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Madenci AL, Kurgansky KE, Dickerman BA, Gerlovin H, Wanis KN, Smith AD, Trinqart L, Gagnon DR, Cho K, Gaziano JM, Casas JP, Robins JM, Hernán MA. Estimating the Effect of Bariatric Surgery on Cardiovascular Events Using Observational Data? Epidemiology 2024; 35:721-729. [PMID: 39024034 DOI: 10.1097/ede.0000000000001765] [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: 07/20/2024]
Abstract
BACKGROUND Observational studies have reported strongly protective effects of bariatric surgery on cardiovascular disease, but with oversimplified definitions of the intervention, eligibility criteria, and follow-up, which deviate from those in a randomized trial. We describe an attempt to estimate the effect of bariatric surgery on cardiovascular disease without introducing these sources of bias, which may not be entirely possible with existing observational data. METHODS We propose two target trials among persons with diabetes: (1) bariatric operation (vs. no operation) among individuals who have undergone preoperative preparation (lifestyle modifications and screening) and (2) preoperative preparation and a bariatric operation (vs. neither preoperative nor operative component). We emulated both target trials using observational data of US veterans. RESULTS Comparing bariatric surgery with no surgery (target trial #1; 8,087 individuals), the 7-year cardiovascular risk was 18.0% (95% CI = 6.9, 32.7) in the surgery group and 18.9% (95% CI = 17.7, 20.1) in the no-surgery group (risk difference -0.9, 95% CI = -12.0, 14.0). Comparing preoperative components plus surgery vs. neither (target trial #2; 10,065 individuals), the 7-year cardiovascular risk was 17.4% (95% CI = 13.6, 22.0) in the surgery group and 18.8% (95% CI = 17.8, 19.9) in the no-surgery group (risk difference -1.4, 95% CI = -5.1, 3.2). Body mass index and hemoglobin A1c were reduced with bariatric interventions in both emulations. CONCLUSIONS Within limitations of available observational data, our estimates do not provide evidence that bariatric surgery reduces cardiovascular disease and support equipoise for a randomized trial of bariatric surgery for cardiovascular disease prevention.
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Affiliation(s)
- Arin L Madenci
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Barbra A Dickerman
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Kerollos Nashat Wanis
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Surgery, Western University, London, ON
| | - Ann D Smith
- Veterans Affairs Boston Healthcare System, Boston, MA
| | - Ludovic Trinqart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - David R Gagnon
- Veterans Affairs Boston Healthcare System, Boston, MA
- Boston University School of Public Health, Boston, MA
| | - Kelly Cho
- Veterans Affairs Boston Healthcare System, Boston, MA
| | - J Michael Gaziano
- Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Juan P Casas
- Veterans Affairs Boston Healthcare System, Boston, MA
| | - James M Robins
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Miguel A Hernán
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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Pietsch B, Manske M, Hanewinkel R, Kaduszkiewicz H, Morgenstern M. Long-term effects of a lifestyle modification program for men with obesity delivered in German football clubs. Clin Obes 2024:e12696. [PMID: 39034636 DOI: 10.1111/cob.12696] [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: 03/08/2024] [Revised: 06/10/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
This study examined the long-term effects of a lifestyle modification program delivered at German Bundesliga football clubs. Weekly 90-minute group sessions over 12 weeks combined health education and physical activity and were delivered by coaches affiliated with the football clubs. A total of 371 men (mean age 49.7 years [SD = 7.6]) attended 41 classes at 19 clubs in 2017 and 2018 and participated in the long-term follow-up. Primary outcome was weight-loss at follow-up with a mean observation period of 20.4 months after baseline. Measures were taken partly by research staff and partly by participants themselves. At baseline, the men had a mean weight of 111.3 kg (SD = 16.9). Three months after baseline (posttest), the men had lost a mean of 6.3 kg (95% CI: 5.7-6.9). From posttest to follow-up, growth curve model showed men lost an average of 0.8 kg (95% CI: 0.2-1.4). Weight regain from posttest to follow-up of at least 3% was observed in 75 participants (20.2%) and was associated with less improvement in vegetable consumption in an adjusted logistic regression model. The data suggest that participation in a male-only lifestyle modification program offered by German football clubs may lead to sustained weight loss, but lack of a randomized control group and drop-outs prevent generalization of the results.
