma apolipoproteins A and B, high density lipoproteins and oxidized low density lipoproteins in obese women after bariatric surgery: comparison between gastric bypass and sleeve gastrectomy. Lipids Health Dis 2018; 17:145. [PMID: 29925393 PMCID: PMC6011580 DOI: 10.1186/s12944-018-0794-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/31/2018] [Indexed: 12/11/2022] Open
Abstract
Background The beneficial effects in lipid profiles after obesity surgery might be associated with the decrease in cardiovascular risk. However, direct comparison between different surgical techniques has not been extensively performed. Methods In the present study we compare 20 obese women submitted to laparoscopic Roux en Y gastric bypass (RYGB) with 20 women submitted to sleeve gastrectomy (SG). Twenty control women matched for age and baseline cardiovascular risk were also included. Both patients and controls were followed up for 1 year after surgery or conventional treatment with diet and exercise, respectively. Lipid profiles were measured at baseline, 6 and 12 months later. Carotid intima-media thickness was measured by ultrasonography at baseline and at the end of the study. Results Women submitted to bariatric surgery showed a decrease in total cholesterol, triglycerides, oxidized-LDL and ApoB, and an increase in HDL and ApoA concentrations that occurred regardless of the surgical procedure. LDL concentrations, however, decreased only after RYGB whereas Lp(a) showed no changes. We did not observe any correlation between the changes in serum lipid concentrations and those in carotid intima-media thickness. Conclusions Sleeve gastrectomy and gastric bypass induce a similar beneficial effect on serum lipids in women with high cardiovascular risk 1 year after surgery.
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Affiliation(s)
- J M Gómez-Martin
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Km. 9.1, 28034, Madrid, Spain
| | - J A Balsa
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital Infanta Sofía & Universidad Europea, Madrid, Spain
| | - E Aracil
- Department of Vascular Surgery, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034, Madrid, Spain
| | - M Cuadrado-Ayuso
- Department of General and Gastrointestinal Surgery, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034, Madrid, Spain
| | - M Rosillo
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034, Madrid, Spain
| | - G De la Peña
- Department of Biochemistry Research, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034, Madrid, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - M A Lasunción
- Department of Biochemistry Research, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034, Madrid, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - H F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Km. 9.1, 28034, Madrid, Spain.,Universidad de Alcalá & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - J I Botella-Carretero
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Km. 9.1, 28034, Madrid, Spain. .,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
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659
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Csipo T, Fulop GA, Lipecz A, Tarantini S, Kiss T, Balasubramanian P, Csiszar A, Ungvari Z, Yabluchanskiy A. Short-term weight loss reverses obesity-induced microvascular endothelial dysfunction. GeroScience 2018; 40:10.1007/s11357-018-0028-9. [PMID: 29916025 PMCID: PMC6060194 DOI: 10.1007/s11357-018-0028-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 12/30/2022] Open
Abstract
Obesity is one of the major risk factors for cardiovascular diseases and its prevalence is increasing in all age groups, with the biggest impact observed in middle-aged and older adults. A critical mechanism by which obesity promotes vascular pathologies in these patients involves impairment of endothelial function. While endothelial dysfunction in large vessels promotes atherogenesis, obesity-induced microvascular endothelial dysfunction impairs organ perfusion and thereby is causally related to the pathogenesis of ischemic heart disease, chronic kidney disease, intermittent claudication, exercise intolerance, and exacerbates cognitive decline in aging. Reduction of weight via calorie-based diet and exercise in animal models of obesity results in significant improvement of endothelial function both in large vessels and in the microcirculation, primarily due to attenuation of oxidative stress and inflammation. Clinical data on the protective effects of weight loss on endothelial function is limited to studies of flow-mediated dilation assessed in brachial arteries. Currently, there is no guideline on testing the effects of different weight management strategies on microvascular endothelial function in obese patients. Here, we provide proof-of-concept that weight loss-induced improvement of microvascular endothelial function can be reliably assessed in the setting of a geriatric outpatient clinic using a fast, reproducible, non-invasive method: laser speckle contrast imaging-based measurement of endothelium-dependent microvascular responses during post-occlusive reactive hyperemia tests. Our study also provides initial evidence that short-term weight loss induced by consumption of a low-carbohydrate low-calorie diet can reverse microvascular endothelial dysfunction associated with obesity.
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Affiliation(s)
- Tamas Csipo
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabor A Fulop
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Agnes Lipecz
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
| | - Priya Balasubramanian
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA.
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660
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Spanish collaborative study: Description of usual clinical practice in infant obesity. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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661
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Kadowaki T, Haneda M, Ito H, Sasaki K, Hiraide S, Matsukawa M, Ueno M. Relationship of Eating Patterns and Metabolic Parameters, and Teneligliptin Treatment: Interim Results from Post-marketing Surveillance in Japanese Type 2 Diabetes Patients. Adv Ther 2018; 35:817-831. [PMID: 29777520 PMCID: PMC6015125 DOI: 10.1007/s12325-018-0704-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Healthy eating is a critical aspect of the prevention and management of type 2 diabetes (T2DM). Disrupted eating patterns can result in poor glucose control and increase the likelihood of diabetic complications. Teneligliptin inhibits dipeptidyl peptidase-4 activity for 24 h and suppresses postprandial hyperglycemia after all three daily meals. This interim analysis of data from the large-scale post-marketing surveillance of teneligliptin (RUBY) in Japan examined eating patterns and their relationship with metabolic parameters and diabetic complications. We also examined whether eating patterns affected safety and efficacy of teneligliptin. METHODS We analyzed baseline data from survey forms collected in RUBY between May 2013 and June 2017, including patient characteristics, metabolic parameters, and eating patterns (eating three meals per day or not; timing of evening meal) before teneligliptin treatment was initiated. Safety and efficacy of 12 months' teneligliptin (20-40 mg/day) treatment was assessed. RESULTS Data from 10,532 patients were available for analysis. Most patients who did not eat three meals per day (n =757) or who ate their evening meal after 10 PM (n =206) were 64 years old or younger. At baseline, glycated hemoglobin (HbA1c), fasting blood glucose, triglycerides, total and low-density lipoprotein cholesterol, body mass index, alanine aminotransferase, and aspartate aminotransferase levels were higher in those patients who did not eat three meals per day (p < 0.05) or who ate their evening meal late (p < 0.05). Diabetic complications were more common in patients who did not eat three meals per day. Treatment with teneligliptin reduced HbA1c over 6 or 12 months across all eating patterns, with a low incidence of adverse drug reactions. CONCLUSIONS Eating patterns may be associated with altered metabolic parameters and diabetic complications among Japanese patients with T2DM. Teneligliptin may be well tolerated and improve hyperglycemia in patients with T2DM irrespective of eating patterns. FUNDING Mitsubishi Tanabe Pharma Corporation and Daiichi Sankyo Co. Ltd. TRIAL REGISTRATION NUMBER Japic CTI-153047.
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Affiliation(s)
- Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masakazu Haneda
- Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
- Medical Corporation Kyousoukai, Osaka, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuyo Sasaki
- Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Osaka, Japan.
| | - Sonoe Hiraide
- Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Osaka, Japan
| | - Miyuki Matsukawa
- Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Osaka, Japan
| | - Makoto Ueno
- Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Osaka, Japan
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Barazzoni R, Gortan Cappellari G, Semolic A, Ius M, Zanetti M, Gabrielli A, Vinci P, Guarnieri G, Simon G. Central adiposity markers, plasma lipid profile and cardiometabolic risk prediction in overweight-obese individuals. Clin Nutr 2018; 38:1171-1179. [PMID: 29779870 DOI: 10.1016/j.clnu.2018.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/13/2018] [Accepted: 04/25/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Waist circumference (WC) is the currently recommended marker of central fat for cardiometabolic risk screening. Alternative surrogate markers have been recently proposed to better reflect the metabolic impact of central fat accumulation per se, based on WC normalization by height (Weight-to-Height Ratio - WtoH; Body Roundness Index - BRI) or body mass index (BMI) without (A Body Shape Index - ABSI) or with inclusion of plasma triglyceride and HDL-cholesterol concentrations (Visceral Adiposity Index - VAI). METHODS We investigated associations between WtoH, BRI, ABSI or VAI and insulin resistance (HOMA-index) or metabolic syndrome (MetS) in a general population cohort from the North-East Italy Mo.Ma. study (n = 1965, age = 49 ± 13 years, BMI = 26.7 ± 5.2 kg/m2). Baseline values were also evaluated as predictors of future insulin resistance and MetS in overweight-obese individuals undergoing 5-year follow-up (Ow-Ob) (n = 263; age = 54 ± 9, BMI = 30,7 ± 4,1). RESULTS Compared to WC or BMI, basal WtoH and BRI were similarly associated with baseline HOMA and MetS prevalence after multiple adjustments (P < 0.001) and all markers similarly predicted 5-year HOMA and MetS (P < 0.001). Under basal conditions, superimposable results were observed for VAI whereas ABSI was less accurate or unable to identify baseline HOMA and MetS (p < 0.05 vs WtoH-BRI-VAI-WC-BMI). VAI had highest 5-year risk predictive value in Ow-Ob [ROC Area Under the Curve (AUC) VAI > WtoH-BRI-WC-BMI; p < 0.05] while no predictive value was in contrast observed for ABSI (ROC AUC ABSI < WtoH-BRI-WC-BMI; p < 0.05). Using alternate formulae with plasma lipid inclusion in ABSI and removal from VAI calculations completely reversed their 5-year predictive value and AUC. CONCLUSIONS The current findings do not support replacement of WC with height-normalized anthropometric central fat surrogate markers to predict cardiometabolic risk in the general and overweight-obese population. BMI-normalization impairs risk assessment unless plasma lipid concentrations are available and included in calculations.
