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Sousa JN, Sousa BVDO, Santos EPD, Ribeiro GHM, Pereira APM, Guimarães VHD, Queiroz LDRP, Motta-Santos D, Farias LC, Guimarães ALS, de Paula AMB, Santos SHS. Effects of gallic acid and physical training on liver damage, force, and anxiety in obese mice: Hepatic modulation of Sestrin 2 (SESN2) and PGC-α expression. Gene 2024; 926:148606. [PMID: 38788813 DOI: 10.1016/j.gene.2024.148606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
Obesity and overweight are multifactorial diseases affecting more than one-third of the world's population. Physical inactivity contributes to a positive energy balance and the onset of obesity. Exercise combined with a balanced diet is an effective non-pharmacological strategy to improve obesity-related disorders. Gallic acid (GA), is a natural endogenous polyphenol found in a variety of fruits, vegetables, and wines, with beneficial effects on energetic homeostasis. The present study aims to investigate the effects of exercise training on obese mice supplemented with GA. Animal experimentation was performed with male Swiss mice divided into five groups: ST (standard control), HFD (obese control), HFD + GA (GA supplement), HFD + Trained (training), and HFD + GA + Trained (GA and training). The groups are treated for eight weeks with 200 mg/kg/body weight of the feed compound and, if applicable, physical training. The main findings of the present study show that GA supplementation improves liver fat, body weight, adiposity, and plasma insulin levels. In addition, animals treated with the GA and a physical training program demonstrate reduced levels of anxiety. Gene expression analyses show that Sesn2 is activated via PGC-1α independent of the GATOR2 protein, which is activated by GA in the context of physical activity. These data are corroborated by molecular docking analysis, demonstrating the interaction of GA with GATOR2. The present study contributes to understanding the metabolic effects of GA and physical training and demonstrates a new hepatic mechanism of action via Sestrin 2 and PGC-1α.
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Affiliation(s)
- Jaciara Neves Sousa
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - Berenilde Valéria de Oliveira Sousa
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - Eduardo Pinheiro Dos Santos
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - Guilherme Henrique Mendes Ribeiro
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil; Institute of Agricultural Sciences (ICA), Post graduate Program in Food and Health, Universidade Federal de Minas Gerais (UFMG), Montes Claros, Minas Gerais, Brazil
| | - Ana Paula Maciel Pereira
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil; Institute of Agricultural Sciences (ICA), Post graduate Program in Food and Health, Universidade Federal de Minas Gerais (UFMG), Montes Claros, Minas Gerais, Brazil
| | - Victor Hugo Dantas Guimarães
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - Lorena Dos Reis Pereira Queiroz
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - Daisy Motta-Santos
- Sports Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucyana Conceição Farias
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - André Luiz Sena Guimarães
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - Alfredo Maurício Batista de Paula
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil
| | - Sérgio Henrique Sousa Santos
- Laboratory of Health Science, Post graduate Program in Health Science, Universidade Estadual de Montes Claros (Unimontes), Minas Gerais, Brazil; Institute of Agricultural Sciences (ICA), Post graduate Program in Food and Health, Universidade Federal de Minas Gerais (UFMG), Montes Claros, Minas Gerais, Brazil.
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Oumeddour DZ, Al-Dalali S, Zhao L, Zhao L, Wang C. Recent advances on cyanidin-3-O-glucoside in preventing obesity-related metabolic disorders: A comprehensive review. Biochem Biophys Res Commun 2024; 729:150344. [PMID: 38976946 DOI: 10.1016/j.bbrc.2024.150344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
Anthocyanins, found in various pigmented plants as secondary metabolites, represent a class of dietary polyphenols known for their bioactive properties, demonstrating health-promoting effects against several chronic diseases. Among these, cyanidin-3-O-glucoside (C3G) is one of the most prevalent types of anthocyanins. Upon consumption, C3G undergoes phases I and II metabolism by oral epithelial cells, absorption in the gastric epithelium, and gut transformation (phase II & microbial metabolism), with limited amounts reaching the bloodstream. Obesity, characterized by excessive body fat accumulation, is a global health concern associated with heightened risks of disability, illness, and mortality. This comprehensive review delves into the biodegradation and absorption dynamics of C3G within the gastrointestinal tract. It meticulously examines the latest research findings, drawn from in vitro and in vivo models, presenting evidence underlining C3G's bioactivity. Notably, C3G has demonstrated significant efficacy in combating obesity, by regulating lipid metabolism, specifically decreasing lipid synthesis, increasing fatty acid oxidation, and reducing lipid accumulation. Additionally, C3G enhances energy homeostasis by boosting energy expenditure, promoting the activity of brown adipose tissue, and stimulating mitochondrial biogenesis. Furthermore, C3G shows potential in managing various prevalent obesity-related conditions. These include cardiovascular diseases (CVD) and hypertension through the suppression of reactive oxygen species (ROS) production, enhancement of endogenous antioxidant enzyme levels, and inhibition of the nuclear factor-kappa B (NF-κB) signaling pathway and by exercising its cardioprotective and vascular effects by decreasing pulmonary artery thickness and systolic pressure which enhances vascular relaxation and angiogenesis. Type 2 diabetes mellitus (T2DM) and insulin resistance (IR) are also managed by reducing gluconeogenesis via AMPK pathway activation, promoting autophagy, protecting pancreatic β-cells from oxidative stress and enhancing glucose-stimulated insulin secretion. Additionally, C3G improves insulin sensitivity by upregulating GLUT-1 and GLUT-4 expression and regulating the PI3K/Akt pathway. C3G exhibits anti-inflammatory properties by inhibiting the NF-κB pathway, reducing pro-inflammatory cytokines, and shifting macrophage polarization from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype. C3G demonstrates antioxidative effects by enhancing the expression of antioxidant enzymes, reducing ROS production, and activating the Nrf2/AMPK signaling pathway. Moreover, these mechanisms also contribute to attenuating inflammatory bowel disease and regulating gut microbiota by decreasing Firmicutes and increasing Bacteroidetes abundance, restoring colon length, and reducing levels of inflammatory cytokines. The therapeutic potential of C3G extends beyond metabolic disorders; it has also been found effective in managing specific cancer types and neurodegenerative disorders. The findings of this research can provide an important reference for future investigations that seek to improve human health through the use of naturally occurring bioactive compounds.
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Affiliation(s)
- Dounya Zad Oumeddour
- Key Laboratory of Geriatric Nutrition and Health, Beijing Technology and Business University, Ministry of Education, Beijing, 100048, China; Beijing Engineering and Technology Research Center of Food Additives, Beijing Technology and Business University, Beijing, 100048, China.
| | - Sam Al-Dalali
- School of Food and Health, Guilin Tourism University, Guilin, 541006, China; Department of Food Science and Technology, Faculty of Agriculture and Food Science, Ibb University, Ibb, 70270, Yemen.
| | - Liang Zhao
- Key Laboratory of Geriatric Nutrition and Health, Beijing Technology and Business University, Ministry of Education, Beijing, 100048, China; Beijing Engineering and Technology Research Center of Food Additives, Beijing Technology and Business University, Beijing, 100048, China.
| | - Lei Zhao
- Key Laboratory of Geriatric Nutrition and Health, Beijing Technology and Business University, Ministry of Education, Beijing, 100048, China; Beijing Engineering and Technology Research Center of Food Additives, Beijing Technology and Business University, Beijing, 100048, China.
| | - Chengtao Wang
- Key Laboratory of Geriatric Nutrition and Health, Beijing Technology and Business University, Ministry of Education, Beijing, 100048, China; Beijing Engineering and Technology Research Center of Food Additives, Beijing Technology and Business University, Beijing, 100048, China.
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Sherf-Dagan S, Refaeli R, Buch A. Phenotyping of Obesity Treatment Candidates: A Narrative Review. Curr Obes Rep 2024; 13:564-573. [PMID: 38874701 DOI: 10.1007/s13679-024-00576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW This review explores characterizing candidates for obesity treatments including pharmacotherapy, endoscopic bariatric therapies, and metabolic bariatric surgery (MBS), focusing on established clinical parameters for diagnosing obesity beyond body mass index alone. RECENT FINDINGS Existing literature primarily provides rates for fat mass percentage (i.e., a marker for adiposity quantity), waist circumference (i.e., a marker for adiposity distribution), and C-reactive protein levels (i.e., a marker for adiposity functionality) among obesity treatment candidates. Limited data on abnormal values and sex-based differentiation exist. The literature indicates high central-tendency measures for fat mass percentage and waist circumference, while C-reactive protein levels vary. Data on the Edmonton Obesity Staging System (i.e., a marker for adiposity-related disease severity) is predominantly available for MBS candidates. Future studies in obesity interventions should improve screening and diagnosis of obesity by incorporating sex-specific considerations and providing abnormal value rates for measurements to enhance understanding of patients' characteristics.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Kiryat H'mada 3, Ariel, Israel.
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel.
| | - Rotem Refaeli
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Kiryat H'mada 3, Ariel, Israel
- Department of Nutrition, Rabin Medical Center, Beilinson hospital, Petah Tikva, Israel
| | - Assaf Buch
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Kiryat H'mada 3, Ariel, Israel
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Sarra F, Paocic D, Zöchling A, Gregor A, Auñon-Lopez A, Pignitter M, Duszka K. Gut microbiota, dietary taurine, and fiber shift taurine homeostasis in adipose tissue of calorie-restricted mice to impact fat loss. J Nutr Biochem 2024:109720. [PMID: 39103106 DOI: 10.1016/j.jnutbio.2024.109720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Previously, we demonstrated that caloric restriction (CR) stimulates the synthesis, conjugation, secretion, and deconjugation of taurine and bile acids in the intestine, as well as their reuptake. Given taurine's potent anti-obesogenic properties, this study aimed to assess whether the CR-induced shift in taurine homeostasis contributes to adipose tissue loss. METHODS Male C57Bl/6 mice were subjected to 20% CR or ad libitum feeding, with variations in cage bedding and gut microbiota conditions. Additional groups received taurine supplementation or were fed a low-taurine diet (LTD). RESULTS In CR animals, taurine derived from the intestine was preferentially trafficked to epididymal white adipose tissue (eWAT) over other tested organs. Besides increased levels of taurine transporter TauT, gene expression of Cysteine dioxygenase (Cdo) involved in taurine synthesis was upregulated in CR eWAT. Taurine concentration in adipocytes was inversely correlated with fat pad weight of CR mice. Different types of cage bedding did not impact eWAT taurine levels; however, the lack of bedding and consumption of a diet high in soluble fiber did. Depleting gut microbiota with antibiotics or inhibiting bile salt hydrolase (BSH) activity reduced WAT taurine concentration in CR mice. Taurine supplementation increased taurine levels in WAT and brown adipose tissue (BAT), promoting fat loss in CR animals. LTD consumption blunted WAT loss in CR animals, with negligible impact on BAT. CONCLUSIONS This study provides multiple insights into taurine's role in CR-triggered fat loss and describes a novel communication path between the liver, gut, microbiota, and WAT, with taurine acting as a messenger.
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Affiliation(s)
- Filomena Sarra
- Department of Nutritional Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria
| | - Daniela Paocic
- Department of Nutritional Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria
| | - Andrea Zöchling
- Department of Nutritional Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria
| | - András Gregor
- Department of Nutritional Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria
| | - Arturo Auñon-Lopez
- Institute of Physiological Chemistry, Faculty of Chemistry, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria; Vienna Doctoral School in Chemistry (DoSChem), Faculty of Chemistry, University of Vienna, Währingerstraße 42, 1090 Vienna, Austria
| | - Marc Pignitter
- Institute of Physiological Chemistry, Faculty of Chemistry, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria
| | - Kalina Duszka
- Department of Nutritional Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria.
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Li H, Xiang X, Yi Y, Yan B, Yi L, Ding N, Yang J, Gu Z, Luo Q, Huang Y, Fan L, Xiang W. Epidemiology of obesity and influential factors in China: a multicenter cross-sectional study of children and adolescents. BMC Pediatr 2024; 24:498. [PMID: 39095721 PMCID: PMC11295318 DOI: 10.1186/s12887-024-04970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE To determine the prevalence of and risk factors for overweight and obese among Chinese children and adolescents. METHODS This analytical cross-sectional study included 16,640 children and adolescents aged 6-18 years across four provinces of China in 2016. Physical characteristics and responses to questionnaires were analyzed. Body Mass Index (BMI) and the prevalence of overweight and obesity were calculated. RESULTS Among children and adolescents, the overall prevalence of overweight and obesity in 2016 in four regions of China was 27.2% and 29.6%, respectively. Among different stages and sexes, the highest prevalence of obesity (15.8%) was observed in adolescent boys. From childhood to adolescence, the obesity rate among boys increased by 0.7% (from 15.1% to 15.8%), while the obesity rate among girls decreased by 0.9% (from 10.8% to 9.9%). Children and adolescents who were overweight or obese had significantly higher systolic blood pressures, larger waist circumferences and larger hip sizes than those with a normal BMI. Logistic regression analyses identified thirteen factors associated with overweight or obesity in children and adolescents. CONCLUSIONS Our results indicate that the prevalence of overweight and obesity is high among children and adolescents, especially among male adolescents in four regions of China. A suitable intervention program should not only help parents understand the serious risk of childhood obesity but also, more importantly, help to encourage a healthy lifestyle among children and adolescents.