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Affiliation(s)
- Benjamin Pietsch
- Department Research and Prevention, Institute for Therapy and Health Research, Kiel, Germany
| | - Michelle Manske
- Institute of General Practice, Kiel University, Kiel, Germany
| | - Reiner Hanewinkel
- Department Research and Prevention, Institute for Therapy and Health Research, Kiel, Germany
| | | | - Matthis Morgenstern
- Department Research and Prevention, Institute for Therapy and Health Research, Kiel, Germany
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3
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Zhang Z, Shao B, Liu H, Huang B, Gao X, Qiu J, Wang C. Construction and Validation of a Predictive Model for Coronary Artery Disease Using Extreme Gradient Boosting. J Inflamm Res 2024; 17:4163-4174. [PMID: 38973999 PMCID: PMC11226989 DOI: 10.2147/jir.s464489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose Early recognition of coronary artery disease (CAD) could delay its progress and significantly reduce mortality. Sensitive, specific, cost-efficient and non-invasive indicators for assessing individual CAD risk in community population screening are urgently needed. Patients and Methods 3112 patients with CAD and 3182 controls were recruited from three clinical centers in China, and differences in baseline and clinical characteristics were compared. For the discovery cohort, the least absolute shrinkage and selection operator (LASSO) regression was used to identify significant features and four machine learning algorithms (logistic regression, support vector machine (SVM), random forest (RF) and extreme gradient boosting (XGBoost)) were applied to construct models for CAD risk assessment, the receiver operating characteristics (ROC) curve and precision-recall (PR) curve were conducted to evaluate their predictive accuracy. The optimal model was interpreted by Shapley additive explanations (SHAP) analysis and assessed by the ROC curve, calibration curve, and decision curve analysis (DCA) and validated by two external cohorts. Results Using LASSO filtration, all included variables were considered to be statistically significant. Four machine learning models were constructed based on these features and the results of ROC and PR curve implied that the XGBoost model exhibited the highest predictive performance, which yielded a high area of ROC curve (AUC) of 0.988 (95% CI: 0.986-0.991) to distinguish CAD patients from controls with a sensitivity of 94.6% and a specificity of 94.6%. The calibration curve showed that the predicted results were in good agreement with actual observations, and DCA exhibited a better net benefit across a wide range of threshold probabilities. External validation of the model also exhibited favorable discriminatory performance, with an AUC, sensitivity, and specificity of 0.953 (95% CI: 0.945-0.960), 89.9%, and 87.1% in the validation cohort, and 0.935 (95% CI: 0.915-0.955), 82.0%, and 90.3% in the replication cohort. Conclusion Our model is highly informative for clinical practice and will be conducive to primary prevention and tailoring the precise management for CAD patients.
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Affiliation(s)
- Zheng Zhang
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Binbin Shao
- Department of Prenatal Diagnosis, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing, Jiangsu Province, People’s Republic of China
| | - Hongzhou Liu
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
- School of Clinical Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuang Province, People’s Republic of China
| | - Ben Huang
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xuechen Gao
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Jun Qiu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Chen Wang
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
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Eriksson JW, Pereira MJ, Kagios C, Kvernby S, Lundström E, Fanni G, Lundqvist MH, Carlsson BCL, Sundbom M, Tarai S, Lubberink M, Kullberg J, Risérus U, Ahlström H. Short-term effects of obesity surgery versus low-energy diet on body composition and tissue-specific glucose uptake: a randomised clinical study using whole-body integrated 18F-FDG-PET/MRI. Diabetologia 2024; 67:1399-1412. [PMID: 38656372 PMCID: PMC11153296 DOI: 10.1007/s00125-024-06150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
AIMS/HYPOTHESIS Obesity surgery (OS) and diet-induced weight loss rapidly improve insulin resistance. We aim to investigate the impact of either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery compared with a diet low in energy (low-calorie diet; LCD) on body composition, glucose control and insulin sensitivity, assessed both at the global and tissue-specific level in individuals with obesity but not diabetes. METHODS In this parallel group randomised controlled trial, patients on a waiting list for OS were randomised (no blinding, sealed envelopes) to either undergo surgery directly or undergo an LCD before surgery. At baseline and 4 weeks after surgery (n=15, 11 RYGB and 4 SG) or 4 weeks after the start of LCD (n=9), investigations were carried out, including an OGTT and hyperinsulinaemic-euglycaemic clamps during which concomitant simultaneous whole-body [18F]fluorodeoxyglucose-positron emission tomography (PET)/MRI was performed. The primary outcome was HOMA-IR change. RESULTS One month after bariatric surgery and initiation of LCD, both treatments induced similar reductions in body weight (mean ± SD: -7.7±1.4 kg and -7.4±2.2 kg, respectively), adipose tissue volume (7%) and liver fat content (2% units). HOMA-IR, a main endpoint, was significantly reduced following OS (-26.3% [95% CI -49.5, -3.0], p=0.009) and non-significantly following LCD (-20.9% [95% CI -58.2, 16.5). For both groups, there were similar reductions in triglycerides and LDL-cholesterol. Fasting plasma glucose and insulin were also significantly reduced only following OS. There was an increase in glucose AUC in response to an OGTT in the OS group (by 20%) but not in the LCD group. During hyperinsulinaemia, only the OS group showed a significantly increased PET-derived glucose uptake rate in skeletal muscle but a reduced uptake in the heart and abdominal adipose tissue. Both liver and brain glucose uptake rates were unchanged after surgery or LCD. Whole-body glucose disposal and endogenous glucose production were not significantly affected. CONCLUSIONS/INTERPRETATION The short-term metabolic effects seen 4 weeks after OS are not explained by loss of body fat alone. Thus OS, but not LCD, led to reductions in fasting plasma glucose and insulin resistance as well as to distinct changes in insulin-stimulated glucose fluxes to different tissues. Such effects may contribute to the prevention or reversal of type 2 diabetes following OS. Moreover, the full effects on whole-body insulin resistance and plasma glucose require a longer time than 4 weeks. TRIAL REGISTRATION ClinicalTrials.gov NCT02988011 FUNDING: This work was supported by AstraZeneca R&D, the Swedish Diabetes Foundation, the European Union's Horizon Europe Research project PAS GRAS, the European Commission via the Marie Sklodowska Curie Innovative Training Network TREATMENT, EXODIAB, the Family Ernfors Foundation, the P.O. Zetterling Foundation, Novo Nordisk Foundation, the Agnes and Mac Rudberg Foundation and the Uppsala University Hospital ALF grants.