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Affiliation(s)
- Rocco Barazzoni
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
| | - Gianluca Gortan Cappellari
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Annamaria Semolic
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Mario Ius
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Michela Zanetti
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | | | - Pierandrea Vinci
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Gianfranco Guarnieri
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Giorgio Simon
- Azienda per l'Assistenza Sanitaria n. 5, Pordenone, Italy
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Assessment of Weight Loss With the Intragastric Balloon in Patients With Different Degrees of Obesity. Surg Laparosc Endosc Percutan Tech 2018; 27:e83-e86. [PMID: 28731953 DOI: 10.1097/sle.0000000000000440] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The intragastric balloon (IGB) is an endoscopic device for the treatment of obesity. Best results are observed in patients who follow a dietary program but few studies have assessed the results of this treatment in patients with different degrees of obesity. AIM The aim of this study is to compare the efficacy of IGB in patients with different degrees of obesity. METHOD A total of 2002 patients with IGB were retrospectively evaluated and were divided into groups according to initial body mass index (BMI) range, as follows: group 1, 27 to 29.9 kg/m; group 2, 30 to 34.9 kg/m; group 3, 35 to 39.9 kg/m; group 4, 40 to 44.9 kg/m; group 5, ≥45 kg/m. Weight was assessed in 3 different times: before (T0), 1 month (T1), 6 months (T2), and 6 months after removal of the IGB (T3). RESULTS A total of 946 patients lost follow-up. Overall, 40 (3.78%) removed the device before programmed by intolerance, and 1016 patients completed the 6-month treatment. The mean weight loss was 18.9%, excess weight loss 60.1% and an BMI reduction of 6.76 points. 6 months after removal of the balloon 842 patients had continued follow-up (82.8%). At this time, weight loss was 19.84%, excess weight loss was 59.49%, and BMI reduction of 7.06 points. In all groups there was statistical difference between the times T0 and T1 and between T1 and T2 (P<0.001). There was no statistical difference between T2 and T3, in any group. CONCLUSION IGB provided sustained weight loss in patients who remained in dietary follow-up for 1 year.
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Barazzoni R, Bischoff SC, Boirie Y, Busetto L, Cederholm T, Dicker D, Toplak H, Van Gossum A, Yumuk V, Vettor R. Sarcopenic obesity: Time to meet the challenge. Clin Nutr 2018; 37:1787-1793. [PMID: 29857921 DOI: 10.1016/j.clnu.2018.04.018] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 01/01/2023]
Abstract
The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social and multi-disciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures and cancer, as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenetic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight-reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term "sarcopenic obesity" has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
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Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
| | - Stephan C Bischoff
- University of Hohenheim, Department of Nutritional Medicine, Stuttgart, Germany
| | - Yves Boirie
- Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, F-63000 Clermont-Ferrand, France; CHU Clermont-Ferrand, Service Nutrition Clinique, F-63000 Clermont-Ferrand, France
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy; Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| | - Tommy Cederholm
- Uppsala University, Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala, Sweden
| | - Dror Dicker
- Internal Medicine Department & Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Austria
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Roberto Vettor
- Department of Medicine, University of Padova, Italy; Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
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Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group. Sports Med 2018; 48:1781-1797. [DOI: 10.1007/s40279-018-0930-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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667
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James BD, Jones AV, Trethewey RE, Evans RA. Obesity and metabolic syndrome in COPD: Is exercise the answer? Chron Respir Dis 2018; 15:173-181. [PMID: 29117797 PMCID: PMC5958471 DOI: 10.1177/1479972317736294] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/11/2017] [Indexed: 01/22/2023] Open
Abstract
Approximately half of all patients with chronic obstructive pulmonary disease (COPD) attending pulmonary rehabilitation (PR) programmes are overweight or obese which negatively impacts upon dyspnoea and exercise tolerance particularly when walking. Within the obese population (without COPD), the observed heterogeneity in prognosis is in part explained by the variability in the risk of developing cardiovascular disease or diabetes (cardiometabolic risk) leading to the description of metabolic syndrome. In obesity alone, high-intensity aerobic training can support healthy weight loss and improve the constituent components of metabolic syndrome. Those with COPD, obesity and/or metabolic syndrome undergoing PR appear to do as well in traditional outcomes as their normal-weight metabolically healthy peers in terms of improvement of symptoms, health-related quality of life and exercise performance, and should therefore not be excluded. To broaden the benefit of PR, for this complex population, we should learn from the extensive literature examining the effects of exercise in obesity and metabolic syndrome discussed in this review and optimize the exercise strategy to improve these co-morbid conditions. Standard PR outcomes could be expanded to include cardiometabolic risk reduction to lower future morbidity and mortality; to this end exercise may well be the answer.
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Affiliation(s)
- Benjamin D James
- Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Amy V Jones
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Ruth E Trethewey
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Rachael A Evans
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- Health Sciences, University of Leicester, Leicester, UK
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668
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Fittipaldi-Fernandez RJ, Guedes MR, Galvao Neto MP, Klein MRST, Diestel CF. Efficacy of Intragastric Balloon Treatment for Adolescent Obesity. Obes Surg 2018; 27:2546-2551. [PMID: 28451930 DOI: 10.1007/s11695-017-2699-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Several studies conducted in adults suggest that intragastric balloon (IGB) is an effective and safe method for weight loss. Although the prevalence of obesity in adolescents has increased in recent years, the outcomes of IGB treatment in this age group are not known. The aim of this study was to evaluate the safety and efficacy of IGB treatment for weight loss in adolescents followed up for 6 months. METHODS This is a retrospective longitudinal study including 27 adolescents (14-19 years; 23 female). All participants were referred to IGB treatment by their attending physician, presented body mass index (BMI) ≥ 29 kg/m2 (>p97 BMI/age index) and failed to lose weight in clinical treatments. A liquid-filled nonadjustable IGB with a volume of 600 to 700 ml was used for 6 months. All patients were included in a multidisciplinary program, and adherence to this program was evaluated as the number of attended appointments. RESULTS There were no serious complications or deaths. The BMI decreased from 37.04 to 31.18 kg/m2 (p < 0.0001), body weight decreased from 102.21 to 86.23 kg (p < 0.0001), and excess weight diminished from 35.18 to 19.12 kg (p < 0.0001). The % excess weight loss (%EWL) was 56.19 and % total weight loss (%TWL) 16.35. Adherence to the multidisciplinary program correlated directly with %EWL (r = 0.55; p = 0.0033) and %TWL (r = 0.53; p = 0.0052). CONCLUSION Endoscopic treatment of obesity with an IGB is safe, effective, and may be an emerging therapeutic option for adolescents.
