1
|
Morandi A, Umano GR, Vania A, Gugliemi V, Muscogiuri G, Maffeis C, Busetto L, Buscemi S, Cherubini V, Barazzoni R, Manco M. Optimising healthcare transition of adolescents and young adults to adult care: a perspective statement of the Italian Society of Obesity. Eat Weight Disord 2024; 29:51. [PMID: 39097845 PMCID: PMC11298504 DOI: 10.1007/s40519-024-01678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/10/2024] [Indexed: 08/05/2024] Open
Abstract
The transition to adult health care (HCT, Health Care Transition), is the purposeful, planned movement of patients from paediatric to adult services. For the adolescent living with obesity (ALwO), the HCT represents a crucial window for effective intervention that can help improve body weight, adiposopathy, and metabolic complications. Nevertheless, no transition guidelines, models, and tools have been developed for these patients. The present statement of the Italian Society of Obesity examines the critical transition of ALwO from paediatric to adult healthcare. It synthesises current knowledge and identifies gaps in HCT of ALwO. Drawing on successful practices and evidence-based interventions worldwide, the paper explores challenges, including disparities and barriers, while advocating for patient and family involvement. Additionally, it discusses barriers and perspectives within the Italian health care scenario. The need for specialised training for healthcare providers and the impact of transition on healthcare policies are also addressed. The conclusions underscore the significance of well-managed transitions. The SIO recognises that without proper support during this transition, ALwOs risk facing a gap in healthcare delivery, exacerbating their condition, and increasing the likelihood of complications. Addressing this gap requires concerted efforts to develop effective transition models, enhance healthcare provider awareness, and ensure equitable access to care for all individuals affected by obesity. The document concludes by outlining avenues for future research and improvement.
Collapse
Affiliation(s)
- Anita Morandi
- Paediatrics B Unit, Regional Centre for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Valeria Gugliemi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia e Andrologia, Unità di Endocrinologia, and Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Claudio Maffeis
- Paediatrics B Unit, Regional Centre for Pediatric Diabetes, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Luca Busetto
- Centre for the Study and the Integrated Treatment of Obesity, Internal Medicine 3, Padua University Hospital, Padua, Italy
| | - Silvio Buscemi
- Unit of Clinical Nutrition, Policlinico University Hospital, and Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, Salesi Hospital, 60123, Ancona, Italy
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Melania Manco
- Unit of Preventive and Predictive Medicine, , Bambino Gesù Children's Hospital, IRCCS, Via F. Baldelli 38, 00146, Rome, Italy.
| |
Collapse
|
2
|
Busetto L, Dicker D, Frühbeck G, Halford JCG, Sbraccia P, Yumuk V, Goossens GH. A new framework for the diagnosis, staging and management of obesity in adults. Nat Med 2024:10.1038/s41591-024-03095-3. [PMID: 38969880 DOI: 10.1038/s41591-024-03095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Affiliation(s)
- Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy.
| | - Dror Dicker
- Internal Medicine Department and Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain
| | | | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gijs H Goossens
- Department of Human Biology, Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center⁺, Maastricht, The Netherlands
| |
Collapse
|
3
|
Schiavon CA, Cavalcanti AB, Oliveira JD, Machado RHV, Santucci EV, Santos RN, Oliveira JS, Damiani LP, Junqueira D, Halpern H, Monteiro FDLJ, Noujaim PM, Cohen RV, de Sousa MG, Bortolotto LA, Berwanger O, Drager LF. Randomized Trial of Effect of Bariatric Surgery on Blood Pressure After 5 Years. J Am Coll Cardiol 2024; 83:637-648. [PMID: 38325988 DOI: 10.1016/j.jacc.2023.11.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. OBJECTIVES The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. METHODS We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. RESULTS A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). CONCLUSIONS Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension [GATEWAY]; NCT01784848).