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Affiliation(s)
- Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
| | - Maria J Pereira
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Christakis Kagios
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Sofia Kvernby
- Department of Surgical Sciences, Molecular Imaging and Medical Physics, Uppsala University, Uppsala, Sweden
| | - Elin Lundström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Giovanni Fanni
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Martin H Lundqvist
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Björn C L Carlsson
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Surgery, Uppsala University, Uppsala, Sweden
| | - Sambit Tarai
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences, Molecular Imaging and Medical Physics, Uppsala University, Uppsala, Sweden
| | - Joel Kullberg
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Antaros Medical, Mölndal, Sweden
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
- Antaros Medical, Mölndal, Sweden.
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5
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Anazco D, Acosta A, Cathcart-Rake EJ, D'Andre SD, Hurtado MD. Weight-centric prevention of cancer. OBESITY PILLARS 2024; 10:100106. [PMID: 38495815 PMCID: PMC10943063 DOI: 10.1016/j.obpill.2024.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Background The link between excess adiposity and carcinogenesis has been well established for multiple malignancies, and cancer is one of the main contributors to obesity-related mortality. The potential role of different weight-loss interventions on cancer risk modification has been assessed, however, its clinical implications remain to be determined. In this clinical review, we present the data assessing the effect of weight loss interventions on cancer risk. Methods In this clinical review, we conducted a comprehensive search of relevant literature using MEDLINE, Embase, Web of Science, and Google Scholar databases for relevant studies from inception to January 20, 2024. In this clinical review, we present systematic reviews and meta-analysis, randomized clinical trials, and prospective and retrospective observational studies that address the effect of different treatment modalities for obesity in cancer risk. In addition, we incorporate the opinions from experts in the field of obesity medicine and oncology regarding the potential of weight loss as a preventative intervention for cancer. Results Intentional weight loss achieved through different modalities has been associated with a reduced cancer incidence. To date, the effect of weight loss on the postmenopausal women population has been more widely studied, with multiple reports indicating a protective effect of weight loss on hormone-dependent malignancies. The effect of bariatric interventions as a protective intervention for cancer has been studied extensively, showing a significant reduction in cancer incidence and mortality, however, data for the effect of bariatric surgery on certain specific types of cancer is conflicting or limited. Conclusion Medical nutrition therapy, exercise, antiobesity medication, and bariatric interventions, might lead to a reduction in cancer risk through weight loss-dependent and independent factors. Further evidence is needed to better determine which population might benefit the most, and the amount of weight loss required to provide a clinically significant preventative effect.
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Affiliation(s)
- Diego Anazco
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Maria D. Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
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Solanki AJ, Kamrava M, Posadas EM, Freedland SJ, Ballas L, Sandler HM, Bairey Merz CN, Atkins KM, Nikolova AP. A practical guide for assessing and managing cardiovascular risk during androgen-deprivation therapy in patients with prostate cancer. Cancer 2024; 130:1916-1929. [PMID: 38529566 DOI: 10.1002/cncr.35285] [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: 12/14/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
Prostate cancer is the most common malignancy among men worldwide, and androgen-deprivation therapy (ADT) is a mainstay of treatment. There are observational data demonstrating an increased risk of cardiovascular events in patients who receive ADT, particularly those who have an elevated baseline cardiovascular risk. Because, for most patients with prostate cancer, death is predominantly from noncancer-related causes, cardiovascular disease and its risk factors should be optimized during cancer treatment. This review provides an overview of the landscape of ADT treatment and serves as a guide for appropriate cardiovascular screening and risk-mitigation strategies. The authors emphasize the importance of shared communication between the multidisciplinary cancer team and primary care to improve baseline cardiovascular screening and treatment of modifiable risk factors within this higher risk population.
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Affiliation(s)
- Aum J Solanki
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Edwin M Posadas
- Department of Medicine, Division of Hematology Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andriana P Nikolova
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Zhang H, Wu L, Wu X, Chen Y, Tian FY, Yin A, Hu F, Tong J, Huang X, Wan Y, Niu J. Maternal BMI changes from the prepregnancy to postpartum period are associated with postpartum cardiometabolic risk factors: a longitudinal study. Arch Gynecol Obstet 2024; 309:2591-2603. [PMID: 37526682 PMCID: PMC11147864 DOI: 10.1007/s00404-023-07154-x] [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: 02/06/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE This study aimed at investigating the associations between the total body mass index (BMI) change at 3 or 4 years postpartum compared to the prepregnancy and cardiometabolic risk factors. METHODS This longitudinal study included 1305 participants. Based on the total postpartum BMI changes, they were divided into < 0 units, 0-1.7 units, and > 1.7 units groups using the interquartile range. Multiple linear regression models were used to analyze the associations. RESULTS Compared to the reference group, there was a progressive increase in the βcoefficient (βcoef) of homeostasis model assessment of insulin resistance (HOMA-IR) of cardiometabolic risk in the following groups: the '0-1.7 units' group with the 'overweight traj' [βcoef 0.33; 95% confidence intervals (CI) 0.22, 0.44)] or the 'obesity traj' [0.66; (0.45, 0.88)] and the '> 1.7 units' group with the 'normal traj' [0.33; (0.22, 0.44)], the 'overweight traj' [0.54; (0.41, 0.67)] or the 'obesity traj' [0.97; (0.79, 1.15)]. The same increasing trend of βcoef was also found in DBP, FPG, LDL, WHR, BF%. However, the '< 0 units' group with the 'low traj' [0.13; (0.06, 0.21)] and the '0-1.7 units' group with the 'low traj' [0.08; (0.03, 0.13)] had higher high-density lipoprotein cholesterol (HDL-C) level than the reference group. CONCLUSION Women with a postpartum BMI gain > 1.7 units are positively associated with cardiometabolic risk factors, especially for those in the 'obesity traj' or 'traj D'. Conversely, women with a postpartum BMI loss > 0 units have negative association with cardiometabolic risk factors, especially for those in the 'low traj' or 'traj B'.
