1
|
Bauman D. Impact of obesity on female puberty and pubertal disorders. Best Pract Res Clin Obstet Gynaecol 2023; 91:102400. [PMID: 37708835 DOI: 10.1016/j.bpobgyn.2023.102400] [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: 06/28/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023]
Abstract
The worldwide epidemic of obesity appears to be one of the crucial health problems. One-third of children and adolescents in the United States are classified as either overweight or obese and 6% of adolescents are severely obese. With the development of high technology, children, and adolescents, spend more time in sedentary life. Together with the availability of consuming fast caloric food, it is almost unavoidable to get an imbalance between caloric intake and caloric expenditure of energy, resulting in the accumulation of fat-energy stores. Obesity has an enormous impact on physical and psychological health and is associated with more than 29 adverse health consequences previously identified in the adult population only, such as type 2 diabetes mellitus, hypertension, metabolic syndrome, postmenopausal breast cancer, and others. In addition, excess adiposity may exert a harmful effect on the reproductive system, resulting in precocious puberty, irregular menstrual cycle, polycystic ovary syndrome, and high-risk sexual behavior. Intervention programs for healthy lifestyle modification, consisting of caloric restriction together with physical activity did not gain the expected efficacy. Other approaches as medical and surgical therapies are currently not evidence-based for the young population. The obesity crisis in children and adolescents requires a better understanding of etiology, pathophysiology, and management of obesity in this unique population. Researchers and physicians must "turn over every stone" to find a solution for deviating obesity ascent.
Collapse
Affiliation(s)
- Dvora Bauman
- Bat-Ami Center, Pediatric & Adolescent Gynecology Division, Obstetrics and Gynecology Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, P.O.B 12000, Jerusalem 91120, Israel.
| |
Collapse
|
2
|
Abstract
Background: Topiramate has been shown to result in significant weight loss compared to placebo in adults with obesity. However, there are no consensus guidelines on the acceptability, safety, and efficacy of topiramate for weight loss in children. We present a literature review and case series on topiramate use in young children with severe obesity. Methods: We performed a PubMed search from January 2000 to February 2022 utilizing keywords, "topiramate" and "obesity" and "children" and "adolescent." For our case series, children were identified through retrospective chart review from a multidisciplinary weight management program. Eligibility criteria: age ≤12 years, class II or III obesity, completed 16 weeks of topiramate therapy as adjunct to lifestyle modifications. Semistructured interviews were conducted with one parent to review side effects. Results: Literature search yielded nine articles. All studies reported trends toward BMI reduction and weight loss with topiramate monotherapy. Five children met case series eligibility (mean age 10 years 3 months ±1.5 years, 60% female). After 16 weeks of topiramate, all children had a decrease in BMI as a percentage of the 95th percentile (mean -12% [-5% to -18%]). Parents reported improvement in impulsive eating and decreased desire to overeat compared to baseline. Four out of five reported no side effects, one reported drowsiness which resolved by dosing at nighttime. Conclusions: Results suggest that topiramate is well tolerated and may be utilized for weight management in younger children. A randomized controlled trial investigating the impact of topiramate for weight management in this age group is warranted.
Collapse
Affiliation(s)
- Casey Berman
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Monica Naguib
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Hegedus
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alaina P. Vidmar
- Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
3
|
Ma X, Yan H, Hong S, Yu S, Gong Y, Wu D, Li Y, Xiao H. Gamma-Aminobutyric Acid Promotes Beige Adipocyte Reconstruction by Modulating the Gut Microbiota in Obese Mice. Nutrients 2023; 15:nu15020456. [PMID: 36678326 PMCID: PMC9864545 DOI: 10.3390/nu15020456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Given the increasing prevalence of obesity, the white-to-beige adipocyte conversion has attracted interest as a target for obesity treatment. Gamma-aminobutyric acid (GABA) treatment can reduce obesity, but the underlying mechanism remains unclear. Here, we aimed to investigate the mechanism by which GABA triggers weight loss by improving the beiging of inguinal white adipose tissue (iWAT) and the role of gut microbiota in this process. The results showed that GABA reduced body weight and adipose inflammation and promoted the expression of thermogenic genes in the iWAT. The 16S rRNA sequence analysis of gut microbiota showed that GABA treatment increased the relative abundance of Bacteroidetes, Akkermansia, and Romboutsia and reduced that of Firmicutes and Erysipelatoclostridium in obese mice. Additionally, serum metabolomic analysis revealed that GABA treatment increased 3-hydroxybutyrate and reduced oxidized lipid levels in obese mice. Spearman's correlation analysis showed that Akkermansia and Romboutsia were negatively associated with the levels of oxidized lipids. Fecal microbiota transplantation analysis confirmed that the gut microbiota was involved in the white-to-beige adipocyte reconstruction by GABA. Overall, our findings suggest that GABA treatment may promote iWAT beiging through the gut microbiota in obese mice. GABA may be utilized to protect obese people against metabolic abnormalities brought on by obesity and gut dysbiosis.
Collapse
Affiliation(s)
- Xiaoyi Ma
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Huanhuan Yan
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Shubin Hong
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Shuang Yu
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yingying Gong
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Dide Wu
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
- Correspondence:
| |
Collapse
|
4
|
Ilias I, Rizzo M, Zabuliene L. Metformin: Sex/Gender Differences in Its Uses and Effects—Narrative Review. Medicina (B Aires) 2022; 58:medicina58030430. [PMID: 35334606 PMCID: PMC8952223 DOI: 10.3390/medicina58030430] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 02/08/2023] Open
Abstract
Metformin (MTF) occupies a major and fundamental position in the therapeutic management of type 2 diabetes mellitus (T2DM). Gender differences in some effects and actions of MTF have been reported. Women are usually prescribed lower MTF doses compared to men and report more gastrointestinal side effects. The incidence of cardiovascular events in women on MTF has been found to be lower to that of men on MTF. Despite some promising results with MTF regarding pregnancy rates in women with PCOS, the management of gestational diabetes, cancer prevention or adjunctive cancer treatment and COVID-19, most robust meta-analyses have yet to confirm such beneficial effects.