Collapse
Affiliation(s)
- Carlos A Schiavon
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil; Hospital BP, A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil.
| | | | - Juliana D Oliveira
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil; Hospital BP, A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | - Renato N Santos
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil
| | | | - Lucas P Damiani
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil
| | | | - Helio Halpern
- Surgical Center, Heart Hospital (hcor), São Paulo, Brazil
| | | | | | | | - Marcio G de Sousa
- Dante Pazzanese Institute of Cardiology, Department of Hypertension, São Paulo, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Otavio Berwanger
- Imperial College London, George Institute for Global Health UK, London, United Kingdom
| | - Luciano F Drager
- Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio Libanes, São Paulo, Brazil
| |
Collapse
|
4
|
Nagpal TS, Pearce N, Dhaliwal K, Abraham JR. Implementing evidence-based obesity management guidelines requires development of medical competencies: A commentary outlining future directions in obesity education in Canada. OBESITY PILLARS (ONLINE) 2023; 8:100086. [PMID: 38125664 PMCID: PMC10728703 DOI: 10.1016/j.obpill.2023.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
Background This commentary provides an overview of forthcoming activities by Obesity Canada (OC) to inform obesity competencies in medical education. Competencies in medical education refer to abilities of medical professionals to appropriately provide patients the care they need. A recognized Canadian framework for informing medical competencies is CanMEDs. Additionally, the Obesity Medicine Education Collaborative (OMEC) provides 32 obesity specific medical competencies to be integrated across medical education curriculum. OC released the first globally recognized Adult Obesity Clinical Practice Guideline (CPGs) in 2020 inclusive of 80 recommendations. Referring to the CanMEDs and OMEC competencies, OC is developing medical education competencies for caring for patients who have obesity in line with the recent CPGs that can be applied to health professions education programs around the world. Methods Activities being completed by OC's Education Action Team include a scoping review to summarize Canadian obesity medical education interventions or programs. Next, with expert consensus a competency set is being developed by utilizing the CanMEDs Framework, OMEC and the CPGs. Following this, OC will initially survey undergraduate medical programs across the country and determine to what degree they are meeting the competencies in content delivery. These findings will lead to a national report card outlining the current state of obesity medical education in Canada within undergraduate medical education. Results To date, OC has completed the scoping review and the competency set. The Education Action Team is in the process of developing the survey tools to assess the current delivery of obesity medical education in Canada. Conclusion The evidenced-based report card will support advocacy to refine and enhance future educational initiatives with the overall goal of improving patient care for individuals living with obesity. The process being applied in Canada may also be applicable and modified for other regions to assess and better obesity medical education.
Collapse
Affiliation(s)
- Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Khushmol Dhaliwal
- Department of Family Medicine Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Roshan Abraham
- Department of Family Medicine Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
5
|
Tremblett M, Webb H, Ziebland S, Stokoe E, Aveyard P, Albury C. The Basis of Patient Resistance to Opportunistic Discussions About Weight in Primary Care. HEALTH COMMUNICATION 2023:1-13. [PMID: 37904324 DOI: 10.1080/10410236.2023.2266622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Clinicians expect that talking to patients with obesity about potential/future weight loss will be a difficult conversation, especially if it is not the reason that a patient is seeking medical help. Despite this expectation, many governments ask clinicians to take every opportunity to talk to patients about weight to help manage increasing levels of obesity. Although this is recommended, little is known about what happens in consultations when clinicians opportunistically talk to patients about weight, and if the anticipated difficulties are reality. This paper examines displays of explicit patient resistance following opportunistic weight-loss conversations initiated by GPs. We analyzed audio recordings and transcribed them for conversation analysis. We focused on the precursors of explicit resistance displays during opportunistic weight loss discussions, the format of the resistance, and the ways it was managed by GPs. We found relatively few instances of explicit resistance displays. When it did occur, rather than be related to the opportunistic nature of the advice, or the topic of weight itself, resistance was nuanced and associated to the sensitivity of the GPs managing unknown patient levels of awareness of weight loss benefits, or prior efforts to lose weight. Clinicians tended not to challenge this resistance from patients, and we suggest this tactic may be acceptable to patients and help foster the long-term collaborative relationships needed to tackle obesity. Data are in British English.