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Affiliation(s)
- Huafan Zhang
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Linlin Wu
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Xiaoxia Wu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Yixuan Chen
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Fu-Ying Tian
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Aiqi Yin
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Fengqiao Hu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Jianing Tong
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Xuna Huang
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Yanmei Wan
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Jianmin Niu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China.
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8
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Ali MM, Parveen S, Williams V, Dons R, Uwaifo GI. Cardiometabolic comorbidities and complications of obesity and chronic kidney disease (CKD). J Clin Transl Endocrinol 2024; 36:100341. [PMID: 38616864 PMCID: PMC11015524 DOI: 10.1016/j.jcte.2024.100341] [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: 02/08/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/16/2024] Open
Abstract
Obesity and chronic kidney disease are two ongoing progressive clinical pandemics of major public health and clinical care significance. Because of their growing prevalence, chronic indolent course and consequent complications both these conditions place significant burden on the health care delivery system especially in developed countries like the United States. Beyond the chance coexistence of both of these conditions in the same patient based on high prevalence it is now apparent that obesity is associated with and likely has a direct causal role in the onset, progression and severity of chronic kidney disease. The causes and underlying pathophysiology of this are myriad, complicated and multi-faceted. In this review, continuing the theme of this special edition of the journal on " The Cross roads between Endocrinology and Nephrology" we review the epidemiology of obesity related chronic kidney disease (ORCKD), and its various underlying causes and pathophysiology. In addition, we delve into the consequent comorbidities and complications associated with ORCKD with particular emphasis on the cardio metabolic consequences and then review the current body of evidence for available strategies for chronic kidney disease modulation in ORCKD as well as the potential unique role of weight reduction and management strategies in its improvement and risk reduction.
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Affiliation(s)
- Mariam M. Ali
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Sanober Parveen
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Vanessa Williams
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Robert Dons
- Southern Illinois School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, 751 North Rutledge Street, Moy Building, Suite 1700, Springfield, Il 62702, United States
| | - Gabriel I. Uwaifo
- Section of Endocrinology, Dept of Medicine, SIU School of Medicine, 751 N Rutledge St, Moy Building, Suite 1700, Room #1813, Springfield, Il 62702, United States
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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10
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Paz E, Pargaonkar VS, Roach BJ, Meadows M, Roberts JM, Gazit T, Zaleski AL, Craig KJT, Serra SJ, Dunn P, Michos ED. Comprehensive Cardiovascular Risk Factor Control With a Mobile Health Cardiovascular Risk Self-Management Program. J Am Heart Assoc 2024; 13:e033328. [PMID: 38757455 PMCID: PMC11179803 DOI: 10.1161/jaha.123.033328] [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: 01/19/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Mobile health technology's impact on cardiovascular risk factor control is not fully understood. This study evaluates the association between interaction with a mobile health application and change in cardiovascular risk factors. METHODS AND RESULTS Participants with hypertension with or without dyslipidemia enrolled in a workplace-deployed mobile health application-based cardiovascular risk self-management program between January 2018 and December 2022. Retrospective evaluation explored the influence of application engagement on change in blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and weight. Multiple regression analyses examined the influence of guideline-based, nonpharmacological lifestyle-based digital coaching on outcomes adjusting for confounders. Of 102 475 participants, 49.1% were women. Median age was 53 (interquartile range, 43-61) years, BP was 134 (interquartile range, 124-144)/84 (interquartile range, 78-91) mm Hg, TC was 183 (interquartile range, 155-212) mg/dL, LDL-C was 106 (82-131) mg/dL, and body mass index was 30 (26-35) kg/m2. At 2 years, participants with baseline systolic BP ≥140 mm Hg reduced systolic BP by 18.6 (SEM, 0.3) mm Hg. At follow up, participants with baseline TC ≥240 mg/dL reduced TC by 65.7 (SEM, 4.6) mg/dL, participants with baseline LDL-C≥160 mg/dL reduced LDL-C by 66.6 (SEM, 6.2) mg/dL, and participants with baseline body mass index ≥30 kg/m2 lost 12.0 (SEM, 0.3) pounds, or 5.1% of body weight. Interaction with digital coaching was associated with greater reduction in all outcomes. CONCLUSIONS A mobile health application-based cardiovascular risk self-management program was associated with favorable reductions in BP, TC, LDL-C, and weight, highlighting the potential use of this technology in comprehensive cardiovascular risk factor control.