Collapse
Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, GR-11521 Athens, Greece
- Correspondence: e-mail:
| | - Manfredi Rizzo
- Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Via del Vespro, 141, 90127 Palermo, Italy;
| | - Lina Zabuliene
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio St. 21/27, LT-03101 Vilnius, Lithuania;
| |
Collapse
|
5
|
Julian V, Haschke F, Fearnbach N, Gomahr J, Pixner T, Furthner D, Weghuber D, Thivel D. Effects of Movement Behaviors on Overall Health and Appetite Control: Current Evidence and Perspectives in Children and Adolescents. Curr Obes Rep 2022; 11:10-22. [PMID: 35020189 PMCID: PMC9165266 DOI: 10.1007/s13679-021-00467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To present the definitions and recommendations for movement behaviors in children and adolescents, including physical activity (PA), sedentary behaviors (SB), and sleep, and to provide an overview regarding their impact on health and obesity outcomes from childhood to adulthood, as well as interactions with appetite control. RECENT FINDINGS PA represents a variable proportion of daily energy expenditure and one can be active with high SB or vice versa. Studies have described movements across the whole day on a continuum from sleep to SB to varying intensities of PA. More PA, less SB (e.g., less screen time) and longer sleep are positively associated with indicators of physical health (e.g., lower BMI, adiposity, cardiometabolic risk) and cognitive development (e.g., motor skills, academic achievement). However, less than 10% of children currently meet recommendations for all three movement behaviors. Movement behaviors, adiposity, and related cardiometabolic diseases in childhood track into adolescence and adulthood. Furthermore, low PA/high SB profiles are associated with increased energy intake. Recent studies investigating energy balance regulation showed that desirable movement behavior profiles are associated with better appetite control and improved eating habits. Early identification of behavioral phenotypes and a comprehensive approach addressing all key behaviors that directly affect energy balance will allow for individual strategies to prevent or treat obesity and its comorbidities. Investigating exercise as a potential "corrector" of impaired appetite control offers a promising weight management approach.
Collapse
Affiliation(s)
- Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, Research Center in Human Nutrition, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - Ferdinand Haschke
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Nicole Fearnbach
- Pediatric Energy Balance Laboratory, Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, LA USA
| | - Julian Gomahr
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Pixner
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics and Adolescent Medicine, Salzkammergut-Klinikum, Vöcklabruck, Austria
| | - Dieter Furthner
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics and Adolescent Medicine, Salzkammergut-Klinikum, Vöcklabruck, Austria
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - David Thivel
- Laboratory AME2P, Research Center in Human Nutrition, University of Clermont Auvergne, Aubière, France
| |
Collapse
|
6
|
Apperley LJ, Blackburn J, Erlandson-Parry K, Gait L, Laing P, Senniappan S. Childhood obesity: A review of current and future management options. Clin Endocrinol (Oxf) 2022; 96:288-301. [PMID: 34750858 DOI: 10.1111/cen.14625] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
Obesity is becoming increasingly prevalent in paediatric populations worldwide. In addition to increasing prevalence, the severity of obesity is also continuing to rise. Taken together, these findings demonstrate a worrying trend and highlight one of the most significant challenges to public health. Childhood obesity affects multiple organs in the body and is associated with both significant morbidity and ultimately premature mortality. The prevalence of complications associated with obesity, including dyslipidaemia, hypertension, fatty liver disease and psychosocial complications are becoming increasingly prevalent within the paediatric populations. Treatment guidelines currently focus on intervention with lifestyle and behavioural modifications, with pharmacotherapy and surgery reserved for patients who are refractory to such treatment. Research into adult obesity has established pharmacological novel therapies, which have been approved and established in clinical practice; however, the research and implementation of such therapies in paediatric populations have been lagging behind. Despite the relative lack of widespread research in comparison to the adult population, newer therapies are being trialled, which should allow a greater availability of treatment options for childhood obesity in the future. This review summarizes the current evidence for the management of obesity in terms of medical and surgical options. Both future therapeutic agents and those which cause weight loss but have an alternative indication are also included and discussed as part of the review. The review summarizes the most recent research for each intervention and demonstrates the potential efficacy and limitations of each treatment option.
Collapse
Affiliation(s)
- Louise J Apperley
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| | - James Blackburn
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | | | - Lucy Gait
- Department of Paediatric Clinical Psychology, Alder Hey Children's Hospital, Liverpool, UK
| | - Peter Laing
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| | - Senthil Senniappan
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| |
Collapse
|
7
|
Sahebkar-Khorasani M, Safarian M, Jarahi L, Yousefi M, Salari R, Meshkat M, Ayati MH, Bahrami-Taghanaki H, Kargozar R, Azizi H. Comparative effectiveness of Hypericum perforatum, acupuncture, and lifestyle modification in the management of obesity: a randomized clinical trial. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Fiskum C, Riiber Å, Eik-Nes TT. Prevention of Unhealthy Weight, Disordered Eating, and Poor Body Image in Children. Perspectives From Norwegian Parents and Healthcare Professionals. Front Psychiatry 2022; 13:895781. [PMID: 35573359 PMCID: PMC9094704 DOI: 10.3389/fpsyt.2022.895781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Childhood obesity (ChO) and eating disorders are on the rise, with concerning effects on health. Early prevention is essential as interventions after problems arise are costly and with a low success rate. In Norway, prevention of ChO has been largely weight-centered, without desired effects. Confident Body, Confident Child (CBCC) is a universal program aimed at preventing ChO, disturbed eating, and body image problems through a health-centered intervention for parents of children between 2 and 6 years. The current study is part of a cultural adaptation and translation of CBCC into Norwegian. METHODS Focus groups with parents (n = 16) and professionals (n = 11) were held around healthy eating, activity, and body image, with an emphasis on possible barriers for prevention as well as approaches considered helpful. The interviews were analyzed using interpretative phenomenological analysis. RESULTS Parents and professionals described parental stress connected to high standards, conflicting information, and parental comparison. A narrowing sense of normality around healthy living was described with little flexibility resulting in "all-or-nothing" thinking. Parents were anxious to say or do the wrong thing when regulating children's food intake and when faced with comments about appearance. Parents and professionals described parental concern around children not eating enough, and professionals described an increase in parents using food as regulation. Both parents and professionals expressed that having a child with overweight was tied to a sense of failure and shame. Interventions related to overweight seemed to increase stress and shame, further complicating follow-up. As an alternative, parents and professionals expressed a desire for interventions with normalizing information around "good-enough" parenting related to food and weight. DISCUSSION The described fear of doing something wrong and lack of flexibility is interpreted within a stress-sensitive understanding, where stress and shame can influence parents toward mobilizing action or disengagement, presenting as dichotomous behaviors of "all-or-nothing". CONCLUSION Interventions that can normalize parental concerns in a non-moralizing way may reduce stress and shame. CBCC addresses all the major concerns raised in this study, providing parents with evidence-based information they can implement into everyday life. The Norwegian cultural adaptation added extra emphasis on normalization and shame-reduction.