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Affiliation(s)
- Hongai Li
- Department of Pediatrics, Hainan Women and Children's Medical Center (Children's Hospital, Hainan Medical University), Haikou, 570206, China
| | - Xiayu Xiang
- Department of New Networks, Peng Cheng Laboratory, Shenzhen, 518000, China
| | - Yajun Yi
- Department of Medicine, Vanderbilt University Medical School, Nashville, TN, 37212, USA
| | - Bailu Yan
- Department of Biostatistics, Vanderbilt University, Nashville, TN, 37205, USA
| | - Leta Yi
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, NC, 27514, USA
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, 110122, China
| | - Jinping Yang
- Clinical Nutrition Department, Zunhua People's Hospital, Zunhua, 064200, China
| | - Zhuohe Gu
- Department of Clinical Nutrition, Maoming People's Hospital, Maoming, 525000, China
| | - Qing Luo
- Department of Pediatrics, Hainan Women and Children's Medical Center (Children's Hospital, Hainan Medical University), Haikou, 570206, China
| | - Yan Huang
- Department of Pediatrics, Hainan Women and Children's Medical Center (Children's Hospital, Hainan Medical University), Haikou, 570206, China.
| | - Lichun Fan
- Department of Pediatrics, Hainan Women and Children's Medical Center (Children's Hospital, Hainan Medical University), Haikou, 570206, China.
| | - Wei Xiang
- Department of Pediatrics, Hainan Women and Children's Medical Center (Children's Hospital, Hainan Medical University), Haikou, 570206, China.
- Key Laboratory of Control of Tropical Diseases, National Health Commission (NHC), Hainan Medical University, Haikou, 571199, China.
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Porri D, Luppino G, Morabito LA, La Rosa E, Pepe G, Corica D, Valenzise M, Messina MF, Zirilli G, Li Pomi A, Alibrandi A, Di Mauro D, Aversa T, Wasniewska MG. The Prevention of Childhood Obesity Is a Priority: The Preliminary Results of the "EpPOI: Education to Prevent Childhood Obesity" Project. Nutrients 2024; 16:2538. [PMID: 39125417 PMCID: PMC11313718 DOI: 10.3390/nu16152538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The increase in childhood obesity rates represents a serious public health problem. The project "EpPOI: Education to prevent childhood obesity" is aimed at a multidisciplinary approach to raise awareness of the importance of preventing childhood obesity through lifestyle education. METHODS Two actions by experts were performed: an intervention with children in schools and a meeting for both parents and school staff. Participants completed a questionnaire structured as a Likert scale. RESULTS The sample size was 96 people, and awareness of the childhood obesity problem as well as the need for obesity prevention was high among respondents. We also found great interest among participants in having more information on pediatric nutrition and physical activity, with a positive correlation with age. Furthermore, the multivariate regression model configured interest in having more information on nutrition and physical activity as an independent and statistically significant predictor of awareness of childhood obesity as a current issue. CONCLUSIONS The results highlight the need to act on childhood obesity through lifestyle prevention strategies early in life.
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Affiliation(s)
- Debora Porri
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Giovanni Luppino
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
| | - Letteria Anna Morabito
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Elisa La Rosa
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Maria Francesca Messina
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
| | - Angela Alibrandi
- Department of Economics, University of Messina, 98100 Messina, Italy;
| | - Debora Di Mauro
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy;
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
| | - Malgorzata Gabriela Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (D.P.); (G.P.); (D.C.); (M.V.); (M.F.M.); (G.Z.); (A.L.P.); (T.A.); (M.G.W.)
- Pediatric Unit, “G. Martino” University Hospital, 98124 Messina, Italy; (L.A.M.); (E.L.R.)
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Weijie Z, Meng Z, Chunxiao W, Lingjie M, Anguo Z, Yan Z, Xinran C, Yanjiao X, Li S. Obesity-induced chronic low-grade inflammation in adipose tissue: A pathway to Alzheimer's disease. Ageing Res Rev 2024; 99:102402. [PMID: 38977081 DOI: 10.1016/j.arr.2024.102402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/19/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
Alzheimer's disease (AD) is a leading cause of cognitive impairment worldwide. Overweight and obesity are strongly associated with comorbidities, such as hypertension, diabetes, and insulin resistance (IR), which contribute substantially to the development of AD and subsequent morbidity and mortality. Adipose tissue (AT) is a highly dynamic organ composed of a diverse array of cell types, which can be classified based on their anatomic localization or cellular composition. The expansion and remodeling of AT in the context of obesity involves immunometabolic and functional shifts steered by the intertwined actions of multiple immune cells and cytokine signaling within AT, which contribute to the development of metabolic disorders, IR, and systemic markers of chronic low-grade inflammation. Chronic low-grade inflammation, a prolonged, low-dose stimulation by specific immunogens that can progress from localized sites and affect multiple organs throughout the body, leads to neurodystrophy, increased apoptosis, and disruption of homeostasis, manifesting as brain atrophy and AD-related pathology. In this review, we sought to elucidate the mechanisms by which AT contributes to the onset and progression of AD in obesity through the mediation of chronic low-grade inflammation, particularly focusing on the roles of adipokines and AT-resident immune cells.
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Affiliation(s)
- Zhai Weijie
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Zhao Meng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Wei Chunxiao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Meng Lingjie
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Zhao Anguo
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou 215000 China
| | - Zhang Yan
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Cui Xinran
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Xu Yanjiao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Sun Li
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China; Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China.
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Ferreira K, Kont E, Abdelkhalik A, Jones D, Baker‐Knight J. The out-of-pocket cost of living with obesity: Results from a survey in Spain, South Korea, Brazil, India, Italy, and Japan. Obes Sci Pract 2024; 10:e70000. [PMID: 39144067 PMCID: PMC11324092 DOI: 10.1002/osp4.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/24/2024] [Accepted: 08/03/2024] [Indexed: 08/16/2024] Open
Abstract
Objectives In many countries, obesity treatments are not fully reimbursed by healthcare systems. People living with obesity (PwO) often pay out-of-pocket (OOP) for pharmacological and non-pharmacological interventions, placing them in a position of financial risk to manage their condition. This study sought to understand the OOP expenditures and non-financial costs incurred by PwO to manage weight. Methods A 25-min cross-sectional online survey was conducted with PwO between ages 18-60 in Italy, Japan, India, Brazil, Spain and South Korea. Respondents were recruited using proprietary vendor panels and non-probability sampling. N = 600 participants completed the survey (n = 100 per country). Results The mean annual OOP expenditure related to weight loss/management was $7,351, accounting for nearly 17% of annual household income. Costs generally increased by BMI. Half or more of the respondents agreed that obesity affected multiple aspects of their lives (outside activities, running a household, social life, work, family life, traveling). 46% agreed that obesity limited their job prospects. Conclusion PwO spend a notable amount of their income paying OOP expenditures related to managing their weight. Quantifying the individual economic burden of living with obesity can inform the understanding of the resources required and policy changes needed to treat obesity as a disease.
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Bomberg EM, Clark J, Rudser KD, Gross AC, Kelly AS, Fox CK. Effectiveness and predictors of weight loss response to phentermine plus lifestyle modifications among youth in a paediatric weight management clinical setting. Pediatr Obes 2024; 19:e13143. [PMID: 38886982 PMCID: PMC11239309 DOI: 10.1111/ijpo.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Anti-obesity medications (AOMs) are promising lifestyle modification (LSM) adjuncts for obesity treatment, and phentermine is commonly prescribed in paediatric weight management clinics. Determining 'real-world' AOM effectiveness and characteristics predicting response is important. OBJECTIVES We sought to describe phentermine plus LSM effectiveness and identify baseline characteristics predicting response. METHODS This was a retrospective cohort study among youth seen in a US academic-based weight management clinic from 2012 to 2020. Baseline characteristics (e.g., body mass index (BMI), liver transaminases, eating-related behaviours) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, %BMI change, weight) were determined through electronic health records and intake surveys. RESULTS Among 91 youth prescribed phentermine plus LSM over 8 years (mean %BMIp95 150%), %BMIp95 was statistically significantly reduced at 1.5, 3, 6 and 12 months (peak reduction 10.9 percentage points at 6 months; p < 0.001). Considering multiple comparisons, the presence of baseline elevated alanine aminotransferase was associated with statistically significant smaller 1.5-month %BMIp95 reductions (p = 0.001) and higher food responsiveness with smaller 3- (p = 0.001) and 6-month (p < 0.001) reductions. CONCLUSIONS Phentermine plus LSM reduced %BMIp95 among youth in a weight management clinic, and baseline characteristics may help determine those more or less likely to respond. Prospective studies are needed to further characterize effectiveness and confirm response predictors.
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Affiliation(s)
- Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Justin Clark
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle D Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
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10
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Neuman T, Corrado R, Banaag A, Koehlmoos TP. Utilization of antiobesity medications within the Military Health System. Obesity (Silver Spring) 2024. [PMID: 39089987 DOI: 10.1002/oby.24097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The prevalence of overweight and obesity among beneficiaries of the Military Health System (MHS) is 41.6% and 30.5%, respectively. This incurs significant medical, fiscal, and military readiness costs. It is not currently known how the utilization of antiobesity medications (AOMs) within the MHS compares with that in the Veterans Health Administration or the private sector. Our aim was to assess the utilization of AOMs within the MHS. METHODS A cross-sectional study was conducted using data gathered from the MHS Data Repository and the inclusion of all adult TRICARE Prime and Plus beneficiaries ages 18 to 64 years who were prescribed at least one TRICARE-approved AOM during the years 2018 to 2022. RESULTS The total study population included 4,414,127 beneficiaries, of whom 1,871,780 were active-duty service members. The utilization of AOMs among the eligible population was 0.56% (0.44% among active-duty personnel). Liraglutide was the most-prescribed AOM (36% of the total). Female sex, age greater than or equal to 30 but less than 60 years, and enlisted or warrant officer rank were all associated with statistically significant higher odds of receiving AOMs. CONCLUSIONS Comparable with the US private sector, the MHS significantly underutilizes AOMs, including among active-duty service members, despite coverage of AOMs since 2018.
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Affiliation(s)
- Taylor Neuman
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Richele Corrado
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Amanda Banaag
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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11
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Welling MS, de Groot CJ, Mohseni M, Meeusen RE, Boon MR, van Haelst MM, van den Akker EL, van Rossum EF. Treatment with liraglutide or naltrexone-bupropion in patients with genetic obesity: a real-world study. EClinicalMedicine 2024; 74:102709. [PMID: 39050109 PMCID: PMC11268126 DOI: 10.1016/j.eclinm.2024.102709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Background Rare genetic obesity commonly features early-onset obesity, hyperphagia, and therapy-resistance to lifestyle interventions. Pharmacotherapy is often required to treat hyperphagia and induce weight loss. We describe clinical outcomes of glucagon-like peptide-1 analogue liraglutide or naltrexone-bupropion treatment in adults with molecularly confirmed genetic obesity (MCGO) or highly suspected for genetic obesity without definite diagnosis (HSGO). Methods We conducted a real-world cohort study at the Obesity Center CGG at Erasmus University Center, Rotterdam, Netherlands, between March 19, 2019, and August 14, 2023. All patients with MCGO and HSGO who were treated with either liraglutide or naltrexone-bupropion were included. Liraglutide 3 mg and naltrexone-bupropion were administered according to the manufacturer's protocol. Treatment evaluation occurred short-term, after 12 weeks on maximum or highest-tolerated dose, preceded by the 4-5 week dose escalation phase. Differences in anthropometrics, body composition, metabolic markers, self-reported appetite, eating behaviour, and quality of life (QoL) were evaluated. Findings Ninety-eight adults were included in the analysis: 23 patients with MCGO and 75 patients with HSGO, with median BMI of 42.0 kg/m2 (IQR 38.7-48.2) and 43.7 kg/m2 (IQR 38.0-48.7), respectively. After liraglutide treatment, median weight at evaluation significantly decreased compared to baseline in both groups: -4.7% (IQR -6.0 to -1.5) in patients with MCGO and -5.2% (IQR -8.1 to -3.5) in patients with HSGO. Additionally, improvements were observed in appetite, fat mass, fasting glucose, and HbA1c in both patients with MCGO and with HSGO. Patients with HSGO also reported significant improvements in several domains of QoL and eating behaviour. In patients with MCGO and HSGO treated with naltrexone-bupropion, mean weight at evaluation significantly differed from baseline: -5.2% ± 5.8 in patients with MCGO and -4.4% ± 4.7 in patients with HSGO. Appetite, fat mass, and waist circumference significantly decreased in both groups. Obesity-related comorbidities improved in significant proportions of patients treated with liraglutide or naltrexone-bupropion. Interpretation In conclusion, our short-term findings show potential of liraglutide and naltrexone-bupropion as treatment options for adults with (a clinical phenotype of) genetic obesity. Funding MB, EvdA, and EvR are supported by the Elisabeth Foundation, a non-profit foundation supporting academic obesity research.