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Affiliation(s)
| | | | - Manoel P Galvao Neto
- Gastro Obeso Center, Sao Paulo, Brazil.,Florida International University, Miami, FL, USA
| | - Márcia Regina Simas Torres Klein
- Department of Applied Nutrition, Nutition Institute, Rio de Janeiro State University, 12th floor/524, São Francisco Xavier Street, Rio de Janeiro/RJ, 20550-900, Brazil
| | - Cristina Fajardo Diestel
- EndogastroRio Clinic, 43/1101, Siqueira Campos Street, Rio de Janeiro/RJ, 22031-901, Brazil.,Department of Applied Nutrition, Nutition Institute, Rio de Janeiro State University, 12th floor/524, São Francisco Xavier Street, Rio de Janeiro/RJ, 20550-900, Brazil
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Johnson S, Schwartz SM. Pharmacologic and Pharmacodynamic Equivalence of 2 Formulations of Orlistat. Clin Pharmacol Drug Dev 2018; 7:773-780. [PMID: 29659193 DOI: 10.1002/cpdd.457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/05/2018] [Indexed: 12/13/2022]
Abstract
We sought to establish the bioequivalence of 2 weight-loss aids: orlistat 27-mg chewable tablet and orlistat 60-mg capsule, measured pharmacodynamically as percentage fecal fat excretion. Two open-label, single-center, randomized, 3-period, 3-treatment crossover studies were conducted in adults with body mass index 25-33 kg/m2 . For each 9-day treatment period, subjects received orlistat 27-mg chewable tablet, 60-mg capsule, or 120-mg capsules (2 60-mg capsules) 3 times daily; a 2-day washout separated treatments. Primary bioequivalence analyses were based on 2 1-sided tests of the 90% CI of the ratio of geometric means using log-transformed data (study 1) and by the dose-scale method to calculate bias-corrected and accelerated 90% CI of relative bioavailability (f) using nontransformed data (study 2). Bioequivalence was established if 90% CIs fell within 0.80-1.25. In total, 48 and 144 subjects were randomized in study 1 and study 2, respectively. Bioequivalence between the formulations was established in both studies: study 1 ratio of geometric means of percentage fecal fat excretion was 0.96 (2 1-sided tests, 90% CI 0.87-1.06); study 2-point estimate of f was 1.09 (bias-corrected and accelerated 90% CI 0.98-1.22). Tolerability of the 27-mg tablet was consistent with the 60-mg capsule; mild gastrointestinal effects were most common.
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670
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Sun S, Borisenko O, Spelman T, Ahmed AR. Patient Characteristics, Procedural and Safety Outcomes of Bariatric Surgery in England: a Retrospective Cohort Study-2006-2012. Obes Surg 2018; 28:1098-1108. [PMID: 29076010 PMCID: PMC5880868 DOI: 10.1007/s11695-017-2978-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The objective of the study is to analyze procedural and safety outcomes associated with bariatric surgery and describe the characteristics of patients undertaking bariatric procedures in England between April 2006 and March 2012. METHODS This is a retrospective cohort study of all adult patients in England diagnosed with obesity and undergoing bariatric surgery as a primary procedure in NHS-funded sites between April 2006 and March 2012 using data sourced from the Hospital Episode Statistics dataset. Length of stay (LOS), 30-day readmission, and post-surgery complication were analyzed as primary outcomes. Socio-demographic background, provider type, procedure volume, and comorbidities were all analyzed as potential explanatory variables. RESULTS Gastric bypass (GBP, 12,628) was the most utilized procedure, followed by gastric banding (GB, 6872) and sleeve gastrectomy (SG, 3251). The most prevalent comorbidity was type 2 diabetes (23%). Inpatient mortality was low (≤ 0.15%) for all procedure types. LOS and the risks of both post-operative complication and 30-day readmission were significantly lower for GB, relative to those for GBP and SG. Ethnicity, geographical area, surgery type, and volume were all associated with LOS, risk of readmission, and complication. Provider type and deprivation were further associated with LOS while age correlated with readmission only. An increasing comorbidity burden was associated with an increased risk of both readmission and complication. CONCLUSIONS Gastric bypass was the most frequently reported procedure in England across the observation period. While utilization across all procedure types increased between 2007 and 2010, overall uptake of bariatric surgery in England represents only a small proportion of the eligible population. Readmission and complication rates were lower for gastric banding relative to those for either gastric bypass or sleeve gastrectomy. The observed inpatient mortality rate was low across all procedure types.
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Affiliation(s)
- Sun Sun
- Synergus AB, Kevinge Strand 20, 182 57, Stockholm, Sweden.
- Health Outcomes and Economic Evaluation Research Group, Center for Healthcare Ethics, Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Oleg Borisenko
- Synergus AB, Kevinge Strand 20, 182 57, Stockholm, Sweden
| | - Tim Spelman
- Synergus AB, Kevinge Strand 20, 182 57, Stockholm, Sweden
- Centre for Population Health, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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671
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Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, Kushner RF, Daniels SR, Wadden TA, Tsai AG, Hu FB, Jakicic JM, Ryan DH, Wolfe BM, Inge TH. The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocr Rev 2018; 39:79-132. [PMID: 29518206 PMCID: PMC5888222 DOI: 10.1210/er.2017-00253] [Citation(s) in RCA: 429] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/19/2022]
Abstract
The prevalence of obesity, measured by body mass index, has risen to unacceptable levels in both men and women in the United States and worldwide with resultant hazardous health implications. Genetic, environmental, and behavioral factors influence the development of obesity, and both the general public and health professionals stigmatize those who suffer from the disease. Obesity is associated with and contributes to a shortened life span, type 2 diabetes mellitus, cardiovascular disease, some cancers, kidney disease, obstructive sleep apnea, gout, osteoarthritis, and hepatobiliary disease, among others. Weight loss reduces all of these diseases in a dose-related manner-the more weight lost, the better the outcome. The phenotype of "medically healthy obesity" appears to be a transient state that progresses over time to an unhealthy phenotype, especially in children and adolescents. Weight loss is best achieved by reducing energy intake and increasing energy expenditure. Programs that are effective for weight loss include peer-reviewed and approved lifestyle modification programs, diets, commercial weight-loss programs, exercise programs, medications, and surgery. Over-the-counter herbal preparations that some patients use to treat obesity have limited, if any, data documenting their efficacy or safety, and there are few regulatory requirements. Weight regain is expected in all patients, especially when treatment is discontinued. When making treatment decisions, clinicians should consider body fat distribution and individual health risks in addition to body mass index.
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Affiliation(s)
- George A Bray
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - William E Heisel
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | - Ashkan Afshin
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | | | - William H Dietz
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Michael Long
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | | | - Stephen R Daniels
- Department of Pediatrics, University of Colorado Children Hospital, Denver, Colorado
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Adam G Tsai
- Kaiser Permanente Colorado, Denver, Colorado
| | - Frank B Hu
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Donna H Ryan
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Bruce M Wolfe
- Oregon Health and Science University, Portland, Oregon
| | - Thomas H Inge
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
- Children’s Hospital Colorado, Aurora, Colorado
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Bettini S, Bordigato E, Fabris R, Serra R, Dal Pra’ C, Belligoli A, Sanna M, Compagnin C, Foletto M, Prevedello L, Fioretto P, Vettor R, Busetto L. Modifications of Resting Energy Expenditure After Sleeve Gastrectomy. Obes Surg 2018. [DOI: 10.1007/s11695-018-3190-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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673
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Distinct activation of the sympathetic adreno-medullar system and hypothalamus pituitary adrenal axis following the caloric vestibular test in healthy subjects. PLoS One 2018. [PMID: 29509800 DOI: 10.1371/journal.pone.0193963]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The vestibular acute stress induces reversible alert-like reactions that involve the sympathetic adrenal-medullar system and hypothalamic-pituitary-adrenal axis responses. The present study aimed to evaluate salivary α-amylase and salivary cortisol production in relation with cardiovascular reactivity induced by acute stress in healthy subjects. MATERIAL AND METHODS Forty-eight young healthy male volunteers were examined under basal conditions and at various times after reaching the maximal nystagmic reaction following air caloric vestibular test. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the same time as measurement of the salivary α-amylase and salivary cortisol. At the end of the caloric vestibular test session, perceived stress scale questionnaires were administered to measure the self-perceived stress impact induced by the task, and individual scores were compared with those measured on the enrollment day. RESULTS Following caloric vestibular test-evoked vertigo, salivary α-amylase and cortisol showed distinct trends in their production after acute stress: Student's t-test was used to compare the α-amylase vs cortisol slopes of the respective interpolated regression lines, and the difference was significant (t = -3.283; p<0.001); an increase in salivary cortisol production corresponded with a decrease in the salivary α-amylase concentration. In addition, salivary biomarker modifications were associated with consistent changes in the heart rate, systolic blood pressure and mean arterial pressure. CONCLUSIONS Using the air caloric vestibular test task as a stressor, the present study demonstrated a connection between the acute hormonal stress response to vestibular stimulation and cardiovascular output. However, further research is needed before we can define the potential importance of the consistent cardiovascular activity changes evoked by vestibular stimulation and the possible functional consequences for cardiovascular regulation and orthostatic tolerance in humans.
