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Heindel JJ, Lustig RH, Howard S, Corkey BE. Obesogens: a unifying theory for the global rise in obesity. Int J Obes (Lond) 2024; 48:449-460. [PMID: 38212644 PMCID: PMC10978495 DOI: 10.1038/s41366-024-01460-3] [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: 08/31/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
Despite varied treatment, mitigation, and prevention efforts, the global prevalence and severity of obesity continue to worsen. Here we propose a combined model of obesity, a unifying paradigm that links four general models: the energy balance model (EBM), based on calories as the driver of weight gain; the carbohydrate-insulin model (CIM), based on insulin as a driver of energy storage; the oxidation-reduction model (REDOX), based on reactive oxygen species (ROS) as a driver of altered metabolic signaling; and the obesogens model (OBS), which proposes that environmental chemicals interfere with hormonal signaling leading to adiposity. We propose a combined OBS/REDOX model in which environmental chemicals (in air, food, food packaging, and household products) generate false autocrine and endocrine metabolic signals, including ROS, that subvert standard regulatory energy mechanisms, increase basal and stimulated insulin secretion, disrupt energy efficiency, and influence appetite and energy expenditure leading to weight gain. This combined model incorporates the data supporting the EBM and CIM models, thus creating one integrated model that covers significant aspects of all the mechanisms potentially contributing to the obesity pandemic. Importantly, the OBS/REDOX model provides a rationale and approach for future preventative efforts based on environmental chemical exposure reduction.
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Affiliation(s)
- Jerrold J Heindel
- Healthy Environment and Endocrine Disruptor Strategies (HEEDS), Bozeman, MT, 59715, USA.
| | - Robert H Lustig
- Department of Pediatrics and Institute for Health Policy Studies, University of California, San Francisco, CA, 94143, USA
| | - Sarah Howard
- Healthy Environment and Endocrine Disruptor Strategies (HEEDS), Bozeman, MT, 59715, USA
| | - Barbara E Corkey
- Department of Medicine, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
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2
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Mascarenhas C, Sousa ACA, Rato L. Effects of Pharmaceutical Substances with Obesogenic Activity on Male Reproductive Health. Int J Mol Sci 2024; 25:2324. [PMID: 38397000 PMCID: PMC10889417 DOI: 10.3390/ijms25042324] [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: 12/30/2023] [Revised: 01/28/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Obesogens have been identified as a significant factor associated with increasing obesity rates, particularly in developed countries. Substances with obesogenic traits are prevalent in consumer products, including certain pharmaceuticals. Specific classes of pharmaceuticals have been recognized for their ability to induce weight gain, often accompanied by hormonal alterations that can adversely impact male fertility. Indeed, research has supplied evidence underscoring the crucial role of obesogens and therapeutic agents in the normal functioning of the male reproductive system. Notably, sperm count and various semen parameters have been closely linked to a range of environmental and nutritional factors, including chemicals and pharmacological agents exhibiting obesogenic properties. This review aimed to explore studies focused on analyzing male fertility parameters, delving into the intricacies of sperm quality, and elucidating the direct and adverse effects that pharmacological agents may have on these aspects.
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Affiliation(s)
- Caio Mascarenhas
- School of Health, Polytechnic Institute of Guarda, 6300-035 Guarda, Portugal;
| | - Ana C. A. Sousa
- Department of Biology, School of Science and Technology, University of Évora, 7006-554 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-671 Évora, Portugal
| | - Luís Rato
- School of Health, Polytechnic Institute of Guarda, 6300-035 Guarda, Portugal;
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal
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3
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Van Zyl N, Lusher J, Meyrick J. A Qualitative Exploration of Postoperative Bariatric Patients' Psychosocial Support for Long-Term Weight Loss and Psychological Wellbeing. Behav Sci (Basel) 2024; 14:122. [PMID: 38392475 PMCID: PMC10886391 DOI: 10.3390/bs14020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND There is a paucity of research exploring postoperative psychosocial interventions for bariatric surgery patients exceeding 2 years, and therefore, an interdisciplinary postoperative approach is warranted. This qualitative study explored the psychosocial support that bariatric surgery patients feel they need to sustain long-term weight loss and their psychological wellbeing. METHODS Fifteen postoperative patients participated in recorded semi-structured online interviews that were transcribed verbatim and analysed using a reflexive thematic analysis approach. RESULTS Three themes and six subthemes emerged. Theme 1, Journey to surgery, has two subthemes: Deep roots and Breaking point. Theme 2, The precipice of change, has two sub-themes: Continuity of care and Can't cut the problem out. Theme 3, Bridging the Gap, has two subthemes: Doing it together and Taking back the reigns. The inconsistencies participants experienced in their pre- and postoperative care led to dissonance, and they felt unprepared for the demands of life postoperatively. CONCLUSIONS Bariatric surgery is a catalyst for physical change, but surgery alone is insufficient to ensure sustained change. Surgical and psychosocial interventions are interdependent rather than mutually exclusive. Patients favour an integrative, personalised, stepped-care approach pre- and postoperatively, with active participation fostering autonomy and access to ongoing support extending into the long-term.
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Affiliation(s)
- Natascha Van Zyl
- Department of Psychology, University of Portsmouth, Portsmouth PO1 2DY, UK
| | - Joanne Lusher
- Provost's Group, Regent's University, London NW1 4NS, UK
| | - Jane Meyrick
- Department of Health and Social Sciences, The University of West England, Bristol BS16 1QY, UK
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4
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Deru LS, Gipson EZ, Hales KE, Bikman BT, Davidson LE, Horne BD, LeCheminant JD, Tucker LA, Bailey BW. The Effects of a High-Carbohydrate versus a High-Fat Shake on Biomarkers of Metabolism and Glycemic Control When Used to Interrupt a 38-h Fast: A Randomized Crossover Study. Nutrients 2024; 16:164. [PMID: 38201992 PMCID: PMC10780935 DOI: 10.3390/nu16010164] [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: 11/10/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
This study aimed to determine the impact of various fast-interrupting shakes on markers of glycemic control including glucose, β-hydroxybutyrate (BHB), insulin, glucagon, GLP-1, and GIP. Twenty-seven sedentary adults (twelve female, fifteen male) with overweight or obesity completed this study. One condition consisted of a 38-h water-only fast, and the other two conditions repeated this, but the fasts were interrupted at 24 h by either a high carbohydrate/low fat (HC/LF) shake or an isovolumetric and isocaloric low carbohydrate/high fat (LC/HF) shake. The water-only fast resulted in 135.3% more BHB compared to the HC/LF condition (p < 0.01) and 69.6% more compared to the LC/HF condition (p < 0.01). The LC/HF condition exhibited a 38.8% higher BHB level than the HC/LF condition (p < 0.01). The area under the curve for glucose was 14.2% higher in the HC/LF condition than in the water condition (p < 0.01) and 6.9% higher compared to the LC/HF condition (p < 0.01), with the LC/HF condition yielding 7.8% more glucose than the water condition (p < 0.01). At the 25-h mark, insulin and glucose-dependent insulinotropic polypeptide (GIP) were significantly elevated in the HC/LF condition compared to the LC/HF condition (p < 0.01 and p = 0.02, respectively) and compared to the water condition (p < 0.01). Furthermore, insulin, GLP-1, and GIP were increased in the LC/HF condition compared to the water condition at 25 h (p < 0.01, p = 0.015, and p < 0.01, respectively). By the 38-h time point, no differences were observed among the conditions for any of the analyzed hormones. While a LC/HF shake does not mimic a fast completely, it does preserve some of the metabolic changes including elevated BHB and glucagon, and decreased glucose and insulin compared to a HC/LF shake, implying a potential for improved metabolic health.
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Affiliation(s)
- Landon S. Deru
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
- Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Elizabeth Z. Gipson
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Katelynn E. Hales
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Benjamin T. Bikman
- Department of Cellular Biology and Physiology, Brigham Young University, Provo, UT 84602, USA
| | - Lance E. Davidson
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Benjamin D. Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT 84107, USA;
| | - James D. LeCheminant
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT 84602, USA;
| | - Larry A. Tucker
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Bruce W. Bailey
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
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Marco Mouriño A, Rivera-Esteban J, Augustin S, Turu Santigosa E, Pericàs JM. [Metabolic morbidity in the prison population of Catalonia, Spain]. Aten Primaria 2023; 55:102620. [PMID: 37043974 PMCID: PMC10119707 DOI: 10.1016/j.aprim.2023.102620] [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: 02/02/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of metabolic morbidity (MM) amongst prison inmates. DESIGN Multicentric, cross-sectional observational study. SETTING All (nine) prisons in Catalonia. PARTICIPANTS Convicted inmates that are not in an «open regime», whose healthcare relies on the Prison Primary Care Teams. INTERVENTIONS MM was defined as the presence of at least one component of the metabolic syndrome, i.e., obesity, arterial hypertension, type2 diabetes, and/or dyslipidemia. The variables collected included anthropometric measurements, medical history and laboratory values related to MM. The source of information was the Catalan Primary Healthcare Services Information System (SISAP). MAIN MEASUREMENTS The prevalence of MM, overall and by several participant subcategories, was calculated. To investigate the risk factors associated to a higher prevalence of MM, a multivariable logistic regression analysis was carried out and expressed as adjusted odds ratios and 95% confidence intervals. RESULTS 4338 inmates were studied, of whom 93.9% were male. Mean age was 38.4years, 51.7% were born in European Union countries, and 6.7% were infected by HIV. The variables associated with a significantly increased risk of presenting MM were older age and HIV infection, whereas certain geographical origins (i.e., non-UE European countries, Maghreb and Sub-Saharan Africa) were associated with lower risk of MM. CONCLUSIONS In spite of being an overall young population, prison inmates present high rates of MM. Older age, HIV infection and geographic origin appear as the most strongly associated factors with MM in the prison population. MM should be detected early in order to prevent complications. Prevention, screening and treatment of MM ought to be considered a priority in the clinical routine of prison healthcare professionals.