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Affiliation(s)
- Edo Paz
- Hello Heart, Inc Menlo Park CA USA
| | | | | | | | | | | | - Amanda L Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health® Hartford CT USA
| | | | - Steven J Serra
- Aetna Commercial, Clinical Business Support CVS Health Philadelphia PA USA
| | - Pat Dunn
- American Heart Association Dallas TX USA
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD USA
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11
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Lau LCM, Chan PK, Lui TWD, Choi SW, Au E, Leung T, Luk MH, Cheung A, Fu H, Cheung MH, Chiu KY. Preoperative weight loss interventions before total hip and knee arthroplasty: a systematic review of randomized controlled trials. ARTHROPLASTY 2024; 6:30. [PMID: 38755708 PMCID: PMC11100102 DOI: 10.1186/s42836-024-00252-4] [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: 11/29/2023] [Accepted: 03/31/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The high co-prevalence of obesity and end-stage osteoarthritis requiring arthroplasty, with the former being a risk factor for complications during arthroplasty, has led to increasing interest in employing preoperative weight loss interventions such as bariatric surgery and diet modification. However, the current evidence is conflicting, and this study aimed to investigate the effect of weight loss intervention before arthroplasty in prospective randomized controlled trials. METHODS Four electronic databases (MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials) were searched for prospective randomized controlled trials that compared weight loss interventions with usual care from inception to October 2023 by following the PRISMA guidelines. The Cochrane risk of bias tool and GRADE framework were used to assess the quality of the studies. Meta-analyses were performed when sufficient data were available from 2 or more studies. RESULTS Three randomized controlled trials involving 198 patients were identified. Two studies employed diet modification, and one study utilized bariatric surgery. All three studies reported significant reductions in body weight and body mass index (BMI), and intervention groups had fewer postoperative complications. There was no difference in the length of stay between the intervention group and the control group. Variable patient-reported outcome measures were used by different research groups. CONCLUSION Weight loss intervention can achieve significant reductions in body weight and body mass index before arthroplasty, with fewer postoperative complications reported. Further studies with different populations could confirm the effect of these interventions among populations with different obesity characteristics.
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Affiliation(s)
- Lawrence Chun Man Lau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Tak Wai David Lui
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Siu Wai Choi
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Elaine Au
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Thomas Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Michelle Hilda Luk
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Amy Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man Hong Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
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12
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Abdullah bin Ahmed I. A Comprehensive Review on Weight Gain following Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists for Obesity. J Obes 2024; 2024:8056440. [PMID: 38765635 PMCID: PMC11101251 DOI: 10.1155/2024/8056440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Obesity is considered the leading public health problem in the medical sector. The phenotype includes overweight conditions that lead to several other comorbidities that drastically decrease health. Glucagon-like receptor agonists (GLP-1RAs) initially designed for treating type 2 diabetes mellitus (T2DM) had demonstrated weight loss benefits in several clinical trials. In vivo studies showed that GLP-1RA encourages reduced food consumption and consequent weight reduction by stimulating brown fat and enhancing energy outlay through the action of the sympathetic nervous system (SNS) pathways. Additionally, GLP-1RAs were found to regulate food intake through stimulation of sensory neurons in the vagus, interaction with the hypothalamus and hindbrain, and through inflammation and intestinal microbiota. However, the main concern with the use of GLP-1RA treatment was weight gain after withdrawal or discontinuation. We could identify three different ways that could lead to weight gain. Potential factors might include temporary hormonal adjustment in response to weight reduction, the central nervous system's (CNS) incompetence in regulating weight augmentation owing to the lack of GLP-1RA, and β-cell malfunction due to sustained exposure to GLP-1RA. Here, we also review the data from clinical studies that reported withdrawal symptoms. Although the use of GLP-1RA could be beneficial in multiple ways, withdrawal after years has the symptoms reversed. Clinical studies should emphasize the downside of these views we highlighted, and mechanistic studies must be carried out for a better outcome with GLP-1RA from the laboratory to the bedside.
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Affiliation(s)
- Ibrahim Abdullah bin Ahmed
- Department of Family Medicine, Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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13
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Liu C, Chiang Y, Hui Q, Zhou JJ, Wilson PWF, Joseph J, Sun YV. High Variability of Body Mass Index Is Independently Associated With Incident Heart Failure. J Am Heart Assoc 2024; 13:e031861. [PMID: 38686888 PMCID: PMC11179915 DOI: 10.1161/jaha.123.031861] [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: 07/20/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Heart failure (HF) is a serious condition with increasing prevalence, high morbidity, and increased mortality. Obesity is an established risk factor for HF. Fluctuation in body mass index (BMI) has shown a higher risk of cardiovascular outcomes. We investigated the association between BMI variability and incident HF. METHODS AND RESULTS In the UK Biobank, we established a prospective cohort after excluding participants with prevalent HF or cancer at enrollment. A total of 99 368 White participants with ≥3 BMI measures during >2 years preceding enrollment were included, with a median follow-up of 12.5 years. The within-participant variability of BMI was evaluated using standardized SD and coefficient of variation. The association of BMI variability with incident HF was assessed using Fine and Gray's competing risk model, adjusting for confounding factors and participant-specific rate of BMI change. Higher BMI variability measured in both SD and coefficient of variation was significantly associated with higher risk in HF incidence (SD: hazard ratio [HR], 1.05 [95% CI, 1.03-1.08], P<0.0001; coefficient of variation: HR, 1.07 [95% CI, 1.04-1.10], P<0.0001). CONCLUSIONS Longitudinal health records capture BMI fluctuation, which independently predicts HF incidence.