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Paravidino VB, Mediano MFF, Silva ICM, Wendt A, Del Vecchio FB, Neves FA, Terra BDS, Gomes EAC, Moura AS, Sichieri R. Effect of physical exercise on spontaneous physical activity energy expenditure and energy intake in overweight adults (the EFECT study): a study protocol for a randomized controlled trial. Trials 2018. [PMID: 29514690 PMCID: PMC5842658 DOI: 10.1186/s13063-018-2445-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Physical exercise interventions have been extensively advocated for the treatment of obesity; however, clinical trials evaluating the effectiveness of exercise interventions on weight control show controversial results. Compensatory mechanisms through a decrease in energy expenditure and/or an increase in caloric consumption is a possible explanation. Several physiological mechanisms involved in the energy balance could explain compensatory mechanisms, but the influences of physical exercise on these adjustments are still unclear. Therefore, the present trial aims to evaluate the effects of exercise on non-exercise physical activity energy expenditure, energy intake and appetite sensations among active overweight/obese adults, as well as, to investigate hormonal changes associated with physical exercise. Methods This study is a randomized controlled trial with parallel, three-group experimental arms. Eighty-one overweight/obese adults will be randomly allocated (1:1:1 ratio) to a vigorous exercise group, moderate exercise group or control group. The trial will be conducted at a military institution and the intervention groups will be submitted to exercise sessions in the evening, three times a week for 65 min, during a 2-week period. The primary outcome will be total spontaneous physical activity energy expenditure during a 2-week period. Secondary outcomes will be caloric intake, appetite sensations and laboratorial biomarkers. Intention-to-treat analysis will be performed using linear mixed-effects models to evaluate the effect of treatment-by-time interaction on primary and secondary outcomes. Data analysis will be performed using SAS 9.3 and statistical significance will be set at p < 0.05. Discussion The results of the present study will help to understand the effect of physical exercise training on subsequent non-exercise physical activity, appetite and energy intake as well as understand the physiological mechanisms underlying a possible compensatory phenomenon, supporting the development of more effective interventions for prevention and treatment of obesity. Trial registration Physical Exercise and Energy Balance trial registry, trial registration number: NCT 03138187. Registered on 30 April 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2445-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vitor Barreto Paravidino
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil. .,Department of Physical Education and Sports, Naval Academy - Brazilian Navy, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Andrea Wendt
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Fabiana Alves Neves
- Department of Physiology Science, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno de Souza Terra
- Research Laboratory of Exercise Sciences, Physical Education Center Admiral Adalberto Nunes, Brazilian Navy, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Anibal Sanchez Moura
- Department of Physiology Science, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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675
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Yang Q, Huang G, Tian Q, Liu W, Sun X, Li N, Sun S, Zhou T, Wu N, Wei Y, Chen P, Wang R. "Living High-Training Low" improved weight loss and glucagon-like peptide-1 level in a 4-week weight loss program in adolescents with obesity: A pilot study. Medicine (Baltimore) 2018; 97:e9943. [PMID: 29465583 PMCID: PMC5842013 DOI: 10.1097/md.0000000000009943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND "Living High-Training Low" (LHTL) is effective for the improvement of athletic ability; however, little is known about the effect of LHTL on obese individuals. The present study determined whether LHTL would have favorable influence on body composition, rebalance the appetite hormones, and explore the underlying mechanism. METHODS Adolescents with obesity [body mass index (BMI) >30 kg/m] were randomly assigned to "Living Low-Training Low" (LLTL, n = 19) group that slept in a normobaric normoxia condition and the LHTL (n = 16) group slept in a normobaric hypoxia room (14.7% PO2 ∼2700 m). Both groups underwent the same aerobic exercise training program. Morphological, blood lipids, and appetite hormones were measured and assessed. RESULTS After the intervention, the body composition improved in both groups, whereas reductions in body weight (BW), BMI, and lean body mass increased significantly in the LHTL group (all, P < .05). In the LLTL group, cholecystokinin (CCK) decreased remarkably (P < .05) and CCK changes were positively associated with changes in BW (r = 0.585, P = .011) and BMI (r = 0.587, P = .010). However, in the LHTL group, changes in plasma glucagon-like peptide-1 (GLP-1) and interleukin-6 (IL-6) levels, positively correlated with each other (r = 0.708, P = .015) but negatively with BW changes (r = -0.608, P = .027 and r = -0.518, P = .048, respectively). CONCLUSION The results indicated that LHTL could induce more weight loss safely and efficiently as compared to LLTL and increase the plasma GLP-1 levels that may be mediated by IL-6 to rebalance the appetite. Thus, an efficient method to treat obesity and prevent weight regain by appetite rebalance in hypoxia condition was established.
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Affiliation(s)
- Qin Yang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Guoyuan Huang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- Pott College of Science, Engineering and Education, University of Southern Indiana, Evansville, IN
| | - Qianqian Tian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Wei Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Xiangdong Sun
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Na Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Shunli Sun
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Tang Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Nana Wu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Yuqin Wei
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Peijie Chen
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Ru Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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676
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Iwata A, Matsubara S, Miyazaki K. Beneficial effects of a beta-cryptoxanthin-containing beverage on body mass index and visceral fat in pre-obese men: Double-blind, placebo-controlled parallel trials. J Funct Foods 2018. [DOI: 10.1016/j.jff.2017.12.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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677
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Tomeleri CM, Cavaglieri CR, de Souza MF, Cavalcante EF, Antunes M, Nabbuco HCG, Venturini D, Barbosa DS, Silva AM, Cyrino ES. Phase angle is related with inflammatory and oxidative stress biomarkers in older women. Exp Gerontol 2018; 102:12-18. [PMID: 29197561 DOI: 10.1016/j.exger.2017.11.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 01/10/2023]
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678
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Derya MA, Demir V, Ede H. Relationship between neutrophil/lymphocyte ratio and epicardial fat tissue thickness in patients with newly diagnosed hypertension. J Int Med Res 2018; 46:940-950. [PMID: 29332485 PMCID: PMC5972270 DOI: 10.1177/0300060517749130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective Epicardial fat tissue thickness (EFT) and the neutrophil/lymphocyte ratio (NLR) are associated with atherosclerosis. Few studies have focused on the relationship between these parameters in patients with newly diagnosed hypertension. In this study, we examined the relationship between EFT and the NLR in patients with newly diagnosed hypertension detected by 24-hour ambulatory blood pressure monitoring (ABPM). Methods Eighty consecutive patients without chronic illness who were diagnosed with hypertension according to ABPM results and 80 otherwise healthy subjects were enrolled in the study. EFT of each participant was measured echocardiographically. The C-reactive protein (CRP) concentration and NLR were measured from venous blood samples. Results The 24-hour average systolic blood pressure was significantly higher in the hypertension group than in the control group (143±17 vs. 117±7 mmHg, respectively). There were no significant differences in age, sex, or body mass index between the two groups. EFT, the NLR, and the CRP concentration were significantly higher in the hypertension group than control group. Additionally, a significantly positive correlation between EFT and the NLR was found in both the control group and hypertension group. Conclusion A higher EFT and NLR were detected in patients with newly diagnosed hypertension than in healthy subjects.
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Affiliation(s)
- Mehmet Ali Derya
- Cardiology Department, Faculty of Medicine, 485513 Bozok University, Yozgat , Turkey
| | - Vahit Demir
- Cardiology Department, Faculty of Medicine, 485513 Bozok University, Yozgat , Turkey
| | - Huseyin Ede
- Cardiology Department, Faculty of Medicine, 485513 Bozok University, Yozgat , Turkey
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679
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Tunay M, Kurdak H, Özcan S, Özdemir Ç, Özer ZY. Family Physician-Led Group Visits for Lifestyle Modification in Women with Weight Problems: A Pilot Intervention and Follow-Up Study. Obes Facts 2018; 11:1-14. [PMID: 29402785 PMCID: PMC5869599 DOI: 10.1159/000486133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/02/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Lifestyle modification requires extensive information sharing and counseling. However, one-on-one primary care consultations are lacking to cover all necessary components due to time constraints. This preliminary study aims to investigate the feasibility and effects of lifestyle-changing intervention by family physician-led group visits (GVs) on weight management in overweight and obese women. METHODS 60 volunteers fulfilling the inclusion criteria were enrolled. Baseline and 6th month assessments consisted of anthropometric measurements, SF-36 Health Survey, blood variables, exercise test, and resting metabolic rate. Weight maintenance was controlled at the 12th month. RESULTS Although weight loss among participants varied, the mean body weights were significantly decreased by 8.2% in full-attenders (n = 30). A significant increase in HDL-cholesterol and decreases in heart rate and blood pressure were found. SF-36 summary scales were significantly improved. Weight change was moderately correlated with exercise duration, compliance to diet, and baseline mental component score. It was determined that 62.5% of the participants either lost or maintained body weight at the 12th month. CONCLUSION Significant weight loss and quality of life improvement was achieved in this pilot study. GVs may be a promising alternative to primary care consultations for obesity management; however, the high dropout level and diverse outcomes need further assessment.