Collapse
Affiliation(s)
- Madeleine Tremblett
- Nuffield Department of Primary Care Health Sciences, University of Oxford
- School of Social Sciences, University of the West of England
| | - Helena Webb
- School of Computer Science, University of Nottingham
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Elizabeth Stokoe
- Department of Psychological and Behavioural Science, The London School of Economics and Political Science
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| |
Collapse
|
6
|
Anyanwu GO, Ejike UD, Gyebi GA, Rauf K, Nisar-Ur-Rehman, Iqbal J, Zaib S, Usunobun U, Onyeneke EC, Alotaibi BS, Batiha GES. Phytochemical analysis, in vitro and in silico effects from Alstonia boonei De Wild stem bark on selected digestive enzymes and adipogenesis in 3T3-L1 preadipocytes. BMC Complement Med Ther 2023; 23:370. [PMID: 37864233 PMCID: PMC10588189 DOI: 10.1186/s12906-023-04202-6] [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] [Received: 12/24/2022] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Obesity is a global health issue arising from the unhealthy accumulation of fat. Medicinal plants such as Alstonia boonei stem bark has been reported to possess body weight reducing effect in obese rats. Thus, this study sought to investigate the in vitro and in silico effects of fractions from Alstonia boonei stem bark on selected obesity-related digestive enzymes and adipogenesis in 3T3-L1 preadipocytes. METHOD Two fractions were prepared from A. boonei: crude alkaloid fraction (CAF) and crude saponin fraction (CSF), and their phytochemical compounds were profiled using Liquid chromatography with tandem mass spectrometry (LCMS/MS). The fractions were assayed for inhibitory activity against lipase, α-amylase and α-glucosidase, likewise their antiadipogenic effect in 3T3-L1 adipocytes. The binding properties with the 3 enzymes were also assessed using in silico tools. RESULTS Eleven alkaloids and six saponin phytochemical compounds were identified in the CAF and CSF using LCMS/MS. The CAF and CSF revealed good inhibitory activity against pancreatic lipase enzyme, but weak and good activity against amylase respectively while only CSF had inhibitory activity against α-glucosidase. Both fractions showed antiadipogenic effect in the clearance of adipocytes and reduction of lipid content in 3T3-L1 adipocytes. The LCMS/MS identified compounds (41) from both fractions demonstrated good binding properties with the 3 enzymes, with at least the top ten compounds having higher binding energies than the reference inhibitors (acarbose and orlistat). The best two docked compounds to the three enzymes were firmly anchored in the substrate binding pockets of the enzymes. In a similar binding pattern as the reference acarbose, Estradiol-17-phenylpropionate (-11.0 kcal/mol) and 3α-O-trans-Feruloyl-2 α -hydroxy-12-ursen-28-oic acid (-10.0 kcal/mol) interacted with Asp197 a catalytic nucleophile of pancreatic amylase. Estradiol-17-phenylpropionate (-10.8 kcal/mol) and 10-Hydroxyyohimbine (-10.4 kcal/mol) interacted with the catalytic triad (Ser152-Asp176-His263) of pancreatic lipase while Estradiol-17-phenylpropionate (-10.1 kcal/mol) and 10-Hydroxyyohimbine (-9.9 kcal/mol) interacted with Asp616 and Asp518 the acid/base and nucleophilic residues of modelled α-glucosidase. CONCLUSION The antiobesity effect of A. boonei was displayed by both the alkaloid and saponin fractions of the plant via inhibition of pancreatic lipase and adipogenesis.
Collapse
Affiliation(s)
- Gabriel O Anyanwu
- Department of Biochemistry, Bingham University, Karu, Nasarawa State, Nigeria.
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Pakistan.