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Affiliation(s)
- Chang Liu
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
| | - Yiyun Chiang
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
| | - Qin Hui
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
| | - Jin J Zhou
- Department of Medicine and Biostatistics University of California Los Angeles CA
| | - Peter W F Wilson
- Atlanta VA Health Care System Decatur GA
- Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jacob Joseph
- VA Providence Healthcare System Providence RI
- Warren Alpert Medical School Brown University Providence RI
| | - Yan V Sun
- Department of Epidemiology Emory University Rollins School of Public Health Atlanta GA
- Atlanta VA Health Care System Decatur GA
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14
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Zhu X, Ma E, Ge Y, Yuan M, Guo X, Peng J, Zhu W, Ren DN, Wo D. Resveratrol protects against myocardial ischemic injury in obese mice via activating SIRT3/FOXO3a signaling pathway and restoring redox homeostasis. Biomed Pharmacother 2024; 174:116476. [PMID: 38520872 DOI: 10.1016/j.biopha.2024.116476] [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: 12/12/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Increasing global overweight and obesity rates not only increase the prevalence of myocardial infarction (MI), but also exacerbate ischemic injury and result in worsened prognosis. Currently, there are no drugs that can reverse myocardial damage once MI has occurred, therefore discovering drugs that can potentially limit the extent of ischemic damage to the myocardium is critical. Resveratrol is a polyphenol known for its antioxidant properties, however whether prolonged daily intake of resveratrol during obesity can protect against MI-induced damage remains unexplored. METHODS We established murine models of obesity via high-fat/high-fructose diet, along with daily administrations of resveratrol or vehicle, then performed surgical MI to examine the effects and mechanisms of resveratrol in protecting against myocardial ischemic injury. RESULTS Daily administration of resveratrol in obese mice robustly protected against myocardial ischemic injury and improved post-MI cardiac function. Resveratrol strongly inhibited oxidative and DNA damage via activating SIRT3/FOXO3a-dependent antioxidant enzymes following MI, which were completely prevented upon administration of 3-TYP, a selective SIRT3 inhibitor. Hence, the cardioprotective effects of prolonged resveratrol intake in protecting obese mice against myocardial ischemic injury was due to reestablishment of intracellular redox homeostasis through activation of SIRT3/FOXO3a signaling pathway. CONCLUSION Our findings provide important new evidence that supports the daily intake of resveratrol, especially in those overweight or obese, which can robustly decrease the extent of ischemic damage following MI. Our study therefore provides new mechanistic insight and suggests the therapeutic potential of resveratrol as an invaluable drug in the treatment of ischemic heart diseases.
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Affiliation(s)
- Xi Zhu
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - En Ma
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Yixuan Ge
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Meng Yuan
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xiaowei Guo
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jun Peng
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Weidong Zhu
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China; Innovation and Transformation Center, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Dan-Ni Ren
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
| | - Da Wo
- Fujian Key Laboratory of Integrative Medicine on Geriatric, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China; Innovation and Transformation Center, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
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15
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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [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] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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16
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Lucherini Angeletti L, Spinelli MC, Cassioli E, Rossi E, Castellini G, Brogioni G, Ricca V, Rotella F. From Restriction to Intuition: Evaluating Intuitive Eating in a Sample of the General Population. Nutrients 2024; 16:1240. [PMID: 38674930 PMCID: PMC11053871 DOI: 10.3390/nu16081240] [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: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Intuitive eating (IE) is a non-dieting approach that promotes listening to internal cues of hunger and satiety, rather than adhering to external dietary restrictions aimed at weight loss. However, the role of IE in dieting behaviors related to weight-loss approaches is still unclear. To address this issue, the aim of this study was to compare IE levels between dieting and non-dieting individuals, exploring the relationship between IE and dieting-related psychological and physical factors. A sample of 2059 females was recruited via social media and self-reported questionnaires were administered to measure IE, eating psychopathology, self-efficacy, and quality of life. Individuals with a history of dieting exhibited lower IE levels, a higher BMI, and a greater eating psychopathology, as well as a reduced self-efficacy and quality of life, compared to non-dieters. IE showed a protective effect against dieting behaviors, with higher IE levels being associated with a lower likelihood of dieting. Additionally, higher BMI and eating psychopathology were predictors of dieting. Promoting IE could represent a relevant clinical target strategy to address disordered eating and enhance overall well-being, underscoring the need for interventions that foster a healthier relationship with food and bodily internal sensations.
