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Negrea MO, Neamtu B, Costea R, Teodoru M, Domnariu C. IGF-1 Levels are Dependent on Age, but Not Weight Status in Children. MAEDICA 2023; 18:395-398. [PMID: 38023764 PMCID: PMC10674113 DOI: 10.26574/maedica.2023.18.3.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction: The intersecting pathways involved in linear growth, glucose, and lipid metabolism may play a key part in the imbalances leading to the dysmetabolic changes observed in obese children, and later adults. The growth-hormone/insulin growth factor 1 (GH/IGF-1) axis is a prime example in this regard and IGF-1 levels have been shown to correlate with insulin resistance. Objectives: The aim of this study is to examine whether there is a relationship between circulating IGF levels and weight status in children as an independent relationship, regardless of insulin sensitivity. Materials and method: We retrospectively collected data from patients aged 5-12 years referred to the Pediatric Clinical Hospital Sibiu between January 2010 and May 2023, for which IGF-1 levels were documented. We excluded patients with pathologies or medication which could have influenced weight status, glucose and lipid metabolism, or growth hormone secretion, and those with short stature or a growth velocity of under 5 cm a year. Anthropometric measurements were retrieved and BMI Z-score was calculated. Results: Our study included 66 patients (32 females and 34 males) with a mean age of 100,09 months (SD: 24,754 months). Initial bivariate analysis showed a significant negative correlation between BMI Z-score and IGF-1 values. However, adjusting for age indicated that there was in fact no significant relationship between these two parameters. Insulin-like growth factor 1 levels did however vary significantly with patient age. Conclusions: Levels of IGF-1 showed an age-dependent variation which should be accounted for in data analysis. Our study found no correlation between weight status and IGF-1 levels when adjusting for age-dependent variation. Further studies may shed light on the possible role of IGF-1 in discerning between obese children with or without increased insulin resistance.
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Affiliation(s)
- Mihai Octavian Negrea
- Faculty of Medicine, Lucian Blaga University, 550024 Sibiu, Romania
- County Clinical Emergency Hospital of Sibiu, 2-4 Corneliu Coposu Str., 550245 Sibiu, Romania
| | - Bogdan Neamtu
- Faculty of Medicine, Lucian Blaga University, 550024 Sibiu, Romania
- Research and Telemedicine Center for Neurological Diseases in Children, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania
| | - Raluca Costea
- Research and Telemedicine Center for Neurological Diseases in Children, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania
| | - Minodora Teodoru
- Faculty of Medicine, Lucian Blaga University, 550024 Sibiu, Romania
- County Clinical Emergency Hospital of Sibiu, 2-4 Corneliu Coposu Str., 550245 Sibiu, Romania
| | - Carmen Domnariu
- Faculty of Medicine, Lucian Blaga University, 550024 Sibiu, Romania
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2
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Wilson C, Carpenter JS, Nichles A, Zmicerevska N, Song YJC, McHugh C, Hamilton B, Hockey S, Crouse J, Koethe D, Scott EM, Hickie IB. Double-blind, randomised placebo-controlled clinical trial of metformin as an adjunct to a sleep-wake, activity and metabolically focused behavioural intervention to improve cardiometabolic outcomes and mood symptoms in youth with major mood syndromes: study protocol. BMJ Open 2023; 13:e064682. [PMID: 36810174 PMCID: PMC9945047 DOI: 10.1136/bmjopen-2022-064682] [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] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Metformin is a medication likely to improve measures of cardiometabolic disturbance in young people with mental illness. Evidence also suggests metformin may improve depressive symptoms. This 52-week double-blind randomised control trial (RCT) aims to investigate the efficacy of metformin pharmacotherapy as an adjunct to a healthy lifestyle behavioural intervention in improving cardiometabolic outcomes, and depressive, anxiety and psychotic symptoms in youth with clinically diagnosed major mood syndromes. METHODS AND ANALYSIS At least 266 young people aged 16-25 presenting for mental healthcare for major mood syndromes who are also at risk for poor cardiometabolic outcomes will be invited to participate in this study. All participants will engage in a 12-week sleep-wake, activity and metabolically focused behavioural intervention programme. As an adjunctive intervention, participants will receive either metformin (500-1000 mg) or placebo pharmacotherapy for 52 weeks.Participants will undergo a series of assessments including: (1) self-report and clinician-administered assessments; (2) blood tests; (3) anthropometric assessments (height, weight, waist circumference and blood pressure); and (4) actigraphy. Univariate and multivariate tests (generalised mixed-effects models) will be used to examine changes in primary and secondary outcomes (and associations with predetermined predictor variables). ETHICS AND DISSEMINATION This study has been approved by the Sydney Local Health District Research Ethics and Governance Office (X22-0017). The results of this double-blind RCT will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001559101p, 12 November 2019.
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Affiliation(s)
- Chloe Wilson
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Samuel Hockey
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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3
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Zhao G, Zhang Q, Wu F, Yin S, Xie Y, Liu H. Comparison of weight loss and adverse events of obesity drugs in children and adolescents: a systematic review and meta-analysis. Expert Rev Clin Pharmacol 2022; 15:1119-1125. [PMID: 36039827 DOI: 10.1080/17512433.2022.2117152] [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: 11/04/2022]
Abstract
BACKGROUND The global incidence of childhood obesity is increasing. Currently, there are only few established drugs for treating adolescent obesity. Randomized clinical trials (RCTs) comparing pharmacological interventions in children with obesity are scarce; therefore, we aimed to analyze the relative efficacy and adverse reactions of these drugs and compare the effects of each drug on body mass index (BMI). RESEARCH DESIGN AND METHODS This meta-analysis focused on the slimming effect, safety, and correlation of metformin, orlistat, exenatide, liraglutide, and topiramate in children with obesity. Several international databases were searched and clinical trials on the treatment of obesity in children in which the drug was administered for ≥ 6 months were included. Changes in BMI before and after treatment were analyzed using a Bayes framework, and the surface under the cumulative ranking was calculated. RESULTS Of 2102 relevant articles retrieved, 21 RCTs were included in the study. Compared to other drugs, liraglutide reduced BMI the most in children with obesity. However, it was most associated with drug withdrawal due to adverse events while topiramate was least. CONCLUSIONS Liraglutide had a higher probability of achieving clinically significant weight loss compared with other drugs while topiramate was superior in safety.
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Affiliation(s)
- Guangming Zhao
- Changchun University of Chinese Medicine, Changchun 130117, China
| | - Qi Zhang
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Fan Wu
- Personnel Section, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Shuang Yin
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Yiqi Xie
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Hongyan Liu
- Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine, Beijing 101300, China
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4
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Robeson MS, Manna K, Randolph C, Byrum S, Hakkak R. Short-Term Metformin Treatment Enriches Bacteroides dorei in an Obese Liver Steatosis Zucker Rat Model. Front Microbiol 2022; 13:834776. [PMID: 35432282 PMCID: PMC9006818 DOI: 10.3389/fmicb.2022.834776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Obesity is the leading cause of health-related diseases in the United States and World. Previously, we reported that obesity can change gut microbiota using the Zucker rat model. Metformin is an oral anti-hyperglycemic agent approved by the FDA to treat type 2 diabetes (T2D) in adults and children older than 10 years of age. The correlation of short-term metformin treatment and specific alterations to the gut microbiota in obese models is less known. Short-term metformin has been shown to reduce liver steatosis. Here we investigate the effects of short-term metformin treatment on population of gut microbiota profile in an obese rat model. Five week old obese (n = 12) female Zucker rats after 1 week of acclimation, received AIN-93 G diet for 8 weeks and then rats were randomly assigned into two groups (6 rats/group): (1) obese without metformin (ObC), or (2) obese with metformin (ObMet). Metformin was mixed with AIN-93G diet at 1,000 mg/kg of diet. Rats were weighed twice per week. All rats were sacrificed at the end of metformin treatment at 10 weeks and fecal samples were collected and kept at -80°C. Total microbial DNA was collected directly from the fecal samples used for shotgun-metagenomics sequencing and subsequently analyzed using MetaPlAn and HUMAnN. After stringent data filtering and quality control we found significant differences (p = 0.0007) in beta diversity (Aitchison distances) between the ObC vs. ObMet groups. Supervised and unsupervised analysis of the log-ratios Bacteroides dorei and B. massiliensis vs. all other Bacteroides spp., revealed that B. dorei and B. massiliensis were enriched in the ObMet group, while the remaining Bacteroides spp. where enriched in the ObC group (p = 0.002). The contributional diversity of pathways is also significantly associated by treatment group (p = 0.008). In summary, in the obese Zucker rat model, short-term metformin treatment changes the gut microbiota profile, particularly altering the composition Bacteroides spp. between ObC and ObMet.
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Affiliation(s)
- Michael S. Robeson
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Kanishka Manna
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Stephanie Byrum
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Reza Hakkak
- Arkansas Children’s Research Institute, Little Rock, AR, United States
- Department of Dietetics and Nutrition, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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5
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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.
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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
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6
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Alfaraidi H, Samaan MC. Metformin therapy in pediatric type 2 diabetes mellitus and its comorbidities: A review. Front Endocrinol (Lausanne) 2022; 13:1072879. [PMID: 36814831 PMCID: PMC9939509 DOI: 10.3389/fendo.2022.1072879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/12/2022] [Indexed: 02/08/2023] Open
Abstract
Type 2 diabetes (T2D) rates in children and adolescents are rising globally. T2D is a complex and aggressive disease in children with several comorbidities, high treatment failure rates, and insulin needs within a few years from diagnosis. While myriads of pharmacotherapies are licensed to treat adults with T2D, treatments accessible to children and adolescents have been limited until recently. Metformin is an old drug with multiple beneficial metabolic health effects beyond glycemic control. This review discusses Metformin's origins, its mechanisms of action, and evidence for its use in the pediatric population to treat and prevent T2D. We also explore the evidence for its use as an obesity therapy, which is the primary driver of T2D, and T2D-driven comorbidities. While emerging therapies create new horizons for managing pediatric T2D, Metformin remains an inexpensive and safe part of the treatment plans of many T2D children globally for its beneficial metabolic effects.