Collapse
Affiliation(s)
- Charlotte Fiskum
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Åshild Riiber
- Healthy Life Centre (Friskliv og mestring), Orkanger, Norway
| | - Trine Tetlie Eik-Nes
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Stjørdal Community Mental Health Centre, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| |
Collapse
|
9
|
Micioni Di Bonaventura MV, Coman MM, Tomassoni D, Micioni Di Bonaventura E, Botticelli L, Gabrielli MG, Rossolini GM, Di Pilato V, Cecchini C, Amedei A, Silvi S, Verdenelli MC, Cifani C. Supplementation with Lactiplantibacillus plantarum IMC 510 Modifies Microbiota Composition and Prevents Body Weight Gain Induced by Cafeteria Diet in Rats. Int J Mol Sci 2021; 22:ijms222011171. [PMID: 34681831 PMCID: PMC8540549 DOI: 10.3390/ijms222011171] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022] Open
Abstract
Changes in functionality and composition of gut microbiota (GM) have been associated and may contribute to the development and maintenance of obesity and related diseases. The aim of our study was to investigate for the first time the impact of Lactiplantibacillus (L.) plantarum IMC 510 in a rat model of diet-induced obesity, specifically in the cafeteria (CAF) diet. This diet provides a strong motivation to voluntary overeat, due to the palatability and variety of selected energy-dense foods. The oral administration for 84 days of this probiotic strain, added to the CAF diet, decreased food intake and body weight gain. Accordingly, it ameliorated body mass index, liver and white adipose tissue weight, hepatic lipid accumulation, adipocyte size, serum parameters, including glycemia and low-density lipoprotein levels, in CAF fed rats, potentially through leptin control. In this scenario, L. plantarum IMC 510 showed also beneficial effects on GM, limiting the microbial imbalance established by long exposure to CAF diet and preserving the proportion of different bacterial taxa. Further research is necessary to better elucidate the relationship between GM and overweight and then the mechanism of action by which L. plantarum IMC 510 modifies weight. However, these promising results prompt a clear advantage of probiotic supplementation and identify a new potential probiotic as a novel and safe therapeutic approach in obesity prevention and management.
Collapse
Affiliation(s)
| | - Maria Magdalena Coman
- Synbiotec S.r.l., Spin-off of UNICAM, Via Gentile III Da Varano, 62032 Camerino, Italy; (M.M.C.); (C.C.); (M.C.V.)
| | - Daniele Tomassoni
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino, Italy; (D.T.); (M.G.G.)
| | - Emanuela Micioni Di Bonaventura
- Pharmacology Unit, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (M.V.M.D.B.); (E.M.D.B.); (L.B.); (C.C.)
| | - Luca Botticelli
- Pharmacology Unit, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (M.V.M.D.B.); (E.M.D.B.); (L.B.); (C.C.)
| | - Maria Gabriella Gabrielli
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino, Italy; (D.T.); (M.G.G.)
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.R.); (A.A.)
- Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genova, Italy;
| | - Cinzia Cecchini
- Synbiotec S.r.l., Spin-off of UNICAM, Via Gentile III Da Varano, 62032 Camerino, Italy; (M.M.C.); (C.C.); (M.C.V.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.R.); (A.A.)
| | - Stefania Silvi
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino, Italy; (D.T.); (M.G.G.)
- Correspondence:
| | - Maria Cristina Verdenelli
- Synbiotec S.r.l., Spin-off of UNICAM, Via Gentile III Da Varano, 62032 Camerino, Italy; (M.M.C.); (C.C.); (M.C.V.)
| | - Carlo Cifani
- Pharmacology Unit, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (M.V.M.D.B.); (E.M.D.B.); (L.B.); (C.C.)
| |
Collapse
|
10
|
Anekwe CV, Knight MG, Seetharaman S, Dutton WP, Chhabria SM, Stanford FC. Pharmacotherapeutic options for weight regain after bariatric surgery. ACTA ACUST UNITED AC 2021; 19:524-541. [PMID: 34511864 DOI: 10.1007/s11938-021-00358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose of review We sought to critically evaluate the recent literature published over the past 3 years on the topic of weight regain after bariatric surgery in children, adolescents, and adults, with an emphasis on clinically- relevant information for pharmacologic treatment of weight regain after metabolic and bariatric surgery. Findings There are multiple pharmacotherapeutic agents available to treat obesity in children, adolescents, and adults; these agents have varying efficacy and indications for use and have been studied in a variety of clinical and research scenarios. We present an overview of these findings. Summary This review represents a comprehensive compilation of the recently published data on efficacy of anti-obesity pharmacotherapy in the treatment of weight regain after bariatric surgery for children, adolescents, and adults.
Collapse
Affiliation(s)
- Chika Vera Anekwe
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology, Boston, MA.,Harvard Medical School, Boston, MA
| | - Michael G Knight
- Division of General Internal Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sujatha Seetharaman
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology, Boston, MA
| | - Wesley P Dutton
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology, Boston, MA
| | - Shradha M Chhabria
- Geisinger Commonwealth School of Medicine, Scranton, PA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA.,Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Division of Endocrinology-Neuroendocrine Unit, Department of Pediatrics-Division of Endocrinology Boston, MA
| |
Collapse
|
11
|
Temporal Effects of Sleeve Gastrectomy on Glucose-Insulin Homeostasis and Incretin Hormone Response at 1 and 6 Months. Obes Surg 2021; 30:2243-2250. [PMID: 32067166 PMCID: PMC7475060 DOI: 10.1007/s11695-020-04457-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bariatric surgery is an effective treatment for morbid obesity and glycaemic dysfunction. OBJECTIVES The aim of the work was to examine both the static and dynamic changes of glucose-insulin homeostasis and incretin hormone response following sleeve gastrectomy (SG) in a sample of 55 participants preoperatively and 1 month and 6 months postoperatively. The focus was on a sample of patients with impaired glucose tolerance and type 2 diabetes (T2D). SETTING Morriston Hospital, UK. METHODS Prospective study comprising of 55 participants with impaired glucose homeostasis and T2D undergoing SG (mean body mass index [BMI] 50.4 kg/m2, mean glycated haemoglobin [A1C] 7.4%). Serial measurements of glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic hormone (GIP) were performed during oral glucose tolerance testing preoperatively and 1 and 6 months postoperatively. Areas under the curve (AUC) were examined at 30, 60, and 120 min. RESULTS We observed significant improvements in measures of obesity, as well as static and dynamic measures of glucose, insulin, C-peptide and HOMA. Furthermore, significant increases in GLP-1 response as early as 6 months postoperatively were also seen. CONCLUSIONS To our knowledge, no study has examined the detailed dynamic changes in glucose and insulin homeostasis in this number of participants undergoing SG in relation to incretin hormones GIP and GLP-1. This current study supports the role of SG for the treatment of obesity-related glucose dysregulation.