| | - Uju D Ejike
- Department of Biochemistry, Bingham University, Karu, Nasarawa State, Nigeria
| | - Gideon A Gyebi
- Department of Biochemistry, Bingham University, Karu, Nasarawa State, Nigeria
| | - Khalid Rauf
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Pakistan
| | - Nisar-Ur-Rehman
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Pakistan
| | - Jamshed Iqbal
- Centre for Advanced Drug Research, COMSATS University Islamabad, Abbottabad Campus, Pakistan
| | - Sumera Zaib
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan
| | - Usunomena Usunobun
- Department of Biochemistry, Faculty of Basic Medical Sciences, Edo University Uzairue, Auchi, Edo State, Nigeria
| | - Eusebius C Onyeneke
- Department of Biochemistry, University of Benin, Benin City, Edo State, Nigeria
| | - Badriyah S Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, AlBeheira, 22511, Egypt
| |
Collapse
|
7
|
Tremblett M, Webb H, Ziebland S, Stokoe E, Aveyard P, Albury C. Talking delicately: Providing opportunistic weight loss advice to people living with obesity. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531292 PMCID: PMC9748302 DOI: 10.1016/j.ssmqr.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a major worldwide public health problem. Clinicians are asked to communicate public health messages, including encouraging and supporting weight loss, during consultations with patients living with obesity. However, research shows that talking about weight with patients rarely happens and both parties find it difficult to initiate. Current guidelines on how to have such conversations do not include evidence-based examples of what to say, when to say it and how to avoid causing offence (a key concern for clinicians). To address this gap, we examined 237 audio recorded consultations between clinicians and patients living with obesity in the UK in which weight was discussed opportunistically. Conversation analysis revealed that framing advice as depersonalised generic information was one strategy clinicians used when initiating discussions. This contrasted to clinicians who made advice clearly relevant and personalised to the patient by first appraising their weight. However not all personalised forms of advice worked equally well. Clinicians who spoke delicately when personalising the discussion avoided the types of patient resistance that we found when clinicians were less delicate. More delicate approaches included forecasting upcoming discussion of weight along with delicacy markers in talk (e.g. strategic use of hesitation). Our findings suggest that clinicians should not avoid talking about a patient's weight, but should speak delicately to help maintain good relationships with patients. The findings also demonstrate the need to examine communication practices to develop better and specific guidance for clinicians. Data are in British English.
Collapse
Affiliation(s)
- Madeleine Tremblett
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Helena Webb
- School of Computer Science, University of Nottingham, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Elizabeth Stokoe
- Discourse and Rhetoric Group, Loughborough University, Loughborough, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| |
Collapse
|
8
|
Busetto L, Carbonelli MG, Caretto A, Colao A, Cricelli C, De Luca M, Giorgino F, Gnessi L, Medea G, Pappagallo G, Santini F, Sbraccia P, Zappa MA. Updating obesity management strategies: an audit of Italian specialists. Eat Weight Disord 2022; 27:2653-2663. [PMID: 35579858 PMCID: PMC9556338 DOI: 10.1007/s40519-022-01402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/02/2022] [Indexed: 11/26/2022] Open
Abstract
Obesity negatively affects physical and psychological health and increases health care costs. Although there is increasing interest in early diagnosis and timely intervention, there are several principles of care included in the current guidelines for clinical management of obesity that can potentially be updated and improved to address the "clinical inertia" and, consequently, to optimize the management of adult obesity. Using an online Delphi-based process, an Italian board of experts involved in the management of obesity discussed the usefulness of a pro-active approach to the care of patients with obesity, providing a consensus document with practical indications to identify risk factors for morbidity and death and raise awareness throughout the treatment continuum, including the early stages of the disease. In clinical practice, it seems inappropriate to delay an intervention that could avoid progression to a more severe level of obesity and/or prevent the onset of obesity-related comorbidities.Level of evidence Level V, report of expert committee.
Collapse
Affiliation(s)
- Luca Busetto
- Departement of Medicine, University of Padova, Padova, Italy.