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Affiliation(s)
- Haifa Alfaraidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
- *Correspondence: M. Constantine Samaan,
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7
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Concepcion JQ, Tucker LY, Huang K. Metformin for pediatric obesity and insulin resistance: a retrospective study within an integrated health care system. Obesity (Silver Spring) 2021; 29:1526-1537. [PMID: 34355850 DOI: 10.1002/oby.23207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few treatments exist for pediatric obesity. Metformin holds potential for pediatric weight loss. This large retrospective study examined the effect of metformin on weight, BMI, BMI z score, and cardiometabolic outcomes. METHODS The study included 7,068 patients aged 10 to 17 years with BMI at or above the 95th percentile and evidence of insulin resistance. The final cohort of 955 patients with BMI data at 0 to 24 months was categorized into three groups: metformin plus intensive lifestyle changes, intensive counseling alone, and routine counseling. In order to adjust for pubertal BMI changes, a subgroup analysis was conducted for adolescents aged 15 to 17 years. RESULTS At 6 and 12 months, metformin treatment produced significant reductions in weight (-3.5 kg and -5.3 kg, p < 0.0001), BMI (-1.06 kg/m² and -1.23 kg/m², p < 0.0001), and BMI z score (-0.05 and -0.07, p ≤ 0.002), which continued to decrease at 24 months (-0.05 and -0.08, p = 0.11 and 0.01), compared with control groups. Adolescents aged 15 to 17 years showed similar improvements. Systolic blood pressure and high-density lipoprotein cholesterol also improved in the metformin group. CONCLUSIONS Metformin with lifestyle interventions significantly reduced weight, BMI, and BMI z score in pediatric patients with obesity and insulin resistance up to 24 months, compared with intensive and routine counseling alone.
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Affiliation(s)
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Karen Huang
- Department of Pediatrics, Division of Endocrinology, Kaiser Permanente, Santa Clara, California, USA
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8
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Levy-Shraga Y, Madi LR, Shalev M, Mazor-Aronovitch K, Schwartz-Lifshitz M, Gothelf D. Effectiveness of Metformin for Weight Reduction in Children and Adolescents Treated with Mixed Dopamine and Serotonin Receptor Antagonists: A Naturalistic Cohort Study. J Child Adolesc Psychopharmacol 2021; 31:376-380. [PMID: 33887146 DOI: 10.1089/cap.2021.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: Mixed dopamine and serotonin receptor antagonists (DSRAs) are associated with significant weight gain and its complications. Our aim was to evaluate the effectiveness of metformin in reducing body mass index (BMI) and metabolic parameters in children treated with DSRAs. Methods: We report a naturalistic study of 49 children and adolescents (mean age 14.9 ± 3.7 years), with BMI >85 percentile for age, treated with DSRAs during 2018-2020 in a child psychiatry clinic. Clinical data, anthropometric measurements, and laboratory tests were compared between those who were (study group, n = 31) and were not (control group, n = 18) treated with metformin. Results: The mean study duration was 9.7 ± 5.9 months. The BMI standard deviation scores (BMI-SDS) of the study group declined significantly (from 2.08 ± 0.40 to 1.81 ± 0.54, p < 0.001), while the BMI-SDS of the control group did not change (from 2.03 ± 0.45 to 2.04 ± 0.47, p = 0.838). In the study group, the decline in the delta BMI-SDS/month was more robust among those with good than poor adherence to metformin (-0.047 ± 0.039 vs. -0.004 ± 0.017, p = 0.003). The decrease in BMI-SDS was greater for patients treated with risperidone and clothiapine than with other DSRAs. Fasting insulin and insulin resistance index (homeostasis model assessment of insulin resistance [HOMA-IR]) declined in the study group (from 25.4 ± 13.8 to 19.9 ± 10.7, p = 0.033 and from 5.4 ± 2.7 to 4.2 ± 2.1, p = 0.028, respectively). Conclusions: Metformin treatment was associated with significant decreases in BMI, fasting insulin, and HOMA-IR. The effect of metformin seems to be dependent on adherence and type of DSRAs.
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Affiliation(s)
- Yael Levy-Shraga
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lee Rima Madi
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Shalev
- The Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Kineret Mazor-Aronovitch
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Schwartz-Lifshitz
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Doron Gothelf
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Division of Child and Adolescent Psychiatry, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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9
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Wang DD, Mao YZ, He SM, Chen X. Analysis of Time Course and Dose Effect From Metformin on Body Mass Index in Children and Adolescents. Front Pharmacol 2021; 12:611480. [PMID: 33981216 PMCID: PMC8107689 DOI: 10.3389/fphar.2021.611480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/01/2021] [Indexed: 01/07/2023] Open
Abstract
The purpose of this study was to analyze the time course and dose effect from metformin on body mass index (BMI) in children and adolescents by model-based meta-analysis (MBMA). Searching randomized controlled trial (RCT) studies of metformin on BMI in children and adolescents. The change rates of BMI from baseline values were used as indicator of evaluating metformin efficacy. A total of 18 RCT studies, 1,228 children and adolescents, were included for analysis, including patients with obesity, patients with type 1 diabetes mellitus, patients with nonalcoholic fatty liver, and patients with precocity. In order to achieve better effect of metformin on BMI in children and adolescents, the present study recommended that for patients with obesity, 1,000 mg/day metformin was required for at least 15.2 weeks and 60.8 weeks to achieve the plateau of metformin effect; for patients with type 1 diabetes mellitus, 1,000 mg/day metformin was required for at least 25.2 weeks and 100.8 weeks to achieve the plateau of metformin effect; for patients with nonalcoholic fatty liver, 1,000 mg/day metformin was required for at least 6.57 weeks and 26.28 weeks to achieve the plateau of metformin effect; for patients with precocity, 425 mg/day metformin was required for at least 12.4 weeks and 49.6 weeks to achieve the plateau of metformin effect. It was the first time to analyze the time course and dose effect from metformin on BMI and to recommend dosage and duration of treatment for metformin in children and adolescents with different disease types.
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Affiliation(s)
- Dong-Dong Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Yi-Zhen Mao
- Department of Endocrinology, Xuzhou Central Hospital, Xuzhou, China
| | - Su-Mei He
- Department of Pharmacy, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Xiao Chen
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, China.,Department of Pharmacy, The People's Hospital of Jiangyin, Jiangyin, China.,Department of Pharmacy, Children's Hospital of Fudan University, Shanghai, China
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10
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Hakkak R, Rose S, Spray B, Kozaczek M, Korourian S. Effects of obesity and 10 weeks metformin treatment on liver steatosis. Biomed Rep 2021; 14:49. [PMID: 33859820 PMCID: PMC8042663 DOI: 10.3892/br.2021.1425] [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] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/08/2021] [Indexed: 01/01/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in adolescents and adults, and the risk of developing NAFLD increases with obesity. In the present study, it was shown that obesity increased fatty liver (steatosis) using an obese Zucker rat model. Metformin is an oral anti-hyperglycemic agent approved by the FDA for treatment of type 2 diabetes in adults and children >10 years of age. There is insufficient evidence regarding the effects of metformin on pediatric liver steatosis. Thus, in the present study, the effects of 10 weeks metformin treatment on liver steatosis and related serum markers for liver damage was assessed. Lean and obese (n=16 per group) 5-week old female Zucker rats were provided an AIN-93 G diet for 8 weeks to induce NAFLD, and then rats were randomly assigned to 4 groups (8 rats/group): i) lean without metformin (LC), ii) lean + metformin (LM), iii) obese without metformin (OC), and iv) obese + metformin (OM). Rats were provided ad libitum access to the diet containing metformin (1 g metformin per kg of food). Rats were weighed twice weekly and were sacrificed 10 weeks later. Serum was collected to measure the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), leptin and adiponectin. Livers were collected for histological analysis. The results showed that obese rats gained significantly more weight than lean rats in both the control and metformin treatment groups (P<0.001). OM treated rats exhibited a lower degree of liver steatosis compared with the OC rats (P<0.04). There were no significant differences in serum ALT levels between the groups. However, obesity significantly increased serum AST levels in both the control and metformin treatment groups (P=0.01). The ratio of leptin to adiponectin was increased in obese compared with the lean rats in both the control and metformin treatment groups (P<0.0001). There was no effect of metformin on serum biomarkers. In summary, short-term metformin treatment decreased liver steatosis but did not affect the serum markers of liver steatosis.
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Affiliation(s)
- Reza Hakkak
- Department of Dietetics and Nutrition, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.,Arkansas Children's Research Institute, Little Rock, AR 72202, USA
| | - Shannon Rose
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.,Arkansas Children's Research Institute, Little Rock, AR 72202, USA
| | - Beverly Spray
- Arkansas Children's Research Institute, Little Rock, AR 72202, USA
| | - Melisa Kozaczek
- Department of Dietetics and Nutrition, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.,Arkansas Children's Research Institute, Little Rock, AR 72202, USA
| | - Soheila Korourian
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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11
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Masarwa R, Brunetti VC, Aloe S, Henderson M, Platt RW, Filion KB. Efficacy and Safety of Metformin for Obesity: A Systematic Review. Pediatrics 2021; 147:peds.2020-1610. [PMID: 33608415 DOI: 10.1542/peds.2020-1610] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The efficacy and safety of metformin for obesity in children and adolescents remains unclear. OBJECTIVE To assess the efficacy and safety of metformin via systematic review. DATA SOURCES Data sources included PubMed, Embase, the Cochrane Library, Scopus, and ClincalTrials.gov (inception to November 2019). STUDY SELECTION We selected randomized controlled trials (RCTs) in which researchers assessed the efficacy and safety of metformin with lifestyle interventions, compared with a placebo with lifestyle interventions, in children and adolescents with obesity. DATA EXTRACTION Two researchers independently extracted data and assessed quality. The primary outcomes were mean changes from baseline in BMI, BMI z score, homeostatic model assessment of insulin resistance, and gastrointestinal adverse effects. RESULTS Twenty-four RCTs (1623 patients; range: 16 to 151) were included. Ages ranged from 4 to 19 years, and follow-up ranged from 2 months to 2 years. Metformin resulted in a modest decrease in BMI (range of mean values: -2.70 to 1.30 vs -1.12 to 1.90), BMI z score (range of mean values: -0.37 to -0.03 vs -0.22 to 0.15), and homeostatic model assessment of insulin resistance (range of mean values: -3.74 to 1.00 vs -1.40 to 2.66). Metformin resulted in a higher frequency of gastrointestinal adverse effects (range: 2% to 74% vs 0% to 42%). LIMITATIONS The available evidence is of varying quality, with high heterogeneity between trials, suggesting some uncertainty in the benefits of metformin in this population. CONCLUSIONS With this systematic review of RCTs, we suggest that metformin has modest but favorable effects on weight and insulin resistance and a tolerable safety profile among children and adolescents with obesity.