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Affiliation(s)
- Mila S. Welling
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Cornelis J. de Groot
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Mostafa Mohseni
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Renate E.H. Meeusen
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mariëtte R. Boon
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mieke M. van Haelst
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Erica L.T. van den Akker
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elisabeth F.C. van Rossum
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Keino BC, Carrel M. Multilevel factors associated with overweight and obesity in East Africa: Comparative analysis in five countries from 2003 to 2016. Health Place 2024; 89:103326. [PMID: 39067171 DOI: 10.1016/j.healthplace.2024.103326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/03/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
Rising rates of overweight/obesity in sub-Saharan Africa (SSA) are a growing concern. Regional analysis of sociodemographic factors associated with overweight/obesity, as is common, may mask nationally specific associations. We examine the spatiotemporal trends of overweight/obesity in women (15-49 years) using 13 years of data (2003-2016) from Demographic and Health Surveys in five East African countries. Multivariable logistic regression reveals that urbanization and individual education, wealth, employment, marital status, and age are linked to overweight/obesity in the region, but their influence varied between nations. Variations in sociodemographic risk factors across nations underscore the need for tailored surveillance and interventions to address the increasing burden of overweight/obesity in East Africa.
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Affiliation(s)
- Barbara Chebet Keino
- Department of Geographical Sciences and Sustainability, University of Iowa, Iowa City, Iowa, USA.
| | - Margaret Carrel
- Department of Geographical Sciences and Sustainability, University of Iowa, Iowa City, Iowa, USA.
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13
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Al Zein M, Akomolafe AF, Mahmood FR, Khrayzat A, Sahebkar A, Pintus G, Kobeissy F, Eid AH. Leptin is a potential biomarker of childhood obesity and an indicator of the effectiveness of weight-loss interventions. Obes Rev 2024:e13807. [PMID: 39044542 DOI: 10.1111/obr.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/12/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
Childhood obesity represents a significant public health concern, imposing a substantial burden on the healthcare system. Furthermore, weight-loss programs often exhibit reduced effectiveness in adults who have a history of childhood obesity. Therefore, early intervention against childhood obesity is imperative. Presently, the primary method for diagnosing childhood obesity relies on body mass index (BMI), yet this approach has inherent limitations. Leptin, a satiety hormone produced by adipocytes, holds promise as a superior tool for predicting both childhood and subsequent adulthood obesity. In this review, we elucidate the tools employed for assessing obesity in children, delve into the biological functions of leptin, and examine the factors governing its expression. Additionally, we discuss maternal and infantile leptin levels as predictors of childhood obesity. By exploring the relationship between leptin levels and weight loss, we present leptin as a potential indicator of the effectiveness of obesity interventions.
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Affiliation(s)
- Mohammad Al Zein
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Fathima R Mahmood
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ali Khrayzat
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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14
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Mohamed AI, Erukainure OL, Salau VF, Islam MS. Impact of coffee and its bioactive compounds on the risks of type 2 diabetes and its complications: A comprehensive review. Diabetes Metab Syndr 2024; 18:103075. [PMID: 39067326 DOI: 10.1016/j.dsx.2024.103075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Coffee beans have a long history of use as traditional medicine by various indigenous people. Recent focus has been given to the health benefits of coffee beans and its bioactive compounds. Research on the bioactivities, applications, and effects of processing methods on coffee beans' phytochemical composition and activities has been conducted extensively. The current review attempts to provide an update on the biological effects of coffee on type 2 diabetes (T2D) and its comorbidities. METHODS Comprehensive literature search was carried out on peer-reviewed published data on biological activities of coffee on in vitro, in vivo and epidemiological research results published from January 2015 to December 2022, using online databases such as PubMed, Google Scholar and ScienceDirect for our searches. RESULTS The main findings were: firstly, coffee may contribute to the prevention of oxidative stress and T2D-related illnesses such as cardiovascular disease, retinopathy, obesity, and metabolic syndrome; secondly, consuming up to 400 mg/day (1-4 cups per day) of coffee is associated with lower risks of T2D; thirdly, caffeine consumed between 0.5 and 4 h before a meal may inhibit acute metabolic rate; and finally, both caffeinated and decaffeinated coffee are associated with reducing the risks of T2D. CONCLUSION Available evidence indicates that long-term consumption of coffee is associated with decreased risk of T2D and its complications as well as decreased body weight. This has been attributed to the consumption of coffee with the abundance of bioactive chemicals.
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Affiliation(s)
- Almahi I Mohamed
- Department of Biochemistry, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa
| | - Ochuko L Erukainure
- Department of Biochemistry, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa; Department of Microbiology, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa
| | - Veronica F Salau
- Department of Biochemistry, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa; Department of Pharmacology, University of the Free State, Bloemfontein, 9300, South Africa
| | - Md Shahidul Islam
- Department of Biochemistry, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa.
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15
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Colangeli L, Russo B, Capristo E, Mariani S, Tuccinardi D, Manco M, Scipione V, Parrotta ME, Capoccia D, Guglielmi V. Attitudes, weight stigma and misperceptions of weight loss strategies among patients living with obesity in the Lazio Region, Italy. Front Endocrinol (Lausanne) 2024; 15:1434360. [PMID: 39076509 PMCID: PMC11284042 DOI: 10.3389/fendo.2024.1434360] [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: 05/17/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Patient engagement is essential to achieve long-term goals in obesity management. It is crucial to identify patients' perspectives, misperceptions and unmet educational needs on obesity etiology and treatments, to establish a correct therapeutic alliance between healthcare providers and patients. Methods Objective: This study, promoted by the regional section of the Italian Obesity Society (SIO Lazio), explores attitudes towards obesity, self-awareness, misperceptions of weight loss strategies, experiences of weight stigma and educational needs of patients living with overweight or obesity. Design and subject: We conducted an anonymous survey among patients who accessed an Obesity Management Centers across the Lazio region of Italy for the first time, from October 2023 to April 2024. Approach: The survey consisted of 27 closed-ended questions grouped into 4 sections: (1) sociodemographic factors and self-reported anthropometric measures; (2) self-awareness and attitudes towards obesity and weight loss strategies; (3) experiences of obesity-related stigma; (4) knowledge and perceptions of obesity treatment options. Results A total of 300 patients (67.9% women, aged 49.1 ± 14.4 years) returned completed surveys. Despite the self-reported BMI 35.3 ± 7.0 kg/m2 with three out of four (75.3%) of participants having a BMI ≥ 30 kg/m2, only 49% correctly identified themselves as affected by obesity. Almost one-third of the patients believed that obesity does not imply a genetic predisposition (31.9%) and that it is always secondary to psychological or behavioral disorders (29.7%). Interestingly, 66.7% of the patients declared themselves as completely responsible for their own condition and 39.4% considered obesity always treatable by means of lifestyle interventions. Stigma and weight discrimination in healthcare settings were reported by a substantial portion of patients (31.9%). A perception of inadequate support from the National Healthcare System emerged in most of the interviews (61.9%). Most patients (72.1%) felt they were not sufficiently informed about anti-obesity medications and a relevant part of their knowledge was derived from healthcare providers (57.7%) and social networks (19.1%). Weight loss medications were considered useful (63.2%) or necessary (18.4%) by the majority of patients, but only 60.1% would accept without any hesitation a pharmacologic treatment. The main reasons for refusal of pharmacological treatments were the belief that lifestyle intervention is a sufficient treatment (46.9%), the fear of adverse effects (28.1%) and feeling defeated (12.5%). Similarly, for most of participants bariatric surgery is useful (73.3%) or necessary (13.6%). Conclusion Despite advancements in obesity research, this study underscores the need to improve patient education and public awareness to optimize the management and treatment of obesity. Addressing misconceptions, stigma, and gaps in knowledge are critical steps towards improving patient outcomes and fostering a supportive healthcare environment.
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Affiliation(s)
- Luca Colangeli
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Unit - Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Benedetta Russo
- Unit of Endocrinology, Isola Tiberina - Gemelli Isola Hospital, Rome, Italy
- Executive Committee of the Regional Section of the Italian Obesity Society (SIO Lazio), Rome, Italy
| | - Esmeralda Capristo
- Executive Committee of the Regional Section of the Italian Obesity Society (SIO Lazio), Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Mariani
- Executive Committee of the Regional Section of the Italian Obesity Society (SIO Lazio), Rome, Italy
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Dario Tuccinardi
- Executive Committee of the Regional Section of the Italian Obesity Society (SIO Lazio), Rome, Italy
- Department of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Melania Manco
- Executive Committee of the Regional Section of the Italian Obesity Society (SIO Lazio), Rome, Italy
- Preventive and Predictive Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valeria Scipione
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Unit - Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Maria Eugenia Parrotta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Unit - Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Danila Capoccia
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Valeria Guglielmi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Unit - Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
- Executive Committee of the Regional Section of the Italian Obesity Society (SIO Lazio), Rome, Italy
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Mo Y, Li Y, Liang S, Wang W, Zhang H, Zhao J, Xu M, Zhang X, Cao H, Xie S, Lv Y, Wu Y, Zhang Z, Yang W. Urinary enterolignans and enterolignan-predicting microbial species are favourably associated with liver fat and other obesity markers. Food Funct 2024; 15:7305-7313. [PMID: 38874113 DOI: 10.1039/d3fo05632e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Aims: Plant-derived lignans may protect against obesity, while their bioactivity needs gut microbial conversion to enterolignans. We used repeated measures to identify enterolignan-predicting microbial species and investigate whether enterolignans and enterolignan-predicting microbial species are associated with obesity. Methods: Urinary enterolignans, fecal microbiota, body weight, height, and circumferences of the waist (WC) and hips (HC) were repeatedly measured at the baseline and after 1 year in 305 community-dwelling adults in Huoshan, China. Body composition and liver fat [indicated by the controlled attenuation parameter (CAP)] were measured after 1 year. Multivariate-adjusted linear models and linear mixed-effects models were used to analyze single and repeated measurements, respectively. Results: Enterolactone and enterodiol levels were both inversely associated with the waist-to-hip ratio, body fat mass (BFM), visceral fat level (VFL), and liver fat accumulation (all P < 0.05). Enterolactone levels were also associated with lower WC (β = -0.0035 and P = 0.013) and HC (β = -0.0028 and P = 0.044). We identified multiple bacterial genera whose relative abundance was positively associated with the levels of enterolactone (26 genera) and enterodiol (22 genera, all P false discovery rate < 0.05), and constructed the enterolactone-predicting microbial score and enterodiol-predicting microbial score to reflect the overall enterolignan-producing potential of the host gut microbiota. Both these scores were associated with lower body weight and CAP (all P < 0.05). The enterolactone-predicting microbial score was also inversely associated with the BFM (β = -0.1128 and P = 0.027) and VFL (β = -0.1265 and P = 0.044). Conclusion: Our findings support that modulating the host gut microbiome could be a potential strategy to prevent obesity by enhancing the production of enterolignans.
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Affiliation(s)
- Yufeng Mo
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China
| | - Yamin Li
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Shaoxian Liang
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wuqi Wang
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Honghua Zhang
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jiajia Zhao
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Mengting Xu
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoyu Zhang
- Department of Physical Examination Center, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hongjuan Cao
- Department of Chronic Non-communicable Diseases Prevention and Control, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Shaoyu Xie
- Department of Chronic Non-communicable Diseases Prevention and Control, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Yaning Lv
- Technology Center of Hefei Customs, and Anhui Province Key Laboratory of Analysis and Detection for Food Safety, Hefei, Anhui, China
| | - Yaqin Wu
- Technology Center of Hefei Customs, and Anhui Province Key Laboratory of Analysis and Detection for Food Safety, Hefei, Anhui, China
| | - Zhuang Zhang
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanshui Yang
- Department of Nutrition, Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China
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Cao N, Zhao F, Kwok LY, Wang H, Sun Z. Impact of probiotics on weight loss, glucose and lipid metabolism in overweight or obese women: A meta-analysis of randomized controlled trials. Curr Res Food Sci 2024; 9:100810. [PMID: 39114432 PMCID: PMC11305212 DOI: 10.1016/j.crfs.2024.100810] [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: 06/19/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Our meta-analysis aimed to assess the effectiveness of probiotics in weight loss and glucose and lipid metabolism in overweight or obese women. PubMed, EMBASE, Cochrane Library, and Web of Science were used from inception until March 2024 to identify randomized controlled trials (RCT's) literature. Finally, 11 RCTs were included. Following critical appraisal, a meta-analysis was conducted using the fixed effects model and the random effects model found that probiotic consumption significantly decreased waist circumference (WC) (SMD = -0.39 cm, 95% CI: -0.60, -0.18 cm, P < 0.00001, I2 = 33%), insulin (SMD = -0.45 mcU/ml; 95% CI: -0.72, -0.18 mcU/ml; P = 0.04, I2 = 40%) and low-density lipoprotein cholesterol (LDL-C) levels (SMD = -0.51 mmol/L; 95% CI: -0.92, -0.11 mmol/L; P = 0.02, I2 = 75%) in overweight or obese women. Moreover, subgroup analyses revealed that the effects of probiotic supplementation were significantly influenced by the intervention duration and diet and/or exercise intervention. This meta-analysis suggested that probiotic supplementation has a moderate and statistically significant effect on weight loss and glucose and lipid metabolism in overweight and obese women.