Collapse
|
12
|
Raman V, Foster CM. Metformin Treatment of Pediatric Obesity. Pediatrics 2021; 147:peds.2020-044982. [PMID: 33608414 DOI: 10.1542/peds.2020-044982] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Vandana Raman
- Division of Endocrinology, Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Carol M Foster
- Division of Endocrinology, Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| |
Collapse
|
13
|
Khoury T, Ilan Y. Platform introducing individually tailored variability in nerve stimulations and dietary regimen to prevent weight regain following weight loss in patients with obesity. Obes Res Clin Pract 2021; 15:114-123. [PMID: 33653665 DOI: 10.1016/j.orcp.2021.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
Prevention of weight regain following successful weight loss is a major challenge in the treatment of obesity, irrespective of the weight reduction method used. The majority of individuals regain the lost weight over time; thus, achieving long-term sustainability in weight loss remains an unresolved issue. A compensatory adaptation to the weight loss methods occurs in several body organs and partly explains the lack of sustainable effect. Variability is inherent in many biological systems, and patterns of variability constitute a body mechanism that is active at several levels, starting from the genes and cellular pathways through to the whole-organ level. This study aimed to describe a platform that introduces individually tailored variability in vagal nerve stimulation and dietary regimen to ensure prolonged and sustainable weight loss and prevent weight regain. The platform is intended to provide a method that can overcome the body's compensatory adaptation mechanisms while ensuring a prolonged beneficial effect.
Collapse
Affiliation(s)
- Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Yaron Ilan
- Department of Medicine, Hebrew University-Hadassah Medical Center, PO Box 12000, IL-91120, Jerusalem, Israel.
| |
Collapse
|
14
|
da Fonseca ACP, Abreu GDM, Palhinha L, Zembrzuski VM, Campos Junior M, Carneiro JRI, Nogueira Neto JF, Magno FCCM, Rosado EL, Maya-Monteiro CM, de Cabello GMK, Cabello PH, Bozza PT. A Rare Potential Pathogenic Variant in the BDNF Gene is Found in a Brazilian Patient with Severe Childhood-Onset Obesity. Diabetes Metab Syndr Obes 2021; 14:11-22. [PMID: 33442278 PMCID: PMC7797284 DOI: 10.2147/dmso.s267202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/29/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a pro-survival factor in the brain that also regulates energy balance. BDNF loss-of-function point mutations are responsible for haploinsufficiency, causing severe early-onset obesity. Up to date, only a few studies have sequenced this gene to search for rare mutations related to obesity. In this study, we aimed to investigate the prevalence of BDNF variants in a cohort of adults with severe obesity from Brazil. MATERIAL AND METHODS This study comprised 201 adults with severe obesity (BMI ≥ 35.0 kg/m2) with onset during childhood- or adolescence/youth. As controls, 73 subjects with normal weight (18.5 ≤ BMI ≤ 24.9 kg/m2) were selected. The exclusion criteria were pregnancy, lactation, the use of medication to lose or gain weight, and the presence of symptoms suggestive of syndromic obesity (only for the case group). The coding region of the BDNF gene was screened by Sanger sequencing. Demographic, anthropometric, and blood pressure parameters were obtained from the participants as well as serum hormone and cytokines concentrations and biochemical values. RESULTS As a result, three missense variants [p.(Thr2Ile), p.(Val66Met), and p.(Arg209Gln)] and four synonymous variants (p.Leu107=, p.Thr149=, p.Ala150=, and p.Ser213=) were identified. The p.(Arg209Gln) was predicted as pathogenic by all in silico algorithms used and was not observed in the control group. The individuals carrying the p.(Val66Met) mutated allele had higher waist circumference, HDL-cholesterol and MCP1 levels, and reduced risk of developing metabolic syndrome. CONCLUSION We observed that the common BDNF p.(Val66Met) variant has influenced waist circumference, HDL-cholesterol, and MCP1 levels. This polymorphism has also a protective effect on metabolic syndrome susceptibility. Additionally, we described for the first time a rare potentially pathogenic BDNF variant in a Brazilian patient with severe obesity and childhood-onset.
Collapse
Affiliation(s)
- Ana Carolina Proença da Fonseca
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Correspondence: Ana Carolina Proença da Fonseca Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, 4365 Brasil Avenue, Leônidas Deane Building – Office 611/615, Rio de Janeiro, RJ21040-360, BrazilTel +552138658192Fax +552138658239 Email
| | | | - Lohanna Palhinha
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Mario Campos Junior
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - João Regis Ivar Carneiro
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Eliane Lopes Rosado
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Pedro Hernán Cabello
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Human Genetics Laboratory, Grande Rio University, Rio de Janeiro, Brazil
| | - Patricia Torres Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
15
|
Jung SH, Yoon JH, Choi HS, Nam SJ, Kim KO, Kim DH, Kim JW, Sohn W, Hyun YS, Park CH, Lee HL. Comparative efficacy of bariatric endoscopic procedures in the treatment of morbid obesity: a systematic review and network meta-analysis. Endoscopy 2020; 52:940-954. [PMID: 32325513 DOI: 10.1055/a-1149-1862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The comparative efficacy of bariatric endoscopic procedures has not been completely elucidated. We aimed to comprehensively evaluate the efficacy of bariatric endoscopic procedures. METHODS We searched for randomized controlled trials investigating the efficacy of bariatric endoscopic procedures, including the use of an intragastric balloon, duodenal-jejunal bypass liner (DJBL), aspiration therapy, primary obesity surgery endoluminal (POSE) procedure, and botulinum toxin injection to the stomach. Network meta-analyses were performed to determine the percentage of weight loss (%weight loss) and percentage of excess weight loss (%EWL). RESULTS 22 studies with 2141 patients were included in the meta-analysis. Most endoscopic procedures showed superior efficacy in terms of %weight loss compared with the control (mean difference [MD] [95 % confidence interval (CI)]: aspiration therapy 10.4 % [7.0 % to 13.7 %]; fluid-filled balloon 5.3 % [3.4 % to 7.2 %]; POSE 4.9 % [1.7 % to 8.2 %]; and DJBL 4.5 % [1.4 % to 7.7 %]). In terms of %EWL, aspiration therapy, fluid-filled balloon, POSE, and DJBL were superior to the control (MD [95 %CI]: 27.3 % [15.3 % to 39.3 %]; 22.4 % [15.4 % to 29.4 %]; 15.3 % [2.5 % to 28.0 %]; and 13.0 % [4.9 % to 21.2], respectively). The gas-filled balloon and botulinum toxin injection did not show a significant difference in %weight loss or %EWL compared with the control. For the fluid-filled balloon, the %EWL and %weight loss tended to decrease after balloon removal at 6 months after the procedure. CONCLUSION All bariatric endoscopic procedures, except for gas-filled balloon and botulinum toxin injection to the stomach, showed superior short-term efficacy in terms of %weight loss or %EWL compared with lifestyle modification.