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Affiliation(s)
- Andrés Marco Mouriño
- Programa de Salud Penitenciaria, Instituto Catalán de la Salud, Catalunya, España; CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, España.
| | - Jesús Rivera-Esteban
- Unidad Hepática, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut of Reseach (VHIR), Universitat Autònoma de Barcelona, Barcelona, España
| | - Salvador Augustin
- Unidad Hepática, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut of Reseach (VHIR), Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Juan M Pericàs
- Unidad Hepática, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut of Reseach (VHIR), Universitat Autònoma de Barcelona, Barcelona, España; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), ISCIII, Madrid, España
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6
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Zapata RC, Zhang D, Libster A, Porcu A, Montilla-Perez P, Nur A, Xu B, Zhang Z, Correa SM, Liu C, Telese F, Osborn O. Nuclear receptor 5A2 regulation of Agrp underlies olanzapine-induced hyperphagia. Mol Psychiatry 2023; 28:1857-1867. [PMID: 36765131 PMCID: PMC10412731 DOI: 10.1038/s41380-023-01981-9] [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: 01/26/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/12/2023]
Abstract
Antipsychotic (AP) drugs are efficacious treatments for various psychiatric disorders, but excessive weight gain and subsequent development of metabolic disease remain serious side effects of their use. Increased food intake leads to AP-induced weight gain, but the underlying molecular mechanisms remain unknown. In previous studies, we identified the neuropeptide Agrp and the transcription factor nuclear receptor subfamily 5 group A member 2 (Nr5a2) as significantly upregulated genes in the hypothalamus following AP-induced hyperphagia. While Agrp is expressed specifically in the arcuate nucleus of the hypothalamus and plays a critical role in appetite stimulation, Nr5a2 is expressed in both the CNS and periphery, but its role in food intake behaviors remains unknown. In this study, we investigated the role of hypothalamic Nr5a2 in AP-induced hyperphagia and weight gain. In hypothalamic cell lines, olanzapine treatment resulted in a dose-dependent increase in gene expression of Nr5a2 and Agrp. In mice, the pharmacological inhibition of NR5A2 decreased olanzapine-induced hyperphagia and weight gain, while the knockdown of Nr5a2 in the arcuate nucleus partially reversed olanzapine-induced hyperphagia. Chromatin-immunoprecipitation studies showed for the first time that NR5A2 directly binds to the Agrp promoter region. Lastly, the analysis of single-cell RNA seq data confirms that Nr5a2 and Agrp are co-expressed in a subset of neurons in the arcuate nucleus. In summary, we identify Nr5a2 as a key mechanistic driver of AP-induced food intake. These findings can inform future clinical development of APs that do not activate hyperphagia and weight gain.
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Affiliation(s)
- Rizaldy C Zapata
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Dinghong Zhang
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Avraham Libster
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Alessandra Porcu
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Drug Discovery and Biomedical Sciences, University of South Carolina, Columbia, SC, 29208, USA
| | | | - Aisha Nur
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Baijie Xu
- Center for Hypothalamic Research, Departments of Internal Medicine and Neuroscience, Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Zhi Zhang
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Stephanie M Correa
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Chen Liu
- Center for Hypothalamic Research, Departments of Internal Medicine and Neuroscience, Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Francesca Telese
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Olivia Osborn
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
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7
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Deru LS, Chamberlain CJ, Lance GR, Gipson EZ, Bikman BT, Davidson LE, Tucker LA, Coleman JL, Bailey BW. The Effects of Exercise on Appetite-Regulating Hormone Concentrations over a 36-h Fast in Healthy Young Adults: A Randomized Crossover Study. Nutrients 2023; 15:nu15081911. [PMID: 37111130 PMCID: PMC10142171 DOI: 10.3390/nu15081911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Hunger and satiety are controlled by several physiological mechanisms, including pancreatic and gastrointestinal hormones. While the influence of exercise and fasting have been described individually, in relation to these hormones, there is a paucity of work showing the effects of the two modalities (fasting and exercise) combined. Twenty healthy adults (11 males, 9 females) completed both conditions of this study, each consisting of a 36-h water-only fast. One of the fasts began with treadmill exercise, and the differences between the conditions on various appetite hormones were measured every 12 h. The difference in the area under the curve between conditions for ghrelin was 211.8 ± 73.1 pg/mL (F = 8.40, p < 0.0105), and, for GLP-1, it was -1867.9 ± 850.4 pg/mL (F = 4.82, p < 0.0422). No significant differences were noted for areas under the curve between conditions for leptin, PP, PYY, insulin, or GIP. Initiating a fast with exercise lowers ghrelin concentrations and elevates GLP-1 concentrations. Given that ghrelin elicits feelings of hunger and GLP-1 signals feelings of satiety, adding exercise to the beginning of a fast may reduce some of the biological drive of hunger, which could make fasting more tolerable, leading to better adherence and more significant health outcomes.
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Affiliation(s)
- Landon S Deru
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | | | - Garrett R Lance
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Elizabeth Z Gipson
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Benjamin T Bikman
- Department of Cellular Biology and Physiology, Brigham Young University, Provo, UT 84602, USA
| | - Lance E Davidson
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Larry A Tucker
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Jacob L Coleman
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
| | - Bruce W Bailey
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA
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8
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Pharmacological Treatments and Natural Biocompounds in Weight Management. Pharmaceuticals (Basel) 2023; 16:ph16020212. [PMID: 37139804 PMCID: PMC9962258 DOI: 10.3390/ph16020212] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The obesity pandemic is one of society’s most urgent public health concerns. One-third of the global adult population may fall under obese or overweight by 2025, suggesting a rising demand for medical care and an exorbitant cost of healthcare expenditure in the coming years. Generally, the treatment strategy for obese patients is largely patient-centric and needs dietary, behavioral, pharmacological, and sometimes even surgical interventions. Given that obesity cases are rising in adults and children and lifestyle modifications have failed to produce the desired results, the need for medical therapy adjunct to lifestyle modifications is vital for better managing obesity. Most existing or past drugs for obesity treatment target satiety or monoamine pathways and induce a feeling of fullness in patients, while drugs such as orlistat are targeted against intestinal lipases. However, many medications targeted against neurotransmitters showed adverse events in patients, thus being withdrawn from the market. Alternatively, the combination of some drugs has been successfully tested in obesity management. However, the demand for novel, safer, and more efficacious pharmaceutical medicines for weight management does exist. The present review elucidates the current understanding of the available anti-obesity medicines of synthetic and natural origin, their main mechanisms of action, and the shortcomings associated with current weight management drugs.
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9
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Smit MMC, Waal ED, Tenback DE, Deenik J. Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial. BJPsych Open 2022; 8:e201. [PMID: 36412504 PMCID: PMC9707511 DOI: 10.1192/bjo.2022.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle interventions can improve health-related outcomes for people with severe mental illness (SMI), but few studies evaluate this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), we sought to replicate this multidisciplinary lifestyle-enhancing support in people with SMI living in sheltered housing (MULTI_sh). AIMS To evaluate the effectiveness and implementation of MULTI_sh (trial registration: NCT03157557). METHOD In an effectiveness-implementation hybrid cluster-randomised controlled trial, six municipalities with sheltered housing facilities in The Netherlands were randomly assigned to MULTI_sh (n = 3) or treatment as usual (TAU, n = 3). After 12 months, we evaluated effects on metabolic health, sedentary behaviour/physical activity (ActiGraph GT3X+), quality of life (EuroQol 5D, WHOQoL-Bref) and psychopathology (Brief Psychiatric Rating Scale Expanded Version) using multiple regression, adjusting for baseline values and municipalities (intention to treat and per protocol). In addition, implementation fidelity and barriers/facilitators were evaluated (Measurement Instrument for Determinants of Innovation). RESULTS Of 177 eligible patients, 74 (42%) could be included in the analyses. Health outcomes did not substantially improve with MULTI_sh (n = 45) compared with TAU (n = 29). MULTI_sh was not implemented as intended. Most patients and all healthcare professionals believed that patients' lifestyle should be part of treatment, but implementation was primarily (in)directly hindered by organisational factors (e.g. staff shortages, complexity of participation, lack of time and difficulty getting patients involved). CONCLUSIONS MULTI_sh was not implemented as intended and no clinical health improvements were found. Organisations are decisive in the success or failure of the implementation of lifestyle interventions for people with SMI. More intensive implementation strategies on this level are warranted in sheltered housing.