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Affiliation(s)
- Ning Cao
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Hohhot, 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Hohhot, 010018, China
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, 010018, China
- School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Feiyan Zhao
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Hohhot, 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Hohhot, 010018, China
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, 010018, China
| | - Lai-Yu Kwok
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Hohhot, 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Hohhot, 010018, China
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, 010018, China
| | - Huan Wang
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Hohhot, 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Hohhot, 010018, China
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, 010018, China
- People's Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia 010110, China
| | - Zhihong Sun
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering, Hohhot, 010018, China
- Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs, Hohhot, 010018, China
- Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, 010018, China
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Aldosari BN, Tawfeek HM, Abdellatif AAH, Almurshedi AS, Alfagih IM, AlQuadeib BT, Abbas AYA, Mohammed HM, Hassan YA, Fayed MH, Tolba NS. Comparative study of Lepidium sativum orally administered seeds, hydrogel and atorvastatin on obesity of rats fed on a high fat diet. Drug Dev Ind Pharm 2024:1-14. [PMID: 38963406 DOI: 10.1080/03639045.2024.2376624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Obesity has become a prevalent issue worldwide, leading to various complications such as hyperlipidemia, diabetes, and cardiovascular problems. Statins, as FDA approved anti-hyperlipidemic drugs, still pose some concerns upon their administration. Recently, researchers have looked for natural products as an alternative to manage hyperlipidemia and obesity. AIM This work aimed to study the hypolipidemic effect of Lepidium sativum garden cress (GC) from different preparations; orally administered seeds, and hydrogel, in comparison to atorvastatin. METHODS GC hydrogel was prepared from the GC aqueous extract and pharmaceutically evaluated for its pH, spreadability, seeds content, homogeneity, rheology, and in vitro release. The rat's body weight, blood glucose levels, total lipid profile, and liver biomarkers were evaluated on obese rats for one month. In addition, the histopathology study was also performed. RESULTS GC hydrogel had acceptable pharmaceutical properties and showed a sustained release performance over 24 h. Oral and topical GC significantly reduced the lipid profiles, blood sugar and ALT, AST levels more than the negative control group and comparable to atorvastatin. It was found that oral GC showed a significant effect on the percentage decrease in the rat's body weight than the applied hydrogel. Histopathology study revealed a better outcome in the histological structure of pancreas and liver compared with rats feed on high fat diet post-treatment for one month. CONCLUSION GC orally administered, or topically applied hydrogel could be a promising, safe alternative formulation to atorvastatin in managing hyperlipidemia and normalizing body weight of obese rats.
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Affiliation(s)
- Basmah N Aldosari
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hesham M Tawfeek
- Industrial Pharmacy Department, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Ahmed A H Abdellatif
- Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt
| | | | - Iman Mohammed Alfagih
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Asmaa Youssef A Abbas
- Histology and Cell Biology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Heba M Mohammed
- Puplic Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yasser A Hassan
- Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Egypt
| | - Mohamed H Fayed
- Department of Pharmaceutics, College of Pharmacy, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia
- Department of Pharmaceutics, Faculty of Pharmacy, Fayoum University, Faiyum, Egypt
| | - Nahla Sameh Tolba
- Department of Pharmaceutics, Faculty of Pharmacy, Sadat City University, Sadat City, Egypt
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19
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Busetto L, Dicker D, Frühbeck G, Halford JCG, Sbraccia P, Yumuk V, Goossens GH. A new framework for the diagnosis, staging and management of obesity in adults. Nat Med 2024:10.1038/s41591-024-03095-3. [PMID: 38969880 DOI: 10.1038/s41591-024-03095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Affiliation(s)
- Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy.
| | - Dror Dicker
- Internal Medicine Department and Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain
| | | | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gijs H Goossens
- Department of Human Biology, Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center⁺, Maastricht, The Netherlands
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20
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Cheng Y, Liang S, Zhang S, Hui X. Thermogenic Fat as a New Obesity Management Tool: From Pharmaceutical Reagents to Cell Therapies. Biomedicines 2024; 12:1474. [PMID: 39062047 PMCID: PMC11275133 DOI: 10.3390/biomedicines12071474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Obesity is a complex medical condition caused by a positive imbalance between calorie intake and calorie consumption. Brown adipose tissue (BAT), along with the newly discovered "brown-like" adipocytes (called beige cells), functions as a promising therapeutic tool to ameliorate obesity and metabolic disorders by burning out extra nutrients in the form of heat. Many studies in animal models and humans have proved the feasibility of this concept. In this review, we aim to summarize the endeavors over the last decade to achieve a higher number/activity of these heat-generating adipocytes. In particular, pharmacological compounds, especially agonists to the β3 adrenergic receptor (β3-AR), are reviewed in terms of their feasibility and efficacy in elevating BAT function and improving metabolic parameters in human subjects. Alternatively, allograft transplantation of BAT and the transplantation of functional brown or beige adipocytes from mesenchymal stromal cells or human induced pluripotent stem cells (hiPSCs) make it possible to increase the number of these beneficial adipocytes in patients. However, practical and ethical issues still need to be considered before the therapy can eventually be applied in the clinical setting. This review provides insights and guidance on brown- and beige-cell-based strategies for the management of obesity and its associated metabolic comorbidities.
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Affiliation(s)
- Ying Cheng
- Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, China;
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China; (S.L.); (S.Z.)
| | - Shiqing Liang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China; (S.L.); (S.Z.)
| | - Shuhan Zhang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China; (S.L.); (S.Z.)
| | - Xiaoyan Hui
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China; (S.L.); (S.Z.)
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21
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Joseph S, McGowan CE, Jirapinyo P, Schulman AR, Thaker AM, Dayyeh BKA, Maselli D, Amundson JR, Zimmermann CJ, VanDruff VN, Che S, Ishii S, Ujiki MB. Endoscopic sleeve gastroplasty: the identification of the key procedural steps through a modified Delphi method. J Gastrointest Surg 2024; 28:1132-1136. [PMID: 38599314 DOI: 10.1016/j.gassur.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an innovative, minimally invasive bariatric procedure with an excellent safety and efficacy profile in adults with obesity. The purpose of the procedure is to shorten and tubularize the stomach along its greater curvature. Nevertheless, there are some heterogeneities in the approach to ESG, which will be important to address as the procedure sees increasingly widespread clinical adoption. Here, an expert consensus on standardized ESG techniques is presented. METHODS The modified Delphi method was used to establish the key procedural steps of an ESG. A panel of 8 experts was selected, of which 6 participated. The panel was selected based on their experience with performing the procedure and consisted of 1 bariatric surgeon and 5 interventional gastroenterologists. A neutral facilitator was designated and produced a skeletonized initial version of the key steps that was sent to each expert. Each survey began with the experts rating the given steps on a Likert scale of 1 to 5, with 1 being the most inaccurate and 5 being the most accurate. Furthermore, the final product was rated. The survey continued with open-ended questions designed to revise and polish the key steps. Areas of discrepancy were addressed using binary questions and a majority vote. The respondents were given 10 days to complete each survey. At the end of each round, the survey was redistributed with updated key steps and questions. This process was continued for a predesignated 3 rounds. RESULTS Of the 8 experts who were queried, 6/8, 5/8, and 5/8 replied to each round. The given ratings for the accuracy of the steps in each round were 4.2, 4.6, and 4.4. The final rating was 4.8. Although expert opinion varied around smaller portions of the procedure, such as the placement of an overtube and the shape of each suture line, there was consensus on the need for full-thickness bites and appropriate swirling of the tissue with the helix device. Whether or not to include the fundus in the gastroplasty was an additional area of discrepancy. Of note, 4 of 5 experts agreed that the fundus should remain intact. The final protocol consisted of 21 steps curated from the summarized responses of the experts. CONCLUSION Using the modified Delphi method, 21 key steps have been described for a safe and effective ESG. This rubric will be standardized across institutions and practitioners. Furthermore, these findings allow for the generation of educational assessment tools to facilitate training and increase the adoption of ESG by endoscopists.
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Affiliation(s)
- Stephanie Joseph
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States.
| | - Christopher E McGowan
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Pichamol Jirapinyo
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Allison R Schulman
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Adarsh M Thaker
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Barham K Abu Dayyeh
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Daniel Maselli
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Julia R Amundson
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | | | - Vanessa N VanDruff
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Simon Che
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Shun Ishii
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, United States
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Pálsson TG, Gilliam-Vigh H, Jensen BAH, Jeppesen PB, Lund AB, Knop FK, Nielsen CK. Targeting the GLP-2 receptor in the management of obesity. Peptides 2024; 177:171210. [PMID: 38579917 DOI: 10.1016/j.peptides.2024.171210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
Recent advancements in understanding glucagon-like peptide 2 (GLP-2) biology and pharmacology have sparked interest in targeting the GLP-2 receptor (GLP-2R) in the treatment of obesity. GLP-2 is a proglucagon-derived 33-amino acid peptide co-secreted from enteroendocrine L cells along with glucagon-like peptide 1 (GLP-1) and has a range of actions via the GLP-2R, which is particularly expressed in the gastrointestinal tract, the liver, adipose tissue, and the central nervous system (CNS). In humans, GLP-2 evidently induces intestinotrophic effects (i.e., induction of intestinal mucosal proliferation and improved gut barrier function) and promotes mesenteric blood flow. However, GLP-2 does not seem to have appetite or food intake-reducing effects in humans, but its gut barrier-promoting effect may be of interest in the context of obesity. Obesity is associated with reduced gut barrier function, increasing the translocation of proinflammatory gut content to the circulation. This phenomenon constitutes a strong driver of obesity-associated systemic low-grade inflammation, which in turn plays a major role in the development of most obesity-associated complications. Thus, the intestinotrophic and gut barrier-improving effect of GLP-2, which in obese rodent models shows strong anti-inflammatory potential, may, in combination with food intake-reducing strategies, e.g., GLP-1 receptor (GLP-1) agonism, be able to rectify core pathophysiological mechanism of obesity. Here, we provide an overview of GLP-2 physiology in the context of obesity pathophysiology and review the pharmacological potential of GLP-2R activation in the management of obesity and related comorbidities.
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Affiliation(s)
- Thorir G Pálsson
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Hannah Gilliam-Vigh
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Benjamin A H Jensen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Palle B Jeppesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Intestinal Failure and Liver Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Asger B Lund
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark; Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Casper K Nielsen
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
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23
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Anastasiadou D, Tárrega S, Fornieles-Deu A, Moncada-Ribera A, Bach-Faig A, Sánchez-Carracedo D. Experienced and internalized weight stigma among Spanish adolescents. BMC Public Health 2024; 24:1743. [PMID: 38951859 PMCID: PMC11218352 DOI: 10.1186/s12889-024-19246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Weight stigma has negative consequences for both physiological and psychological health. Studies on weight stigma in adolescence, particularly from general populations, are scarce in the Mediterranean area. The main aim of this study is to describe the prevalence of experienced and internalized weight stigma among a representative sample of adolescents from the Spanish city of Terrassa, and to determine its association with sociodemographic variables and weight status. METHODS Drawing on data from the initial assessment of a longitudinally funded project on weight stigma in adolescents, a cross-sectional survey-based study was conducted using random multistage cluster sampling. Weight stigma experiences, their frequency and sources, and weight bias internalization with the Modified Weight Bias Internalization Scale (WBISM) were assessed in a sample of 1016 adolescents. Adjusted odds ratios (AOR) between sociodemographic variables, weight status and having experienced weight stigma, and having reported high scores of WBISM (WBISM ≥ 4) were estimated by multiple logistic regression models. RESULTS The prevalence of weight-related stigma experiences was 43.2% in the sample (81.8 in adolescents with obesity) and the prevalence of high levels of weight bias internalization was 19.4% (50.7 in adolescents with obesity). Other kids and school were the most prevalent sources of weight stigma, with society and family being other significant sources of stigma reported by girls. A significantly higher risk of having experienced weight stigma was observed in girls (AOR = 2.6) and in older adolescents (AOR = 1.9). Compared to normal weight adolescents, all weight statuses showed higher risk, being 3.4 times higher in adolescents with underweight and reaching 11.4 times higher risk in those with obesity. Regarding high levels of weight bias internalization, girls had a risk 6.6 times higher than boys. Once again, a "J-shaped" pattern was observed, with a higher risk at the lowest and highest weight statuses. The risk was 6.3 times higher in adolescents with underweight, and 13.1 times higher in adolescents with obesity compared to those with normal weight. CONCLUSIONS Considering the high prevalence of experienced and internalized weight stigma among adolescents in Spain, especially in adolescents with obesity and girls, it seems important to implement preventive strategies in different settings and address all sources of stigma.