Collapse
Affiliation(s)
- Sung Hoon Jung
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jai Hoon Yoon
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyoung Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Wook Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Won Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yil Sik Hyun
- Division of Gastroenterology, Department of Internal Medicine, Seoul Chuk Hospital, Seoul, Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hang Lak Lee
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | | |
Collapse
|
16
|
Kerry RG, Das G, Golla U, Del Pilar Rodriguez-Torres M, Shin H, Patra JK. Engineered probiotic and prebiotic nutraceutical supplementations in combating non-communicable disorders: A review. Curr Pharm Biotechnol 2020; 23:72-97. [PMID: 33050862 DOI: 10.2174/1389201021666201013153142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022]
Abstract
Nutritional supplementations are a form of nutrition sources that may help in improving health complexities throughout the life span of a person. Under the umbrella of food supplementations, nutraceuticals are products extracted from edible sources that provide medical benefits along with primary nutritional value, these can be considered as functional foods. These nutraceutical supplementations are also evidenced in altering the commensal gut microbiota and help to prevent or fight against chronic non-communicable degenerative diseases in adults including neurological disorders (Autism Spectrum Disorder [ASD], Parkinson's disease [PD] and Multiple sclerosis [MS]) and metabolic disorder (Type-II Diabetes, Obesity and non-alcoholic fatty liver disease). Even the complexities of preterm babies like extra-uterine growth restriction, necrotizing enterocolitis, infant eczema and allergy (during pregnancy) and bronchopulmonary dysplasia, etc. could also be lessened up by providing proper nutrition. Molecular perceptive of inflammatory and apoptotic modulators regulating the pathogenesis of these health risks, their control and management by probiotics and prebiotics could further emphasize the scientific overview of their utility. The pivotal role of nutraceutical supplementations in regulating or modulating molecular pathways coupled with the above mentioned non-communicable diseases are briefly described. Lastly, an overall introduction to the sophisticated genome-editing techniques and advanced delivery systems in therapeutic activities applicable under these health risks are also emphasized in this paper.
Collapse
Affiliation(s)
| | - Gitishree Das
- Research Institute of Biotechnology & Medical Converged Science, Dongguk University-Seoul, Goyangsi 10326. Korea
| | - Upendarrao Golla
- Division of Hematology and Oncology, Penn State College of Medicine, Hershey, PA 17033. United States
| | - Maria Del Pilar Rodriguez-Torres
- Laboratorio de Ondas de Choque (LOCH), Centro de Física Aplicada y Tecnología Avanzada (CFATA), Universidad Nacional Autónoma de México, Campus UNAM Juriquilla Boulevard Juriquilla no. 3001, Santiago de Querétaro, Qro., C.P. 76230. Mexico
| | - HanSeung Shin
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyangsi 10326. Korea
| | - Jayanta Kumar Patra
- Research Institute of Biotechnology & Medical Converged Science, Dongguk University-Seoul, Goyangsi 10326. Korea
| |
Collapse
|
17
|
Romanelli R, Cecchi N, Carbone MG, Dinardo M, Gaudino G, Miraglia Del Giudice E, Umano GR. Pediatric obesity: prevention is better than care. Ital J Pediatr 2020; 46:103. [PMID: 32709246 PMCID: PMC7379757 DOI: 10.1186/s13052-020-00868-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Pediatric obesity is one of the most relevant health issues of the last century. Obesity-related short and long-term consequences are responsible of a large amount of economic cost. In addition, the different therapeutic strategies, such as lifestyle correction, drug, and bariatric surgery have displayed low effectiveness. Considering this evidence, prevention appears to be more promising than treatment in contrasting obesity epidemic. In this review, we summarize obesity pathogenesis with the aim of highlight the main obesity risk factors that can be addressed as target of preventive interventions. Moreover, we report the evidence about effectiveness of different interventions targeting family, school, and community. A multiple-component intervention, addressing different targets and settings, might be desirable, however more studies are needed to confirm long-term efficacy and to direct policy interventions.
Collapse
Affiliation(s)
- Roberta Romanelli
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Nicola Cecchi
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Grazia Carbone
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Michele Dinardo
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppina Gaudino
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy
| | - Giuseppina Rosaria Umano
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy.