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Affiliation(s)
- Marij M C Smit
- GGz Centraal, Amersfoort, The Netherlands; and Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Elze de Waal
- GGz Centraal, Amersfoort, The Netherlands; and Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik E Tenback
- Centre for Transcultural Psychiatry (CTP)Veldzicht, Balkbrug, The Netherlands
| | - Jeroen Deenik
- GGz Centraal, Amersfoort, The Netherlands; and School for Mental Health and Neuroscience, Maastricht University, Maastricht,The Netherlands
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10
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Zapata RC, Silver A, Yoon D, Chaudry B, Libster A, McCarthy MJ, Osborn O. Antipsychotic-induced weight gain and metabolic effects show diurnal dependence and are reversible with time restricted feeding. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:70. [PMID: 36042214 PMCID: PMC9427943 DOI: 10.1038/s41537-022-00276-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023]
Abstract
Antipsychotic drugs (AP) are highly efficacious treatments for psychiatric disorders but are associated with significant metabolic side-effects. The circadian clock maintains metabolic homeostasis by sustaining daily rhythms in feeding, fasting and hormone regulation but how circadian rhythms interact with AP and its associated metabolic side-effects is not well-known. We hypothesized that time of AP dosing impacts the development of metabolic side-effects. Weight gain and metabolic side-effects were compared in C57Bl/6 mice and humans dosed with APs in either the morning or evening. In mice, AP dosing at the start of the light cycle/rest period (AM) resulted in significant increase in food intake and weight gain compared with equivalent dose before the onset of darkness/active period (PM). Time of AP dosing also impacted circadian gene expression, metabolic hormones and inflammatory pathways and their diurnal expression patterns. We also conducted a retrospective examination of weight and metabolic outcomes in patients who received risperidone (RIS) for the treatment of serious mental illness and observed a significant association between time of dosing and severity of RIS-induced metabolic side-effects. Time restricted feeding (TRF) has been shown in both mouse and some human studies to be an effective therapeutic intervention against obesity and metabolic disease. We demonstrate, for the first time, that TRF is an effective intervention to reduce AP-induced metabolic side effects in mice. These studies identify highly effective and translatable interventions with potential to mitigate AP-induced metabolic side effects.
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Affiliation(s)
- Rizaldy C. Zapata
- grid.266100.30000 0001 2107 4242Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Allison Silver
- grid.266100.30000 0001 2107 4242Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Dongmin Yoon
- grid.266100.30000 0001 2107 4242Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Besma Chaudry
- grid.266100.30000 0001 2107 4242Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Avraham Libster
- grid.266100.30000 0001 2107 4242Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Michael J. McCarthy
- Psychiatry Service, VA San Diego Healthcare, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry and Center for Circadian Biology, University of California San Diego, La Jolla, CA 92093 USA
| | - Olivia Osborn
- grid.266100.30000 0001 2107 4242Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
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11
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Grunvald E. Obesogenic and leptogenic medication utilization in people with obesity: Is there a prescription for improvement? LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100259. [PMID: 36778927 PMCID: PMC9904072 DOI: 10.1016/j.lana.2022.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Eduardo Grunvald
- Division of General Internal Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Center for Advanced Weight Management, Bariatric and Metabolic Institute, Department of Surgery, University of California San Diego, 4303 La Jolla Village Drive, Suite 2110, San Diego, CA, USA
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12
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Baweja R, Waxmonsky JG. Updates in Pharmacologic Strategies for Emotional Dysregulation in Attention Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:479-498. [PMID: 35697397 DOI: 10.1016/j.chc.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emotional dysregulation (ED) manifesting as irritability or aggression produces appreciable impairment in children with attention deficit hyperactivity disorder and a main reason why they present for treatment. Central nervous system (CNS) stimulants seem to be a safe and tolerable treatment of most youth with these presentations. Optimization of CNS stimulants dose in combination with psychosocial interventions led to reductions in ED. Randomized controlled trials support that addition of risperidone further reduces aggression when these treatments are not sufficient. There is evidence for the efficacy of divalproex, molindone and selective serotonin reuptake inhibitor improve these outcomes when used as adjunct to CNS stimulants.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
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Heindel JJ, Howard S, Agay-Shay K, Arrebola JP, Audouze K, Babin PJ, Barouki R, Bansal A, Blanc E, Cave MC, Chatterjee S, Chevalier N, Choudhury M, Collier D, Connolly L, Coumoul X, Garruti G, Gilbertson M, Hoepner LA, Holloway AC, Howell G, Kassotis CD, Kay MK, Kim MJ, Lagadic-Gossmann D, Langouet S, Legrand A, Li Z, Le Mentec H, Lind L, Monica Lind P, Lustig RH, Martin-Chouly C, Munic Kos V, Podechard N, Roepke TA, Sargis RM, Starling A, Tomlinson CR, Touma C, Vondracek J, Vom Saal F, Blumberg B. Obesity II: Establishing causal links between chemical exposures and obesity. Biochem Pharmacol 2022; 199:115015. [PMID: 35395240 PMCID: PMC9124454 DOI: 10.1016/j.bcp.2022.115015] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
Abstract
Obesity is a multifactorial disease with both genetic and environmental components. The prevailing view is that obesity results from an imbalance between energy intake and expenditure caused by overeating and insufficient exercise. We describe another environmental element that can alter the balance between energy intake and energy expenditure: obesogens. Obesogens are a subset of environmental chemicals that act as endocrine disruptors affecting metabolic endpoints. The obesogen hypothesis posits that exposure to endocrine disruptors and other chemicals can alter the development and function of the adipose tissue, liver, pancreas, gastrointestinal tract, and brain, thus changing the set point for control of metabolism. Obesogens can determine how much food is needed to maintain homeostasis and thereby increase the susceptibility to obesity. The most sensitive time for obesogen action is in utero and early childhood, in part via epigenetic programming that can be transmitted to future generations. This review explores the evidence supporting the obesogen hypothesis and highlights knowledge gaps that have prevented widespread acceptance as a contributor to the obesity pandemic. Critically, the obesogen hypothesis changes the narrative from curing obesity to preventing obesity.
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Affiliation(s)
- Jerrold J Heindel
- Healthy Environment and Endocrine Disruptor Strategies, Commonweal, Bolinas, CA 92924, USA.
| | - Sarah Howard
- Healthy Environment and Endocrine Disruptor Strategies, Commonweal, Bolinas, CA 92924, USA
| | - Keren Agay-Shay
- Health and Environment Research (HER) Lab, The Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Juan P Arrebola
- Department of Preventive Medicine and Public Health University of Granada, Granada, Spain
| | - Karine Audouze
- Department of Systems Biology and Bioinformatics, University of Paris, INSERM, T3S, Paris France
| | - Patrick J Babin
- Department of Life and Health Sciences, University of Bordeaux, INSERM, Pessac France
| | - Robert Barouki
- Department of Biochemistry, University of Paris, INSERM, T3S, 75006 Paris, France
| | - Amita Bansal
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Etienne Blanc
- Department of Biochemistry, University of Paris, INSERM, T3S, 75006 Paris, France
| | - Matthew C Cave
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY 40402, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, University of South Carolina, Columbia, SC 29208, USA
| | - Nicolas Chevalier
- Obstetrics and Gynecology, University of Cote d'Azur, Cote d'Azur, France
| | - Mahua Choudhury
- College of Pharmacy, Texas A&M University, College Station, TX 77843, USA
| | - David Collier
- Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Lisa Connolly
- The Institute for Global Food Security, School of Biological Sciences, Queen's University, Belfast, Northern Ireland, UK
| | - Xavier Coumoul
- Department of Biochemistry, University of Paris, INSERM, T3S, 75006 Paris, France
| | - Gabriella Garruti
- Department of Endocrinology, University of Bari "Aldo Moro," Bari, Italy
| | - Michael Gilbertson
- Occupational and Environmental Health Research Group, University of Stirling, Stirling, Scotland
| | - Lori A Hoepner
- Department of Environmental and Occupational Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Alison C Holloway
- McMaster University, Department of Obstetrics and Gynecology, Hamilton, Ontario, CA, USA
| | - George Howell
- Center for Environmental Health Sciences, Mississippi State University, Mississippi State, MS 39762, USA
| | - Christopher D Kassotis
- Institute of Environmental Health Sciences and Department of Pharmacology, Wayne State University, Detroit, MI 48202, USA
| | - Mathew K Kay
- College of Pharmacy, Texas A&M University, College Station, TX 77843, USA
| | - Min Ji Kim
- Sorbonne Paris Nord University, Bobigny, INSERM U1124 (T3S), Paris, France
| | | | - Sophie Langouet
- Univ Rennes, INSERM EHESP, IRSET UMR_5S 1085, 35000 Rennes, France
| | - Antoine Legrand
- Sorbonne Paris Nord University, Bobigny, INSERM U1124 (T3S), Paris, France
| | - Zhuorui Li
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA 92697, USA
| | - Helene Le Mentec
- Sorbonne Paris Nord University, Bobigny, INSERM U1124 (T3S), Paris, France
| | - Lars Lind
- Clinical Epidemiology, Department of Medical Sciences, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - P Monica Lind
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Robert H Lustig
- Division of Endocrinology, Department of Pediatrics, University of California San Francisco, CA 94143, USA
| | | | - Vesna Munic Kos
- Department of Physiology and Pharmacology, Karolinska Institute, Solna, Sweden
| | - Normand Podechard
- Sorbonne Paris Nord University, Bobigny, INSERM U1124 (T3S), Paris, France
| | - Troy A Roepke
- Department of Animal Science, School of Environmental and Biological Science, Rutgers University, New Brunswick, NJ 08901, USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes and Metabolism, The University of Illinois at Chicago, Chicago, Il 60612, USA
| | - Anne Starling
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Craig R Tomlinson
- Norris Cotton Cancer Center, Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Charbel Touma
- Sorbonne Paris Nord University, Bobigny, INSERM U1124 (T3S), Paris, France
| | - Jan Vondracek
- Department of Cytokinetics, Institute of Biophysics of the Czech Academy of Sciences, Brno, Czech Republic
| | - Frederick Vom Saal
- Division of Biological Sciences, The University of Missouri, Columbia, MO 65211, USA
| | - Bruce Blumberg
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA 92697, USA
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Lyu B, Chang AR, Inker LA, Selvin E, Grams ME, Shin JI. Socioeconomic status and use of obesogenic and anti-obesity medications in the United States: A population-based study. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100249. [PMID: 35928911 PMCID: PMC9348594 DOI: 10.1016/j.lana.2022.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background The Endocrine Society Clinical Practice Guidelines recommend the avoidance of medications that may cause weight gain (i.e., obesogenic medications) in individuals with overweight or obesity. Obesity disproportionately affects people with lower socioeconomic status (SES); however, it is unknown whether the use of obesogenic medications differs by SES. Methods We included adults with overweight or obesity and used prescription medications from 2009-2018 of the US National Health and Nutrition Examination Survey. We examined the associations between a composite measure of SES and use of obesogenic medications and anti-obesity medications. The composite SES included <high school education (1 point), household income below federal poverty level (1 point), no insurance (2 points), and public health insurance only (1 point). We defined 3 composite SES groups (0 [high], 1 [intermediate], and ≥2 points [low]). Findings Among 10,673 US adults with overweight or obesity, 20.0% had low SES. Use of obesogenic medications was common (37.7%). Low (vs. high) SES was associated with greater obesogenic medication use, independent of demographic characteristics, prescription medication burden, and comorbidities (OR 1.3 [1.2-1.5]). Among 12,133 eligible participants, utilization of anti-obesity medications was very low overall (0.5%) and within all SES groups (low 0.27%, intermediate 0.71, and high 0.65%). Interpretation Our findings highlight common and modifiable risk factors for obesity. Clinicians should screen patient medications for those that may cause weight gain and increase adoption of anti-obesity medications, especially among adults living in low SES. Funding The National Institute of Diabetes and Digestive and Kidney Disease (R01DK115534, K24HL155861, and K01DK121825).