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Affiliation(s)
- Dimitra Anastasiadou
- Eating and Weight-Related Problems Unit, Universitat Autònoma de Barcelona, Edifici B. Campus de la UAB. 08193, Bellaterra (Cerdanyola del Vallés), Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Edifici B. Campus de la UAB. 08193, Bellaterra (Cerdanyola del Vallés), Barcelona, Spain
| | - Salomé Tárrega
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Edifici B. Campus de la UAB. 08193, Bellaterra (Cerdanyola del Vallés), Barcelona, Spain
- Department of Epidemiology and Methodology of Social and Health Sciences, Faculty of Health Sciences at Manresa, Universitat de Vic - Universitat Central de Catalunya (UVic- UCC), Av. Universitària, 4-6, Manresa, 08242, Spain
- Research Group in Epidemiology and Public Health in the Digital Health context (Epi4Health), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), Ctra. De Roda Núm. 70, Vic, 08500, Spain
| | - Albert Fornieles-Deu
- Eating and Weight-Related Problems Unit, Universitat Autònoma de Barcelona, Edifici B. Campus de la UAB. 08193, Bellaterra (Cerdanyola del Vallés), Barcelona, Spain
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona Serra Húnter fellow, Edifici B. Campus de la UAB, 08193, Bellaterra (Cerdanyola del Vallés), Barcelona, Spain
| | - Albert Moncada-Ribera
- Head of Community and Health Service, Social Rights Section, City Council of Terrassa, Ca. Torres Garcia 35, Terrassa, Barcelona, 08221, Spain
| | - Anna Bach-Faig
- Food Lab Research Group, Faculty of Health Sciences (2021 SGR 01357), Open University of Catalonia (UOC), Barcelona, 08018, Spain
| | - David Sánchez-Carracedo
- Eating and Weight-Related Problems Unit, Universitat Autònoma de Barcelona, Edifici B. Campus de la UAB. 08193, Bellaterra (Cerdanyola del Vallés), Barcelona, Spain.
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Edifici B. Campus de la UAB. 08193, Bellaterra (Cerdanyola del Vallés), Barcelona, Spain.
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Wong KYY, Moy FM, Shafie A, Rampal S. Identifying obesogenic environment through spatial clustering of body mass index among adults. Int J Health Geogr 2024; 23:16. [PMID: 38926856 PMCID: PMC11201309 DOI: 10.1186/s12942-024-00376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The escalating trend of obesity in Malaysia is surmounting, and the lack of evidence on the environmental influence on obesity is untenable. Obesogenic environmental factors often emerge as a result of shared environmental, demographic, or cultural effects among neighbouring regions that impact lifestyle. Employing spatial clustering can effectively elucidate the geographical distribution of obesity and pinpoint regions with potential obesogenic environments, thereby informing public health interventions and further exploration on the local environments. This study aimed to determine the spatial clustering of body mass index (BMI) among adults in Malaysia. METHOD This study utilized information of respondents aged 18 to 59 years old from the National Health and Morbidity Survey (NHMS) 2014 and 2015 at Peninsular Malaysia and East Malaysia. Fast food restaurant proximity, district population density, and district median household income were determined from other sources. The analysis was conducted for total respondents and stratified by sex. Multilevel regression was used to produce the BMI estimates on a set of variables, adjusted for data clustering at enumeration blocks. Global Moran's I and Local Indicator of Spatial Association statistics were applied to assess the general clustering and location of spatial clusters of BMI, respectively using point locations of respondents and spatial weights of 8 km Euclidean radius or 5 nearest neighbours. RESULTS Spatial clustering of BMI independent of individual sociodemographic was significant (p < 0.001) in Peninsular and East Malaysia with Global Moran's index of 0.12 and 0.15, respectively. High-BMI clusters (hotspots) were in suburban districts, whilst the urban districts were low-BMI clusters (cold spots). Spatial clustering was greater among males with hotspots located closer to urban areas, whereas hotspots for females were in less urbanized areas. CONCLUSION Obesogenic environment was identified in suburban districts, where spatial clusters differ between males and females in certain districts. Future studies and interventions on creating a healthier environment should be geographically targeted and consider gender differences.
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Affiliation(s)
- Kimberly Yuin Y'ng Wong
- Centre of Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Foong Ming Moy
- Centre of Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Aziz Shafie
- Department of Geography, Faculty of Social Sciences, University Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Centre of Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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25
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Pantelis AG. Comment on Salazar et al. Weight Regain after Metabolic Surgery: Beyond the Surgical Failure. J. Clin. Med. 2024, 13, 1143. J Clin Med 2024; 13:3608. [PMID: 38930135 PMCID: PMC11205002 DOI: 10.3390/jcm13123608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
I read the article by Salazar J. [...].
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Affiliation(s)
- Athanasios G Pantelis
- Athens Medical Group, Obesity and Metabolic Disorders Department, Psychiko Clinic, 1 Andersen Str., Psychiko, 11525 Athens, Greece
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26
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Shenoy MT, Mondal S, Fernandez CJ, Pappachan JM. Management of male obesity-related secondary hypogonadism: A clinical update. World J Exp Med 2024; 14:93689. [PMID: 38948417 PMCID: PMC11212738 DOI: 10.5493/wjem.v14.i2.93689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 06/19/2024] Open
Abstract
The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism (MOSH) with emerging evidence on the role of testosterone therapy. We aim to provide an updated and practical approach towards its management. We did a comprehensive literature search across MEDLINE (via PubMed), Scopus, and Google Scholar databases using the keywords "MOSH" OR "Obesity-related hypogonadism" OR "Testosterone replacement therapy" OR "Selective estrogen receptor modulator" OR "SERM" OR "Guidelines on male hypogonadism" as well as a manual search of references within the articles. A narrative review based on available evidence, recommendations and their practical implications was done. Although weight loss is the ideal therapeutic strategy for patients with MOSH, achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice. Therefore, androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity. However, there is conflicting evidence for the appropriate use of testosterone replacement therapy (TRT), and it can also be associated with complications. This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH. Before starting testosterone replacement in functional hypogonadism of obesity, it would be desirable to initiate lifestyle modification to ensure weight reduction. TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients. Balancing the risks and benefits of TRT should be considered in every patient before and during long-term management.
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Affiliation(s)
- Mohan T Shenoy
- Department of Endocrinology, Sree Gokulam Medical College, and Research Foundation, Trivandrum 695607, Kerala, India
| | - Sunetra Mondal
- Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Cornelius James Fernandez
- Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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Warmbrunn MV, Bahrar H, de Clercq NC, Koopen AM, de Groot PF, Rutten J, Joosten LAB, Kootte RS, Bouter KEC, ter Horst KW, Hartstra AV, Serlie MJ, Soeters MR, van Raalte DH, Davids M, Levin E, Herrema H, Riksen NP, Netea MG, Groen AK, Nieuwdorp M. Novel Proteome Targets Marking Insulin Resistance in Metabolic Syndrome. Nutrients 2024; 16:1822. [PMID: 38931177 PMCID: PMC11206392 DOI: 10.3390/nu16121822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
CONTEXT/OBJECTIVE In order to better understand which metabolic differences are related to insulin resistance in metabolic syndrome (MetSyn), we used hyperinsulinemic-euglycemic (HE) clamps in individuals with MetSyn and related peripheral insulin resistance to circulating biomarkers. DESIGN/METHODS In this cross-sectional study, HE-clamps were performed in treatment-naive men (n = 97) with MetSyn. Subjects were defined as insulin-resistant based on the rate of disappearance (Rd). Machine learning models and conventional statistics were used to identify biomarkers of insulin resistance. Findings were replicated in a cohort with n = 282 obese men and women with (n = 156) and without (n = 126) MetSyn. In addition to this, the relation between biomarkers and adipose tissue was assessed by nuclear magnetic resonance imaging. RESULTS Peripheral insulin resistance is marked by changes in proteins related to inflammatory processes such as IL-1 and TNF-receptor and superfamily members. These proteins can distinguish between insulin-resistant and insulin-sensitive individuals (AUC = 0.72 ± 0.10) with MetSyn. These proteins were also associated with IFG, liver fat (rho 0.36, p = 1.79 × 10-9) and visceral adipose tissue (rho = 0.35, p = 6.80 × 10-9). Interestingly, these proteins had the strongest association in the MetSyn subgroup compared to individuals without MetSyn. CONCLUSIONS MetSyn associated with insulin resistance is characterized by protein changes related to body fat content, insulin signaling and pro-inflammatory processes. These findings provide novel targets for intervention studies and should be the focus of future in vitro and in vivo studies.
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Affiliation(s)
- Moritz V. Warmbrunn
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam UMC, Cardiovascular Sciences, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Harsh Bahrar
- Department of Internal Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands; (H.B.)
| | - Nicolien C. de Clercq
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Annefleur M. Koopen
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Pieter F. de Groot
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Joost Rutten
- Department of Internal Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands; (H.B.)
| | - Leo A. B. Joosten
- Department of Internal Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands; (H.B.)
| | - Ruud S. Kootte
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Kristien E. C. Bouter
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Kasper W. ter Horst
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Annick V. Hartstra
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Mireille J. Serlie
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maarten R. Soeters
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Daniel H. van Raalte
- Diabetes Center, Department of Endocrniology and Metabolism, Amsterdam UMC, VU University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Mark Davids
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Evgeni Levin
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Hilde Herrema
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Niels P. Riksen
- Department of Internal Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands; (H.B.)
| | - Mihai G. Netea
- Department of Internal Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands; (H.B.)
| | - Albert K. Groen
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.V.W.); (N.C.d.C.); (P.F.d.G.); (R.S.K.); (A.K.G.)
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Almandoz JP, Wadden TA, Tewksbury C, Apovian CM, Fitch A, Ard JD, Li Z, Richards J, Butsch WS, Jouravskaya I, Vanderman KS, Neff LM. Nutritional considerations with antiobesity medications. Obesity (Silver Spring) 2024. [PMID: 38853526 DOI: 10.1002/oby.24067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 06/11/2024]
Abstract
The improved efficacy and generally favorable safety profile of recently approved and emerging antiobesity medications (AOMs), which result in an average weight reduction of ≥15%, represent significant advancement in the treatment of obesity. This narrative review aims to provide practical evidence-based recommendations for nutritional assessment, management, and monitoring of patients treated with AOMs. Prior to treatment, clinicians can identify preexisting nutritional risk factors and counsel their patients on recommended intakes of protein, dietary fiber, micronutrients, and fluids. During treatment with AOMs, ongoing monitoring can facilitate early recognition and management of gastrointestinal symptoms or inadequate nutrient or fluid intake. Attention should also be paid to other factors that can impact response to treatment and quality of life, such as physical activity and social and emotional health. In the context of treatment with AOMs, clinicians can play an active role in supporting their patients with obesity to improve their health and well-being and promote optimal nutritional and medical outcomes.
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Affiliation(s)
- Jaime P Almandoz
- Division of Endocrinology, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen Tewksbury
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Caroline M Apovian
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Jamy D Ard
- Department of Epidemiology and Prevention and Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Zhaoping Li
- Center for Human Nutrition, University of California Los Angeles, Los Angeles, California, USA
| | - Jesse Richards
- Department of Internal Medicine, University of Oklahoma School of Medicine, Tulsa, Oklahoma, USA
| | - W Scott Butsch
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Lisa M Neff
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Khorrami Chokami K, Khorrami Chokami A, Cammarata G, Piras G, Albertelli M, Gatto F, Vera L, Ferone D, Boschetti M. Current perspectives in obesity management: unraveling the impact of different therapy approach in real life obesity care. J Transl Med 2024; 22:536. [PMID: 38844956 PMCID: PMC11155047 DOI: 10.1186/s12967-024-05322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/20/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND The challenge of addressing obesity persists in healthcare, necessitating nuanced approaches and personalized strategies. This study aims to evaluate the effects of diverse therapeutic interventions on anthropometric and biochemical parameters in individuals with overweight and obesity within a real-world clinical context. METHODS A retrospective analysis was conducted on 192 patients (141 females, 51 males) aged 18 to 75, with a BMI ranging from 25 to 30 (14.1%) and BMI ≥ 30 (85.9%), observed over a 12-month period at our Endocrinology Unit. Treatment cohorts comprised individuals following different regimens: Mediterranean Diet (MD), with an approximate daily intake of 1500 kcal for women and 1800 kcal for men (71% patients); Ketogenic Diet (KD), utilizing the VLCKD protocol characterized by a highly hypocaloric dietary regimen < 800 kcal/day (14% patients); metformin, administered using the oral formulation (5% patients); pharmacological intervention with GLP1-RA administered via subcutaneous injection with incremental dosage (10% patients). Supply constraints limited the efficacy of Liraglutide, whereas Semaglutide was excluded from comparisons due to its unavailability for obesity without diabetes. Blood tests were conducted to assess lipid profile, glycemic profile, and anthropometric parameters, including BMI, waist circumference, and waist-to-height ratio. RESULTS Significant BMI changes were observed from baseline to 6 months across MD, KD, and Liraglutide groups (p < 0.05). KD exhibited notable reductions in waist circumference and waist-to-height ratio within the initial quarter (p < 0.05), with a significant triglyceride decrease after 6 months (p < 0.05), indicating its efficacy over MD. Liraglutide demonstrated a substantial reduction in HbA1c levels in the first quarter (p < 0.05). During the first three months, the ANOVA test on fasting blood glucose showed a statistically significant impact of the time variable (p < 0.05) rather than the specific treatments themselves (Liraglutide and KD), suggesting that adherence during the early stages of therapy may be more critical than treatment choice. CONCLUSIONS Positive outcomes from targeted interventions, whether pharmacological or dietary should encourage the exploration of innovative, long-term strategies that include personalized treatment alternation. The absence of standardized protocols underscores the importance of careful and tailored planning in managing obesity as a chronic condition.