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Affiliation(s)
- Merthan Tunay
- Department of Family Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hatice Kurdak
- Department of Family Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
- *Hatice Kurdak, Tıp Fakültesi, Çukurova Üniversitesi, Aile Hekimliği AD, 01330 Sarıçam, Adana, Turkey, ,
| | - Sevgi Özcan
- Department of Family Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Çiğdem Özdemir
- Department of Sports Physiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Zeliha Yelda Özer
- Department of Family Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
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680
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Abusnana S, Fargaly M, Alfardan SH, Al Hammadi FH, Bashier A, Kaddaha G, McGowan B, Nawar R, Sadiya A. Clinical Practice Recommendations for the Management of Obesity in the United Arab Emirates. Obes Facts 2018; 11:413-428. [PMID: 30372696 PMCID: PMC6257093 DOI: 10.1159/000491796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022] Open
Abstract
With rapid urbanisation and improved living conditions as a result of rising incomes in Gulf Cooperation Council (GCC) countries, obesity has become a major and growing health problem for the region. The United Arab Emirates (UAE) has a resident population of 9.3 million (in 2016), many of whom (85.5%) lived in urban areas and led sedentary lifestyles. Based on the World Health Organisation (WHO) estimates for 2010, 25% of Emirati men and 40% of the women were obese. Obesity rates in this country has doubled from 16 to 34% compared to the year 2000, and severe obesity (BMI > 40 kg/m2) has risen dramatically from 2 to 11%. While a number of international guidelines for the management of obesity are already available in public domain, local guidelines for the UAE and the region, which are structured and individualized for the management of obesity, are sorely needed to help the family physician to provide affordable treatment for the patient at the point-of-care and to reduce the burden on the local healthcare system. A multi-disciplinary panel of international and regional experts who treat patients with overweight and obesity was convened with the aim of developing consensus recommendations for the UAE. The objective is to have a simple and easy-to-refer set of recommendations for busy clinicians as there were already many comprehensive international guidelines available. The panel reviewed and streamlined these recommendations in its entirety for relevance, coherence and usability in the local context. These recommendations for overweight and obesity management were circulated and endorsed by the local practising family medicine community, namely, the Emirates Medical Association and Family Medicine Society. We believe these recommendations would also be of interest to clinicians in other GCC countries. A summary and algorithm of these recommendations are provided.
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Affiliation(s)
- Salahedeen Abusnana
- University of Sharjah, Sharjah, United Arab Emirates
- *Prof. Dr. Salahedeen Abusnana, HoD Diabetes and Endocrine, University of Sharjah, 72772 Sharjah, United Arab Emirates,
| | | | - Shaima Hasan Alfardan
- Behavior Sciences Pavilion, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Alaaeldin Bashier
- Department of Diabetes and Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - Ghaida Kaddaha
- Dr Sulaiman Al-Habib Medical Center, Dubai, United Arab Emirates
| | - Barbara McGowan
- Department of Diabetes and Endocrinology, Guy's & St Thomas's Hospital, London, UK
| | - Rita Nawar
- The Weight Care Clinic, Dubai HealthCare City, Dubai, United Arab Emirates
| | - Amena Sadiya
- Lifestyle Clinic, Sheikh Khalifa Medical City, Ajman, United Arab Emirates
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681
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Harris L, McGarty A, Hutchison L, Ells L, Hankey C. Short-term intermittent energy restriction interventions for weight management: a systematic review and meta-analysis. Obes Rev 2018; 19:1-13. [PMID: 28975722 DOI: 10.1111/obr.12593] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 11/30/2022]
Abstract
This systematic review synthesized the available evidence on the effect of short-term periods of intermittent energy restriction (weekly intermittent energy restriction; ≥7-d energy restriction) in comparison with usual care (daily continuous energy restriction), in the treatment of overweight and obesity in adults. Six electronic databases were searched from inception to October 2016. Only randomized controlled trials of interventions (≥12 weeks) in adults with overweight and obesity were included. Five studies were included in this review. Weekly intermittent energy restriction periods ranged from an energy intake between 1757 and 6276 kJ/d-1 . The mean duration of the interventions was 26 (range 14 to 48) weeks. Meta-analysis demonstrated no significant difference in weight loss between weekly intermittent energy restriction and continuous energy restriction post-intervention (weighted mean difference: -1.36 [-3.23, 0.51], p = 0.15) and at follow-up (weighted mean difference: -0.82 [-3.76, 2.11], p = 0.58). Both interventions achieved comparable weight loss of >5 kg and therefore were associated with clinical benefits to health. The findings support the use of weekly intermittent energy restriction as an alternative option for the treatment of obesity. Currently, there is insufficient evidence to support the long-term sustainable effects of weekly intermittent energy restriction on weight management.
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Affiliation(s)
- L Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A McGarty
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Hutchison
- College of Medical Veterinary and Life Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Ells
- Health and Social Care Institute, Teesside University, United Kingdom Teesside Centre for Evidence Informed Practice: A Joanna Briggs Institute Centre of Excellence, Middlesbrough, UK
| | - C Hankey
- College of Medical Veterinary and Life Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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682
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Barazzoni R, Bischoff S, Boirie Y, Busetto L, Cederholm T, Dicker D, Toplak H, Van Gossum A, Yumuk V, Vettor R. Sarcopenic Obesity: Time to Meet the Challenge. Obes Facts 2018; 11:294-305. [PMID: 30016792 PMCID: PMC6189532 DOI: 10.1159/000490361] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social, and multidisciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures, and cancer as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability, and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term 'sarcopenic obesity' has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification, and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria, and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has a strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
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Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
- *Rocco Barazzoni, MD, PhD, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy,
| | - Stephan Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Yves Boirie
- Unité de Nutrition Humaine, Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, Clermont-Ferrand, France
- Service Nutrition Clinique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy
- Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Dror Dicker
- Internal Medicine Department & Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Roberto Vettor
- Department of Medicine, University of Padova, Italy
- Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
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683
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Cozma S, Ghiciuc CM, Damian L, Pasquali V, Saponaro A, Lupusoru EC, Patacchioli FR, Dima-Cozma LC. Distinct activation of the sympathetic adreno-medullar system and hypothalamus pituitary adrenal axis following the caloric vestibular test in healthy subjects. PLoS One 2018; 13:e0193963. [PMID: 29509800 PMCID: PMC5839583 DOI: 10.1371/journal.pone.0193963] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The vestibular acute stress induces reversible alert-like reactions that involve the sympathetic adrenal-medullar system and hypothalamic-pituitary-adrenal axis responses. The present study aimed to evaluate salivary α-amylase and salivary cortisol production in relation with cardiovascular reactivity induced by acute stress in healthy subjects. MATERIAL AND METHODS Forty-eight young healthy male volunteers were examined under basal conditions and at various times after reaching the maximal nystagmic reaction following air caloric vestibular test. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the same time as measurement of the salivary α-amylase and salivary cortisol. At the end of the caloric vestibular test session, perceived stress scale questionnaires were administered to measure the self-perceived stress impact induced by the task, and individual scores were compared with those measured on the enrollment day. RESULTS Following caloric vestibular test-evoked vertigo, salivary α-amylase and cortisol showed distinct trends in their production after acute stress: Student's t-test was used to compare the α-amylase vs cortisol slopes of the respective interpolated regression lines, and the difference was significant (t = -3.283; p<0.001); an increase in salivary cortisol production corresponded with a decrease in the salivary α-amylase concentration. In addition, salivary biomarker modifications were associated with consistent changes in the heart rate, systolic blood pressure and mean arterial pressure. CONCLUSIONS Using the air caloric vestibular test task as a stressor, the present study demonstrated a connection between the acute hormonal stress response to vestibular stimulation and cardiovascular output. However, further research is needed before we can define the potential importance of the consistent cardiovascular activity changes evoked by vestibular stimulation and the possible functional consequences for cardiovascular regulation and orthostatic tolerance in humans.