| | | | - Antonio Caretto
- Presidente ADI (Italian Dietetic and Clinical Nutrition Association) Foundation, Rome, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Università Federico II di Napoli, Naples, Italy
| | - Claudio Cricelli
- Medico di Medicina Generale-Presidente SIMG (Italian Society of General Medicin), Firenze, Italy
| | - Maurizio De Luca
- Department of General Surgery, Ospedale di Rovigo, Viale Tre Martiri 140, Rovigo, Italy
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Lucio Gnessi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, 00161, Rome, Italy
| | - Gerardo Medea
- Medico Di Medicina Generale, ATS Brescia; Responsabile nazionale ricerca e macroarea prevenzione della SIMG, Firenze, Italy
| | - Giovanni Pappagallo
- School of Clinical Methodology, IRCCS "Sacre Heart-Don Calabria", Negrar di Valpolicella, Italy
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, Unit of Internal Medicine-Obesity Center, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Marco Antonio Zappa
- Department of General Surgery, ASST Fatebenefratelli-Sacco Milano, Presidio ospedaliero Fatebenefratelli Milano; Presidente Nazionale Sicob (Italian Society of Obesity Surgery), Milan, Italy
| |
Collapse
|
9
|
Huangshan Maofeng Green Tea Extracts Prevent Obesity-Associated Metabolic Disorders by Maintaining Homeostasis of Gut Microbiota and Hepatic Lipid Classes in Leptin Receptor Knockout Rats. Foods 2022; 11:foods11192939. [PMID: 36230016 PMCID: PMC9562686 DOI: 10.3390/foods11192939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Huangshan Maofeng green tea (HMGT) is one of the most well-known green teas consumed for a thousand years in China. Research has demonstrated that consumption of green tea effectively improves metabolic disorders. However, the underlying mechanisms of obesity prevention are still not well understood. This study investigated the preventive effect and mechanism of long-term intervention of Huangshan Maofeng green tea water extract (HTE) on obesity-associated metabolic disorders in leptin receptor knockout (Lepr−/−) rats by using gut microbiota and hepatic lipidomics data. The Lepr−/− rats were administered with 700 mg/kg HTE for 24 weeks. Our results showed that HTE supplementation remarkably reduced excessive fat accumulation, as well as ameliorated hyperlipidemia and hepatic steatosis in Lepr−/− rats. In addition, HTE increased gut microbiota diversity and restored the relative abundance of the microbiota responsible for producing short chain fatty acids, including Ruminococcaceae, Faecalibaculum, Veillonellaceae, etc. Hepatic lipidomics analysis found that HTE significantly recovered glycerolipid and glycerophospholipid classes in the liver of Lepr−/− rats. Furthermore, nineteen lipid species, mainly from phosphatidylcholines (PCs), phosphatidylethanolamines (PEs), and triglycerides (TGs), were significantly restored increases, while nine lipid species from TGs and diglycerides (DGs) were remarkably recovered decreases by HTE in the liver of Lepr−/− rats. Our results indicated that prevention of obesity complication by HTE may be possible through maintaining homeostasis of gut microbiota and certain hepatic lipid classes.
Collapse
|
10
|
Blüher M, Ceriello A, Davies M, Rodbard H, Sattar N, Schnell O, Tonchevska E, Giorgino F. Managing weight and glycaemic targets in people with type 2 diabetes—How far have we come? Endocrinol Diabetes Metab 2022; 5:e00330. [PMID: 35298097 PMCID: PMC9094453 DOI: 10.1002/edm2.330] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction As the vast majority of people with type 2 diabetes (T2D) are also overweight or obese, healthcare professionals (HCP) are faced with the task of addressing both weight management and glucose control. In this narrative review, we aim to identify the challenges of reaching and maintaining body weight targets in people with T2D and highlight current and future treatment interventions. Methods A search of the PubMed database was conducted using the search terms “diabetes” and “weight loss.” Results According to emerging evidence, treating obesity may be antecedent to the development and progression of T2D. While clinical benefits typically set in upon achieving a weight loss of 3–5%, these benefits are progressive leading to further health improvements, and weight loss of >15% can have a disease‐modifying effect in people with T2D, an outcome that up to recently could not be achieved with any blood glucose‐lowering pharmacotherapy. However, advanced treatment options with weight‐loss effects currently in development including the dual GIP/GLP‐1 receptor agonists may enable simultaneous achievement of individual glycemic and weight goals. Conclusion Despite considerable therapeutic progress, there is still a large unmet medical need in patients with T2D who miss their individualized glycemic and weight‐loss targets. Nonetheless, it is to be expected that development of future therapies and their use will favourably change the scenario of weight and glucose control in T2D.
Collapse
Affiliation(s)
- Matthias Blüher
- Medical Department III – Endocrinology, Nephrology, Rheumatology University of Leipzig Medical Center Leipzig Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI‐MAG) of the Helmholtz Zentrum München at the University of Leipzig Leipzig Germany
| | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases IRCCS MultiMedica Milan Italy
| | - Melanie Davies
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre Leicester UK
| | - Helena Rodbard
- Endocrine and Metabolic Consultants Rockville Maryland USA
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Oliver Schnell
- Sciarc GmbH Baierbrunn Germany
- Forschergruppe Diabetes e. V. Munich Germany
| | | | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases University of Bari Aldo Moro Bari Italy
| |
Collapse
|