| |
Collapse
|
18
|
Rojas IY, Moyer BJ, Ringelberg CS, Tomlinson CR. Reversal of obesity and liver steatosis in mice via inhibition of aryl hydrocarbon receptor and altered gene expression of CYP1B1, PPARα, SCD1, and osteopontin. Int J Obes (Lond) 2020; 44:948-963. [PMID: 31911663 PMCID: PMC7103522 DOI: 10.1038/s41366-019-0512-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity is a global epidemic and the underlying basis for numerous comorbidities. We report that the aryl hydrocarbon receptor (AHR) plays a key role in the metabolism of obesity. The AHR is a promiscuous, ligand-activated nuclear receptor primarily known for regulating genes involved in xenobiotic metabolism and T cell polarization. The aims of the work reported here were to understand the underlying mechanism of AHR-based obesity and to determine whether inhibition of AHR activity would reverse obesity. METHODS Mice were fed control (low fat) and Western (high fat) diets with and without the AHR antagonist alpha-naphthoflavone (aNF). Gene expression of identified AHR-regulated genes from liver and adipose tissue was characterized. To determine the role of the AHR in obesity reversal, selected mice in control and Western diet regimens were switched at midpoint to the respective control and Western diets containing aNF, and the identified AHR-regulated genes characterized. RESULTS AHR inhibition prevented obesity in mice on a 40-week diet regimen. The likely AHR-regulated and cross-regulated downstream effectors of AHR-based obesity were shown to be CYP1B1, PPARα-target genes, SCD1, and SPP1 (osteopontin). Western diet caused an increase of mRNA and protein expression of the Cyp1b1, Scd1, and Spp1, and PPARα-target genes in the liver, and inhibition of the AHR maintained expression of these genes near control levels. The body weight of obese mice on Western diet switched to Western diet containing aNF decreased to that of mice on control diet concurrently with a reduction in the expression of liver CYP1B1, PPARα-target genes, SCD1, and SPP1. AHR inhibition prevented hypertrophy and hyperplasia in visceral adipose tissue and limited expression levels of CYP1B1 and SPP1 to that of mice on control diet. CONCLUSIONS AHR inhibition prevents and reverses obesity by likely reducing liver expression of the Cyp1b1, Scd1, Spp1, and PPARα-target genes; and the AHR is a potentially potent therapeutic target for the treatment and prevention of obesity and linked diseases.
Collapse
Affiliation(s)
- Itzel Y Rojas
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.,Tufts University School of Medicine, 711 Washington Street, Boston, MA, 02111, USA
| | - Benjamin J Moyer
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Carol S Ringelberg
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Craig R Tomlinson
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA. .,Department of Molecular & Systems Biology, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| |
Collapse
|
19
|
Czepiel KS, Perez NP, Campoverde Reyes KJ, Sabharwal S, Stanford FC. Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Front Endocrinol (Lausanne) 2020; 11:290. [PMID: 32477270 PMCID: PMC7237714 DOI: 10.3389/fendo.2020.00290] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ~6.5 million patients, individuals aged 5-25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5-12 years old), adolescents (13-18 years old), and YA (19-25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m2, respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.
Collapse
Affiliation(s)
- Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Kathryn S. Czepiel
| | - Numa P. Perez
- Department of General Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Karen J. Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shreya Sabharwal
- Department of Bioethics, Harvard Medical School, Boston, MA, United States
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
| |
Collapse
|
20
|
Liu M, Zheng M, Cai D, Xie J, Jin Z, Liu H, Liu J. Zeaxanthin promotes mitochondrial biogenesis and adipocyte browning via AMPKα1 activation. Food Funct 2019; 10:2221-2233. [PMID: 30950462 DOI: 10.1039/c8fo02527d] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Zeaxanthin (ZEA), a type of oxygenated carotenoid with strong antioxidant activity, has previously been found to exhibit an anti-lipogenesis effect. In the present study, we investigated the effect of ZEA on brown-like adipocyte formation and mitochondrial biogenesis in 3T3-L1 adipocytes. Brown adipocyte-specific markers, mitochondrial biogenesis and oxidative stress, and the involvement of AMP-activated protein kinase (AMPK) α1 were assessed. ZEA treated adipocytes demonstrated a brown-like pattern, with upregulated expression of uncoupling protein 1 (UCP1) and other brown adipocyte markers. In addition, ZEA intervention induced a dramatic increase in mitochondrial DNA (mtDNA) content and in the mRNA levels of genes associated with mitochondrial biogenesis. Furthermore, ZEA attenuated mitochondrial oxidative damage caused by lipid peroxidation in adipocytes, significantly improved the mitochondrial membrane potential (MMP), and scavenged intracellular reactive oxygen species (ROS) and mitochondrial superoxide. Finally, we concluded that AMPKα1 mediated the ZEA-caused inhibition of lipid accumulation and promotion of brown and beige adipocyte-biomarker expression, as the positive effects of ZEA were diminished by Prkaa1 (AMPKα1) knockdown. These findings demonstrated that ZEA promoted the expression of brown and beige adipogenesis markers and mitochondrial biogenesis, which involved AMPKα1 activation, thus contributing to the anti-obesity effects of ZEA.
Collapse
Affiliation(s)
- Meihong Liu
- College of Food Science and Engineering, Jilin Agricultural University, Changchun, Jilin 130118, China.
| | | | | | | | | | | | | |
Collapse
|
21
|
Shi M, Li Z, Miao Z, Guo Y, Yi L. Interleukin-15 inhibits adipogenic differentiation of cattle bone marrow-derived mesenchymal stem cells via regulating the crosstalk between signal transducer and activator of transcription 5A and Akt signalling. Biochem Biophys Res Commun 2019; 517:346-352. [PMID: 31358322 DOI: 10.1016/j.bbrc.2019.07.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
Abstract
Interleukin (IL)-15 is an important regulator of adipogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). This study was designed to clarify the underlying mechanism. BMSCs were obtained from Nanyang cattle and stimulated to differentiate into adipocytes using standard differentiation medium. Oil Red O staining was used to assess lipid accumulation. Western blotting and quantitative real-time polymerase chain reaction were used to assess protein and mRNA levels, respectively. Recombinant IL-15 treatment inhibited adipogenic differentiation of cattle BMSCs in vitro, as evidenced by reduced induction of the adipocyte markers, peroxisome proliferator activated receptor γ (PPARγ) and fatty acid binding protein 4 (αP2). IL-15 not only activated the signal transducers and activators of transcription (STAT) pathway, but also attenuated the activation of phosphoinositide 3-kinase (PI3K)/Akt signalling by insulin, a major inducer of adipocyte differentiation. In the presence of the STAT-specific inhibitor, 573108, the inhibitory effect of IL-15 on PPARγ and αP2 expression was abolished. Meanwhile, IL-15-attenuated PI3K/Akt signalling was also rescued. IL-15 may regulate adipogenic differentiation of BMSCs by inhibiting PI3K/Akt activation via the STAT5A pathway. Our data raise the possibility of using IL-15 in the therapy of obesity-related diseases, such as cardiovascular diseases and type 2 diabetes.