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Affiliation(s)
- Sebastian Cozma
- Department of Otorhinolaryngology, Rehabilitation Hospital, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Department of Pharmacology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | - Lisandra Damian
- Department of Pharmacology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | | | - Angelo Saponaro
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Rome, Italy
| | - Elena Catalina Lupusoru
- Department of Pharmacology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | | | - Lucia Corina Dima-Cozma
- Department of Internal Medicine, Rehabilitation Hospital, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
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684
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Harris L, Melville C, Murray H, Hankey C. The effects of multi-component weight management interventions on weight loss in adults with intellectual disabilities and obesity: A systematic review and meta-analysis of randomised controlled trials. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:42-55. [PMID: 29107176 DOI: 10.1016/j.ridd.2017.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities have been shown to experience higher rates of obesity in comparison to the general population. AIM To examine the effectiveness of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. METHODS AND PROCEDURES A systematic search of six electronic databases was conducted from database inception to January 2016. Risk of bias was assessed by the Cochrane Collaboration tool. Behavioural change techniques were defined by coding against the Coventry Aberdeen LOndon REfined (CALO-RE) taxonomy. Meta-analyses were conducted as Weighted Mean Difference (WMD) between intervention and control/comparator intervention. OUTCOMES AND RESULTS Six randomised controlled trials were included. The interventions did not adhere to clinical recommendations [the inclusion of an energy deficit diet (EDD), physical activity, and behaviour change techniques]. Meta-analysis revealed that current multi-component weight management interventions are not more effective than no treatment (WMD: -0.38kg; 95% CI -1.34kg to 0.58kg; p=0.44). CONCLUSION AND IMPLICATIONS There is a paucity of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. Current interventions, based on a health education approach are ineffective. Future long-term interventions that include an EDD and adhere to clinical recommendations on the management of obesity are warranted.
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Affiliation(s)
- Leanne Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Craig Melville
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Heather Murray
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Catherine Hankey
- College of Medical Veterinary and Life Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow G31 2ER, UK.
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685
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Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies. Front Endocrinol (Lausanne) 2018; 9:546. [PMID: 30319539 PMCID: PMC6168639 DOI: 10.3389/fendo.2018.00546] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum. Methods: A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009-2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected. Results: In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference -1.8 to -0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio [RR] 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (-0.91 to -0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (-2.57 to -2.3 kg, very low quality evidence) or with overweight/obesity (-3.6 to -1.22, moderate to very low-quality-evidence), but no other effects were reported. Conclusions: Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30-60 min per day 3-5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.
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Affiliation(s)
- Nathalie J. Farpour-Lambert
- Obesity Prevention and Care Program “Contrepoids,” Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Pediatric Sports Medicine Consultation, Service of General Pediatrics, Department of Child and Adolescent, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Nathalie J. Farpour-Lambert
| | - Louisa J. Ells
- School of Health and Social Care, Teesside University, Middlesbrough, United Kingdom
| | - Begoña Martinez de Tejada
- Service of Obstetrics, Department of Gynaecology and Obstetrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Courtney Scott
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
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686
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Steele T, Narayanan RP, James M, James J, Mazey N, Wilding JPH. Evaluation of Aintree LOSS, a community-based, multidisciplinary weight management service: outcomes and predictors of engagement. Clin Obes 2017; 7:368-376. [PMID: 28871633 DOI: 10.1111/cob.12216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/26/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
Aintree LOSS is a community-based, multidisciplinary weight management programme for patients with severe and complex obesity, focusing on a flexible and individualized service with follow-up for up to 2 years. We evaluated all 2472 patients referred to the service between October 2009 and 2013. Demographic data were recorded at baseline, with the Index of Multiple Deprivation (IMD) used to measure socioeconomic deprivation. Weight was recorded at each visit. Mean body mass index at baseline was 45.6 (standard deviation 6.8), and 58.9% of patients lived in areas in the most deprived decile nationally. Of 2315 appropriate referrals, 1249 (55.1%) attended >2 visits; mean final weight loss was 3.50 ± 8.55 kg, and 24.1% achieved ≥5% weight loss. Of the patients, 754 (33.3%) attended for over 6 months; mean final weight loss was 4.94 ± 10 kg, and 34% achieved 5% weight loss. Multivariate logistic regression analysis showed increasing age, residence in a less deprived area and sleep apnoea to be independently associated with attendance for >6 months, and there was a linear relationship between 6-month attendance and deprivation quintile. Year-on-year analyses showed improvement in engagement over time, coinciding with efforts to improve access to the service. This work shows a multidisciplinary, community-based weight loss programme prioritizing a fully flexible and individualized approach functioning effectively in real-world practice. Maintaining engagement remains a challenge in weight loss programmes, and our results suggest younger patients living in areas with greater deprivation should be a target for efforts to improve engagement.
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Affiliation(s)
- T Steele
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R P Narayanan
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - M James
- Aintree Weight Management Services, Aintree University Hospital, Liverpool, UK
| | - J James
- Aintree Weight Management Services, Aintree University Hospital, Liverpool, UK
| | - N Mazey
- Brownlow Group Practice, Liverpool, UK
| | - J P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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687
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Accardi R, Fave AD, Ronchi S, Terzoni S, Racaniello E, Destrebecq A. The Role of Quality of Life Instruments in Obesity Management: Review. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roberto Accardi
- Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Silvia Ronchi
- Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | - Emanuela Racaniello
- Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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688
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El Ghoch M, Calugi S, Dalle Grave R. Weight cycling in adults with severe obesity: A longitudinal study. Nutr Diet 2017; 75:256-262. [PMID: 29114979 DOI: 10.1111/1747-0080.12387] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/12/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Abstract
AIM Although weight cycling is a common phenomenon in treatment-seeking patients with obesity, its consequences on health outcomes have not yet been completely clarified. We therefore aimed to investigate the effect of one cycle of intentional weight loss and regain on energy expenditure, body composition, cardiovascular risk factors and psychosocial variables in patients with severe obesity. METHODS Clinical and psychosocial variables were measured in 38 adult patients with severe obesity (body mass index (BMI): 43.5 ± 7.2 kg/m2 ) consecutively readmitted to rehabilitative residential treatment (T1) for severe obesity after a cycle of weight loss (16.7 ±7.7 kg) and regain (15.1 ±11.3 kg), and compared with those recorded at a prior admission (T0). RESULTS No significant differences were found between T0 and T1 values for weight, BMI, waist circumference, total body fat percentage, fat-free mass percentage, respiratory quotient, measured or predicted resting energy expenditure, metabolic adaptation, cardiovascular risk factors or psychosocial variables. However, younger patients (r = -0.38, P = 0.023) and those with higher historical weight (r = 0.43, P = 0.010) tended to regain more weight. CONCLUSIONS The absence of negative physical and psychological effects of weight cycling indicates that the risk of weight regain should not be a barrier to encouraging weight loss efforts in patients with severe obesity.
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Affiliation(s)
- Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
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689
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Brasil AMB, Brasil F, Maurício AA, Vilela RM. Cross-cultural adaptation and validation to Brazil of the Obesity-related Problems Scale. EINSTEIN-SAO PAULO 2017; 15:327-333. [PMID: 29091155 PMCID: PMC5823047 DOI: 10.1590/s1679-45082017ao4004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/16/2017] [Indexed: 11/29/2022] Open
Abstract
Objective To validate a reliable version of the Obesity-related Problems Scale in Portuguese to use it in Brazil. Methods The Obesity-related Problems Scale was translated and transculturally adapted. Later it was simultaneously self-applied with a 12-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), to 50 obese patients and 50 non-obese individuals, and applied again to half of them after 14 days. Results The Obesity-related Problems scale was able to differentiate obese from non-obese individuals with higher accuracy than WHODAS 2.0, correlating with this scale and with body mass index. The factor analysis determined a two-dimensional structure, which was confirmed with χ2/df=1.81, SRMR=0.05, and CFI=0.97. The general a coefficient was 0.90 and the inter-item intra-class correlation, in the reapplication, ranged from 0.75 to 0.87. Conclusion The scale proved to be valid and reliable for use in the Brazilian population, without the need to exclude items.