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Affiliation(s)
- Lorenzo Lucherini Angeletti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
- The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON K1Z 7K4, Canada
| | - Maria Chiara Spinelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Giulietta Brogioni
- Psychiatry Unit, AOU Careggi Hospital, Largo Brambilla, 3, 50134 Florence, Italy;
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
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17
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Mainieri F, La Bella S, Rinaldi M, Chiarelli F. Rare genetic forms of obesity in childhood and adolescence: A narrative review of the main treatment options with a focus on innovative pharmacological therapies. Eur J Pediatr 2024; 183:1499-1508. [PMID: 38227053 DOI: 10.1007/s00431-024-05427-4] [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: 07/26/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
The prevalence of obesity in children and adolescents is increasing, and it is recognised as a complex disorder that often begins in early childhood and persists throughout life. Both polygenic and monogenic obesity are influenced by a combination of genetic predisposition and environmental factors. Rare genetic obesity forms are caused by specific pathogenic variants in single genes that have a significant impact on weight regulation, particularly genes involved in the leptin-melanocortin pathway. Genetic testing is recommended for patients who exhibit rapid weight gain in infancy and show additional clinical features suggestive of monogenic obesity as an early identification allows for appropriate treatment, preventing the development of obesity-related complications, avoiding the failure of traditional treatment approaches. In the past, the primary recommendations for managing obesity in children and teenagers have been focused on making multiple lifestyle changes that address diet, physical activity, and behaviour, with the goal of maintaining these changes long-term. However, achieving substantial and lasting weight loss and improvements in body mass index (BMI) through lifestyle interventions alone is rare. Recently the progress made in genetic analysis has paved the way for innovative pharmacological treatments for different forms of genetic obesity. By understanding the molecular pathways that contribute to the development of obesity, it is now feasible to identify specific patients who can benefit from targeted treatments based on their unique genetic mechanisms. Conclusion: However, additional preclinical research and studies in the paediatric population are required, both to develop more personalised prevention and therapeutic programs, particularly for the early implementation of innovative and beneficial management options, and to enable the translation of these novel therapy approaches into clinical practice. What is Known: • The prevalence of obesity in the paediatric population is increasing, and it is considered as a multifaceted condition that often begins in early childhood and persists in the adult life. Particularly, rare genetic forms of obesity are influenced by a combination of genetic predisposition and environmental factors and are caused by specific pathogenic variants in single genes showing a remarkable impact on weight regulation, particularly genes involved in the leptin-melanocortin pathway. • Patients who present with rapid weight gain in infancy and show additional clinical characteristics indicative of monogenic obesity should undergo genetic testing, which, by enabling a correct diagnosis, can prevent the development of obesity-related consequences through the identification for appropriate treatment. What is New: • In recent years, advances made in genetic analysis has made it possible to develop innovative pharmacological treatments for various forms of genetic obesity. In fact, it is now achievable to identify specific patients who can benefit from targeted treatments based on their unique genetic mechanisms by understanding the molecular pathways involved in the development of obesity. • As demonstrated over the last years, two drugs, setmelanotide and metreleptin, have been identified as potentially effective interventions in the treatment of certain rare forms of monogenic obesity caused by loss-of-function mutations in genes involved in the leptin-melanocortin pathway. Recent advancements have led to the development of novel treatments, including liraglutide, semaglutide and retatrutide, that have the potential to prevent the progression of metabolic abnormalities and improve the prognosis of individuals with these rare and severe forms of obesity. However, extensive preclinical research and, specifically, additional studies in the paediatric population are necessary to facilitate the translation of these innovative treatment techniques into clinical practice.
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Affiliation(s)
| | | | - Marta Rinaldi
- Paediatric Department, Stoke Mandeville Hospital - Thames Valley Deanery, Oxford, UK
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18
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Zhou XY, Guo KH, Huang SF, Liu RK, Zeng CP. Ketogenic diet combined with intermittent fasting: an option for type 2 diabetes remission? Nutr Rev 2024:nuae014. [PMID: 38472140 DOI: 10.1093/nutrit/nuae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.
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Affiliation(s)
- Xiao-Ying Zhou
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Kai-Heng Guo
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Shao-Feng Huang
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Rui-Ke Liu
- Department of Endocrinology and Metabolism, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Chun-Ping Zeng
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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19
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Eklund SA, Israelsson H, Brunström M, Forsberg K, Malm J. 10-year mortality, causes of death and cardiovascular comorbidities in idiopathic normal pressure hydrocephalus. J Neurol 2024; 271:1311-1319. [PMID: 37917232 PMCID: PMC10896765 DOI: 10.1007/s00415-023-12067-5] [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: 08/30/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The objective was to investigate 10-year mortality, causes of death and cardiovascular comorbidity in idiopathic normal pressure hydrocephalus (iNPH) and to evaluate their mutual associations. METHODS This prospective cohort study included 176 CSF-shunted iNPH patients, and 368 age- and sex-matched controls. At inclusion, participants were medically examined, had blood analyzed and answered a questionnaire. The vascular comorbidities investigated were smoking, diabetes, body mass index, blood pressure (BP), hyperlipidemia, kidney function, atrial fibrillation and, cerebro- and cardiovascular disease. RESULTS Survival was observed for a mean period of 10.3 ± 0.84 years. Shunted iNPH patients had an increased risk of death compared to controls (hazard ratio (HR) = 2.5, 95% CI 1.86-3.36; p < 0.001). After 10 years, 50% (n = 88) of iNPH patients and 24% (n = 88) of the controls were dead (p < 0.001). The risk of dying from cardiovascular disease, falls and neurological diseases were higher in iNPH (p < 0.05). The most common cause of death in iNPH was cardiovascular diseases (14% vs 7% for controls). Seven out of nine iNPH dying from falls had subdural hematomas. Systolic BP (HR = 0.985 95% CI 0.972-0.997, p = 0.018), atrial fibrillation (HR = 2.652, 95% CI 1.506-4.872, p < 0.001) and creatinine (HR = 1.018, 95% CI 1.010-1.027, p < 0.001) were independently associated with mortality for iNPH. DISCUSSION This long-term and population-matched cohort study indicates that in spite of CSF-shunt treatment, iNPH has shorter life expectancy. It may be important to treat iNPH in supplementary ways to reduce mortality. Both cardiovascular comorbidities and lethal falls are contributing to the excess mortality in iNPH and reducing these preventable risks should be an established part of the treatment plan.