Collapse
Affiliation(s)
- Mingyan Shi
- College of Life Science, Luoyang Normal University, Luoyang, 471934, China.
| | - Zhichao Li
- School of Life Sciences and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Zhiguo Miao
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, 453003, China
| | - Yanjie Guo
- College of Life Science, Luoyang Normal University, Luoyang, 471934, China
| | - Li Yi
- College of Life Science, Luoyang Normal University, Luoyang, 471934, China
| |
Collapse
|
22
|
Serra-Juhé C, Martos-Moreno GÁ, Bou de Pieri F, Flores R, Chowen JA, Pérez-Jurado LA, Argente J. Heterozygous rare genetic variants in non-syndromic early-onset obesity. Int J Obes (Lond) 2019; 44:830-841. [PMID: 30926952 PMCID: PMC7101277 DOI: 10.1038/s41366-019-0357-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/07/2019] [Accepted: 02/07/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity is a very heterogeneous disorder at both the clinical and molecular levels and with high heritability. Several monogenic forms and genes with strong effects have been identified for non-syndromic severe obesity. Novel therapeutic interventions are in development for some genetic forms, emphasizing the importance of determining genetic contributions. OBJECTIVE We aimed to define the contribution of rare single-nucleotide genetic variants (RSVs) in candidate genes to non-syndromic severe early-onset obesity (EOO; body mass index (BMI) >+3 standard deviation score, <3 years). METHODS Using a pooled DNA-sequencing approach, we screened for RSVs in 15 obesity candidate genes in a series of 463 EOO patients and 480 controls. We also analysed exome data from 293 EOO patients from the "Viva la Familia" (VLF) study as a replication dataset. RESULTS Likely or known pathogenic RSVs were identified in 23 patients (5.0%), with 7 of the 15 genes (BDNF, FTO, MC3R, MC4R, NEGR1, PPARG and SIM1) harbouring RSVs only in cases (3.67%) and none in controls. All were heterozygous changes, either de novo (one in BDNF) or inherited from obese parents (seven maternal, three paternal), and no individual carried more than one variant. Results were replicated in the VLF study, where 4.10% of probands carried RSVs in the overrepresented genes. RSVs in five genes were either absent (LEP) or more common in controls than in cases (ADRB3, LEPR, PCSK1 and PCSK2) in both obese datasets. CONCLUSIONS Heterozygous RSVs in several candidate genes of the melanocortin pathway are found in ~5.0% patients with EOO. These results support the clinical utility of genetic testing to identify patients who might benefit from targeted therapeutic intervention.
Collapse
Affiliation(s)
- Clara Serra-Juhé
- Genetics Unit, Universitat Pompeu Fabra, Hospital del Mar Research Institute (IMIM), C/Doctor Aiguader, 8, 08003, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, C/Sinesio Delgado, 4, 28029, Madrid, Spain
| | - Gabriel Á Martos-Moreno
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology, Instituto de Investigación La Princesa, Universidad Autónoma de Madrid, Department of Pediatrics, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain.,CIBER de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, C/Sinesio Delgado, 4, 28029, Madrid, Spain
| | - Francesc Bou de Pieri
- Genetics Unit, Universitat Pompeu Fabra, Hospital del Mar Research Institute (IMIM), C/Doctor Aiguader, 8, 08003, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, C/Sinesio Delgado, 4, 28029, Madrid, Spain
| | - Raquel Flores
- Genetics Unit, Universitat Pompeu Fabra, Hospital del Mar Research Institute (IMIM), C/Doctor Aiguader, 8, 08003, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, C/Sinesio Delgado, 4, 28029, Madrid, Spain
| | - Julie A Chowen
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology, Instituto de Investigación La Princesa, Universidad Autónoma de Madrid, Department of Pediatrics, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain.,CIBER de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, C/Sinesio Delgado, 4, 28029, Madrid, Spain
| | - Luis A Pérez-Jurado
- Genetics Unit, Universitat Pompeu Fabra, Hospital del Mar Research Institute (IMIM), C/Doctor Aiguader, 8, 08003, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, C/Sinesio Delgado, 4, 28029, Madrid, Spain.,Women's and Children's Hospital, South Australia Medical and Health Research Institute (SAMHRI) and University of Adelaide, 72 King William Road, North Adelaide, SA, 5006, Australia
| | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology, Instituto de Investigación La Princesa, Universidad Autónoma de Madrid, Department of Pediatrics, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain. .,CIBER de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, C/Sinesio Delgado, 4, 28029, Madrid, Spain. .,IMDEA Food Institute, CEIUAM + CSI, Crta. de Cantoblanco, 8, 28049, Madrid, Spain.
| |
Collapse
|
23
|
Sikora M, Rakowska A, Olszewska M, Rudnicka L. The Use of Naltrexone in Dermatology. Current Evidence and Future Directions. Curr Drug Targets 2019; 20:1058-1067. [PMID: 30887922 DOI: 10.2174/1389450120666190318121122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 01/29/2023]
Abstract
Naltrexone is a competitive opioid receptor antagonist approved as supportive treatment in alcohol dependence and opioid addiction. At a dose of 50-100 mg daily, naltrexone is used off-label in dermatology for the treatment of trichotillomania and different types of pruritus. At a dose as low as 1- 5 mg per day, naltrexone demonstrates immunomodulatory action i.e. modulates Toll-like receptors signaling, decreases release of proinflammatory cytokines (tumor necrosis factor, interleukin-6, interleukin- 12), inhibits T lymphocyte proliferation, down-regulates the expression of chemokine receptors and adhesion molecules. The efficacy of standard and low doses of naltrexone in a variety of dermatological disorders has been reported. These include diseases such as familial benign chronic pemphigus (Hailey-Hailey disease), dermatomyositis, systemic sclerosis, psoriasis and lichen planopilaris. Optimistic preliminary findings, low cost of therapy and good tolerance make naltrexone a promising alternative therapy or adjunct drug in dermatology.