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Affiliation(s)
| | - Fábio Brasil
- Universidade Federal do Paraná, Curitiba, PR, Brazil
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690
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Leitner DR, Frühbeck G, Yumuk V, Schindler K, Micic D, Woodward E, Toplak H. Obesity and Type 2 Diabetes: Two Diseases with a Need for Combined Treatment Strategies - EASO Can Lead the Way. Obes Facts 2017; 10:483-492. [PMID: 29020674 PMCID: PMC5741209 DOI: 10.1159/000480525] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/17/2017] [Indexed: 12/14/2022] Open
Abstract
Obesity is a chronic metabolic disease affecting adults and children worldwide. It has become one of the leading causes of death, as obesity is known to be the main risk factor for a number of non-communicable diseases, in particular type 2 diabetes. This close relationship led to the connotation 'diabesity', highlighting the fact that the majority of individuals with diabetes are overweight or obese. Until today the BMI is still used to classify overweight and obesity. Since reduced muscle mass is highly prevalent throughout the BMI range, the measurement of body composition is strongly recommended. Moreover, it is essential for monitoring the course of weight reduction, which is part of every effective anti-obesity treatment. Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention (diet and exercise), pharmacotherapy, or bariatric surgery. However, not all of these strategies are suitable for all patients, and any further needs should be considered. Besides, attention should also be drawn to concomitant therapies. These therapies may promote additional weight gain and further trigger the deterioration of blood glucose control. Thus, therapeutic strategies are warranted, which can be easily used for the management of obese patients with type 2 diabetes to achieve their glycemic and weight loss goals.
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Affiliation(s)
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Univ. de Navarra, University of Navarra, CIBERobn, Instituto de Salud Carlos III, Pamplona, Spain
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria
| | - Dragan Micic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Euan Woodward
- European Association for the Study of Obesity, London, UK
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
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691
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McEvedy SM, Sullivan-Mort G, McLean SA, Pascoe MC, Paxton SJ. Ineffectiveness of commercial weight-loss programs for achieving modest but meaningful weight loss: Systematic review and meta-analysis. J Health Psychol 2017; 22:1614-1627. [PMID: 28810454 DOI: 10.1177/1359105317705983] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
This study collates existing evidence regarding weight loss among overweight but otherwise healthy adults who use commercial weight-loss programs. Systematic search of 3 databases identified 11 randomized controlled trials and 14 observational studies of commercial meal-replacement, calorie-counting, or pre-packaged meal programs which met inclusion criteria. In meta-analysis using intention-to-treat data, 57 percent of individuals who commenced a commercial weight program lost less than 5 percent of their initial body weight. One in two (49%) studies reported attrition ≥30 percent. A second meta-analysis found that 37 percent of program completers lost less than 5 percent of initial body weight. We conclude that commercial weight-loss programs frequently fail to produce modest but clinically meaningful weight loss with high rates of attrition suggesting that many consumers find dietary changes required by these programs unsustainable.
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692
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Golden A. Current pharmacotherapies for obesity. J Am Assoc Nurse Pract 2017; 29:S43-S52. [DOI: 10.1002/2327-6924.12519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 01/12/2023]
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693
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Lechuga Sancho A, Palomo Atance E, Rivero Martin MJ, Gil-Campos M, Leis Trabazo R, Bahíllo Curieses MP, Bueno Lozano G. [Spanish collaborative study: Description of usual clinical practice in infant obesity]. An Pediatr (Barc) 2017; 88:340-349. [PMID: 28943259 DOI: 10.1016/j.anpedi.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. MATERIAL AND METHODS An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of "Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity" issued by the Spanish Ministry of Health. RESULTS A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. CONCLUSIONS There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition.
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Affiliation(s)
- Alfonso Lechuga Sancho
- Departamento Materno-Infantil y Radiología, Facultad de Medicina, Universidad de Cádiz, UGC de Pediatría, Hospital Universitario Puerta de Mar, Cádiz, España
| | - Enrique Palomo Atance
- Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | - Mercedes Gil-Campos
- IMIBIC, Facultad de Medicina, Universidad de Córdoba, Unidad de Metabolismo e Investigación Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España; ciberobn isciii
| | - Rosaura Leis Trabazo
- Departamento de Pediatría, Facultad de Medicina, Universidad de Santiago de Compostela, Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España; ciberobn isciii
| | | | - Gloria Bueno Lozano
- Departamento de Pediatría, Radiología y Medicina Física, Facultad de Medicina, Universidad de Zaragoza, Servicio de Pediatría, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; ciberobn isciii.
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694
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Weight Management Interventions in Women with and without PCOS: A Systematic Review. Nutrients 2017; 9:nu9090996. [PMID: 28885578 PMCID: PMC5622756 DOI: 10.3390/nu9090996] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 01/05/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy among women associated with reproductive, metabolic and psychological features. While weight management is recommended as first-line treatment, it is unclear if women with PCOS achieve similar benefits as women without PCOS. This systematic review thus aimed to compare the efficacy of weight management interventions in women with and without PCOS. Databases were searched until May 2017. The primary outcome was weight and anthropometric, reproductive, metabolic and psychological measures were secondary outcomes. Of 3264 articles identified, 14 studies involving n = 933 (n = 9 high and n = 5 moderate risk of bias) met the inclusion criteria. No statistically significant differences in weight or weight loss following the intervention were found between women with and without PCOS in five studies, with the remaining studies not comparing the difference in weight or weight loss between these groups. Secondary outcomes did not differ significantly between the two groups. This review identified that there is a paucity of high quality research in this area and that more rigorous research is needed.
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695
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A cluster randomised control trial of a multi-component weight management programme for adults with intellectual disabilities and obesity. Br J Nutr 2017; 118:229-240. [DOI: 10.1017/s0007114517001933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AbstractThere have been few published controlled studies of multi-component weight management programmes that include an energy deficit diet (EDD), for adults with intellectual disabilities and obesity. The objective of this study was to conduct a single-blind, cluster randomised controlled trial comparing a multi-component weight management programme to a health education programme. Participants were randomised to either TAKE 5, which included an EDD or Waist Winners Too (WWToo), based on health education principles. Outcomes measured at baseline, 6 months (after a weight loss phase) and 12 months (after a 6-month weight maintenance phase), by a researcher blinded to treatment allocation, included: weight; BMI; waist circumference; physical activity; sedentary behaviour and health-related quality of life. The recruitment strategy was effective with fifty participants successfully recruited. Both programmes were acceptable to adults with intellectual disabilities, evidenced by high retention rates (90 %). Exploratory efficacy analysis revealed that at 12 months there was a trend for more participants in TAKE 5 (50·0 %) to achieve a clinically important weight loss of 5–10 %, in comparison to WWToo (20·8 %) (OR 3·76; 95 % CI 0·92, 15·30; 0·064). This study found that a multi-component weight management programme that included an EDD, is feasible and an acceptable approach to weight loss when tailored to meet the needs of adults with intellectual disabilities and obesity.
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696
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Ponti F, Soverini V, Plazzi A, Aparisi Gómez MP, Mercatelli D, Guglielmi G, Battista G, Marchesini G, Bazzocchi A. DXA-assessed changes in body composition in obese women following two different weight loss programs. Nutrition 2017; 46:13-19. [PMID: 29290349 DOI: 10.1016/j.nut.2017.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/21/2017] [Accepted: 07/24/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Changes in body composition during weight loss programs might have a significant effect on long-term results. The aim of this study was to test these changes by dual energy x-ray absorptiometry (DXA) in obese women enrolled into two different weight loss medical programs. METHODS We prospectively studied 71 women assigned to either an intensive 3-mo cognitive-behavioral therapy (CBT) or a 1-mo nutritional counseling plan (NCP). All patients underwent DXA whole-body scan before treatment and after 3, 6, and 12 mo. Fat mass (FM), non-bone lean mass (LM) and bone mineral content were assessed at whole-body and regional levels. Android visceral adipose tissue (VAT) also was estimated. RESULTS Twenty-three patients missed one or more follow-up controls and were excluded from the final analysis. Twenty-seven patients (body mass index [BMI] 41.9 ± 6.7 kg/m2) remained in the CBT group and 21 (BMI 33.4 ± 4 kg/m2) in the NCP group. The progressive decrease of BMI in both groups was associated with reduced whole-body and regional FM, which was more marked in CBT. During follow-up, a progressive decrease of total FM-to-LM and android FM-to-LM ratios were observed both in CBT (Δ12-mo versus baseline -7.8 ± 9.6% and -9.5 ± 12.7%, respectively; P < 0.01) and NCP (Δ12-mo versus baseline -5.9 ± 9.6% and -7 ± 13.4%, respectively; P < 0.05). VAT was the parameter showing the largest decrease (-14.2 ± 17.4% and -11.3 ± 18.2% at 12 mo, respectively in CBT and NCP; P < 0.05). CONCLUSIONS Lifestyle-induced weight loss is associated with selective changes in body composition parameters, regardless of initial BMI and treatment program, limiting sarcopenic obesity. DXA may quantify the metabolically healthier redistribution of total and regional FM and VAT.
