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Zhu J, Wilding JPH. Body Fat Depletion: the Yin Paradigm for Treating Type 2 Diabetes. Curr Atheroscler Rep 2024; 26:1-10. [PMID: 38148417 PMCID: PMC10776473 DOI: 10.1007/s11883-023-01181-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE OF REVIEW To highlight that body fat depletion (the Yin paradigm) with glucose-lowering treatments (the Yang paradigm) are associated with metabolic benefits for patients with type 2 diabetes mellitus (T2DM). RECENT FINDINGS The sodium-glucose cotransporter-2 inhibitor-mediated sodium/glucose deprivation can directly improve glycemic control and kidney outcome in patients with T2DM. The glucose deprivation might also promote systemic fatty acid β-oxidation to deplete ectopic/visceral fat and thereby contribute to the prevention of cardiovascular diseases. As with metabolic surgery, bioengineered incretin-based medications with potent anorexigenic and insulinotropic efficacy can significantly reduce blood glucose as well as body weight (especially in the ectopic/visceral fat depots). The latter effects could be a key contributor to their cardiovascular-renal protective effects. In addition to a healthy diet, the newer glucose-lowering medications, with body fat reduction effects, should be prioritized when treating patients with T2DM, especially for those with established cardiovascular/renal risks or diseases.
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Affiliation(s)
- Jingjing Zhu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Longmoor Lane, Liverpool, UK
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Clinical Sciences Centre, Liverpool University Hospitals NHS Foundation Trust, Longmoor Lane, Liverpool, UK.
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Salminen P, Kow L, Aminian A, Kaplan LM, Nimeri A, Prager G, Behrens E, White KP, Shikora S. IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management-an International Delphi Study. Obes Surg 2024; 34:30-42. [PMID: 37999891 PMCID: PMC10781804 DOI: 10.1007/s11695-023-06913-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity. METHODS A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement. RESULTS Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m2, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease. CONCLUSIONS In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.
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Affiliation(s)
- Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland.
- Division of Digestive Surgery and Urology, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland.
| | - Lilian Kow
- Department of Surgery, Flinders University, Adelaide, SA, Australia
| | - Ali Aminian
- Department of General Surgery, Cleveland Clinic, Bariatric and Metabolic Institute, Cleveland, OH, USA
| | - Lee M Kaplan
- Section On Obesity Medicine, Geisel School of Medicine at Darthmouth, Hanover, NH, USA
| | - Abdelrahman Nimeri
- Division of General & GI Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerhard Prager
- Division of Visceral Surgery, Vienna Medical University, Vienna, Austria
| | | | - Kevin P White
- ScienceRight International Health Research, London, ON, Canada
| | - Scott Shikora
- Division of General & GI Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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Koschker AC, Warrings B, Morbach C, Seyfried F, Jung P, Dischinger U, Edelmann F, Herrmann MJ, Stier C, Frantz S, Malzahn U, Störk S, Fassnacht M. Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe obesity: A randomized controlled trial. Metabolism 2023; 147:155655. [PMID: 37393945 DOI: 10.1016/j.metabol.2023.155655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Randomized evidence comparing the cardiovascular effects of surgical and conservative weight management is lacking. PATIENTS & METHODS In this single-center, open-label randomized trial, obese patients with indication for Roux-en-Y gastric bypass (RYGB) and able to perform treadmill cardiopulmonary exercise testing (CPET) were included. After a 6-12 month run-in phase of multimodal anti-obesity treatment, patients were randomized to RYGB or psychotherapy-enhanced lifestyle intervention (PELI) and co-primary endpoints were assessed 12 months later. Thereafter, PELI patients could opt for surgery and patients were reassessed 24 months after randomization. Co-primary endpoints were mean change (95 % confidence intervals) in peak VO2 (ml/min/kg body weight) in CPET and the physical functioning scale (PFS) of the Short Form health survey (SF-36). RESULTS Of 93 patients entering the study, 60 were randomized. Among these (median age 38 years; 88 % women; mean BMI 48·2 kg/m2), 46 (RYGB: 22 and PELI: 24) were evaluated after 12 months. Total weight loss was 34·3 % after RYGB vs. 1·2 % with PELI, while peak VO2 increased by +4·3 ml/min/kg (2·7, 5·9) vs +1·1 ml/min/kg (-0·2, 2·3); p < 0·0001. Respective improvement in PFS score was +40 (30, 49) vs +10 (1, 15); p < 0·0001. 6-minute walking distance also favored the RYGB group: +44 m (17, 72) vs +6 m (-14, 26); p < 0·0001. Left ventricular mass decreased after RYGB, but not with PELI: -32 g (-46, -17) vs 0 g (-13,13); p < 0·0001. In the non-randomized follow-up, 34 patients were assessed. Favorable changes were sustained in the RYGB group and were repeated in the 15 evaluated patients that opted for surgery after PELI. CONCLUSIONS Among adults with severe obesity, RYGB in comparison to PELI resulted in improved cardiopulmonary capacity and quality of life. The observed effect sizes suggest that these changes are clinically relevant.
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Affiliation(s)
- Ann-Cathrin Koschker
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany.
| | - Bodo Warrings
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital, University of Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. of Internal Medicine I, Division of Cardiology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Florian Seyfried
- Dept. General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Pius Jung
- Dept. Internal Medicine I, Division of Pneumology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ulrich Dischinger
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Frank Edelmann
- Dept. Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany; German Centre for Cardiovascular research (DZHK), Partner Site Berlin, Germany
| | - Martin J Herrmann
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital, University of Würzburg, Würzburg, Germany
| | - Christine Stier
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany; Dept. General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. of Internal Medicine I, Division of Cardiology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Uwe Malzahn
- Center for Clinical Trials, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany; Dept. of Internal Medicine I, Division of Cardiology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Dept. Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany; Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital, University of Würzburg, Würzburg, Germany
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