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Affiliation(s)
- Keyvan Khorrami Chokami
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, 16132, Italy
| | | | - Giuseppe Cammarata
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, 16132, Italy
| | - Grazia Piras
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, 16132, Italy
| | - Manuela Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, 16132, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy
| | - Federico Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy
| | - Lara Vera
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, 16132, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy
| | - Mara Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, 16132, Italy.
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.
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Tzoulis P, Baldeweg SE. Semaglutide for weight loss: unanswered questions. Front Endocrinol (Lausanne) 2024; 15:1382814. [PMID: 38904050 PMCID: PMC11188346 DOI: 10.3389/fendo.2024.1382814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Ploutarchos Tzoulis
- Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, London, United Kingdom
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31
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Maselli DB, Donnangelo LL, Jirapinyo P, Thompson CC, McGowan CE. Transoral Outlet Reduction: Expert Tips, Tricks, and Troubleshooting. Am J Gastroenterol 2024; 119:1047-1055. [PMID: 38634547 DOI: 10.14309/ajg.0000000000002821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
Transoral outlet reduction (TORe) is an incisionless, endoscopic procedure to address weight recurrence after Roux-en-Y gastric bypass. Given the chronic, progressive nature of obesity and the minimally invasive, anatomy preserving technique of TORe, the procedure is expected to be met with high patient acceptance and widening clinical adoption. Nevertheless, the approach to TORe has been heterogeneous. As endoscopic bariatric therapies are increasingly incorporated into the multidisciplinary management of obesity, it is crucial to have a standardized, evidence-based framework for their implementation. In this review, based on the available literature and the authors' combined experience of over 1,000 TORe procedures, we present our approach to patient selection, procedural technique, troubleshooting, and patient aftercare unique to TORe.
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Affiliation(s)
| | | | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Geetha V, Mayookha VP, Das M, Kumar GS. Bioactive carbohydrate polymers from marine sources as potent nutraceuticals in modulating obesity: a review. Food Sci Biotechnol 2024; 33:1517-1528. [PMID: 38623423 PMCID: PMC11016051 DOI: 10.1007/s10068-024-01525-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 04/17/2024] Open
Abstract
The majority of bioactive polysaccharides are present in some marine creatures. These polysaccharides are considered as promising anti-obesity agents, their anti-obesity properties involve a number of mechanisms, including suppression of lipid metabolism and absorption, impact on satiety, and prevention of adipocyte differentiation. Obesity is linked to type 2 diabetes, cardiovascular disease, and other metabolic syndromes. In this review various bioactive polysaccharides like chitin, chitosan, fucosylated chondroitin sulphate, chitooligosaccharides and glycosaminoglycans have been discussed for their anti-obesity effects through various pathways. Critical evaluation of observational studies and intervention trials on obesity, lipid hypertrophy, dyslipidemia, and type 2 diabetes was done with a primary focus on specific marine fauna polysaccharide as a source of seafood that is consumed all over the world. It has been observed that consumption of individual seafood constituents was effective in reducing obesity. Thus, marine derived novel bioactive polysaccharides have potential applications in food and pharmaceutical industries.
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Affiliation(s)
- V. Geetha
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysuru, 570020 India
- Department of Biosciences, Mangalore University, Mangalagangothri, Mangalore, Karnataka 574199 India
| | - V. P. Mayookha
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysuru, 570020 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Moumita Das
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysuru, 570020 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - G. Suresh Kumar
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysuru, 570020 India
- Department of Biosciences, Mangalore University, Mangalagangothri, Mangalore, Karnataka 574199 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
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Gao L, Qin Y, Zhou X, Jin W, He Z, Li X, Wang Q. Microalgae as future food: Rich nutrients, safety, production costs and environmental effects. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 927:172167. [PMID: 38580118 DOI: 10.1016/j.scitotenv.2024.172167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/31/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
The improvement of food security and nutrition has attracted wide attention, and microalgae as the most promising food source are being further explored. This paper comprehensively introduces basic and functional nutrients rich in microalgae by elaborated tables incorporating a wide variety of studies and summarizes factors influencing their accumulation effects. Subsequently, multiple comparisons of nutrients were conducted, indicating that microalgae have a high protein content. Moreover, controllable production costs and environmental friendliness prompt microalgae into the list that contains more promising and reliable future food. However, microalgae and -based foods approved and sold are limited strictly, showing that safety is a key factor affecting dietary consideration. Notably, sensory profiles and ingredient clarity play an important role in improving the acceptance of microalgae-based foods. Finally, based on the bottleneck in the microalgae food industry, suggestions for its future development were discussed.
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Affiliation(s)
- Le Gao
- State Key Lab of Urban Water Resource and Environment, School of Civil and Environmental Engineering, Harbin Institute of Technology Shenzhen, Shenzhen 518055, China; Shenzhen Engineering Laboratory of Microalgal Bioenergy, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China; Australian Centre for Water and Environmental Biotechnology, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Yujia Qin
- State Key Lab of Urban Water Resource and Environment, School of Civil and Environmental Engineering, Harbin Institute of Technology Shenzhen, Shenzhen 518055, China; Shenzhen Engineering Laboratory of Microalgal Bioenergy, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Xu Zhou
- State Key Lab of Urban Water Resource and Environment, School of Civil and Environmental Engineering, Harbin Institute of Technology Shenzhen, Shenzhen 518055, China; Shenzhen Engineering Laboratory of Microalgal Bioenergy, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
| | - Wenbiao Jin
- State Key Lab of Urban Water Resource and Environment, School of Civil and Environmental Engineering, Harbin Institute of Technology Shenzhen, Shenzhen 518055, China; Shenzhen Engineering Laboratory of Microalgal Bioenergy, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Zhongqi He
- State Key Lab of Urban Water Resource and Environment, School of Civil and Environmental Engineering, Harbin Institute of Technology Shenzhen, Shenzhen 518055, China; Shenzhen Engineering Laboratory of Microalgal Bioenergy, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Xuan Li
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Qilin Wang
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Adekunle OA, Schommer JC, Wang YS, Yunusa I, Fleming ML, Seoane-Vazquez E, Brown LM. Perceptions of metabolic syndrome management utilization in relation to patient experience and health-related quality of life. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100457. [PMID: 38868396 PMCID: PMC11168489 DOI: 10.1016/j.rcsop.2024.100457] [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: 04/16/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024] Open
Abstract
Background One factor for the poor health outcomes among adult people with metabolic syndrome (MetS) is poor utilization of disease management resources, which may be attributable to prior experience with pharmacists (PEwP) and perceptions of disease management resource utilization (PMU). Therefore, understanding patients' experience could be critical to improving their perceptions and promoting health outcomes. Objectives The study explored the influence of PEwP and PMU on the health-related quality of life (HRQoL) of people with MetS. Methods Data on perceptions of healthcare, medication, and pharmacy services utilization, PEwP, and HRQoL were collected using validated tools via an electronic survey. Chi-square and ordinal regression tests were used to predict the association between PMU, PEwP, and HRQoL. Also, mediation analysis through Haye's model 4 explored the direct and indirect relationship of PMU and PEwP on HRQoL. Results A total of 706 completed surveys were collected and used for analyses. On average, respondents reported three comorbidities. Of the respondents, 72.0% had good PEwP, while 32.6% had good PMU. Comparatively, 38.4% of those with good PEwP had good PMU, compared to 17.3% of those with poor PEwP. Also, 47.0% of those with good PMU had good HRQoL compared to 35.3% with poor PMU. The odds of having fair or good PMU were nearly triple (OR = 2.97, p < 0.001) among those with good PEwP compared to those with poor PEwP. Also, respondents with good PMU had 58% (OR = 1.58, p = 0.008) higher odds of having fair or good HRQoL. Analysis through bootstrap indicated a significant relationship (BootCI = -0.072, -0.022) between PEwP and HRQoL via respondents' PMU. Conclusions MetS individuals with good experience and PMU were more likely to have good HRQoL. Prior experience with pharmacists influenced PMU and indirectly impacted HRQoL. Therefore, pharmacists must consider patients' experience and management utilization perceptions to promote health outcome among people with MetS, while implementing interventions.
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Affiliation(s)
- Olajide A. Adekunle
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
| | - Jon C. Schommer
- Department of Pharmaceutical Care & Health Systems, University of Minnesota 7-155 Weaver-Densford Hall, Minneapolis, MN 55455, USA
| | - Yun S. Wang
- Department of Biomedical and Pharmaceutical Sciences School of Pharmacy, Chapman University, 9401 Jeronimo Road, Irvine, CA 92618, USA
| | - Ismaeel Yunusa
- Clinical Pharmacy and Outcomes Sciences (CPOS), College of Pharmacy, University of South Carolina, 715 Sumter Street, Suite 311L, Columbia, SC 29208, USA
| | - Marc L. Fleming
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
| | - Enrique Seoane-Vazquez
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
| | - Lawrence M. Brown
- Department of Pharmaceutical Economics and Policy Chapman, University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618-1908, USA
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Mohamad RMA, Alhawiti WM, Alshehri WA, Alhaj Ali RM, Alhakami ST, Alatawi MM, Almutairi AA, Al Atawi ES, Alkhaibari DG, Saleh RM, Awaji HH. Assessment of Adolescents' Overweight and Obesity Risk Factors Among Alabnaa Schools in Tabuk City, Saudi Arabia. Cureus 2024; 16:e61533. [PMID: 38957243 PMCID: PMC11218896 DOI: 10.7759/cureus.61533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The prevalence of overweight and obesity among adolescents in Saudi Arabia has been progressively increasing. Obesity is associated with an increased risk of various morbidities and mortality. Identifying the factors that contribute to obesity in this age group is crucial for implementing targeted prevention measures. AIM The aim of this study was to identify risk factors for overweight and obesity among adolescents aged nine to 17 years residing in Tabuk City, Saudi Arabia. METHODS A case-control study was conducted during the 2021-2022 academic year at Alabnaa Schools in Tabuk City, Saudi Arabia. The study included overweight/obese individuals (cases, n = 125) and normal-weight individuals (controls, n = 201) who were selected based on their body mass index and classified according to the World Health Organization's reference for defining overweight and obesity in individuals aged five to 19 years. Data were collected from both groups using a self-administered questionnaire. RESULTS The study analyzed 125 overweight/obese students and 201 normal-weight students who were matched for sex and age (p > 0.05). Logistic regression analysis identified several risk factors for overweight or obesity among adolescents. A family history of obesity was found to be associated with a 5.735 times increased likelihood of obesity (95% CI: 3.318-9.912, p < 0.001). Another significant contributing risk factor for obesity was frequent consumption of four or more meals per day (adjusted odds ratio: 3.091, 95% CI: 1.094-8.736, p = 0.033). Students who used electronic devices for more than five hours were 2.422 times more likely to exhibit obesity (p = 0.006). CONCLUSIONS Certain factors may increase the risk of overweight or obesity in adolescents aged nine to 17 years. These factors include frequent eating, prolonged use of electronic devices, family history of obesity, and the misconception that obesity is not an illness. Tailored school health programs are needed to improve students' healthy lifestyles and eating behaviors, minimize sedentary entertainment and use of electronic devices, and engage children in physical activity.
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Affiliation(s)
| | | | - Waheed Ali Alshehri
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | | | | | | | - Eman Saeed Al Atawi
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Rakan Mahmoud Saleh
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Hosam Hadi Awaji
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
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Guo D, Wang C, Liu X. Association of chronic diseases with depression in the United States, NHANES 2007-2018. PSYCHOL HEALTH MED 2024; 29:1077-1090. [PMID: 37990352 DOI: 10.1080/13548506.2023.2277153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
Depression often coexists with many chronic diseases. However, previous studies mainly focused on the association between a single chronic disease or chronic diseases of the elderly and depression. This study included 26,177 adults aged more than 20 years old from the 2007-2018 National Health and Nutrition Examination Survey. Depression was determined by nine questions which were from the Patient Health Questionnaire. We used propensity score matching to reduce the influence of confounders between the depression and non-depression groups. A multivariate logistic regression model was used to analyze the relationship between various chronic diseases and the number of diseases and depression. The prevalence of depression in participants with chronic diseases was higher than that in participants without chronic diseases, 20.8% of participants with chronic bronchitis had depression. After matching and controlling sleep, insurance and smoking, the highest risk of depression (OR = 1.524; 95% CI: 1.162-2.001) was found in people with stroke, followed by arthritis (OR = 1.464; 95% CI: 1.275-1.681). The percentage of participants with two or more chronic diseases with depression and without depression was 68.9% and 51.9%, respectively. Participants with five or more chronic diseases had the highest risk of depression (OR = 3.653; 95% CI: 3.001-4.446). In conclusion, patients with chronic diseases are at higher risk for depression, especially those with multiple chronic diseases. This study suggested that we should pay more attention to the mental health of people with chronic diseases.