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Affiliation(s)
- Beini Lyu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600 (room 2-204), Baltimore, MD 21205, USA
| | - Alex R. Chang
- Kidney Health Research Institute, Geisinger Health System, Danville, PA, USA
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600 (room 2-204), Baltimore, MD 21205, USA,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600 (room 2-204), Baltimore, MD 21205, USA,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600 (room 2-204), Baltimore, MD 21205, USA,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA,Corresponding author at: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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15
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Mechanisms of reduced leptin-mediated satiety signaling during obesity. Int J Obes (Lond) 2022; 46:1212-1221. [PMID: 35241786 DOI: 10.1038/s41366-022-01079-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 01/17/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Disrupted leptin signaling in vagal afferent neurons contributes to hyperphagia and obesity. Thus, we tested the hypothesis that intrinsic negative regulators of leptin signaling, suppressor of cytokine signaling 3 (SOCS3) and protein tyrosine phosphatase 1B (PTP1B) underlie dysfunctional leptin-mediated vagal afferent satiety signaling during obesity. METHODS Experiments were performed on standard chow-fed control mice, high-fat fed (HFF), or low-fat fed (LFF) mice. SOCS3 and PTP1B expression were quantified using western blot and quantitative PCR. Nodose ganglion neuronal excitability and jejunal afferent sensitivity were measured by patch clamp and extracellular afferent recordings, respectively. RESULTS Increased expression of SOCS3 and PTP1B were observed in the jejunum of HFF mice. Prolonged incubation with leptin attenuated nodose ganglion neuronal excitability, and this effect was reversed by inhibition of SOCS3. Leptin potentiated jejunal afferent nerve responses to CCK in LFF mice but decreased them in HFF mice. Inhibition of SOCS3 restored impaired vagal afferent neuronal excitability and afferent nerve responses to satiety mediators during obesity. Two-pore domain K+ channel (K2P) conductance and nitric oxide (NO) production that we previously demonstrated were elevated during obesity were decreased by inhibitions of SOCS3 or PTP1B. CONCLUSIONS This study suggests that obesity impairs vagal afferent sensitivity via SOCS3 and PTP1B, likely as a consequence of obesity-induced hyperleptinemia. The mechanisms underlying leptin resistance appear also to cause a more global impairment of satiety-related vagal afferent responsiveness.
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16
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D’Alessandro C, Benedetti A, Di Paolo A, Giannese D, Cupisti A. Interactions between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative Review. Nutrients 2022; 14:nu14010212. [PMID: 35011087 PMCID: PMC8747252 DOI: 10.3390/nu14010212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022] Open
Abstract
Drugs and food interact mutually: drugs may affect the nutritional status of the body, acting on senses, appetite, resting energy expenditure, and food intake; conversely, food or one of its components may affect bioavailability and half-life, circulating plasma concentrations of drugs resulting in an increased risk of toxicity and its adverse effects, or therapeutic failure. Therefore, the knowledge of these possible interactions is fundamental for the implementation of a nutritional treatment in the presence of a pharmacological therapy. This is the case of chronic kidney disease (CKD), for which the medication burden could be a problem, and nutritional therapy plays an important role in the patient’s treatment. The aim of this paper was to review the interactions that take place between drugs and foods that can potentially be used in renal patients, and the changes in nutritional status induced by drugs. A proper definition of the amount of food/nutrient intake, an adequate definition of the timing of meal consumption, and a proper adjustment of the drug dosing schedule may avoid these interactions, safeguarding the quality of life of the patients and guaranteeing the effectiveness of drug therapy. Hence, a close collaboration between the nephrologist, the renal dietitian, and the patient is crucial. Dietitians should consider that food may interact with drugs and that drugs may affect nutritional status, in order to provide the patient with proper dietary suggestions, and to allow the maximum effectiveness and safety of drug therapy, while preserving/correcting the nutritional status.
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17
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Hales CM, Gu Q, Ogden CL, Yanovski SZ. Use of prescription medications associated with weight gain among US adults, 1999-2018: A nationally representative survey. Obesity (Silver Spring) 2022; 30:229-239. [PMID: 34907655 PMCID: PMC8842491 DOI: 10.1002/oby.23299] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/20/2021] [Accepted: 08/28/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate trends in the use of obesogenic medications among adults. METHODS Cross-sectional data on adults aged ≥20 years are from the 1999 to 2018 National Health and Nutrition Examination Survey (n = 52,340). Obesogenic medications were defined according to the 2015 Endocrine Society guidelines on the pharmacological management of obesity. Weight status was categorized according to BMI. Trends in prior 30-day use were evaluated. RESULTS In NHANES 2017-2018, 20.3% of US adults used an obesogenic medication. Beta-blockers (9.8%) and antidiabetics (5.7%) were the most common; antipsychotics (1.0%) were the least common. Most common indications were disorders of glucose metabolism, hypertension, neuralgia or neuritis, heart disease, and musculoskeletal pain and/or inflammation. From 1999 to 2018, the proportional use of obesogenic medications increased for anticonvulsants (34.4% to 55.0%) but decreased for antidepressants (32.1% to 18.8%), antidiabetics (82.9% to 52.5%), and beta-blockers (83.9% to 80.7%). The proportional use of obesogenic medications was not associated with weight status, except for antipsychotics. CONCLUSIONS Use of obesogenic medications was common. Differences in the proportional use of obesogenic medication may reflect changing availability of obesogenic versus nonobesogenic medications over time. The decision to prescribe a nonobesogenic alternative, if one exists, is guided by weighing the risks and benefits of available treatments.
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Affiliation(s)
- Craig M Hales
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Qiuping Gu
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Cynthia L Ogden
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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18
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El-Shimi OS, Farag AA, El-Rebigi AM, Kharboush TG, Bayomy HES, Khashaba RA. Carbamazepine-Induced Hematological and Immunological Alterations in Egyptian Children with Idiopathic Generalized Seizures. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1736156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractCarbamazepine (CBZ) is one of the oldest antiepileptic drugs (AEDs) that is still used for the treatment of tonic-clonic seizures in children. Long-term use of AEDs induces potential toxic effects that may remain undetermined for a long time. Earlier studies have revealed a wide spectrum of hematological toxicities associated with CBZ. This study was conducted to unveil the toxic effects of carbamazepine as an antiepileptic monotherapy on hematological and immunological parameters in a group of Egyptian pediatric patients using it for different durations. Fifty pediatric epileptics of either sex were enrolled; 38 were taking CBZ as antiepileptic monotherapy for ≥ 6 months and 12 were newly diagnosed untreated patients. Hematological and immunological parameters studied were compared with their age and sex-matched 15 controls and among groups. CBZ was found more toxic for total leukocyte count, lymphocyte count, serum IgA and IgM levels (p < 0.001, 0.001, < 0.001, < 0.001, respectively). Hemoglobin level, platelets count, serum C4 level and IgA were negatively correlated with serum CBZ level (Spearman's rho = – 0.62, – 0.42, – 0.34, – 0.13; p < 0.001, 0.008, 0.04, 0.44, respectively). CBZ treatment duration associated inversely with platelets, lymphocyte, and eosinophil counts (p < 0.001, 0.03, 0.01, respectively). Epileptic children on CBZ monotherapy had their hematologic and immunologic systems affected, which mandates routine monitoring of these children.