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Affiliation(s)
- Reem Masarwa
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vanessa C Brunetti
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Stephanie Aloe
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Endocrinology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Mélanie Henderson
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and University of Montreal, Montreal, Quebec, Canada; and.,Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Robert W Platt
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Departments of Pediatrics
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; .,Medicine, and.,Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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12
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Malin SK, Stewart NR. Metformin May Contribute to Inter-individual Variability for Glycemic Responses to Exercise. Front Endocrinol (Lausanne) 2020; 11:519. [PMID: 32849302 PMCID: PMC7431621 DOI: 10.3389/fendo.2020.00519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
Metformin and exercise independently improve glycemic control. Metformin traditionally is considered to reduce hepatic glucose production, while exercise training is thought to stimulate skeletal muscle glucose disposal. Collectively, combining treatments would lead to the anticipation for additive glucose regulatory effects. Herein, we discuss recent literature suggesting that metformin may inhibit, enhance or have no effect on exercise mediated benefits toward glucose regulation, with particular emphasis on insulin sensitivity. Importantly, we address issues surrounding the impact of metformin on exercise induced glycemic benefit across multiple insulin sensitive tissues (e.g., skeletal muscle, liver, adipose, vasculature, and the brain) in effort to illuminate potential sources of inter-individual glycemic variation. Therefore, the review identifies gaps in knowledge that require attention in order to optimize medical approaches that improve care of people with elevated blood glucose levels and are at risk of cardiovascular disease.
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Affiliation(s)
- Steven K. Malin
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, United States
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Nathan R. Stewart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
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13
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Pu R, Shi D, Gan T, Ren X, Ba Y, Huo Y, Bai Y, Zheng T, Cheng N. Effects of metformin in obesity treatment in different populations: a meta-analysis. Ther Adv Endocrinol Metab 2020; 11:2042018820926000. [PMID: 32499908 PMCID: PMC7243386 DOI: 10.1177/2042018820926000] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/15/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Some studies have shown that metformin can reduce body weight. However, metformin has not been officially approved as a medicine for weight loss because its effect on different populations remains inconsistent. This meta-analysis aimed to summarize the weight loss effect of metformin quantitatively. METHOD The randomized controlled and high-quality case-control trials of metformin monotherapy in obesity treatment were eligible. Baseline body mass index (BMI) was chosen as a self-control to compare the changes in BMI of different populations before and after treatment. All changes were calculated as differences between the final and initial BMI values (with negative values indicating a decrease). Results were presented as weighted mean difference (WMD) with a 95% confidence interval (CI 95%). Subgroup analysis was performed based on baseline BMI, age, daily dose, and duration of medication. RESULTS A total of 21 trials (n = 1004) were included, and the meta-analysis of metformin treatment in different populations showed that metformin has a modest reduction in the BMI of included participants (WMD -0.98; 95% CI, -1.25 to -0.72), and the reduction of BMI was most significant in the simple obesity population (WMD -1.31; 95% CI, -2.07 to -0.54). The subgroup analysis showed that metformin treatment significantly reduced BMI in obesity patients with a BMI >35kg/m2 (WMD -1.12; 95% CI, -1.84 to -0.39) compared with before treatment. BMI in the high dose group decreased by 1.01 units (WMD-1.01; 95% CI, -1.29 to -0.73) and BMI did not continue to decrease significantly after treatment of more than 6 months. CONCLUSION Patients treated with metformin experienced about a one-unit reduction in BMI at the end of treatment. But whether this decreased value produced enough weight loss (5% of baseline body weight) to qualify as a "weight loss drug" as current guidelines require, requires larger specific randomized control trials.
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Affiliation(s)
- Ruiyang Pu
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Basic Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Dian Shi
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Basic Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Ting Gan
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Basic Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Xiaoyu Ren
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Basic Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Yupei Ba
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Basic Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Yanbei Huo
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Basic Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Yana Bai
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, RI, USA
| | - Ning Cheng
- Basic Medical College, Lanzhou University, Lanzhou, Gansu, 730000, P.R. China
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14
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Sadeghi A, Mousavi SM, Mokhtari T, Parohan M, Milajerdi A. Metformin Therapy Reduces Obesity Indices in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Child Obes 2020; 16:174-191. [PMID: 32068434 DOI: 10.1089/chi.2019.0040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: Few studies have summarized findings for the effect of metformin on obesity indices. Therefore, we aimed to conduct a systematic review and meta-analysis on the effect of metformin on obesity indices among children and adolescents. Methods: Relevant articles published up to September 2018 were searched in SCOPUS, Medline, and Google Scholar using appropriate keywords. All clinical trials that examined the effect of metformin on obesity indices in children and adolescents were included. Results: Overall, 38 studies, including 2199 participants (39.75% male and 60.25% female), were included. The pooled results indicated that metformin significantly reduced BMI [weighted mean difference (WMD): -1.07 kg/m2; 95% confidence interval (CI): -1.43 to -0.72]. Same findings were found for waist circumference (WC) (WMD: -1.93 cm; 95% CI: -2.69 to -1.16). Metformin also reduced body weight in all participants (WMD: -2.51 kg; 95% CI: -3.14 to -1.89). Moreover, it reduced body fat mass in patients with overweight or obesity (WMD: -1.90%; 95% CI: -3.25 to -0.56) and chronic diseases (WMD: -1.41%; 95% CI: -2.23 to -0.58), but not among those with growth problems. Metformin therapy did not affect lean body mass (LBM) in patients with overweight or obesity and growth problems; however, it reduced LBM in patients with chronic diseases (WMD: -1.49 kg; 95% CI: -2.69 to -0.30). Conclusions: We found a significant reduction in BMI, body weight, WC, and fat mass following administration with metformin. However, the effect of metformin on LBM was not significant. Further studies are required to confirm these findings.
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Affiliation(s)
- Alireza Sadeghi
- Students' Scientific Research Center, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Tahereh Mokhtari
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT
| | - Mohammad Parohan
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Milajerdi
- Students' Scientific Research Center, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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15
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The influence of metformin on IGF-1 levels in humans: A systematic review and meta-analysis. Pharmacol Res 2020; 151:104588. [DOI: 10.1016/j.phrs.2019.104588] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 01/20/2023]
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16
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Fox CK, Gross AC, Bomberg EM, Ryder JR, Oberle MM, Bramante CT, Kelly AS. Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care. Curr Obes Rep 2019; 8:201-209. [PMID: 31054014 DOI: 10.1007/s13679-019-00347-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. RECENT FINDINGS Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA.
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Megan M Oberle
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
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17
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Bomberg EM, Ryder JR, Brundage RC, Straka RJ, Fox CK, Gross AC, Oberle MM, Bramante CT, Sibley SD, Kelly AS. Precision medicine in adult and pediatric obesity: a clinical perspective. Ther Adv Endocrinol Metab 2019; 10:2042018819863022. [PMID: 31384417 PMCID: PMC6661805 DOI: 10.1177/2042018819863022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual's genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.
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Affiliation(s)
- Eric M. Bomberg
- Department of Pediatrics and Center for
Pediatric Obesity Medicine, University of Minnesota, Minneapolis, 717
Delaware Street SE, Room 371, Minneapolis, MN 55414, USA
| | - Justin R. Ryder
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Richard C. Brundage
- Department of Experimental and Clinical
Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Robert J. Straka
- Department of Experimental and Clinical
Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Claudia K. Fox
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Amy C. Gross
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Megan M. Oberle
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Carolyn T. Bramante
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of
Minnesota, Minneapolis, MN, USA
| | | | - Aaron S. Kelly
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of
Minnesota, Minneapolis, MN, USA
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18
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Lentferink YE, Knibbe CAJ, van der Vorst MMJ. Efficacy of Metformin Treatment with Respect to Weight Reduction in Children and Adults with Obesity: A Systematic Review. Drugs 2019; 78:1887-1901. [PMID: 30511324 DOI: 10.1007/s40265-018-1025-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Obesity and its related complications are increasing health issues. Since generally only minor weight loss is obtained with lifestyle intervention, additional pharmacological therapies such as metformin are often used. OBJECTIVE We conducted a systematic review to provide an overview of the efficacy of ≥ 6 months of metformin treatment in children and adults with respect to weight, insulin resistance, and progression toward type 2 diabetes mellitus (T2DM). METHODS In September 2018, we searched PubMed, Embase, and the Cochrane Library for studies published in English using the keywords metformin, obesity/overweight, and weight loss. Prospective studies reporting weight/body mass index (BMI) as a primary or secondary outcome in patients with overweight/obesity with ≥ 6 months' metformin treatment were included. Included subjects were children and adults with overweight/obesity who received ≥ 6 months of metformin and/or lifestyle intervention, and/or placebo and/or lifestyle intervention, and/or standard care. Studies were independently screened by two reviewers. Data were extracted by one and verified by the other reviewer, and both reviewers assessed the risk of bias using the Cochrane risk-of-bias tool. RESULTS Our review includes 15 pediatric and 14 adult studies. In children, after 6 months, more than half the studies reported a greater reduction in BMI with metformin versus controls. Only six studies had an intervention of > 6 months, and these studies found no further improvement in BMI in the metformin users, though their BMI was lower than that of controls. Three studies showed a significant improvement in insulin sensitivity in the metformin versus the control group. Adults using metformin experienced and maintained small decreases in weight irrespective of duration of intervention. In 11 of 14 studies, a greater reduction in weight/BMI was observed with metformin than with placebo. Progression toward T2DM was significantly reduced in adults using metformin, ranging from 7 to 31%. The safety and tolerability of metformin, withdrawal of participants, and comparison with other drugs were not taken into account. CONCLUSIONS The effects of metformin on weight/BMI vary, with smaller reductions in children than in adults. This could be because of differences in adherence, daily dosage, and insulin status. Metformin significantly reduced the progression toward T2DM in adults. Therefore, metformin should be considered as a treatment for obesity and its related complications.
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Affiliation(s)
- Y E Lentferink
- Department of Pediatrics, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, Utrecht, The Netherlands
| | - C A J Knibbe
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands.,Division of Systems Biomedicine and Pharmacology, LACDR, Leiden University, Leiden, The Netherlands
| | - M M J van der Vorst
- Department of Pediatrics, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, Utrecht, The Netherlands.
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19
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Hui F, Zhang Y, Ren T, Li X, Zhao M, Zhao Q. Role of metformin in overweight and obese people without diabetes: a systematic review and network meta-analysis. Eur J Clin Pharmacol 2018; 75:437-450. [DOI: 10.1007/s00228-018-2593-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022]
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20
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Kyler KE, Kadakia RB, Palac HL, Kwon S, Ariza AJ, Binns HJ. Use of Metformin for Weight Management in Children and Adolescents With Obesity in the Clinical Setting. Clin Pediatr (Phila) 2018; 57:1677-1685. [PMID: 30261744 DOI: 10.1177/0009922818803404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Use of metformin for weight loss for children in a clinical setting has not been well described; therefore, we aimed to identify characteristics of obese patients prescribed metformin in a clinical setting and evaluate changes in anthropometric measures. Records of obese patients aged 10 to 18 years without diabetes attending an academic endocrinology practice from 2009 to 2013 were reviewed. Analyses assessed changes in anthropometric measures (weight, body mass index [BMI], and BMI z-score) over 12 months between those prescribed metformin (n = 49) and those not prescribed metformin (n = 142). Outcomes were standardized before using multivariable linear regression models. Patients prescribed metformin were significantly older, more often female, and had larger baseline anthropometric measures (all P < .05). In the models, subjects prescribed metformin had significantly less gain in standardized weight, BMI, and BMI z-score over 6 and 12 months (all P < .05). Metformin may be a useful weight management aid in children in a clinical setting.