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Affiliation(s)
- Dingjie Guo
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Chunpeng Wang
- School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin, China
| | - Xin Liu
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
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Andreassen P, Jensen SD, Bruun JM, Sandbæk A. Managing the new wave of weight loss medication in general practice: A qualitative study. Clin Obes 2024; 14:e12666. [PMID: 38660941 DOI: 10.1111/cob.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
In early 2023, a new type of weight loss medication, Wegovy (semaglutide), was made available in Denmark. Both subsequent media coverage and public demand were huge. Wegovy is only available by prescription, primarily via general practitioners. However, there is very little knowledge about how healthcare professionals (HCPs) in general practice might deal with the great demand for and attention surrounding a new weight loss drug. The aim of this qualitative study was, therefore, to explore how Wegovy is managed and negotiated in general practice, particularly in terms of prescribing and follow-up. We conducted a focused ethnography study based on direct observation of consultations and both formal and informal interviews with seven doctors and four nurses from three general practices in Denmark. Using discourse analysis, we identified four central discourses revolving around trust in medicine, individual responsibility for health, the cost of weight loss medication, and the importance of shared decision-making. This study shows that the availability of a new, sought-after weight loss medication presents both opportunities and challenges for HCPs in general practice. The management of Wegovy involves numerous factors, including medical, economic, organizational, interpersonal and moral concerns.
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Affiliation(s)
| | - Sissel Due Jensen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens M Bruun
- The Danish National Center for Obesity, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Unit of General Practice, Aarhus, Denmark
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38
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Lister NB, Baur LA, Paxton SJ, Garnett SP, Ahern AL, Wilfley DE, Maguire S, Sainsbury A, Steinbeck K, Braet C, Hill AJ, Nicholls D, Jones RA, Dammery G, Grunseit A, Cooper K, Kyle TK, Heeren FA, Hunter KE, McMaster CM, Johnson BJ, Seidler AL, Jebeile H. Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design. Nutr Res Rev 2024; 37:32-42. [PMID: 36788665 PMCID: PMC7615933 DOI: 10.1017/s0954422423000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Kids Research, Sydney Children's Hospital Network, Westmead, New South Wales2145, Australia
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Denise E Wilfley
- School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Katharine Steinbeck
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales2145, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, 2nd Floor, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Grunseit
- The Children's Hospital at Westmead, Nutrition and Dietetics, Weight Management Services, Westmead, New South Wales, NSW 2145, Australia
| | | | | | - Faith A Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin M McMaster
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia5042, Australia
| | - Anna Lene Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
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Bin-Abbas B, Al Sagheir A, Taher L, Elbadawi H, Al Fares A, Al Harbi M, Refaat M, Ashmawy A. ACTION Teens Saudi Arabia: Perceptions, attitudes, motivators, and barriers among adolescents living with obesity, caregivers, and healthcare professionals in Saudi Arabia. Clin Obes 2024:e12674. [PMID: 38740496 DOI: 10.1111/cob.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/08/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
Obesity is predicted to affect approximately one-quarter of children/adolescents in Saudi Arabia by 2030, but there is limited evidence regarding the perceptions, attitudes, behaviours, and barriers to effective obesity care for adolescents living with obesity (ALwO), caregivers of ALwO, and healthcare professionals (HCPs). We report data from 500 ALwO (aged 12-<18 years), 500 caregivers, and 200 HCPs surveyed in Saudi Arabia as part of the global, cross-sectional ACTION Teens study (NCT05013359). Nearly all respondents recognized that obesity has a strong impact on overall health (ALwO 88%; caregivers 85%; HCPs 90%). Most ALwO and caregivers were aware of the ALwO's obesity status (95% and 99%, respectively) and worried about weight impacting the ALwO's future health (both ≥99%), and social media was their most commonly used source of weight-management information (60% and 53%, respectively). Among ALwO and caregivers who had discussed weight with an HCP in the past year, most experienced ≥1 negative feeling following their most recent discussion (61% and 59%, respectively). Although 81% of HCPs felt motivated to help their ALwO patients lose weight, 57% believed weight loss was completely the ALwO's responsibility (compared with only 37% of ALwO and 35% of caregivers). This may reflect the finding that only 24% of HCPs had received advanced training in obesity/weight management after medical school. Overall, while respondents had similar perceptions of the impact of obesity, we found HCPs' attitudes towards weight loss were not aligned with those of ALwO and caregivers, suggesting a need for improved communication and obesity education.
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Affiliation(s)
- Bassam Bin-Abbas
- Department of Pediatrics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Afaf Al Sagheir
- Department of Pediatrics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Lama Taher
- Department of Psychiatry, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Abdulah Al Fares
- Department of Pediatrics, Endocrine Unit, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Mohammed Al Harbi
- Therapeutic Services Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohamed Refaat
- Clinical and Medical Department, Novo Nordisk, Riyadh, Saudi Arabia
| | - Ahmed Ashmawy
- Clinical and Medical Department, Novo Nordisk, Riyadh, Saudi Arabia
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Díaz-González BV, Bautista-Castaño I, Hernández García E, Cornejo Torre J, Hernández Hernández JR, Serra-Majem L. Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits. Nutrients 2024; 16:1466. [PMID: 38794704 PMCID: PMC11123891 DOI: 10.3390/nu16101466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Bariatric surgery therapy (BST) is an effective treatment for obesity; however, little is known about its impacts on health-related quality of life (HRQoL) and related factors. This study aimed to evaluate changes in HRQoL and its relationship with weight loss, depression status, physical activity (PA), and nutritional habits after BST. Data were obtained before and 18 months postprocedure from 56 obese patients who underwent BST. We administered four questionnaires: Short Form-36 health survey for HRQoL, 14-item MedDiet adherence questionnaire, Rapid Assessment of PA (RAPA) questionnaire, and Beck's Depression Inventory-II. Multivariable linear regression analysis was used to identify factors associated with improvement in HRQoL. After the surgery, MedDiet adherence and HRQoL improved significantly, especially in the physical component. No changes in PA were found. Patients without previous depression have better mental quality of life, and patients who lost more than 25% of %TBWL have better results in physical and mental quality of life. In the multivariable analysis, we found that %TBWL and initial PCS (inversely) were related to the improvement in PCS and initial MCS (inversely) with the MCS change. In conclusion, BST is an effective intervention for obesity, resulting in significant weight loss and improvements in HRQoL and nutritional habits.
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Affiliation(s)
- Beatriz Vanessa Díaz-González
- Triana Primary Health Care Center, Canarian Health Service, 35002 Las Palmas de Gran Canaria, Spain;
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; (E.H.G.); (J.C.T.); (J.R.H.H.); (L.S.-M.)
| | - Inmaculada Bautista-Castaño
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; (E.H.G.); (J.C.T.); (J.R.H.H.); (L.S.-M.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Elisabeth Hernández García
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; (E.H.G.); (J.C.T.); (J.R.H.H.); (L.S.-M.)
| | - Judith Cornejo Torre
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; (E.H.G.); (J.C.T.); (J.R.H.H.); (L.S.-M.)
| | - Juan Ramón Hernández Hernández
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; (E.H.G.); (J.C.T.); (J.R.H.H.); (L.S.-M.)
- Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas de Gran Canaria, Spain
| | - Lluis Serra-Majem
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; (E.H.G.); (J.C.T.); (J.R.H.H.); (L.S.-M.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas de Gran Canaria, Spain
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Bomberg EM, Clark J, Rudser KD, Gross AC, Kelly AS, Fox CK. Clinical effectiveness and predictors of response to topiramate plus lifestyle modification in youth with obesity seen in a weight management clinical setting. Front Endocrinol (Lausanne) 2024; 15:1369270. [PMID: 38800488 PMCID: PMC11116594 DOI: 10.3389/fendo.2024.1369270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Obesity affects approximately 20% of U.S. youth. Anti-obesity medications (AOMs) are promising lifestyle modification adjuncts for obesity treatment, and topiramate is commonly prescribed in pediatric weight management clinics. It is important to determine "real-world" effectiveness of AOMs and, given shifts towards personalized approaches, characteristics potentially predicting better or worse response. We therefore sought to describe clinical effectiveness from topiramate plus lifestyle modification, and to determine if baseline phenotypic characteristics are associated with better or worse response. Methods We performed a retrospective cohort study (2012-2020) among youth (<18 years old) followed in a U.S. academic-based weight management clinic. Baseline characteristics (i.e., body mass index (BMI), liver function tests, eating-related behaviors) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, percent %BMI change, weight) were determined through review of electronic health records and clinic intake survey data. Results Among 282 youth prescribed topiramate plus lifestyle modifications (mean baseline age 12.7 years, %BMIp95 144%), %BMIp95 and percent BMI change were statistically significantly reduced at each time point (1.5-, 3-, 6-, and 12-month %BMIp95 reductions: -2.2, -3.9, -6.6, and -9.3 percentage points, respectively; percent BMI reduction: -1.2%, -1.9%, -3.2%, and -3.4%, respectively; all p<0.01). Considering multiple comparisons, no baseline characteristics statistically significantly predicted response at any time point. Conclusions We found that topiramate plus lifestyle modification reduced %BMIp95 and BMI among youth in a weight management clinical setting, and that no baseline characteristics evaluated were associated with response. These results should be considered preliminary given the observational nature of this study, and prospective studies are needed to further characterize clinical effectiveness and identify and confirm potential predictors of response.
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Affiliation(s)
- Eric M. Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Justin Clark
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kyle D. Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Amy C. Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
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Ceylan Hİ, Silva AF, Ramirez-Campillo R, Murawska-Ciałowicz E. Exploring the Effect of Acute and Regular Physical Exercise on Circulating Brain-Derived Neurotrophic Factor Levels in Individuals with Obesity: A Comprehensive Systematic Review and Meta-Analysis. BIOLOGY 2024; 13:323. [PMID: 38785805 PMCID: PMC11117522 DOI: 10.3390/biology13050323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Obesity is a major global health concern linked to cognitive impairment and neurological disorders. Circulating brain-derived neurotrophic factor (BDNF), a protein crucial for neuronal growth and survival, plays a vital role in brain function and plasticity. Notably, obese individuals tend to exhibit lower BDNF levels, potentially contributing to cognitive decline. Physical exercise offers health benefits, including improved circulating BDNF levels and cognitive function, but the specific impacts of acute versus regular exercise on circulating BDNF levels in obesity are unclear. Understanding this can guide interventions to enhance brain health and counter potential cognitive decline in obese individuals. Therefore, this study aimed to explore the impact of acute and regular physical exercise on circulating BDNF in individuals with obesity. The target population comprised individuals classified as overweight or obese, encompassing both acute and chronic protocols involving all training methods. A comprehensive search was conducted across computerized databases, including PubMed, Academic Search Complete, and Web of Science, in August 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Initially, 98 studies were identified, from which 16 studies, comprising 23 trials, met the selection criteria. Substantial heterogeneity was observed for both acute (I2 = 80.4%) and long-term effects (I2 = 88.7%), but low risk of bias for the included studies. A single session of exercise increased circulating BDNF levels among obese patients compared to the control group (ES = 1.25, 95% CI = 0.19 to 2.30, p = 0.021). However, with extended periods of physical exercise, there was no significant increase in circulating BDNF levels when compared to the control group (ES = 0.49, 95% CI = -0.08 to 1.06, p = 0.089). These findings highlight the need to consider exercise duration and type when studying neurobiological responses in obesity and exercise research. The study's results have implications for exercise prescription in obesity management and highlight the need for tailored interventions to optimize neurotrophic responses. Future research should focus on elucidating the adaptive mechanisms and exploring novel strategies to enhance BDNF modulation through exercise in this population. However, further research is needed considering limitations such as the potential age-related confounding effects due to diverse participant ages, lack of sex-specific analyses, and insufficient exploration of how specific exercise parameters (e.g., duration, intensity, type) impact circulating BDNF.
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Affiliation(s)
- Halil İbrahim Ceylan
- Physical Education and Sports Teaching Department, Kazim Karabekir Faculty of Education, Ataturk University, 25240 Erzurum, Turkey
| | - Ana Filipa Silva
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT), 4960-320 Melgaço, Portugal
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile 7591538, Chile;
| | - Eugenia Murawska-Ciałowicz
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Wrocław University of Health and Sport Sciences, 51-612 Wrocław, Poland;
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Guglielmi V, Dalle Grave R, Leonetti F, Solini A. Female obesity: clinical and psychological assessment toward the best treatment. Front Endocrinol (Lausanne) 2024; 15:1349794. [PMID: 38765954 PMCID: PMC11099266 DOI: 10.3389/fendo.2024.1349794] [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: 12/05/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Obesity is a heterogeneous condition which results from complex interactions among sex/gender, sociocultural, environmental, and biological factors. Obesity is more prevalent in women in most developed countries, and several clinical and psychological obesity complications show sex-specific patterns. Females differ regarding fat distribution, with males tending to store more visceral fat, which is highly correlated to increased cardiovascular risk. Although women are more likely to be diagnosed with obesity and appear more motivated to lose weight, as confirmed by their greater representation in clinical trials, males show better outcomes in terms of body weight and intra-abdominal fat loss and improvements in the metabolic risk profile. However, only a few relatively recent studies have investigated gender differences in obesity, and sex/gender is rarely considered in the assessment and management of the disease. This review summarizes the evidence of gender differences in obesity prevalence, contributing factors, clinical complications, and psychological challenges. In addition, we explored gender differences in response to obesity treatments in the specific context of new anti-obesity drugs.