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Affiliation(s)
- Ola Samir El-Shimi
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Amina Ali Farag
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Benha University, Benha, Egypt
| | | | | | - Hanaa El-Sayed Bayomy
- Department Public Health and Community Medicine, Faculty of Medicine, Benha University, Benha, Egypt
| | - Rana Atef Khashaba
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Benha, Egypt
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Deru LS, Bikman BT, Davidson LE, Tucker LA, Fellingham G, Bartholomew CL, Yuan HL, Bailey BW. The Effects of Exercise on β-Hydroxybutyrate Concentrations over a 36-h Fast: A Randomized Crossover Study. Med Sci Sports Exerc 2021; 53:1987-1998. [PMID: 33731648 DOI: 10.1249/mss.0000000000002655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study assessed β-hydroxybutyrate (BHB) concentration during a short-term fast and the degree to which an initial bout of exercise influences the rate of ketogenesis. METHODS Twenty subjects (11 male, 9 female) completed two 36-h fasts, with one protocol requiring the subject to complete a treadmill exercise session at the beginning of the fast. BHB levels were assessed via portable meter every 2 h, along with mood and hunger ratings. Venipuncture was performed every 12 h. RESULTS The mean (SD) areas under the curve for BHB concentration were 19.19 (2.59) mmol·L-1 (nonexercised) and 27.49 (2.59) mmol·L-1 (exercised), yielding a difference of 8.30 mmol·L-1 between conditions (95% posterior probability interval (PPI), 1.94 to 14.82 mmol·L-1; posterior probability (PP) = 0.99). The mean (SD) times to BHB concentration of 0.5 mmol·L-1 were 21.07 (2.95) h (nonexercised) and 17.5 (1.69) h (exercised), a 3.57-h difference (95% PPI, -2.11 to 10.87 h; PP = 0.89). The differences in area under the curve between conditions were 5.07 μU·mL-1 (95% PPI, -21.64 to 36.18 μU·mL-1; PP = 0.67) for insulin, 97.13 pg·mL-1 (95% PPI, 34.08 to 354.21 pg·mL-1; PP = 0.98) for glucagon, and 20.83 (95% PPI, 4.70 to 24.22; PP = 0.99) for the insulin/glucagon ratio. CONCLUSIONS Completing aerobic exercise at the beginning of a fast accelerates the production of BHB throughout the fast without altering subjective feelings of hunger, thirst, stomach discomfort, or mood. Insulin and the insulin/glucagon ratio experience a marked reduction within the first 12 h of fasting and was not altered with exercise. Thus, exercising at the beginning of a fast may improve the metabolic outcomes of fasting.
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Affiliation(s)
- Landon S Deru
- Department of Exercise Science, Brigham Young University, Provo, UT
| | - Benjamin T Bikman
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT
| | - Lance E Davidson
- Department of Exercise Science, Brigham Young University, Provo, UT
| | - Larry A Tucker
- Department of Exercise Science, Brigham Young University, Provo, UT
| | | | | | - Holly L Yuan
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT
| | - Bruce W Bailey
- Department of Exercise Science, Brigham Young University, Provo, UT
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Metabolic and behavioral effects of olanzapine and fluoxetine on the model organism Caenorhabditis elegans. Saudi Pharm J 2021; 29:917-929. [PMID: 34408550 PMCID: PMC8363109 DOI: 10.1016/j.jsps.2021.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/04/2021] [Indexed: 12/29/2022] Open
Abstract
The use of many psychotropic drugs (PDs) is associated with increased caloric intake, significant weight gain, and metabolic disorders. The nematode Caenorhabditis elegans (C. elegans) has been used to study the effects of PDs on food intake. However, little is known about PDs effects on the body fat of C. elegans. In C. elegans, feeding behavior and fat metabolism are regulated through independent mechanisms. This study aims to evaluate the body fat and food intake of C. elegans in response to treatment olanzapine and fluoxetine. Here we report that, with careful consideration to the dosage used, administration of fluoxetine and olanzapine increases body fat and food intake in C. elegans.
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21
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Baweja R, Hale DE, Waxmonsky JG. Impact of CNS Stimulants for Attention-Deficit/Hyperactivity Disorder on Growth: Epidemiology and Approaches to Management in Children and Adolescents. CNS Drugs 2021; 35:839-859. [PMID: 34297331 DOI: 10.1007/s40263-021-00841-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 12/30/2022]
Abstract
Central nervous system stimulants are established treatments for pediatric attention-deficit/hyperactivity disorder with robust efficacy data. Reductions in appetite, weight, and growth velocity are some of the most common concerns regarding the long-term use of central nervous system stimulants in developing children. They are associated with suppression of weight and body mass index in childhood. However, both weight and body mass index often progressively increase over adolescence at rates faster than those seen in non-attention-deficit/hyperactivity disorder youth to the degree that attention-deficit/hyperactivity disorder is associated with elevated body mass index by the end of adolescence regardless of medication use. The capacity of central nervous system stimulants to slow growth was identified 50 years ago. Recent work has established that the growth deficits accumulate during the first 2 years of use and may persist provided medication is used. Early initiation coupled with persistent use through adolescence is most likely to be associated with clinical impactful growth suppression. There has been limited formal investigation of treatments for stimulant-associated reductions in weight and height. The most robust evidence exists for drug holidays improving weight gain. Observational studies suggest that limiting lifetime exposure or discontinuing medication is associated with greater adult height. Additional research is needed to identify the causal mechanisms driving the observed slowing in growth as well as the identification of predictors of clinically impactful growth suppression.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Daniel E Hale
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
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22
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Surial B, Mugglin C, Calmy A, Cavassini M, Günthard HF, Stöckle M, Bernasconi E, Schmid P, Tarr PE, Furrer H, Ledergerber B, Wandeler G, Rauch A. Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV : A Cohort Study. Ann Intern Med 2021; 174:758-767. [PMID: 33721521 DOI: 10.7326/m20-4853] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tenofovir-based antiretroviral therapy (ART) has become first-line in all major HIV treatment guidelines. Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has a favorable renal and bone safety profile, but concerns about metabolic complications remain. OBJECTIVE To assess weight changes, the development of overweight/obesity, and changes in lipid levels 18 months after replacing TDF with TAF. DESIGN Cohort study. SETTING 5 university hospitals, affiliated hospitals, and private physicians in Switzerland. PARTICIPANTS 4375 adults living with HIV who received TDF-containing ART for 6 months or longer. MEASUREMENTS Changes in weight and lipid levels were assessed using mixed-effect models. Differences in proportions of newly overweight/obese participants were calculated using 2-proportions Z tests. RESULTS 4375 individuals were included, with follow-up between 1 January 2016 and 31 July 2019. Median age was 50 years (interquartile range, 43 to 56 years), 25.9% were female, and 51.7% had a normal body mass index (BMI); 3484 (79.6%) switched to TAF and 891 (20.4%) continued TDF. After 18 months, switching to TAF was associated with an adjusted mean weight increase of 1.7 kg (95% CI, 1.5 to 2.0 kg), compared with 0.7 kg (CI, 0.4 to 1.0 kg) with the continued use of TDF (between-group difference, 1.1 kg [CI, 0.7 to 1.4 kg]). Among individuals with a normal BMI, 13.8% who switched to TAF became overweight/obese, compared with 8.4% of those continuing TDF (difference, 5.4 percentage points [CI, 2.1 to 8.8 percentage points]). Switching to TAF led to increases in adjusted mean total cholesterol (0.25 mmol/L [9.5 mg/dL]), high-density lipoprotein cholesterol (0.05 mmol/L [1.9 mg/dL]), low-density lipoprotein cholesterol (0.12 mmol/L [4.7 mg/dL]), and triglyceride (0.18 mmol/L [16.1 mg/dL]) levels after 18 months. LIMITATION Short follow-up, small subgroup analyses, and potential residual confounding. CONCLUSION Replacing TDF with TAF is associated with adverse metabolic changes, including weight increase, development of obesity, and worsening serum lipid levels. PRIMARY FUNDING SOURCE Swiss National Science Foundation.