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Affiliation(s)
- Kathryn E Kyler
- 1 Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
| | - Rachel B Kadakia
- 1 Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
| | | | - Soyang Kwon
- 1 Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA.,3 Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Adolfo J Ariza
- 1 Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA.,3 Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Helen J Binns
- 1 Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA.,3 Stanley Manne Children's Research Institute, Chicago, IL, USA
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21
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Albert Pérez E, Mateu Olivares V, Martínez-Espinosa RM, Molina Vila MD, Reig García-Galbis M. New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT. Nutrients 2018; 10:E878. [PMID: 29986479 PMCID: PMC6073719 DOI: 10.3390/nu10070878] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS). METHOD search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition). RESULTS 1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m² and BW (body weight) in kg. CONCLUSIONS Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.
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Affiliation(s)
| | | | - Rosa María Martínez-Espinosa
- Division of Biochemistry and Molecular Biology, Department of Agrochemistry and Biochemistry, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
- Members of the Research Group of Applied Biochemistry (AppBiochem), Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
| | - Mariola D Molina Vila
- Members of the Research Group of Applied Biochemistry (AppBiochem), Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
- Department of Mathematics, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
| | - Manuel Reig García-Galbis
- Members of the Research Group of Applied Biochemistry (AppBiochem), Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Atacama, Avda Copayapu 2862, III Region, Copiapo 1530000, Chile.
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22
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Bussler S, Penke M, Flemming G, Elhassan YS, Kratzsch J, Sergeyev E, Lipek T, Vogel M, Spielau U, Körner A, de Giorgis T, Kiess W. Novel Insights in the Metabolic Syndrome in Childhood and Adolescence. Horm Res Paediatr 2018; 88:181-193. [PMID: 28848168 DOI: 10.1159/000479510] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023] Open
Abstract
Metabolic syndrome (MetS) is recognized as an escalating major health risk in adults as well as in children and adolescents. Its prevalence ranges from 6 to 39% depending on the applied definition criteria. To date, there is no consensus on a MetS definition for children and adolescents. However, most authors agree on essential components such as glucose intolerance, central obesity, hypertension, and dyslipidemia; each representing a risk for cardiovascular disease. Recently, associations between MetS and non-alcoholic fatty liver disease, hyperuricemia, and sleep disturbances have emerged. Biomarkers like adipocytokines are a subject of current research as they are implicated in the pathogenesis of the MetS. Epigenetics and gestational programming, especially the role of microRNA, comprise a novel, rapidly developing and promising research focus on the topic of MetS. MicroRNAs are increasingly valued for potential roles in the diagnosis, stratification, and therapeutics of MetS. Early detection of risk factors, screening for metabolic disturbances, and the identification of new therapies are major aims to reduce morbidity and mortality related to MetS. Dietary modification and physical activity are currently the only adopted treatment approaches. Pharmacological therapies and bariatric surgery are still contradictory and, therefore, are only recommended in selected high-risk cases.
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Affiliation(s)
- Sarah Bussler
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany.,LIFE Child Research Centre, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Penke
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany
| | - Gunter Flemming
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany
| | - Yasir S Elhassan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Jürgen Kratzsch
- Institute of Clinical Chemistry, Laboratory Medicine and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Elena Sergeyev
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany
| | - Tobias Lipek
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany
| | - Mandy Vogel
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany.,LIFE Child Research Centre, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Ulrike Spielau
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany.,Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Leipzig, Germany
| | - Antje Körner
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany.,LIFE Child Research Centre, Medical Faculty, University of Leipzig, Leipzig, Germany.,Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Leipzig, Germany
| | - Tommaso de Giorgis
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Centre for Pediatric Research, Department Woman and Child Health, University of Leipzig, Leipzig, Germany.,LIFE Child Research Centre, Medical Faculty, University of Leipzig, Leipzig, Germany
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23
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Khokhar A, Umpaichitra V, Chin VL, Perez-Colon S. Metformin Use in Children and Adolescents with Prediabetes. Pediatr Clin North Am 2017; 64:1341-1353. [PMID: 29173789 DOI: 10.1016/j.pcl.2017.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
With the increasing incidence of childhood obesity, clinicians need to understand its comorbidities and their management. The American Diabetes Association recommends pediatricians screen high-risk overweight and obese children. Identifying and treating prediabetic children and adolescents can help to reduce the burden of type 2 diabetes. Lifestyle interventions are pivotal. Metformin is the only oral medication approved for diabetes treatment in children. It has been studied in clinical trials in nondiabetic children and has been shown to have beneficial effects on body weight. Effects on diabetes prevention have not been studied and long-term data are limited in the pediatric population.
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Affiliation(s)
- Aditi Khokhar
- Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Upstate Medical University, 3229 East Genesee Street, Syracuse, NY 13214, USA
| | - Vatcharapan Umpaichitra
- Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Medical Center and Kings County Hospital Center, 445 Lenox Road, Box 49, Brooklyn, NY 11203, USA
| | - Vivian L Chin
- Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Medical Center and Kings County Hospital Center, 445 Lenox Road, Box 49, Brooklyn, NY 11203, USA
| | - Sheila Perez-Colon
- Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Medical Center and Kings County Hospital Center, 445 Lenox Road, Box 49, Brooklyn, NY 11203, USA.
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24
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Kaplowitz P. Is There a Role for Metformin in the Treatment of Childhood Obesity? Pediatrics 2017; 140:peds.2017-1205. [PMID: 28759418 DOI: 10.1542/peds.2017-1205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Paul Kaplowitz
- Division of Endocrinology, Children's National Health System, George Washington University School of Medicine and the Health Sciences, Washington, District of Columbia
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25
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Pastor-Villaescusa B, Cañete MD, Caballero-Villarraso J, Hoyos R, Latorre M, Vázquez-Cobela R, Plaza-Díaz J, Maldonado J, Bueno G, Leis R, Gil Á, Cañete R, Aguilera CM. Metformin for Obesity in Prepubertal and Pubertal Children: A Randomized Controlled Trial. Pediatrics 2017; 140:peds.2016-4285. [PMID: 28759403 DOI: 10.1542/peds.2016-4285] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Metformin has shown its effectiveness in treating obesity in adults. However, little research has been conducted in children, with a lack of attention on pubertal status. The objectives were to determine whether oral metformin treatment reduces BMI z score, cardiovascular risk, and inflammation biomarkers in children who are obese depending on pubertal stage and sex. METHODS This was a randomized, prospective, double-blind, placebo-controlled, multicenter trial, stratified according to pubertal stage and sex, conducted at 4 Spanish clinical hospitals. Eighty prepubertal and 80 pubertal nondiabetic children who were obese aged 7 to 14 years with a BMI >95th percentiles were recruited. The intervention included 1 g/d of metformin versus placebo for 6 months. The primary outcome was a reduction in BMI z score. Secondary outcomes comprised insulin resistance, cardiovascular risk, and inflammation biomarkers. RESULTS A total of 140 children completed the study (72 boys). Metformin decreased the BMI z score versus placebo in the prepubertal group (-0.8 and -0.6, respectively; difference, 0.2; P = .04). Significant increments were observed in prepubertal children treated with metformin versus placebo recipients in the quantitative insulin sensitivity check index (0.010 and -0.007; difference, 0.017; P = .01) and the adiponectin-leptin ratio (0.96 and 0.15; difference, 0.81; P = .01) and declines in interferon-γ (-5.6 and 0; difference, 5.6; P = .02) and total plasminogen activator inhibitor-1 (-1.7 and 2.4; difference, 4.1; P = .04). No serious adverse effects were reported. CONCLUSIONS “Metformin decreased the BMI z score and improved inflammatory and cardiovascular-related obesity parameters only in prepubertal children, but a differential effect of metformin was not observed in prepubertal compared to pubertal children. Nevertheless, the doses per kilogram of weight administrated may have had an impact on the metformin effect. Further investigations are necessary.”
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Affiliation(s)
- Belén Pastor-Villaescusa
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center for Biomedical Research, University of Granada, Granada. Spain.,CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - M Dolores Cañete
- PAIDI CTS-329, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
| | | | | | - Miriam Latorre
- Health Sciences Institute in Aragon, Zaragoza, Spain.,Pediatric Department, Lozano Blesa University Clinical Hospital, University of Zaragoza, Zaragoza, Spain
| | - Rocío Vázquez-Cobela
- Unit of Investigation in Nutrition, Growth and Human Development of Galicia, Pediatric Department, Clinic University Hospital of Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julio Plaza-Díaz
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center for Biomedical Research, University of Granada, Granada. Spain.,CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - José Maldonado
- Pediatric Gastroenterology and Nutrition Unit, Virgen de las Nieves University Hospital, Andalusian Health Service, Granada, Spain
| | - Gloria Bueno
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,Pediatric Department, Lozano Blesa University Clinical Hospital, University of Zaragoza, Zaragoza, Spain
| | - Rosaura Leis
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,Unit of Investigation in Nutrition, Growth and Human Development of Galicia, Pediatric Department, Clinic University Hospital of Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center for Biomedical Research, University of Granada, Granada. Spain.,CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; and
| | - Ramón Cañete
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,Unit of Pediatric Endocrinology, Reina Sofia University Hospital, Córdoba, Spain
| | - Concepción M Aguilera
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center for Biomedical Research, University of Granada, Granada. Spain; .,CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; and
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26
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Stagi S, Ricci F, Bianconi M, Sammarco MA, Municchi G, Toni S, Lenzi L, Verrotti A, de Martino M. Retrospective Evaluation of Metformin and/or Metformin Plus a New Polysaccharide Complex in Treating Severe Hyperinsulinism and Insulin Resistance in Obese Children and Adolescents with Metabolic Syndrome. Nutrients 2017; 9:nu9050524. [PMID: 28531113 PMCID: PMC5452254 DOI: 10.3390/nu9050524] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/01/2017] [Accepted: 05/12/2017] [Indexed: 01/20/2023] Open
Abstract
Background: Pharmacological treatment of obesity and glucose-insulin metabolism disorders in children may be more difficult than in adults. Thus, we evaluate the effects of metformin in comparison with metformin plus a polysaccharide complex (Policaptil Gel Retard®, PGR) on body weight and metabolic parameters in obese children and adolescents with metabolic syndrome (MetS). Patients and methods: We retrospectively collected 129 children and adolescents (67 girls, 62 boys; median age 12.6 years) treated for a minimum of two years with metformin and low glycemic index (LGI) diet. Of these, 71 patients were treated with metformin plus PGR after at least 12 months of metformin alone. To minimize the confounding effect of the LGI on auxological and metabolic parameters, the patients were compared with age-, sex-, and BMI-matched control group with obesity and MetS (51 subjects; 24 males, 27 females) treated only with a LGI diet. Assessments included lipids, glucose and insulin (fasting and after oral glucose tolerance test) concentrations. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Matsuda, insulinogenic and disposition indices were calculated. Results: Metformin treatment led to a significant reduction in BMI SDS (p < 0.0001), with a significant difference in ΔBMI SDS between patients and controls (p < 0.0001). Moreover, metformin treated patients showed a reduction in HOMA-IR (p < 0.0001), HbA1c levels (p < 0.0001) and a significant increase in Matsuda index (p < 0.0001) in respect to the reduction discovered in controls (p < 0.05). Moreover, in contrast to the group treated with metformin alone and controls, patients treated with metformin plus PGR showed a further reduction in BMI SDS (p < 0.0001), HOMA-IR (p < 0.0001), HbA1c (p < 0.0001), total, HDL and LDL cholesterol (p < 0.0001), as well as an increase in Matsuda (p < 0.0001), disposition (p < 0.005) and insulinogenic (respectively, p < 0.05 and p < 0.0001) indices. Conclusions: Metformin appears to show short-term efficacy in reducing BMI, adiposity and glucose and insulin parameters in obese children and adolescents with MetS. However, PGR added to metformin may be useful to potentiate weight loss and to improve glucose-insulin metabolism and adiposity parameters in these patients.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence 50139, Italy.