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Affiliation(s)
- Federico Ponti
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola - Malpighi Hospital, Bologna, Italy; Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Valentina Soverini
- Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna. Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Andrea Plazzi
- Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna. Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand; Department of Radiology, Hospital Nueve de Octubre, Valencia, Spain
| | - Daniele Mercatelli
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola - Malpighi Hospital, Bologna, Italy; Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
| | - Giuseppe Battista
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna. Sant'Orsola - Malpighi Hospital, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Bologna, Italy.
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697
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Miller GD. Appetite Regulation: Hormones, Peptides, and Neurotransmitters and Their Role in Obesity. Am J Lifestyle Med 2017; 13:586-601. [PMID: 31662725 DOI: 10.1177/1559827617716376] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/18/2017] [Accepted: 05/31/2017] [Indexed: 12/29/2022] Open
Abstract
Understanding body weight regulation will aid in the development of new strategies to combat obesity. This review examines energy homeostasis and food intake behaviors, specifically with regards to hormones, peptides, and neurotransmitters in the periphery and central nervous system, and their potential role in obesity. Dysfunction in feeding signals by the brain is a factor in obesity. The hypothalamic (arcuate nucleus) and brainstem (nucleus tractus solitaris) areas integrate behavioral, endocrine, and autonomic responses via afferent and efferent pathways from and to the brainstem and peripheral organs. Neurons present in the arcuate nucleus express pro-opiomelanocortin, Neuropeptide Y, and Agouti Related Peptide, with the former involved in lowering food intake, and the latter two acutely increasing feeding behaviors. Action of peripheral hormones from the gut, pancreas, adipose, and liver are also involved in energy homeostasis. Vagal afferent neurons are also important in regulating energy homeostasis. Peripheral signals respond to the level of stored and currently available fuel. By studying their actions, new agents maybe developed that disable orexigenic responses and enhance anorexigenic signals. Although there are relatively few medications currently available for obesity treatment, a number of agents are in development that work through these pathways.
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Affiliation(s)
- Gary D Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
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698
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Giordano F, Berteotti M, Budui S, Calgaro N, Franceschini L, Gilli F, Masiero M, Raschellà G, Salvetti S, Taddei M, Schena F, Busetto L. Multidimensional improvements induced by an intensive obesity inpatients rehabilitation programme. Eat Weight Disord 2017; 22:329-338. [PMID: 28455681 DOI: 10.1007/s40519-017-0393-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/18/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To analyse the short-term effectiveness of an intensive multidimensional inpatient programme specifically developed for patients with severe obesity. METHODS A multidisciplinary team managed a 3-week residential programme characterised by the integration of nutritional and physical rehabilitation with psychological and educational intervention. All patients consecutively admitted in 10 months were analysed at admission and discharge for changes in the following domains: anthropometry (weight, body mass index (BMI), waist and neck circumferences), cardiovascular risk factors (glycaemia, HbA1c, lipid profile, blood pressure), quality of life, eating behaviour, and physical performance (VO2peak by incremental cycle ergometer test, 6-min walking test (6MWT), chair stands test). RESULTS 136 subjects (61% females, median age 52.7 years) with obesity (mean BMI 43.2 kg/m2) and multiple comorbidities were analysed. A 3.9% BMI reduction and a reduction in waist (-3.8%) and neck (-3.3%) circumferences were observed. Glycaemic control was achieved in 68% of patients with uncontrolled diabetes at admission. Blood pressure control was achieved in all patients with uncontrolled hypertension at admission. Total cholesterol (-16%), LDL-cholesterol (-19%) and triglycerides (-9%) were significantly reduced. Psychometric assessment showed improvements in quality of life perception and binge eating disorder. Finally, a significant improvement in physical performance (+4.7% improvement in VO2peak, with longer distances in 6MWT and a higher number of standings) was observed. CONCLUSIONS Our preliminary data prove that a 3-week programme determined a clinically significant multi-dimensional improvement in patients with severe obesity. Long-term follow-up data are needed to confirm the efficacy of our rehabilitation setting.
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Affiliation(s)
| | | | | | | | | | - Federica Gilli
- CeRiSM Sport Mountain and Health Research Centre, University of Verona, Rovereto, TN, Italy
| | - Marina Masiero
- CeRiSM Sport Mountain and Health Research Centre, University of Verona, Rovereto, TN, Italy
| | | | | | | | - Federico Schena
- CeRiSM Sport Mountain and Health Research Centre, University of Verona, Rovereto, TN, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128, Padua, Italy.
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699
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Opie CA, Haines HM, Ervin KE, Glenister K, Pierce D. Why Australia needs to define obesity as a chronic condition. BMC Public Health 2017; 17:500. [PMID: 28535781 PMCID: PMC5442589 DOI: 10.1186/s12889-017-4434-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
Background In Australia people with a diagnosed chronic condition can be managed on unique funded care plans that allow the recruitment of a multidisciplinary team to assist in setting treatment goals and adequate follow up. In contrast to the World Health Organisation, the North American and European Medical Associations, the Australian Medical Association does not recognise obesity as a chronic condition, therefore excluding a diagnosis of obesity from qualifying for a structured and funded treatment plan. Body The Australian guidelines for management of Obesity in adults in Primary Care are structured around a five step process -the ‘5As’: Ask & Assess, Advise, Assist and Arrange’. This article aims to identify the key challenges and successes associated with the ‘5As’ approach, to better understand the reasons for the gap between the high Australian prevalence of overweight and obesity and an actual diagnosis and treatment plan for managing obesity. It argues that until the Australian health system follows the international lead and defines obesity as a chronic condition, the capacity for Australian doctors to diagnose and initiate structured treatment plans will remain limited and ineffective. Conclusion Australian General Practitioners are limited in their ability manage obesity, as the current treatment guidelines only recognise obesity as a risk factor rather than a chronic condition.
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Affiliation(s)
- C A Opie
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia.
| | - H M Haines
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - K E Ervin
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - K Glenister
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - D Pierce
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
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700
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Effects of a whey protein supplementation on oxidative stress, body composition and glucose metabolism among overweight people affected by diabetes mellitus or impaired fasting glucose: A pilot study. J Nutr Biochem 2017; 50:95-102. [PMID: 29053995 DOI: 10.1016/j.jnutbio.2017.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 04/04/2017] [Accepted: 05/06/2017] [Indexed: 12/24/2022]
Abstract
Obesity and diabetes mellitus type 2 (DM2) are characterized by chronic inflammation and oxidative stress [Donath et al. 2013] and this leads to cardiovascular diseases [Hulsmans & Holvoet 2010]. Whey proteins (WP) have antioxidant [Chitapanarux et al. 2009], anti-inflammatory [Sugawara et al. 2012] and hypoglycemic activities [Mignone et al. 2015], while data on weight, body composition [Frestedt et al. 2008; Aldrich et al. 2011] and blood pressure are conflicting [Kawase et al. 2000; Lee et al. 2007]. WP have unpleasant taste and smell [Patel 2015], but a new WP isolate (ProLYOtin®) seems to be more palatable. 40 g/die of ProLYOtin® were supplemented to overweight people (n=31) with impaired fasting glucose/DM2 for 12 weeks. Markers of antioxidant status (total antioxidant status, glutathione peroxidase, glutathione reductase, uric acid), oxidative damage (thiobarbituric acid reactive substances, advanced oxidation protein products, 8-hydroxydeoxyguanosine), inflammation (interleukin-6, high sensitive reactive protein C) and glicemic status (fasting glucose, insulin, glycated hemoglobin), anthropometric data (weight, height, waist circumference), body composition (body cell mass, fat mass), blood pressure, hand grip strength and skin autofluorescence were measured before and at the end of supplementation. Isolate palatability was evaluated. An increase in glutathione peroxidase, a decrease in uric acid and no change in glutathione reductase, total antioxidant status, oxidative damage, inflammation and glucose markers were found. Significant improvements in anthropometric parameters and fat mass were detected. There wasn't any change in blood pressure, skin autofluorescence and physical performance. Two-thirds of subjects judged the supplement positively. ProLYOtin® seems suitable for treatment of OS and overweight.
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