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Affiliation(s)
- Bernard Surial
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Catrina Mugglin
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Alexandra Calmy
- Geneva University Hospital, University of Geneva, Geneva, Switzerland (A.C.)
| | - Matthias Cavassini
- University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland (M.C.)
| | - Huldrych F Günthard
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Marcel Stöckle
- University Hospital Basel, University of Basel, Basel, Switzerland (M.S.)
| | - Enos Bernasconi
- Regional Hospital of Lugano, University of Geneva, and University of Southern Switzerland, Lugano, Switzerland (E.B.)
| | - Patrick Schmid
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland (P.S.)
| | - Philip E Tarr
- and Kantonsspital Baselland, University of Basel, Basel, Switzerland (P.E.T.)
| | - Hansjakob Furrer
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Bruno Ledergerber
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Gilles Wandeler
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Andri Rauch
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
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van Oort S, Rutters F, Warlé‐van Herwaarden MF, Schram MT, Stehouwer CD, Tack CJ, Abbink EJ, Wolffenbuttel BH, van der Klauw MM, DeVries JH, Siegelaar SE, Sijbrands EJ, Özcan B, de Valk HW, Silvius B, Schroijen MA, Jazet IM, van Ballegooijen AJ, Beulens JWJ, Elders PJ, Kramers C. Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort. Diabet Med 2021; 38:e14406. [PMID: 32961611 PMCID: PMC8048843 DOI: 10.1111/dme.14406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 09/11/2020] [Indexed: 12/30/2022]
Abstract
AIM To describe the prevalence and characteristics of polypharmacy in a Dutch cohort of individuals with type 2 diabetes. METHODS We included people with type 2 diabetes from the Diabetes Pearl cohort, of whom 3886 were treated in primary care and 2873 in academic care (secondary/tertiary). With multivariable multinomial logistic regression analyses stratified for line of care, we assessed which sociodemographic, lifestyle and cardiometabolic characteristics were associated with moderate (5-9 medications) and severe polypharmacy (≥10 medications) compared with no polypharmacy (0-4 medications). RESULTS Mean age was 63 ± 10 years, and 40% were women. The median number of daily medications was 5 (IQR 3-7) in primary care and 7 (IQR 5-10) in academic care. The prevalence of moderate and severe polypharmacy was 44% and 10% in primary care, and 53% and 29% in academic care respectively. Glucose-lowering and lipid-modifying medications were most prevalent. People with severe polypharmacy used a relatively large amount of other (i.e. non-cardiovascular and non-glucose-lowering) medication. Moderate and severe polypharmacy across all lines of care were associated with higher age, low educational level, more smoking, longer diabetes duration, higher BMI and more cardiovascular disease. CONCLUSIONS Severe and moderate polypharmacy are prevalent in over half of people with type 2 diabetes in primary care, and even more in academic care. People with polypharmacy are characterized by poorer cardiometabolic status. These results highlight the significance of polypharmacy in type 2 diabetes.
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Affiliation(s)
- S. van Oort
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
| | - F. Rutters
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | | | - M. T. Schram
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. D. Stehouwer
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. J. Tack
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - E. J. Abbink
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - B. H. Wolffenbuttel
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - M. M. van der Klauw
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - J. H. DeVries
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - S. E. Siegelaar
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - E. J. Sijbrands
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - B. Özcan
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - H. W. de Valk
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - B. Silvius
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - M. A. Schroijen
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - I. M. Jazet
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - A. J. van Ballegooijen
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of NephrologyAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research InstituteAmsterdamthe Netherlands
| | - J. W. J. Beulens
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - P. J. Elders
- Department of General Practice and Elderly Care MedicineAmsterdam University Medical Center, location VUmc, Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - C. Kramers
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
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Cox JS, Searle AJ, Hinton EC, Giri D, Shield JPH. Perceptions of non-successful families attending a weight-management clinic. Arch Dis Child 2021; 106:377-382. [PMID: 33139347 DOI: 10.1136/archdischild-2020-319558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study seeks to understand family's perceptions of their care at a paediatric weight management service, with a view to informing service improvement. DESIGN A qualitative service review conducted via semistructured interviews with parents (n=11) and children (n=3) who attended the clinic. The recruitment was open to all, but those who were not succeeding in their weight-loss goals self-selected to participate. Self-Determination Theory was used as a framework to explore families' experiences of the clinic. SETTING Recruitment occurred during clinical appointments and interviews were conducted over the phone in the days following the appointments. PATIENTS The service sees paediatric patients with a body mass index >99th percentile, with comorbidities or safeguarding concerns. INTERVENTIONS The clinic's service includes appointments typically every 2 months, with a multidisciplinary team including consultant endocrinologists, a dietician, a clinical psychologist, a social worker and a clinical nurse specialist. MAIN OUTCOME MEASURES Families' feedback on the multi-disciplinary team (MDT) clinic, and their perceptions of how improvements could be made. RESULTS Families perceive a lack of autonomy, competency and feel a lack of connectivity both in their lives broadly and within their experience at the clinic. CONCLUSIONS Interventions in families struggling with weight improvements should see the clinical team placing more emphasis on working alongside parents to develop young people's sense of self-determination. Expectations must be set that success originates from changes outside of clinical appointments and that the clinical team is in place to support the family's development of sustainable, self-determined lifestyle habits.
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Affiliation(s)
- Jennifer S Cox
- National Institute for Health Research Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
| | - Aidan J Searle
- National Institute for Health Research Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
| | - Elanor C Hinton
- National Institute for Health Research Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
| | - Dinesh Giri
- Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, UK.,Department of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Julian P H Shield
- National Institute for Health Research Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
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25
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Verhaegen AA, Van Gaal LF. Drugs Affecting Body Weight, Body Fat Distribution, and Metabolic Function-Mechanisms and Possible Therapeutic or Preventive Measures: an Update. Curr Obes Rep 2021; 10:1-13. [PMID: 33400222 DOI: 10.1007/s13679-020-00419-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Weight gain and body fat redistribution are common side effects of many widely used drugs. We summarize recent literature on prevalence data and mechanisms associated with drug-induced body fat changes and mechanisms to prevent or treat metabolic side effects. RECENT FINDINGS The highest prevalence of metabolic complications is seen with antipsychotics and antiretroviral drugs used in the treatment of HIV and may, at least partly, be responsible for the increased risk for co-morbid diseases such as diabetes, steatosis of the liver, and cardiovascular disease. The pathogenetic mechanisms leading to weight gain from antipsychotics are increasingly known and help to unravel the complex interaction that exists between psychopathology and metabolic complications. Although the classic lipodystrophy mainly occurred with older HIV drugs, also with the newer HIV treatment, weight gain seems to be a major side effect. Early detection of the metabolic consequences of drugs can lead to an early diagnosis of the complications and their treatment. Different medications, including the newer antidiabetics, are being studied in the therapy of drug-induced obesity. Future research should focus on identifying individuals at risk for metabolic side effects and on early markers to identify individuals with side effects so that timely treatment of metabolic complications can be initiated.
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Affiliation(s)
- Ann A Verhaegen
- Department of Endocrinology, Diabetes and Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
- Department of Endocrinology, ZNA - Jan Palfijn, Lange Bremstraat 70,, 2170, Merksem, Belgium.
| | - Luc F Van Gaal
- Department of Endocrinology, Diabetes and Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
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26
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Abstract
The highly variable response to obesity therapies justifies the search for treatment strategies that are best suited to individual patients to enhance their effectiveness and tolerability via precision medicine. Precision medicine development in recent years has been driven by the emergence of powerful methods to characterize patients ("omic" assays). Current available information has revealed that there are numerous intermediary processes that contribute to obesity and have provided a framework for partially comprehending the mechanisms behind the heterogeneity of obesity and its clinical consequences. Some of these processes have or are currently being targeted to individualize obesity therapy with some success.
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Affiliation(s)
- Maria Daniela Hurtado A
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic Health System, 700 West Ave South, La Crosse, WI 54601, USA; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. https://twitter.com/MDanielaHurtado
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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27
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Sweeney B, Kelly AS, San Giovanni CB, Kelsey MM, Skelton JA. Clinical approaches to minimize iatrogenic weight gain in children and adolescents. Clin Obes 2021; 11:e12417. [PMID: 32987450 DOI: 10.1111/cob.12417] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
Clinical providers may underestimate the role of management of diseases that can occur with obesity, termed co-morbid conditions, distinct from disease that arise as a result of obesity, co-morbidities. Many of these conditions are associated with iatrogenic weight gain, and can interfere with weight loss outcomes in children and adolescents with obesity. Management of co-morbid conditions, and thoughtful selection of medications associated with weight neutrality or weight loss may increase the effectiveness of obesity treatment strategies. The aim of this commentary is to summarize the literature and discuss considerations for obesity treatment in the context of the more complicated patient, which often requires strategic management of co-morbid conditions and minimizing iatrogenic weight gain.
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Affiliation(s)
- Brooke Sweeney
- Department of Pediatrics, University of Missouri, Kansas City, Missouri, USA
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Megan M Kelsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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28
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Baweja R, Waschbusch DA, Pelham WE, Pelham WE, Waxmonsky JG. The Impact of Persistent Irritability on the Medication Treatment of Paediatric Attention Deficit Hyperactivity Disorder. Front Psychiatry 2021; 12:699687. [PMID: 34366928 PMCID: PMC8333707 DOI: 10.3389/fpsyt.2021.699687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
This study compares the efficacy and tolerability of central nervous system (CNS) stimulants in children with attention deficit hyperactivity disorder (ADHD) with and without prominent irritability (IRR) over the course of 30 months. This is a secondary analysis of a study examining growth patterns in medication naïve children with ADHD subsequently treated with CNS stimulants (predominantly OROS-Methylphenidate, up to 54 mg per day) for 30 months. Participants had to meet full diagnostic criteria for ADHD and been treated with CNS stimulants for under 30 days. Children were classified as IRR if they were rated as pretty much or very much on either of the "often angry" or easily annoyed" items plus "lose temper," items of the Disruptive Behavior Disorders Rating Scale (DBDRS). Structured ratings of ADHD symptoms, impairment, side effects, and symptoms of oppositional defiant disorder (ODD) were collected every 2-12 weeks for the duration of the study. Medication use was measured by pill count and parent report. The IRR group comprised 28% of all participants. The IRR group had significantly higher levels of ADHD and ODD symptoms, impairment, and side effects ratings at baseline. In the IRR group, ODD symptoms, emotional lability, and impairment significantly decreased for participants with higher medication use. Total side effects increased for non-IRR participants with higher medication use. Emotional side effects decreased for IRR participants with higher medication use. Central nervous system stimulants were a tolerable and efficacious treatment in treatment naïve youth with ADHD with irritability. Clinical Trials Registration: NCT01109849.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, United States
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, United States
| | - William E Pelham
- Center of Human Development, University of California, San Diego, San Diego, CA, United States
| | - William E Pelham
- Center for Children and Families Florida International University, Miami, FL, United States
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, United States
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29
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Metabolomic profiles associated with a mouse model of antipsychotic-induced food intake and weight gain. Sci Rep 2020; 10:18581. [PMID: 33122657 PMCID: PMC7596057 DOI: 10.1038/s41598-020-75624-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
Antipsychotic drugs (AP) are used to treat a multitude of psychiatric conditions including schizophrenia and bipolar disorder. However, APs also have metabolic side effects including increased food intake and body weight, but the underlying mechanisms remain unknown. We previously reported that minocycline (MINO) co-treatment abrogates olanzapine (OLZ)-induced hyperphagia and weight gain in mice. Using this model, we investigated the changes in the pharmacometabolome in the plasma and hypothalamus associated with OLZ-induced hyperphagia and weight gain. Female C57BL/6 mice were divided into groups and fed either i) control, CON (45% fat diet) ii) CON + MINO, iii) OLZ (45% fat diet with OLZ), iv) OLZ + MINO. We identified one hypothalamic metabolite indoxylsulfuric acid and 389 plasma metabolites (including 19 known metabolites) that were specifically associated with AP-induced hyperphagia and weight gain in mice. We found that plasma citrulline, tricosenoic acid, docosadienoic acid and palmitoleic acid were increased while serine, asparagine and arachidonic acid and its derivatives were decreased in response to OLZ. These changes were specifically blocked by co-treatment with MINO. These pharmacometabolomic profiles associated with AP-induced hyperphagia and weight gain provide candidate biomarkers and mechanistic insights related to the metabolic side effects of these widely used drugs.