| | - Franco Ricci
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence 50139, Italy.
| | - Martina Bianconi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence 50139, Italy.
| | - Maria Amina Sammarco
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence 50139, Italy.
| | - Giovanna Municchi
- Department of Paediatrics, University of Siena, Siena 53100, Italy; gmunicchi@technet.
| | - Sonia Toni
- Paediatric Diabetology Unit, Anna Meyer Children's University Hospital, University of Florence, Florence 50139, Italy.
| | - Lorenzo Lenzi
- Paediatric Diabetology Unit, Anna Meyer Children's University Hospital, University of Florence, Florence 50139, Italy.
| | - Alberto Verrotti
- Department of Paediatrics, University of L'Aquila, L'Aquila 67100, Italy.
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence 50139, Italy.
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27
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Rajjo T, Mohammed K, Alsawas M, Ahmed AT, Farah W, Asi N, Almasri J, Prokop LJ, Murad MH. Treatment of Pediatric Obesity: An Umbrella Systematic Review. J Clin Endocrinol Metab 2017; 102:763-775. [PMID: 28359101 DOI: 10.1210/jc.2016-2574] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Multiple interventions are available to reduce excess body weight in children. We appraised the quality of evidence supporting each intervention and assessed the effectiveness on different obesity-related outcomes. METHODS We conducted a systematic search for systematic reviews of randomized controlled trials evaluating pediatric obesity interventions applied for ≥6 months. We assessed the quality of evidence for each intervention using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. RESULTS From 16 systematic reviews, we identified 133 eligible randomized controlled trials. Physical activity interventions reduced systolic blood pressure and fasting glucose (low to moderate quality of evidence). Dietary interventions with low-carbohydrate diets had a similar effect to low-fat diets in terms of body mass index (BMI) reduction (moderate quality of evidence). Educational interventions reduced waist circumference, BMI, and diastolic blood pressure (low quality of evidence). Pharmacological interventions reduced BMI (metformin, sibutramine, orlistat) and waist circumference (sibutramine, orlistat) and increased high-density lipoprotein cholesterol (sibutramine) but also raised systolic and diastolic blood pressure (sibutramine). Surgical interventions (laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) resulted in the largest BMI reduction (moderate quality of evidence). Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education significantly reduced systolic and diastolic blood pressure, BMI, and triglycerides. Combined parent-child interventions and parent-only interventions had similar effects on BMI (low quality of evidence). CONCLUSIONS Several childhood obesity interventions are effective in improving metabolic and anthropometric measures. A comprehensive multicomponent intervention, however, appears to have the best overall outcomes.
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Affiliation(s)
- Tamim Rajjo
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Department of Family Medicine
| | - Khaled Mohammed
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Mouaz Alsawas
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Ahmed T Ahmed
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
| | - Wigdan Farah
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Noor Asi
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Jehad Almasri
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
| | - Larry J Prokop
- Library Public Services, Mayo Clinic, Rochester, Minnesota 55905
| | - Mohammad Hassan Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Division of Preventive, Occupational and Aerospace Medicine, and
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28
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Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:709-757. [PMID: 28359099 PMCID: PMC6283429 DOI: 10.1210/jc.2016-2573] [Citation(s) in RCA: 620] [Impact Index Per Article: 88.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
COSPONSORING ASSOCIATIONS The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSION Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.
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Affiliation(s)
- Dennis M Styne
- University of California Davis, Sacramento, California 95817
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29
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An update on the assessment and management of metabolic syndrome, a growing medical emergency in paediatric populations. Pharmacol Res 2017; 119:99-117. [PMID: 28111263 DOI: 10.1016/j.phrs.2017.01.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 01/19/2023]
Abstract
In the last decades the increasing rate of obesity in children and adolescents worldwide has led to the onset in paediatric age of metabolic syndrome, a disease commonly associated to adulthood. Central obesity, dyslipidaemia, hyperglycaemia, and hypertension are typical features of metabolic syndrome that seem to hesitate often in type 2 diabetes, cardiovascular disease, non-alcoholic fatty liver disease, and many other clinical conditions. Thus preventing and curing metabolic syndrome in paediatric patients is becoming an urgent need for public health. While diagnostic criteria and therapy of metabolic syndrome in adults are very well defined, there is no consensus on the definition of metabolic syndrome in children and adolescents as well as on healing approaches. The aim of this review is to describe the recent advances on the pathogenesis and clinical outcomes of paediatric metabolic syndrome. We then detail the therapeutic strategies (i.e. dietary regimens, physical exercise, nutraceuticals, and medications) employed to manage the disease. Finally, we analyse the safety profile of the drugs used in children and adolescents by performing a retrospective review of paediatric adverse reactions reported in the FDA's Adverse Event Reporting System database.
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30
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Sedaka NM, Olsen CH, Yannai LE, Stutzman WE, Krause AJ, Sherafat-Kazemzadeh R, Condarco TA, Brady SM, Demidowich AP, Reynolds JC, Yanovski SZ, Hubbard VS, Yanovski JA. A longitudinal study of serum insulin and insulin resistance as predictors of weight and body fat gain in African American and Caucasian children. Int J Obes (Lond) 2017; 41:61-70. [PMID: 27534840 PMCID: PMC5209266 DOI: 10.1038/ijo.2016.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/16/2016] [Accepted: 07/20/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The influence of insulin and insulin resistance (IR) on children's weight and fat gain is unclear. OBJECTIVE To evaluate insulin and IR as predictors of weight and body fat gain in children at high risk for adult obesity. We hypothesized that baseline IR would be positively associated with follow-up body mass index (BMI) and fat mass. SUBJECTS/METHODS Two hundred and forty-nine healthy African American and Caucasian children aged 6-12 years at high risk for adult obesity because of early-onset childhood overweight and/or parental overweight were followed for up to 15 years with repeated BMI and fat mass measurements. We examined baseline serum insulin and homeostasis model of assessment-IR (HOMA-IR) as predictors of follow-up BMI Z-score and fat mass by dual-energy X-ray absorptiometry in mixed model longitudinal analyses accounting for baseline body composition, pubertal stage, sociodemographic factors and follow-up interval. RESULTS At baseline, 39% were obese (BMI⩾95th percentile for age/sex). Data from 1335 annual visits were examined. Children were followed for an average of 7.2±4.3 years, with a maximum follow-up of 15 years. After accounting for covariates, neither baseline insulin nor HOMA-IR was significantly associated with follow-up BMI (Ps>0.26), BMIz score (Ps>0.22), fat mass (Ps>0.78) or fat mass percentage (Ps>0.71). In all models, baseline BMI (P<0.0001), body fat mass (P<0.0001) and percentage of fat (P<0.001) were strong positive predictors for change in BMI and fat mass. In models restricted to children without obesity at baseline, some but not all models had significant interaction terms between body adiposity and insulinemia/HOMA-IR that suggested less gain in mass among those with greater insulin or IR. The opposite was found in some models restricted to children with obesity at baseline. CONCLUSIONS In middle childhood, BMI and fat mass, but not insulin or IR, are strong predictors of children's gains in BMI and fat mass during adolescence.