Collapse
Affiliation(s)
- Mariusz Sikora
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| | - Małgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| |
Collapse
|
24
|
Case Reports: Multifaceted Experiences Treating Youth with Severe Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060927. [PMID: 30875836 PMCID: PMC6466372 DOI: 10.3390/ijerph16060927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
The management of youth with severe obesity is strongly impacted by social determinants of health and family dynamics. We present case studies of three patients seen in our tertiary care obesity treatment clinic as examples of the challenges faced by these patients and their families, as well as by the medical team. We discuss how these cases illustrate potential barriers to care, the role of child protective services, and we reflect upon lessons learned through the care of these patients. These cases highlight the need for comprehensive care in the management of youth with severe obesity, which can include: visits to multiple medical specialists, and mental and behavioral health providers; school accommodations; linkage to community resources; and, potentially, child protective services involvement. Through the care of these youth, our medical team gained more experience with using anti-obesity medications and meal replacements. The care of these youth also heightened our appreciation for the integral role of mental health services and community-based resources in the management of youth with severe obesity.
Collapse
|
25
|
Pilitsi E, Farr OM, Polyzos SA, Perakakis N, Nolen-Doerr E, Papathanasiou AE, Mantzoros CS. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metabolism 2019; 92:170-192. [PMID: 30391259 DOI: 10.1016/j.metabol.2018.10.010] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/13/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
Abstract
Obesity is a chronic disease with a continuously rising prevalence that currently affects more than half a billion people worldwide. Energy balance and appetite are highly regulated via central and peripheral mechanisms, and weight loss triggers a homeostatic response leading to weight regain. Lifestyle and behavioral modifications are the cornerstones of obesity management; however, they often fail to achieve or sustain long-term weight loss. Pharmacotherapy added onto lifestyle modifications results in an additional, albeit limited, weight reduction. Regardless, this weight reduction of 5-10% conveys multiple cardiovascular and metabolic benefits. In this review, evidence on the food and drug administration (FDA)-approved medications, i.e., orlistat, lorcaserin, phentermine/topiramate, liraglutide and naltrexone/bupropion, is summarized. Furthermore, anti-obesity agents in the pipeline for potential future therapeutic use are presented.
Collapse
Affiliation(s)
- Eleni Pilitsi
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215
| | - Olivia M Farr
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215.
| | - Stergios A Polyzos
- First Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Perakakis
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215
| | - Eric Nolen-Doerr
- Department of Medicine, Boston Medical Center, Boston, MA, 02118, United States of America
| | - Aimilia-Eirini Papathanasiou
- Division of Pediatric Newborn Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02215, United States of America
| | - Christos S Mantzoros
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215; Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
26
|
Song QQ, Rao Y, Tang GH, Sun ZH, Zhang JS, Huang ZS, Yin S. Tigliane Diterpenoids as a New Type of Antiadipogenic Agents Inhibit GRα-Dexras1 Axis in Adipocytes. J Med Chem 2019; 62:2060-2075. [DOI: 10.1021/acs.jmedchem.8b01693] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Qin-Qin Song
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, People’s Republic of China
| | - Yong Rao
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, People’s Republic of China
| | - Gui-Hua Tang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, People’s Republic of China
| | - Zhang-Hua Sun
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, People’s Republic of China
| | - Jun-Sheng Zhang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, People’s Republic of China
| | - Zhi-Shu Huang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, People’s Republic of China
| | - Sheng Yin
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, People’s Republic of China
| |
Collapse
|
27
|
Honoré SM, Grande MV, Gomez Rojas J, Sánchez SS. Smallanthus sonchifolius (Yacon) Flour Improves Visceral Adiposity and Metabolic Parameters in High-Fat-Diet-Fed Rats. J Obes 2018; 2018:5341384. [PMID: 30510798 PMCID: PMC6230400 DOI: 10.1155/2018/5341384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/31/2018] [Accepted: 09/26/2018] [Indexed: 11/29/2022] Open
Abstract
Smallanthus sonchifolius (yacon), a native plant of South America, was observed to improve lipid profile in rodents and humans. This study aimed to investigate the antiobesity properties of yacon roots in a high-fat-diet (HFD) model and the underlying mechanisms. A total of 30 Wistar male rats were divided into five groups (n=6): the standard chow diet (SD) group was fed a SD; the HFD group was fed a HFD; and the HFD Y340 and HFD Y680 groups were fed a HFD plus yacon flour (340 and 680 mg FOS/kg b. w./day, respectively). HFD Y340 and HFD Y680 rats exhibited marked attenuation of weight gain, a decrease in visceral fat pad weight, a restoration of the serum lipid profile and atherogenic index in a dose-dependent manner, being the higher dose more effective (p < 0.05). In addition, we found that HFD Y680 rats showed lower glucose and insulin levels, improved glucose tolerance, and insulin sensitivity (p < 0.5). A downregulation of several adipocyte specific-transcription factors, including peroxisome proliferator-activated receptor gamma2 (PPAR-γ2), CCAAT/enhancer binding protein a (C/EBP-a) and activating protein (aP2) mRNA levels, was determined in the visceral adipose tissue of HFD Y680 rats (p < 0.05). An improvement of adipokine profile in HFD Y680 rats and decreased serum proinflammatory cytokine levels (p < 0.05) were determined by ELISA. Decreased macrophage infiltration and F4/80 and MCP-1 expression in the visceral adipose tissue of HFD Y680 rats (p < 0.5), together with a higher pAkt/Akt expression (p < 0.05) were also observed by immunofluorescence and immunoblotting. A significant increase in glucagon (Gcg) and PYY mRNA levels in distal ileum of HFD Y680 rats (p < 0.05) were also detected. In the second approach, we determined that yacon supplementation potentiates the effects of the HFD reversion to a standard diet. In conclusion, yacon showed antiobesity properties by inhibiting adipogenesis and improving the visceral adipose tissue function.
Collapse
Affiliation(s)
- Stella Maris Honoré
- Instituto Superior de Investigaciones Biológicas (INSIBIO), Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad Nacional de Tucumán (CONICET-UNT), Chacabuco 461, T4000ILI San Miguel de Tucumán, Argentina
| | - Maria Virginia Grande
- Instituto Superior de Investigaciones Biológicas (INSIBIO), Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad Nacional de Tucumán (CONICET-UNT), Chacabuco 461, T4000ILI San Miguel de Tucumán, Argentina
| | - Jorge Gomez Rojas
- Instituto Superior de Investigaciones Biológicas (INSIBIO), Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad Nacional de Tucumán (CONICET-UNT), Chacabuco 461, T4000ILI San Miguel de Tucumán, Argentina
| | - Sara Serafina Sánchez
- Instituto Superior de Investigaciones Biológicas (INSIBIO), Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad Nacional de Tucumán (CONICET-UNT), Chacabuco 461, T4000ILI San Miguel de Tucumán, Argentina
| |
Collapse
|