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31
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Zhuravleva EO, Vel’ts NY, Snegireva II, Kutekhova GV, Alyautdin RN. Pharmacogenetic Tests for Antipsychotic-Induced Weight Gain. Pharm Chem J 2019. [DOI: 10.1007/s11094-019-02059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Caprio M, Infante M, Moriconi E, Armani A, Fabbri A, Mantovani G, Mariani S, Lubrano C, Poggiogalle E, Migliaccio S, Donini LM, Basciani S, Cignarelli A, Conte E, Ceccarini G, Bogazzi F, Cimino L, Condorelli RA, La Vignera S, Calogero AE, Gambineri A, Vignozzi L, Prodam F, Aimaretti G, Linsalata G, Buralli S, Monzani F, Aversa A, Vettor R, Santini F, Vitti P, Gnessi L, Pagotto U, Giorgino F, Colao A, Lenzi A. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2019; 42:1365-1386. [PMID: 31111407 DOI: 10.1007/s40618-019-01061-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Weight loss is a milestone in the prevention of chronic diseases associated with high morbility and mortality in industrialized countries. Very-low calorie ketogenic diets (VLCKDs) are increasingly used in clinical practice for weight loss and management of obesity-related comorbidities. Despite evidence on the clinical benefits of VLCKDs is rapidly emerging, some concern still exists about their potential risks and their use in the long-term, due to paucity of clinical studies. Notably, there is an important lack of guidelines on this topic, and the use and implementation of VLCKDs occurs vastly in the absence of clear evidence-based indications. PURPOSE We describe here the biochemistry, benefits and risks of VLCKDs, and provide recommendations on the correct use of this therapeutic approach for weight loss and management of metabolic diseases at different stages of life.
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Affiliation(s)
- M Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
| | - M Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - E Moriconi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Armani
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy
| | - A Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - G Mantovani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - S Mariani
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - C Lubrano
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Poggiogalle
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Migliaccio
- Section of Health Sciences, Department of Movement, Human and Health Sciences, "Foro Italico" University of Rome, Rome, Italy
| | - L M Donini
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Basciani
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Cignarelli
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - E Conte
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - G Ceccarini
- Endocrinology Unit, Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - F Bogazzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Cimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A Gambineri
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, AOU Careggi, Florence, Italy
| | - F Prodam
- Endocrinology, Department of Translational Medicine and Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - G Aimaretti
- Endocrinology, Department of Translational Medicine and Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - G Linsalata
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Buralli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - R Vettor
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padua, Italy
| | - F Santini
- Endocrinology Unit, Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - P Vitti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Gnessi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - U Pagotto
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - F Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - A Colao
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A Lenzi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Desalermos A, Russell B, Leggett C, Parnell A, Ober K, Hagerich K, Gerlan C, Ganji G, Lee E, Proudfoot JA, Grunvald E, Gupta S, Ho SB, Zarrinpar A. Effect of Obesogenic Medications on Weight-Loss Outcomes in a Behavioral Weight-Management Program. Obesity (Silver Spring) 2019; 27:716-723. [PMID: 31012292 PMCID: PMC6544176 DOI: 10.1002/oby.22444] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to evaluate a possible association between the use of obesogenic medications and inadequate weight loss in a behavioral weight-management program. METHODS This is a case-control, single-center study of 666 adult patients within a Veterans Health Administration health system who participated in the MOVE! behavioral weight-loss program. The cohort was divided into responders (n = 150), patients who achieved ≥ 5% total weight loss by the end of the MOVE! program, and nonresponders (n = 516), those who achieved < 5% total weight loss. We reviewed each patient's medical records for exposure to obesogenic medication during the time of treatment. RESULTS Approximately 62% (n = 411) of patients entering MOVE! had a prescription for obesogenic medications. Obesogenic medication use was associated with worse weight-loss outcomes, and participants were 37% less likely to achieve a clinically meaningful (≥ 5% total weight loss) outcome at the end of the MOVE! program (odds ratio, 0.633; 95% CI: 0.427-0.937; adjusted P = 0.022). Patients who received three or more medications (n = 72) had the greatest difficulty achieving 5% weight loss compared with the control group (odds ratio, 0.265; 95% CI: 0.108-0.646; adjusted P = 0.003). CONCLUSIONS The use of provider-prescribed obesogenic medications was associated with worse weight-loss outcomes in a behavioral weight-loss program. Closer scrutiny of patient medications is necessary to help improve outcomes of weight-loss treatments.
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Affiliation(s)
- Athanasios Desalermos
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Division of Gastroenterology. University of California, San Diego, La Jolla, California, USA
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Baylee Russell
- Division of Gastroenterology. University of California, San Diego, La Jolla, California, USA
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Cecilia Leggett
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Amelia Parnell
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Kathleen Ober
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Kelley Hagerich
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Cindy Gerlan
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Gelareh Ganji
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Euyhyun Lee
- Clinical and Translational Research Institute, University of California, San Diego, La Jolla, California, USA
| | - James A. Proudfoot
- Clinical and Translational Research Institute, University of California, San Diego, La Jolla, California, USA
| | - Eduardo Grunvald
- School of Medicine, University of California, San Diego, La Jolla, California, USA
- Bariatric and Metabolic Institute, University of California, San Diego, La Jolla, California, USA
- Division of General Internal Medicine, University of California, San Diego, La Jolla, California, USA
- Institute of Diabetes and Metabolic Health, University of California, San Diego, La Jolla, California, USA
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Division of Gastroenterology. University of California, San Diego, La Jolla, California, USA
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Samuel B. Ho
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Division of Gastroenterology. University of California, San Diego, La Jolla, California, USA
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Amir Zarrinpar
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Division of Gastroenterology. University of California, San Diego, La Jolla, California, USA
- School of Medicine, University of California, San Diego, La Jolla, California, USA
- Clinical and Translational Research Institute, University of California, San Diego, La Jolla, California, USA
- Institute of Diabetes and Metabolic Health, University of California, San Diego, La Jolla, California, USA
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Wharton S, Bonder R, Jeffery A, Christensen RAG. The safety and effectiveness of commonly-marketed natural supplements for weight loss in populations with obesity: A critical review of the literature from 2006 to 2016. Crit Rev Food Sci Nutr 2019; 60:1614-1630. [PMID: 30896252 DOI: 10.1080/10408398.2019.1584873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the evidence published from 2006 to 2016 on the effectiveness and safety of commonly used natural supplements for weight loss in individuals with obesity.Methods: Amazon and Google were searched for names of mono-agent natural supplements marketed for weight loss and a list of the 10 supplements was created. Google Scholar, Pubmed, Science Direct, and the Cochrane Library were searched for articles that met inclusion.Results: At least one article was published on the effectiveness or safety of bitter orange, capsinoid, carnitine, chromium picolinate, Coleus forskohlii, conjugated linoleic acid, glucomannan, green tea and psyllium for weight loss in populations with obesity from 2006 to 2016. There was insufficient evidence to suggest that the natural supplements examined contribute to significant weight loss, with the exception of perhaps glucomannan in the form of PGX. In general, the majority of side-effects reported were minor to moderate, and gastrointestinal-related. However, in some cases extreme side-effects such as liver and kidney failure were observed.Conclusion: Contrary to popular belief, results of this review suggest that the use of natural supplements for weight loss are unlikely to contribute to meaningful weight loss and in some cases may contribute to harm.