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Affiliation(s)
- N M Sedaka
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - C H Olsen
- Biostatistics Consulting Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - L E Yannai
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - W E Stutzman
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - A J Krause
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - R Sherafat-Kazemzadeh
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - T A Condarco
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - S M Brady
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - A P Demidowich
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - J C Reynolds
- Nuclear Medicine Department, Hatfield Clinical Research Center, NIH, Bethesda, MD, USA
| | - S Z Yanovski
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
- Nutritional Sciences Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - V S Hubbard
- Nutritional Sciences Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
- Division of Nutrition Research Coordination, NIH, Bethesda, MD, USA
| | - J A Yanovski
- Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
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31
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Axon E, Atkinson G, Richter B, Metzendorf M, Baur L, Finer N, Corpeleijn E, O'Malley C, Ells LJ. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 2016; 11:CD012436. [PMID: 27899001 PMCID: PMC6472619 DOI: 10.1002/14651858.cd012436] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Child and adolescent obesity has increased globally, and can be associated with significant short- and long-term health consequences. OBJECTIVES To assess the efficacy of drug interventions for the treatment of obesity in children and adolescents. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PubMed (subsets not available on Ovid), LILACS as well as the trial registers ICTRP (WHO) and ClinicalTrials.gov. Searches were undertaken from inception to March 2016. We checked references and applied no language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of pharmacological interventions for treating obesity (licensed and unlicensed for this indication) in children and adolescents (mean age under 18 years) with or without support of family members, with a minimum of three months' pharmacological intervention and six months' follow-up from baseline. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. In addition, we excluded trials which included growth hormone therapies and pregnant participants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data following standard Cochrane methodology. Where necessary we contacted authors for additional information. MAIN RESULTS We included 21 trials and identified eight ongoing trials. The included trials evaluated metformin (11 trials), sibutramine (six trials), orlistat (four trials), and one trial arm investigated the combination of metformin and fluoxetine. The ongoing trials evaluated metformin (four trials), topiramate (two trials) and exenatide (two trials). A total of 2484 people participated in the included trials, 1478 participants were randomised to drug intervention and 904 to comparator groups (91 participants took part in two cross-over trials; 11 participants not specified). Eighteen trials used a placebo in the comparator group. Two trials had a cross-over design while the remaining 19 trials were parallel RCTs. The length of the intervention period ranged from 12 weeks to 48 weeks, and the length of follow-up from baseline ranged from six months to 100 weeks.Trials generally had a low risk of bias for random sequence generation, allocation concealment and blinding (participants, personnel and assessors) for subjective and objective outcomes. We judged approximately half of the trials as having a high risk of bias in one or more domain such as selective reporting.The primary outcomes of this review were change in body mass index (BMI), change in weight and adverse events. All 21 trials measured these outcomes. The secondary outcomes were health-related quality of life (only one trial reported results showing no marked differences; very low certainty evidence), body fat distribution (measured in 18 trials), behaviour change (measured in six trials), participants' views of the intervention (not reported), morbidity associated with the intervention (measured in one orlistat trial only reporting more new gallstones following the intervention; very low certainty evidence), all-cause mortality (one suicide in the orlistat intervention group; low certainty evidence) and socioeconomic effects (not reported).Intervention versus comparator for mean difference (MD) in BMI change was -1.3 kg/m2 (95% confidence interval (CI) -1.9 to -0.8; P < 0.00001; 16 trials; 1884 participants; low certainty evidence). When split by drug type, sibutramine, metformin and orlistat all showed reductions in BMI in favour of the intervention.Intervention versus comparator for change in weight showed a MD of -3.9 kg (95% CI -5.9 to -1.9; P < 0.00001; 11 trials; 1180 participants; low certainty evidence). As with BMI, when the trials were split by drug type, sibutramine, metformin and orlistat all showed reductions in weight in favour of the intervention.Five trials reported serious adverse events: 24/878 (2.7%) participants in the intervention groups versus 8/469 (1.7%) participants in the comparator groups (risk ratio (RR) 1.43, 95% CI 0.63 to 3.25; 1347 participants; low certainty evidence). A total 52/1043 (5.0%) participants in the intervention groups versus 17/621 (2.7%) in the comparator groups discontinued the trial because of adverse events (RR 1.45, 95% CI 0.83 to 2.52; 10 trials; 1664 participants; low certainty evidence). The most common adverse events in orlistat and metformin trials were gastrointestinal (such as diarrhoea, mild abdominal pain or discomfort, fatty stools). The most frequent adverse events in sibutramine trials included tachycardia, constipation and hypertension. The single fluoxetine trial reported dry mouth and loose stools. No trial investigated drug treatment for overweight children. AUTHORS' CONCLUSIONS This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn. Trials were generally of low quality with many having a short or no post-intervention follow-up period and high dropout rates (overall dropout of 25%). Future research should focus on conducting trials with sufficient power and long-term follow-up, to ensure the long-term effects of any pharmacological intervention are comprehensively assessed. Adverse events should be reported in a more standardised manner specifying amongst other things the number of participants experiencing at least one adverse event. The requirement of regulatory authorities (US Food and Drug Administration and European Medicines Agency) for trials of all new medications to be used in children and adolescents should drive an increase in the number of high quality trials.
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Affiliation(s)
- Emma Axon
- University of NottinghamCochrane Skin GroupNottinghamUKNG7 2NR
| | - Greg Atkinson
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Nicholas Finer
- UCL Institute of Cardiovascular ScienceNational Centre for Cardiovascular Prevention and Outcomes170 Tottenham Court RoadLondonUKW1T 7HA
- Novo Nordisk A/SGlobal Medical Affairs ManagementCopenhagenDenmark
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUKDH1 3HN
| | - Louisa J Ells
- Teesside UniversitySchool of Health and Social CareParkside West OfficesMiddlesbroughUKTS1 3BA
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van der Aa MP, Elst MAJ, van de Garde EMW, van Mil EGAH, Knibbe CAJ, van der Vorst MMJ. Long-term treatment with metformin in obese, insulin-resistant adolescents: results of a randomized double-blinded placebo-controlled trial. Nutr Diabetes 2016; 6:e228. [PMID: 27571249 PMCID: PMC5022149 DOI: 10.1038/nutd.2016.37] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/14/2023] Open
Abstract
Background: As adolescents with obesity and insulin resistance may be refractory to lifestyle intervention therapy alone, additional off-label metformin therapy is often used. In this study, the long-term efficacy and safety of metformin versus placebo in adolescents with obesity and insulin resistance is studied. Methods: In a randomized placebo-controlled double-blinded trial, 62 adolescents with obesity aged 10–16 years old with insulin resistance received 2000 mg of metformin or placebo daily and physical training twice weekly over 18 months. Primary end points were change in body mass index (BMI) and insulin resistance measured by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Secondary end points were safety and tolerability of metformin. Other end points were body fat percentage and HbA1c. Results: Forty-two participants completed the 18-month study (66% girls, median age 13 (12–15) years, BMI 30.0 (28.3 to 35.0) kg m−2 and HOMA-IR 4.08 (2.40 to 5.88)). Median ΔBMI was +0.2 (−2.9 to 1.3) kg m−2 (metformin) versus +1.2 (−0.3 to 2.4) kg m−2 (placebo) (P=0.015). No significant difference was observed for HOMA-IR. No serious adverse events were reported. Median change in fat percentage was −3.1 (−4.8 to 0.3) versus −0.8 (−3.2 to 1.6)% (P=0.150), in fat mass −0.2 (−5.2 to 2.1) versus +2.0 (1.2–6.4) kg (P=0.007), in fat-free mass +2.0 (−0.1 to 4.0) versus +4.5 (1.3 to 11.6) kg (P=0.047) and in ΔHbA1c +1.0 (−1.0 to 2.3) versus +3.0 (0.0 to 5.0) mmol mol−1 (P=0.020) (metformin versus placebo). Conclusions: Long-term treatment with metformin in adolescents with obesity and insulin resistance results in stabilization of BMI and improved body composition compared with placebo. Therefore, metformin may be useful as an additional therapy in combination with lifestyle intervention in adolescents with obesity and insulin resistance.
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Affiliation(s)
- M P van der Aa
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M A J Elst
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands
| | - E M W van de Garde
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
| | - E G A H van Mil
- Department of Pediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - C A J Knibbe
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
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Huang TTK, Ferris E, Tripathi D. An Integrative Analysis of the Effect of Lifestyle and Pharmacological Interventions on Glucose Metabolism in the Prevention and Treatment of Youth-Onset Type 2 Diabetes. Curr Diab Rep 2016; 16:78. [PMID: 27380713 DOI: 10.1007/s11892-016-0767-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preventing and managing youth-onset type 2 diabetes are a major challenge. This paper reviews the evidence of lifestyle and drug therapies in improving glucose, insulin, and insulin sensitivity. Forty-four interventions were analyzed, of which 11 were drug (mainly metformin) interventions combined with lifestyle while the remainder used lifestyle strategies only. Fewer than a dozen out of 44 interventions reported significant improvements in glucose-related outcomes. Metformin in addition to lifestyle therapy did not necessarily enhance intervention effects. The overall lack of findings can be partially attributed to the heterogeneity of study populations, the lack of intervention intensity, under-powered study design, and the challenging lives of at-risk populations. New treatment options in both drugs and lifestyle strategies are direly needed.
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Affiliation(s)
- Terry T-K Huang
- Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, #803, New York, NY, 10027, USA.
| | - Emily Ferris
- Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, #803, New York, NY, 10027, USA
| | - Devanshi Tripathi
- Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, #803, New York, NY, 10027, USA
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Pastor-Villaescusa B, Caballero-Villarraso J, Cañete MD, Hoyos R, Maldonado J, Bueno G, Leis R, Gil Á, Cañete R, Aguilera CM. Evaluation of differential effects of metformin treatment in obese children according to pubertal stage and genetic variations: study protocol for a randomized controlled trial. Trials 2016; 17:323. [PMID: 27432166 PMCID: PMC4950074 DOI: 10.1186/s13063-016-1403-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/12/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Overweight and obesity are considered to be serious public health problems. In pediatric populations, insulin resistance, dyslipidemia, and hypertension associated with obesity occur with increased frequencies. Metformin is an oral anti-hyperglycemic agent that has been demonstrated to be efficacious in the treatment of diabetic and non-diabetic obese adults. A considerable amount of pharmacogenetic research has demonstrated that genetic variation is one of the major factors affecting metformin response. Additionally, potential microbiota-mediated mechanisms of metformin effect have been recently described. However, scant work has been conducted in children, with no attention being paid to the potential effects of pubertal development. Thus, the main objective of the present study is to evaluate the effect of metformin treatment together with lifestyle recommendations in a randomized control trial (RCT) of obese children according to pubertal stage, genetic variants and signature of gut microbiota. METHODS/DESIGN This is a randomized, prospective, double-blind, placebo-controlled, multicenter trial, which is stratified by puberty and sex. Eighty pre-pubertal (40 boys and 40 girls) and 80 pubertal non-diabetic obese children (40 boys and 40 girls) are being recruited in four Spanish Clinical Hospitals. The inclusion criteria to participate in the RCT include a Body Mass Index (BMI) above the 95th percentile and age 7-14 years. The pubertal stage is determined based on the Tanner criteria. Participants are assigned to two groups in accordance with a randomization schedule and receive 1 g of metformin or placebo for six months in combination with healthy lifestyle recommendations in both groups. The primary outcomes include changes in the BMI Z score and the biomarkers associated with the early appearance of insulin resistance syndrome, inflammation, cardiovascular risk according of the presence of genetic determinants of metformin response, as well as possible modifications in microbiota. DISCUSSION This study will assess the differential response of metformin treatment at six months in pre-pubertal and pubertal obese children. TRIAL REGISTRATION Registered by European Clinical Trials Database (EudraCT, ID: 2010-023061-21) on 14 November 2011.
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Affiliation(s)
- Belén Pastor-Villaescusa
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research Laboratory 123, University of Granada, Avenida del Conocimiento s/n. 18006 Armilla, Granada, Spain
| | | | - M Dolores Cañete
- PAIDI CTS-329. Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
| | - Raúl Hoyos
- Pediatric Department, Virgen de las Nieves University Hospital, Andalusian Health Service, Granada, Spain
| | - José Maldonado
- Pediatric Gastroenterology and Nutrition Unit, Virgen de las Nieves University Hospital, Pediatric Department, University of Granada, Granada, Spain
| | - Gloria Bueno
- Pediatric Department, Lozano Blesa University Clinical Hospital, University of Zaragoza, Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Rosaura Leis
- Unit of Investigation in Nutrition, Growth and Human Development of Galicia, Pediatric Department, Clinic University Hospital of Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research Laboratory 123, University of Granada, Avenida del Conocimiento s/n. 18006 Armilla, Granada, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | - Ramón Cañete
- Unit of Pediatric Endocrinology, Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Concepción M Aguilera
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research Laboratory 123, University of Granada, Avenida del Conocimiento s/n. 18006 Armilla, Granada, Spain.
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.