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Affiliation(s)
- Valeria Guglielmi
- Unit of Internal Medicine and Obesity Center, Department of Systems Medicine, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
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Pan XH, Tan B, Chin YH, Lee ECZ, Kong G, Chong B, Kueh M, Khoo CM, Mehta A, Majety P, Grandhi GR, Dimitriadis GK, Foo R, Chew NWS, Le Roux CW, Mamas MA, Chan MY. Efficacy and safety of tirzepatide, GLP-1 receptor agonists, and other weight loss drugs in overweight and obesity: a network meta-analysis. Obesity (Silver Spring) 2024; 32:840-856. [PMID: 38413012 DOI: 10.1002/oby.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This network meta-analysis evaluates the efficacy and safety of tirzepatide compared to glucagon-like peptide-1 receptor agonists (GLP-1 RA) and other weight loss drugs in the treatment of overweight and obesity. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials on tirzepatide, GLP-1 RA, and weight loss drugs approved by the US Food and Drug Administration. A network meta-analysis was performed, drawing direct and indirect comparisons between treatment groups. Network diagrams and surface under the cumulative ranking curve analysis were performed for primary (≥5%, ≥10%, ≥15%, absolute weight loss) and secondary outcomes and adverse effects. RESULTS Thirty-one randomized controlled trials, involving more than 35,000 patients, were included in this study. Tirzepatide 15 mg ranked in the top three across weight-related parameters, glycemic profile (glycated hemoglobin), lipid parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides), and blood pressure. Tirzepatide 15 mg had the highest efficacy compared with placebo for achieving ≥15% weight loss (risk ratio 10.24, 95% CI: 6.42-16.34). As compared to placebo, tirzepatide and GLP-1 RA across all doses had significant increases in gastrointestinal adverse effects. CONCLUSIONS The superiority of tirzepatide and GLP-1 RA in inducing weight loss and their ability to target multiple metabolic parameters render them promising candidates in the treatment of patients with overweight and obesity.
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Affiliation(s)
- Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Martin Kueh
- Royal College of Surgeons in Ireland & University College Dublin Malaysia Campus, George Town, Malaysia
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Priyanka Majety
- Department of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Gowtham R Grandhi
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Carel W Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
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Collado-Perez R, Chamoso-Sánchez D, García A, Fernández-Alfonso MS, Jiménez-Hernáiz M, Canelles S, Argente J, Frago LM, Chowen JA. The differential effects of palmitic acid and oleic acid on the metabolic response of hypothalamic astrocytes from male and female mice. J Neurosci Res 2024; 102:e25339. [PMID: 38741550 DOI: 10.1002/jnr.25339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
Diets rich in saturated fats are more detrimental to health than those containing mono- or unsaturated fats. Fatty acids are an important source of energy, but they also relay information regarding nutritional status to hypothalamic metabolic circuits and when in excess can be detrimental to these circuits. Astrocytes are the main site of central fatty acid β-oxidation, and hypothalamic astrocytes participate in energy homeostasis, in part by modulating hormonal and nutritional signals reaching metabolic neurons, as well as in the inflammatory response to high-fat diets. Thus, we hypothesized that how hypothalamic astrocytes process-specific fatty acids participates in determining the differential metabolic response and that this is sex dependent as males and females respond differently to high-fat diets. Male and female primary hypothalamic astrocyte cultures were treated with oleic acid (OA) or palmitic acid (PA) for 24 h, and an untargeted metabolomics study was performed. A clear predictive model for PA exposure was obtained, while the metabolome after OA exposure was not different from controls. The observed modifications in metabolites, as well as the expression levels of key metabolic enzymes, indicate a reduction in the activity of the Krebs and glutamate/glutamine cycles in response to PA. In addition, there were specific differences between the response of astrocytes from male and female mice, as well as between hypothalamic and cerebral cortical astrocytes. Thus, the response of hypothalamic astrocytes to specific fatty acids could result in differential impacts on surrounding metabolic neurons and resulting in varied systemic metabolic outcomes.
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Affiliation(s)
- Roberto Collado-Perez
- Department of Endocrinology, Instituto de Investigación La Princesa, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatrics, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - David Chamoso-Sánchez
- Center for Metabolomics and Bioanalysis (CEMBIO), Faculty of Pharmacy, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
| | - Antonia García
- Center for Metabolomics and Bioanalysis (CEMBIO), Faculty of Pharmacy, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
| | | | - Maria Jiménez-Hernáiz
- Department of Endocrinology, Instituto de Investigación La Princesa, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sandra Canelles
- Department of Endocrinology, Instituto de Investigación La Princesa, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Argente
- Department of Endocrinology, Instituto de Investigación La Princesa, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatrics, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Laura M Frago
- Department of Endocrinology, Instituto de Investigación La Princesa, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Pediatrics, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Julie A Chowen
- Department of Endocrinology, Instituto de Investigación La Princesa, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
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Chun DW, Kwon YJ, Heo SJ, Lee JW. Secular trends in dietary energy, carbohydrate, fat, and protein intake among Korean adults, 2010-2020 KHANES. Nutrition 2024; 121:112360. [PMID: 38368797 DOI: 10.1016/j.nut.2024.112360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES The composition and balance of macronutrient intake play key roles in promoting a longer lifespan. In this study, we aimed to investigate the secular trends in carbohydrate, fat, and protein intakes in South Koreans from 2010 to 2020. METHODS We examined the dietary nutritional intake of South Koreans using data from the Korean National Health and Nutrition Examination Survey. A total of 60,190 adults aged ≥19 y who completed the 24-h dietary recall interviews in a single day on all survey periods were included in this study. The outcomes included changes in macronutrient intake according to subgroups, such as age; sex; and the presence of diabetes, dyslipidemia, stroke, or heart disease, as well as energy intake from macronutrients. RESULTS The study population showed a significant decrease in total energy intake from 2010 to 2020, with a corresponding decrease in the percentage of energy intake from carbohydrates (p-values for trend < 0.001). Conversely, the proportions of energy intake from proteins and fats increased during the same period (p < 0.001). Subgroup analyses revealed variations in macronutrient intake trends according to age, sex, obesity status, and underlying diseases. The analysis of trends in energy intake from various fat subtypes, total sugar, and fiber revealed a decrease in the energy intake percentage of total sugar from 2016 to 2020 and an increase in the energy intake percentage of all fat subtypes and fiber from 2013 to 2020. CONCLUSIONS In the past 10 y, the dietary patterns in Korea have shifted toward the consumption of high-fat and high-protein diets with reduced carbohydrate intake.
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Affiliation(s)
- Dong-Wook Chun
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Ji-Won Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
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Cuevas A, Pardo F, Alonso R, Barros E, Rendón A. Features and behaviours for weight loss in the Chilean cohort with obesity from the ACTION study. Clin Obes 2024:e12673. [PMID: 38686641 DOI: 10.1111/cob.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
In Latin America, obesity rates are among the highest in the world. Currently, people with obesity (PWO) receive suboptimal care due to several challenges and barriers. The international ACTION-IO study aimed to identify perceptions, attitudes and behaviours of PWO and healthcare providers (HCP), and to assess potential barriers to effective obesity care. The aim of this subanalysis of the Chilean cohort was to compare their characteristics, perceptions, attitudes and behaviours according to the percentage of weight loss (lower weight loss [LWL; ≤10%] or higher weight loss [HWL; >10%] of basal weight). The ACTION-IO survey was completed by 1000 Chilean PWO and 200 HCPs. Mean age of PWO was 38 years (range 18-75); 62% were female. The majority had class I obesity. HWL subgroup represented 17.2% of all Chilean subset. Specific characteristics of patients with HWL were identified (higher educational level, lower proportion of class III obesity, preference for consulting obesity specialists, considering conversations with HCP as very helpful). HWL patients reported higher rates of favourable outcomes following HCP advice and a higher probability of attending scheduled follow-up visits. Certain demographic and behavioural variables (educational level, consultation to obesity specialists, adherence to HCP advice, follow-up scheduled visits and becoming aware of the obesity state) may identify PWO with a higher probability of a greater weight loss.
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Affiliation(s)
- Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN), Santiago, Chile
| | - Fabián Pardo
- Metabolic Diseases Research Laboratory (MDRL), School of Medicine, Faculty of Medicine, San Felipe Campus, Universidad de Valparaiso, Valparaíso, Chile
- Center of Interdisciplinary Biomedical and Engineering Research for Health (MEDING), School of Medicine, Faculty of Medicine, San Felipe Campus, Universidad de Valparaiso, Valparaíso, Chile
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN), Santiago, Chile
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Silva Miguel L, Soares M, Olivieri A, Sampaio F, Lamotte M, Shukla S, Conde V, Freitas P, Costa J, Borges M. Cost-effectiveness of semaglutide 2.4 mg in chronic weight management in Portugal. Diabetol Metab Syndr 2024; 16:97. [PMID: 38689367 PMCID: PMC11059577 DOI: 10.1186/s13098-024-01338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Obesity and overweight are a significant public health concern. Subcutaneous semaglutide 2.4 mg injection is a glucagon-like peptide-1 (GLP-1) analogue approved by the European Medicines Agency as an adjunct to a reduced calorie diet and increased physical activity (diet and exercise, D&E) for the treatment obesity and overweight in the presence of at least one weight related comorbidity. This study aimed to assess the cost-effectiveness of semaglutide 2.4 mg in combination with D&E compared to D&E alone for the Portuguese setting. METHODS Analysis were conducted using the Core Obesity Model (COM) version 18, a Markov state transition cohort model, to predict the health outcomes and costs of weight related complications based on changes in surrogate endpoints. Efficacy and safety data were sourced from the STEP trials (Body Mass Index, systolic blood pressure and glycemic status) from a cohort of adults aged on average 48 years with obesity (BMI ≥ 30 kg/m2) and ≥ 1 obesity-related comorbidities, over a time horizon of 40 years. Costs were estimated from the perspective of the Portuguese National Health Service. Sensitivity analyses were conducted to test the robustness of results across a range of assumptions. RESULTS On a patient level, Semaglutide 2.4 mg in addition to D&E compared to D&E alone, improved QALYs by 0.098 and yielded higher costs by 1,325 EUR over a 40-year time horizon, with an ICER of 13,459 EUR per QALY gained and 100% probability of cost-effectiveness at the given WTP. Semaglutide 2.4 mg remained cost-effective across all different scenarios and sensitivity analysis at a WTP of 20,000 EUR per QALY. Among the subpopulations examined, Semaglutide 2.4 mg yielded ICERs of 18,459 EUR for patients with BMI ≥ 30 kg/m2 and of 22,657 EUR for patients with BMI ≥ 35 kg/m2. CONCLUSIONS Semaglutide 2.4 mg was cost-effective compared to D&E alone for patients with obesity (BMI ≥ 30 kg/m2) and weight related comorbidities in Portugal, over a 40-year time horizon.
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Affiliation(s)
| | | | | | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | | | | | - Paula Freitas
- Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| | - João Costa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Margarida Borges
- IQVIA, Lisbon, Portugal
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Sumithran P, Finucane FM, Cohen RV. Obesity drug shortages are symptomatic of wider malaise. Lancet 2024; 403:1613-1615. [PMID: 37783217 DOI: 10.1016/s0140-6736(23)01963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Priya Sumithran
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia.
| | - Francis M Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland; Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland; Cúram, University of Galway, Galway, Ireland
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
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Majstorovic M, Chur-Hansen A, Andrews JM, Burke ALJ. Bariatric surgeons' views on pre-operative factors associated with improved health-related quality of life following surgery. Clin Obes 2024:e12668. [PMID: 38641997 DOI: 10.1111/cob.12668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
Abstract
Bariatric surgery is an effective treatment for severe obesity, affording significant improvements in weight loss and health-related quality of life. However, bariatric surgeons' views on whether certain pre-operative factors predict improvements in post-operative health-related quality of life, and if so, which ones, are largely unknown. This cross-sectional survey study examined the views of 58 bariatric surgeons from Australia and New Zealand. A total of 18 factors were selected for exploration based on their mention in the literature. Participants rated the extent to which they thought these pre-operative factors would improve post-operative health-related quality of life. Responses showed that bariatric surgeons held diverse perspectives and revealed a lack of consensus regarding "predictive" factors. Generally, respondents agreed that better than average health literacy, higher socioeconomic status, good physical and psychological health, and positive social support were predictors of improved health-related quality of life following surgery. However, poor eating behaviours, smoking, and the use of alcohol or other substances were deemed negative predictors. Interestingly, aside from higher socioeconomic status, good psychological health, and positive social support, none of the aforementioned views aligned with existing literature. This study offers an initial insight into bariatric surgeons' views on the influence of different pre-operative factors on post-operative health-related quality of life. The array of views identified suggests that there may be an opportunity for medical education, but the findings warrant caution due to the sample size. Replication with a larger survey may be useful, especially as predicted health-related quality of life outcomes could guide decisions regarding surgical (non)progression.
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Affiliation(s)
- M Majstorovic
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - A Chur-Hansen
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - J M Andrews
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Surgery Program, The Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - A L J Burke
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, The Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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