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Affiliation(s)
- Sean Wharton
- The Wharton Medical Clinic, Toronto, Ontario, Canada.,School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Revi Bonder
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Aaron Jeffery
- The Wharton Medical Clinic, Toronto, Ontario, Canada
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Skonieczna-Żydecka K, Łoniewski I, Misera A, Stachowska E, Maciejewska D, Marlicz W, Galling B. Second-generation antipsychotics and metabolism alterations: a systematic review of the role of the gut microbiome. Psychopharmacology (Berl) 2019; 236:1491-1512. [PMID: 30460516 PMCID: PMC6598971 DOI: 10.1007/s00213-018-5102-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/31/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE Multiple drugs are known to induce metabolic malfunctions, among them second-generation antipsychotics (SGAs). The pathogenesis of such adverse effects is of multifactorial origin. OBJECTIVES We investigated whether SGAs drive dysbiosis, assessed whether gut microbiota alterations affect body weight and metabolic outcomes, and looked for the possible mechanism of metabolic disturbances secondary to SGA treatment in animal and human studies. METHODS A systematic literature search (PubMed/Medline/Embase/ClinicalTrials.gov/PsychInfo) was conducted from database inception until 03 July 2018 for studies that reported the microbiome and weight alterations in SGA-treated subjects. RESULTS Seven articles reporting studies in mice (experiments = 8) and rats (experiments = 3) were included. Olanzapine was used in five and risperidone in six experiments. Only three articles (experiments = 4) in humans fit our criteria of using risperidone and mixed SGAs. The results confirmed microbiome alterations directly (rodent experiments = 5, human experiments = 4) or indirectly (rodent experiments = 4) with predominantly increased Firmicutes abundance relative to Bacteroidetes, as well as weight gain in rodents (experiments = 8) and humans (experiments = 4). Additionally, olanzapine administration was found to induce both metabolic alterations (adiposity, lipogenesis, plasma free fatty acid, and acetate levels increase) (experiments = 3) and inflammation (experiments = 2) in rodents, whereas risperidone suppressed the resting metabolic rate in rodents (experiments = 5) and elevated fasting blood glucose, triglycerides, LDL, hs-CRP, antioxidant superoxide dismutase, and HOMA-IR in humans (experiment = 1). One rodent study suggested a gender-dependent effect of dysbiosis on body weight. CONCLUSIONS Antipsychotic treatment-related microbiome alterations potentially result in body weight gain and metabolic disturbances. Inflammation and resting metabolic rate suppression seem to play crucial roles in the development of metabolic disorders.
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Affiliation(s)
| | - Igor Łoniewski
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland ,Sanprobi sp. z o.o. sp. k, Szczecin, Poland
| | - Agata Misera
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ewa Stachowska
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland
| | - Dominika Maciejewska
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Britta Galling
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany ,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health,, Glen Oaks, NY USA ,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY USA
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Perez-Gomez A, Carretero M, Weber N, Peterka V, To A, Titova V, Solis G, Osborn O, Petrascheck M. A phenotypic Caenorhabditis elegans screen identifies a selective suppressor of antipsychotic-induced hyperphagia. Nat Commun 2018; 9:5272. [PMID: 30532051 PMCID: PMC6288085 DOI: 10.1038/s41467-018-07684-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/12/2018] [Indexed: 12/30/2022] Open
Abstract
Antipsychotic (AP) drugs are used to treat psychiatric disorders but are associated with significant weight gain and metabolic disease. Increased food intake (hyperphagia) appears to be a driving force by which APs induce weight gain but the mechanisms are poorly understood. Here we report that administration of APs to C. elegans induces hyperphagia by a mechanism that is genetically distinct from basal food intake. We exploit this finding to screen for adjuvant drugs that suppress AP-induced hyperphagia in C. elegans and mice. In mice AP-induced hyperphagia is associated with a unique hypothalamic gene expression signature that is abrogated by adjuvant drug treatment. Genetic analysis of this signature using C. elegans identifies two transcription factors, nhr-25/Nr5a2 and nfyb-1/NFYB to be required for AP-induced hyperphagia. Our study reveals that AP-induced hyperphagia can be selectively suppressed without affecting basal food intake allowing for novel drug discovery strategies to combat AP-induced metabolic side effects.
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Affiliation(s)
- Anabel Perez-Gomez
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Maria Carretero
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Natalie Weber
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Veronika Peterka
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Alan To
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Viktoriya Titova
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Gregory Solis
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Olivia Osborn
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Michael Petrascheck
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA.
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA.
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Causes and solutions to “globesity”: The new fa(s)t alarming global epidemic. Food Chem Toxicol 2018; 121:173-193. [DOI: 10.1016/j.fct.2018.08.071] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/10/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
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Wharton S, Raiber L, Serodio KJ, Lee J, Christensen RA. Medications that cause weight gain and alternatives in Canada: a narrative review. Diabetes Metab Syndr Obes 2018; 11:427-438. [PMID: 30174450 PMCID: PMC6109660 DOI: 10.2147/dmso.s171365] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The cause of the obesity epidemic is multifactorial, but may, in part, be related to medication-induced weight gain. While clinicians may strive to do their best to select pharmacotherapy(ies) that has the least negative impact on weight, the literature regarding the weight effects of medication is often limited and devoid of alternative therapies. RESULTS Antipsychotics, antidepressants, antihyperglycemics, antihypertensives and corticosteroids all contain medications that were associated with significant weight gain. However, there are several medication alternatives within the majority of these classes associated with weight neutral or even weight loss effects. Further, while not all of the classes of medication examined in this review have weight-favorable alternatives, there exist many other tools to mitigate weight gain associated with medication use, such as changes in dosing, medication delivery or the use of adjunctive therapies. CONCLUSION Medication-induced weight gain can be frustrating for both the patient and the clinician. As the use of pharmaceuticals continues to increase, it is pertinent for clinicians to consider the weight effects of medications prior to prescribing or in the course of treatment. In the case where it is not feasible to make changes to medication, adjunctive therapies should be considered.
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Affiliation(s)
- Sean Wharton
- The Wharton Medical Clinic, Toronto, Canada,
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | | | - Jasmine Lee
- The Wharton Medical Clinic, Toronto, Canada,
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Role of Serotonin Transporter in Antidepressant-Induced Diabetes Mellitus: A Pharmacoepidemiological–Pharmacodynamic Study in VigiBase®. Drug Saf 2018; 41:1087-1096. [DOI: 10.1007/s40264-018-0693-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Greydanus DE, Agana M, Kamboj MK, Shebrain S, Soares N, Eke R, Patel DR. Pediatric obesity: Current concepts. Dis Mon 2018; 64:98-156. [DOI: 10.1016/j.disamonth.2017.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Deenik J, Tenback DE, van Driel HF, Tak ECPM, Hendriksen IJM, van Harten PN. Less Medication Use in Inpatients With Severe Mental Illness Receiving a Multidisciplinary Lifestyle Enhancing Treatment. The MULTI Study III. Front Psychiatry 2018; 9:707. [PMID: 30618878 PMCID: PMC6305587 DOI: 10.3389/fpsyt.2018.00707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/03/2018] [Indexed: 12/31/2022] Open
Abstract
Besides having an unhealthy lifestyle contributing to premature mortality, inpatients with severe mental illness (SMI) use high dosages of medication. Previous research has shown improved health after lifestyle improvements in SMI. In addition, we aimed to retrospectively study whether a multidisciplinary lifestyle enhancing treatment (MULTI) was associated with changes in medication use after 18 months, as compared with patients that continued treatment as usual (TAU) and explored mediation by a change in physical activity. We conducted an observational study within a cohort of inpatients with SMI, who received MULTI (N = 65) or continued TAU (N = 49). Data on their somatic and psychotropic medications were collected, converted into defined daily dose (DDD), and analyzed using linear multilevel regression, correcting for baseline value and differences between groups in age, diagnosis, and illness severity. Compared with TAU, the DDD for psychotropic medication significantly decreased with MULTI (B = -0.55, P = 0.02). Changes in total activity did not mediate this association, suggesting that multiple components of MULTI contributed. Corrected between-group analyses for subgroups of medication were not possible due to lack of power and skewed distributions. Within-group data showed a decreased proportion of users as well as median DDD in both groups for almost all medications. In addition to previously reported health improvements after 18 months of MULTI, we observed a significant decrease in dose of psychotropic medication in MULTI compared to TAU. This first study evaluating a wide range of medications indicates a possible effect of lifestyle improvements on medication use in inpatients with SMI. Findings need to be confirmed in future controlled studies, however.
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Affiliation(s)
- Jeroen Deenik
- GGz Centraal, Amersfoort, Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | | | | | | | - Peter N van Harten
- GGz Centraal, Amersfoort, Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
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Abstract
Obesity is a chronic disease with serious consequences and although lifestyle modification is considered first line treatment, it is often ineffective, especially in the long term. Relatively few people with obesity will undergo the most effective currently available treatment of bariatric surgery. Pharmacotherapy can bridge the gap between lifestyle modification and surgery, but many monotherapies have only modest efficacy or require high doses with unacceptable side effects. As with many other areas of medicine, combination therapy is now becoming accepted as a way of optimising efficacy for weight management, whilst minimising adverse effects. Combinations may use different medications with complementary modes of action. Currently available combination therapies are low-dose phentermine and sustained release topiramate and naltrexone/bupropion. Many other possibilities exist and promising options include combination of phentermine with a sodium glucose co-transporter 2 inhibitor or combination of a glucagon-like peptide 1 agonist with other gut hormones or with a sodium glucose co-transporter 2 inhibitor. The ultimate aim is to match the efficacy of bariatric surgery with a combination of medicines, but this remains an elusive goal.
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Affiliation(s)
- John Ph Wilding
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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