- Instituto de Investigación Biosanitaria ibs, Granada, Spain.
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Affiliation(s)
- Chrystal Wittcopp
- Department of Pediatrics, Baystate Children's Hospital, Tufts University School of Medicine, Boston, MA
| | - Rushika Conroy
- Department of Pediatrics, Baystate Children's Hospital, Tufts University School of Medicine, Boston, MA
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Kelly AS, Fox CK, Rudser KD, Gross AC, Ryder JR. Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations. Int J Obes (Lond) 2016; 40:1043-50. [PMID: 27113643 DOI: 10.1038/ijo.2016.69] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/22/2016] [Accepted: 04/04/2016] [Indexed: 12/13/2022]
Abstract
Despite the increasing number of medications recently approved to treat obesity among adults, few agents have been formally evaluated in children or adolescents for this indication. Moreover, there is a paucity of guidance in the literature addressing best practices with regard to pediatric obesity pharmacotherapy clinical trial design, and only general recommendations have been offered by regulatory agencies on this topic. The purposes of this article are to (1) offer a background of the current state of the field of pediatric obesity medicine, (2) provide a brief review of the literature summarizing pediatric obesity pharmacotherapy clinical trials, and (3) highlight and discuss some of the unique aspects that should be considered when designing and conducting high-quality clinical trials evaluating the safety and efficacy of obesity medications in children and adolescents. Suggestions are offered in the areas of target population and eligibility criteria, clinical trial end-point selection, trial duration, implementation of lifestyle modification therapy and recruitment and retention of participants. Efforts should be made to design and conduct trials appropriately to ensure that high-quality evidence is generated on the safety and efficacy of various medications used to treat pediatric obesity.
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Affiliation(s)
- A S Kelly
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C K Fox
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - K D Rudser
- Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - A C Gross
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - J R Ryder
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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Marques P, Limbert C, Oliveira L, Santos MI, Lopes L. Metformin effectiveness and safety in the management of overweight/obese nondiabetic children and adolescents: metabolic benefits of the continuous exposure to metformin at 12 and 24 months. Int J Adolesc Med Health 2016; 29:/j/ijamh.ahead-of-print/ijamh-2015-0110/ijamh-2015-0110.xml. [PMID: 26894572 DOI: 10.1515/ijamh-2015-0110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/14/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Childhood obesity prevalence is rising and new therapeutical approaches are needed. Metformin is likely beneficial in obese and/or insulin-resistant children/adolescents, but its role in this setting is still unclear. We aimed to evaluate the effectiveness, in terms of weight loss and insulin resistance, and safety of metformin in nondiabetic overweight/obese children and adolescents. METHODS We retrospectively reviewed clinical records of 78 nondiabetic obese/overweight [body mass index (BMI)≥85th/95th percentile for age and sex] children and adolescents. Anthropometric and metabolic outcomes of 39 patients treated with metformin (mean daily dose: 1.3±0.5 g) were analyzed and compared to lifestyle intervention alone at different follow-up times (12 and 24 months). RESULTS The mean age of the 78 patients was 13.3 years, 41 were females and mean BMI and BMI-SDS were 32.8 kg/m2 and 3.1, respectively. There was a decrease in mean BMI-SDS within each treatment group in all periods, except at 24 months for lifestyle intervention. However, the change in BMI-SDS was not significantly superior in the metformin group when compared to lifestyle intervention. Metformin had greater effectiveness over lifestyle intervention alone in reducing fasting insulin levels and homeostasis model assessment for insulin-resistance index (HOMA-IR) at both 12 and 24 months. Five patients had gastrointestinal adverse effects (12.8%), four requiring dose reduction, but metformin could be resumed in all. CONCLUSION Metformin for nondiabetic obese/overweight children and adolescents resulted in a noteworthy insulin resistance improvement, without significant BMI advantage when compared to lifestyle intervention. Metformin metabolic and anthropometric effects appear to be beneficial up to 24 months, without relevant adverse effects, highlighting its potential long-term benefits.
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Cadeddu C, Nocco S, Cugusi L, Deidda M, Fabio O, Bandino S, Cossu E, Incani M, Baroni MG, Mercuro G. Effects of Metformin and Exercise Training, Alone or in Combination, on Cardiac Function in Individuals with Insulin Resistance. Cardiol Ther 2016; 5:63-73. [PMID: 26831122 PMCID: PMC4906084 DOI: 10.1007/s40119-016-0057-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction In patients affected by insulin resistance (IR), metformin (MET) therapy has been shown to exert its positive effects by improving glucose tolerance and preventing the evolution to diabetes. Recently, it was shown that the addition of metformin to physical training did not improve sensitivity to insulin or peak oxygen consumption (peak VO2). The purpose of this study was to establish the effect of metformin and exercise, separately or in combination, on systolic left ventricular (LV) function in individuals with IR. Methods Seventy-five patients with IR were enrolled and subsequently assigned to MET, combination MET and exercise, or exercise alone. The LV systolic and diastolic functions were evaluated with standard echocardiography tissue Doppler imaging (TDI) and speckle tracking echocardiography at baseline and after 12 weeks of treatment. Results MET, administered alone or in association with exercise, improved longitudinal LV function, as evidenced by an increase in systolic (S) wave on TDI, alongside increases in longitudinal global strain and strain rate in comparison to the group undergoing physical training alone. The traditional echocardiographic parameters showed no statistically significant differences among the three groups before or after the different cycles of therapy. Conclusions Treatment with MET, either with or without exercise, but not exercise alone, produced a significant increase in global longitudinal LV systolic function at rest. These findings validate the observation that the use of MET alone or in association with exercise has a crucial role to counteract the negative effects of IR on cardiovascular function. Electronic supplementary material The online version of this article (doi:10.1007/s40119-016-0057-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Cadeddu
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Silvio Nocco
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy.
| | - Lucia Cugusi
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Martino Deidda
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Orru Fabio
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Stefano Bandino
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Efisio Cossu
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Michela Incani
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Marco Giorgio Baroni
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences "M Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, CA, Italy
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Nathan BM, Rudser KD, Abuzzahab MJ, Fox CK, Coombes BJ, Bomberg EM, Kelly AS. Predictors of weight-loss response with glucagon-like peptide-1 receptor agonist treatment among adolescents with severe obesity. Clin Obes 2016; 6:73-8. [PMID: 26683756 PMCID: PMC4721217 DOI: 10.1111/cob.12128] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/15/2015] [Accepted: 11/22/2015] [Indexed: 01/10/2023]
Abstract
In two previous, separate clinical trials, we demonstrated significant reductions in body mass index (BMI) with exenatide in adolescents with severe obesity. In the present study, we pooled data from these near identical trials to evaluate factors that may predict BMI reduction at 3 months. Data from 32 patients (mean age 14.3 ± 2.2 years; 69% female; mean BMI 39.8 ± 5.8 kg m(-2)) were included. Exenatide treatment consisted of 5 mcg twice daily for 1 month, followed by an increase to 10 mcg twice daily for 2 additional months. Predictor variables included baseline BMI, BMI percent change at 1 month, incidence of nausea or vomiting and baseline appetite and satiety measures. Treatment effects of percent change in BMI from baseline were estimated within predictor subgroups using generalized estimating equations with exchangeable working correlation and robust variance estimation for confidence intervals and P-values to account for paired observations. The pooled data treatment effect on absolute BMI at 3 months was -3.42% (95% confidence interval: -5.41%, -1.42%) compared to placebo. Within treated participants, appetite at baseline (treatment effect in high [-4.28%] vs. low [1.02%], P = 0.028) and sex (treatment effect in female [-4.78%] vs. male [0.76%], P = 0.007) were significant predictors of change in BMI at 3 months. Baseline BMI, BMI percent change at 1 month, age, incidence of nausea, vomiting, or other gastrointestinal symptoms and satiety scores did not predict 3-month responses. Sex and measures of appetite may serve as useful predictors of glucagon-like peptide-1 receptor agonist treatment response among adolescents with severe obesity.
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Affiliation(s)
- Brandon M. Nathan
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
| | - Kyle D. Rudser
- Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | | | - Claudia K. Fox
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
| | - Brandon J. Coombes
- Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Eric M. Bomberg
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
| | - Aaron S. Kelly
- Department of Pediatrics, University of Minnesota, and University of Minnesota Children’s Hospital, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
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Malin SK, Braun B. Impact of Metformin on Exercise-Induced Metabolic Adaptations to Lower Type 2 Diabetes Risk. Exerc Sport Sci Rev 2016; 44:4-11. [DOI: 10.1249/jes.0000000000000070] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Clarson CL, Brown HK, De Jesus S, Jackman M, Mahmud FH, Prapavessis H, Robinson T, Shoemaker JK, Watson M, Dowd AJ, Hill DJ. Effects of a Comprehensive, Intensive Lifestyle Intervention Combined with Metformin Extended Release in Obese Adolescents. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:659410. [PMID: 27433488 PMCID: PMC4897295 DOI: 10.1155/2014/659410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 12/13/2022]
Abstract
Objective. To assess a comprehensive, intensive lifestyle intervention in combination with metformin extended release (MXR) or placebo on body mass index (BMI) and risk factors for type 2 diabetes and cardiovascular disease in obese adolescents. Study Design. Sixty-nineobese adolescents (mean BMI 32.5) received a comprehensive lifestyle intervention with structured dietary, physical activity, and behavioral components for 24 months. Subjects were randomized to 1 of 4 groups: MXR (33) 2,000 mg daily or placebo, with either moderate or vigorous intensity exercise for the first 3 months. Subsequently the exercise intervention was the same for all 4 groups. Results. Anthropometry measurements did not differ with initial exercise intensity at any time. At 3 months % body fat decreased in all 4 groups (P < 0.006). BMI and % body fat decreased in the MXR groups, but not the placebo groups, at 6 (-0.88, -3.16) and 12 months (-0.56, -2.34) (P < 0.05). Insulin resistance, fasting blood glucose, and leptin improved in all groups at 6 and 12 months. A high subject attrition rate (58%) occurred by 24 months. Conclusion. A comprehensive, intensive lifestyle intervention combined with MXR led to a decline in BMI and % body fat at 1 year independent of initial exercise intensity. This trial is registered with ClinicalTrials.gov NCT00934570 .
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Affiliation(s)
- Cheril L. Clarson
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Paediatrics, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Hilary K. Brown
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Stefanie De Jesus
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Michelle Jackman
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - Farid H. Mahmud
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - Harry Prapavessis
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Tracy Robinson
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - J. Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Margaret Watson
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - A. Justine Dowd
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - David J. Hill
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada N6A 5A5
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Boland CL, Harris JB, Harris KB. Pharmacological Management of Obesity in Pediatric Patients. Ann Pharmacother 2014; 49:220-32. [DOI: 10.1177/1060028014557859] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. Data Sources: A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. Study Selection and Data Extraction: Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. Data Synthesis: Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m2, but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m2, with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m2 and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. Conclusions: Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated.
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Worsley R, Jane F, Robinson PJ, Bell RJ, Davis SR. Metformin for overweight women at midlife: a double-blind, randomized, controlled trial. Climacteric 2014; 18:270-7. [DOI: 10.3109/13697137.2014.954997] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Astiz S, Gonzalez-Bulnes A, Astiz I, Barbero A, Perez-Solana M, Garcia-Real I. Advanced onset of puberty after metformin therapy in swine with thrifty genotype. Exp Physiol 2014; 99:1241-52. [DOI: 10.1113/expphysiol.2014.081455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- S. Astiz
- Departamento de Reproducción Animal; INIA, Avda. Puerta de Hierro s/n. 28040 Madrid Spain
| | - A. Gonzalez-Bulnes
- Departamento de Reproducción Animal; INIA, Avda. Puerta de Hierro s/n. 28040 Madrid Spain
| | - I. Astiz
- Unidad de Pediatría; Atención Primaria; Centro de Salud Ciudad San Pablo; Avenida de Madrid; 13 Coslada 28022 Madrid Spain
| | - A. Barbero
- Departamento Medicina y Cirugía Animal; Facultad de Veterinaria; Universidad Complutense de Madrid; Ciudad Universitaria s/n; 28040 Madrid Spain
| | - M.L. Perez-Solana
- Departamento de Reproducción Animal; INIA, Avda. Puerta de Hierro s/n. 28040 Madrid Spain
| | - I. Garcia-Real
- Departamento Medicina y Cirugía Animal; Facultad de Veterinaria; Universidad Complutense de Madrid; Ciudad Universitaria s/n; 28040 Madrid Spain
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van der Aa MP, Elst MAJ, van Mil EGAH, Knibbe CAJ, van der Vorst MMJ. METFORMIN: an efficacy, safety and pharmacokinetic study on the short-term and long-term use in obese children and adolescents - study protocol of a randomized controlled study. Trials 2014; 15:207. [PMID: 24899137 PMCID: PMC4053305 DOI: 10.1186/1745-6215-15-207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/12/2014] [Indexed: 12/26/2022] Open
Abstract
Background The prevalence of childhood obesity and insulin resistance is rising, increasing the risk of diabetes mellitus type 2. To prevent these complications, lifestyle intervention is the corner stone in treatment. However, long-term efficacy of lifestyle intervention is questionable. In addition to lifestyle intervention, pharmacological treatments have been explored. Metformin has been shown to be moderately effective to reduce BMI in obese adolescents with hyperinsulinemia. However, data on pharmacokinetics and long-term efficacy and safety are lacking as well as an evidence-based dosing regimen for this age group. The primary objective of the METFORMIN study is to determine the effect of adding metformin treatment to lifestyle intervention in reducing BMI in obese adolescents with insulin resistance. In addition, the pharmacokinetics of metformin in obese adolescents will be studied. Methods/design The METFORMIN study is a multi-centre prospective study that consists of two 18-month phases: a double-blind randomized placebo-controlled trial (part 1) and an open-label follow-up study (part 2). During part 1, the participants will be given metformin 1,000 mg or placebo twice daily and will be offered a lifestyle intervention programme; 144 participants will be included, 72 in each arm. Primary endpoints are reduction in body mass index, insulin resistance, and percentage body fat. Discussion This study will provide data on short- and long-term efficacy and safety of metformin and on the pharmacokinetics of metformin in obese adolescents. Trial registration ClinicalTrials.gov number
NCT01487993; EudraCT nr. 2010-023980-17. Registration date: 06-01-2011
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Affiliation(s)
| | - Marieke A J Elst
- Department of Paediatrics, St, Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.
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Cadeddu C, Nocco S, Cugusi L, Deidda M, Bina A, Fabio O, Bandinu S, Cossu E, Baroni MG, Mercuro G. Effects of metformin and exercise training, alone or in association, on cardio-pulmonary performance and quality of life in insulin resistance patients. Cardiovasc Diabetol 2014; 13:93. [PMID: 24884495 PMCID: PMC4030458 DOI: 10.1186/1475-2840-13-93] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/03/2014] [Indexed: 12/25/2022] Open
Abstract
Background Metformin (MET) therapy exerts positive effects improving glucose tolerance and preventing the evolution toward diabetes in insulin resistant patients. It has been shown that adding MET to exercise training does not improve insulin sensitivity. The aim of this study was to determine the effect of MET and exercise training alone or in combination on maximal aerobic capacity and, as a secondary end-point on quality of life indexes in individuals with insulin resistance. Methods 75 insulin resistant patients were enrolled and subsequently assigned to MET (M), MET with exercise training (MEx), and exercise training alone (Ex). 12-weeks of supervised exercise-training program was carried out in both Ex and MEx groups. Cardiopulmonary exercise test and SF-36 to evaluate Health-Related Quality of Life (HRQoL) was performed at basal and after 12-weeks of treatment. Results Cardiopulmonary exercise test showed a significant increase of peak VO2 in Ex and MEx whereas M showed no improvement of peak VO2 (∆ VO2 [CI 95%] Ex +0.26 [0.47 to 0.05] l/min; ∆ VO2 MEx +0.19 [0.33 to 0.05] l/min; ∆ VO2 M -0.09 [-0.03 to -0.15] l/min; M vs E p < 0.01; M vs MEx p < 0.01; MEx vs Ex p = ns). SF-36 highlighted a significant increase in general QoL index in the MEx (58.3 ± 19 vs 77.3 ± 16; p < 0.01) and Ex (62.1 ± 17 vs 73.7 ± 12; p < 0.005) groups. Conclusions We evidenced that cardiopulmonary negative effects showed by MET therapy may be counterbalanced with the combination of exercise training. Given that exercise training associated with MET produced similar effects to exercise training alone in terms of maximal aerobic capacity and HRQoL, programmed exercise training remains the first choice therapy in insulin resistant patients.
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Affiliation(s)
- Christian Cadeddu
- Department of Medical Sciences "M, Aresu", University Hospital of Cagliari, SS 554, Km 4,500, 09042 Monserrato, Italy.
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Brufani C, Crinò A, Fintini D, Patera PI, Cappa M, Manco M. Systematic review of metformin use in obese nondiabetic children and adolescents. Horm Res Paediatr 2014; 80:78-85. [PMID: 23899569 DOI: 10.1159/000353760] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 06/17/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Childhood obesity has become epidemic and has been accompanied by an increase in prevalence of type 2 diabetes (T2DM) in youth. Addressing obesity and insulin resistance by drug treatment represents a rational strategy for the prevention of T2DM. A systematic review was performed to evaluate the effectiveness of metformin in reducing weight and ameliorating insulin resistance in obese nondiabetic children. METHODS A PubMed database search was conducted, using 'metformin', 'obesity', 'insulin resistance', 'children', 'adolescents' as search terms. RESULTS Eleven trials were included in the present review. Metformin was administered for 6-12 months at a dosage of 1,000-2,000 mg/daily, decreasing BMI by 1.1-2.7 compared with placebo or lifestyle intervention alone. Concomitantly, fasting insulin resistance improved after metformin therapy. Posttreatment follow-up was performed in one study, showing that after 1 year of discontinuation of therapy the decrease in BMI disappears. CONCLUSIONS Short-term metformin treatment appears to moderately affect weight reduction in severely obese children and adolescents, with a concomitant improvement in fasting insulin sensitivity. Further studies with longer treatment period are needed to establish how much metformin can reduce weight and its real utility in preventing T2DM development in pediatric patients.
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Affiliation(s)
- Claudia Brufani
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sun AP, Kirby B, Black C, Helms PJ, Bennie M, McLay JS. Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study. BMC Pharmacol Toxicol 2014; 15:11. [PMID: 24594374 PMCID: PMC3946605 DOI: 10.1186/2050-6511-15-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 02/20/2014] [Indexed: 11/15/2022] Open
Abstract
Background Because of relatively small treatment numbers together with low adverse drug reaction (ADR) reporting rates the timely identification of ADRs affecting children and young people is problematic. The primary objective of this study was to assess the utility of unplanned medication discontinuation as a signal for possible ADRs in children and young people. Methods Using orlistat as an exemplar, all orlistat prescriptions issued to patients up to 18 years of age together with patient characteristics, prescription duration, co-prescribed medicines and recorded clinical (Read) codes were identified from the Primary Care Informatics Unit database between 1st Jan 2006-30th Nov 2009. Binary logistic regression was used to assess association between characteristics and discontinuation. Results During the study period, 79 patients were prescribed orlistat (81% female, median age 17 years). Unplanned medication discontinuation rates for orlistat were 52% and 77% at 1 and 3-months. Almost 20% of patients were co-prescribed an anti-depressant. One month unplanned medication discontinuation was significantly lower in the least deprived group (SIMD 1–2 compared to SIMD 9–10 OR 0.09 (95% CI0.01 – 0.83)) and those co-prescribed at least one other medication. At 3 months, discontinuation was higher in young people (≥17 yr versus, OR 3.07 (95% CI1.03 – 9.14)). Read codes were recorded for digestive, respiratory and urinary symptoms around the time of discontinuation for 24% of patients. Urinary retention was reported for 7.6% of patients. Conclusions Identification of unplanned medication discontinuation using large primary care datasets may be a useful tool for pharmacovigilance signal generation and detection of potential ADRs in children and young people.
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Affiliation(s)
| | | | | | | | | | - James Stuart McLay
- Division of Applied Health Sciences, University of Aberdeen, King's College, Aberdeen AB24 3FX, UK.
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Kendall DL, Amin R, Clayton PE. Metformin in the treatment of obese children and adolescents at risk of type 2 diabetes. Paediatr Drugs 2014; 16:13-20. [PMID: 23949947 DOI: 10.1007/s40272-013-0045-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Metformin is the first-line treatment for type 2 diabetes (T2D) in adults, children and young people, particularly in obese or overweight patients. Many studies have demonstrated that metformin is associated with weight reduction in adults and in prevention or delay of T2D onset in those who are at increased risk. In 2012, metformin was recommended by the UK National Institute for Health and Care Excellence as a treatment option in adults aged 18 years or over, who remain at high risk of T2D, despite participation in an intensive lifestyle-change programme. Prevalence of childhood obesity is increasing and is associated with elevated long-term risk of T2D and other adverse cardio-metabolic events; however, consensus is lacking on intervention strategies aimed at reducing this risk. This article discusses the rationale and evidence for the use of metformin in obese children and young people at high risk of T2D.
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Affiliation(s)
- Deborah L Kendall
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK,
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50
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Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128:1689-712. [PMID: 24016455 DOI: 10.1161/cir.0b013e3182a5cfb3] [Citation(s) in RCA: 707] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.
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