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Affiliation(s)
- Sanna A Eklund
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.
| | - Hanna Israelsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Karin Forsberg
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
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20
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Bailey CJ, Flatt PR, Conlon JM. Recent advances in peptide-based therapies for obesity and type 2 diabetes. Peptides 2024; 173:171149. [PMID: 38184193 DOI: 10.1016/j.peptides.2024.171149] [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: 12/04/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Options for the treatment of type 2 diabetes mellitus (T2DM) and obesity have recently been expanded by the results of several large clinical trials with incretin-based peptide therapies. Most of these studies have been conducted with the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide, which is available as a once weekly subcutaneous injection and once daily tablet, and the once weekly injected dual agonist tirzepatide, which interacts with receptors for GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). In individuals with T2DM these therapies have achieved reductions of glycated haemoglobin (HbA1c) by > 2% and lowered body weight by > 10%. In some studies, these agents tested in non-diabetic, obese individuals at much higher doses have lowered body weight by > 15%. Emerging evidence suggests these agents can also offer cardio-protective and potentially reno-protective effects. Other incretin-based peptide therapies in early clinical development, notably a triple GLP-1/GIP/glucagon receptor agonist (retatrutide) and a combination of semaglutide with the amylin analogue cagrilintide (CagriSema), have shown strong efficacy. Although incretin therapies can incur adverse gastrointestinal effects these are for most patients mild-to-moderate and transient but result in cessation of treatment in some cases. Thus, the efficacy of new incretin-based peptide therapies is enhancing the opportunity to control body weight and blood glucose and improve the treatment of T2DM and obesity.
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Affiliation(s)
| | - Peter R Flatt
- Diabetes Research Centre, School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, Northern Ireland, UK
| | - J Michael Conlon
- Diabetes Research Centre, School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, Northern Ireland, UK.
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21
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Diao Z, Molludi J, Latef Fateh H, Moradi S. Comparison of the low-calorie DASH diet and a low-calorie diet on serum TMAO concentrations and gut microbiota composition of adults with overweight/obesity: a randomized control trial. Int J Food Sci Nutr 2024; 75:207-220. [PMID: 38149315 DOI: 10.1080/09637486.2023.2294685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/09/2023] [Indexed: 12/28/2023]
Abstract
This study compares two diets, Dietary Approaches to Stop Hypertension (DASH) and a Low-Calorie Diet on Trimethylamine N-oxide (TMAO) levels and gut microbiota. 120 obese adults were randomly allocated to these three groups: a low-calorie DASH diet, a Low-Calorie diet, or a control group for 12 weeks. Outcomes included plasma TMAO, lipopolysaccharides (LPS), and gut microbiota profiles. After the intervention, the low-calorie DASH diet group demonstrated a greater decrease in TMAO levels (-20 ± 8.1 vs. -10.63 ± 4.6 μM) and a significant decrease in LPS concentration (-19.76 ± 4.2 vs. -5.68 ± 2.3) compared to the low-calorie diet group. Furthermore, the low-calorie DASH diet showed a higher decrease in the Firmicutes and Bactericides (F/B) ratio, which influenced TMAO levels, compared to the Low-Calorie diet (p = 0.028). The current study found the low-calorie DASH diet improves TMAO and LPS in comparison to a Low-Calorie diet.
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Affiliation(s)
- Zhipeng Diao
- Tianjin Yite Life Science R&D Co. LTD, Tianjin, China
| | - Jalall Molludi
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hawal Latef Fateh
- Nursing Department, Kalar Technical College, Sulaimani Polytechnic University, Sulaymaniyah, Iraq
- Nursing Department, Kalar Technical College, Garmian Polytechnic University, Kalar, Iraq
| | - Sara Moradi
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
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22
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Lincoff AM, Ryan DH. The SELECT trial of semaglutide in patients with overweight or obesity without diabetes: establishing a new pathway to secondary prevention of cardiovascular disease. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:93-94. [PMID: 38066700 DOI: 10.1093/ehjcvp/pvad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 02/24/2024]
Affiliation(s)
- A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Donna H Ryan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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23
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Liuzzo G, Patrono C. Reducing cardiovascular outcomes with semaglutide: a metabolic route for a SELECT few. Eur Heart J 2024; 45:570-571. [PMID: 38103177 DOI: 10.1093/eurheartj/ehad823] [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] [Indexed: 12/17/2023] Open
Affiliation(s)
- Giovanna Liuzzo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Largo F.Vito 1, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Carlo Patrono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Largo F.Vito 1, 00168 Rome, Italy
- Department of Pharmacology, Catholic University School of Medicine, Largo F.Vito 1, 00168 Rome, Italy
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24
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Watts EL, Moore SC, Gunter MJ, Chatterjee N. Adiposity and cancer: meta-analysis, mechanisms, and future perspectives. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.16.24302944. [PMID: 38405761 PMCID: PMC10889047 DOI: 10.1101/2024.02.16.24302944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Obesity is a recognised risk factor for many cancers and with rising global prevalence, has become a leading cause of cancer. Here we summarise the current evidence from both population-based epidemiologic investigations and experimental studies on the role of obesity in cancer development. This review presents a new meta-analysis using data from 40 million individuals and reports positive associations with 19 cancer types. Utilising major new data from East Asia, the meta-analysis also shows that the strength of obesity and cancer associations varies regionally, with stronger relative risks for several cancers in East Asia. This review also presents current evidence on the mechanisms linking obesity and cancer and identifies promising future research directions. These include the use of new imaging data to circumvent the methodological issues involved with body mass index and the use of omics technologies to resolve biologic mechanisms with greater precision and clarity.
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Affiliation(s)
- Eleanor L Watts
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Shady Grove, MD, USA
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Shady Grove, MD, USA
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Nilanjan Chatterjee
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, USA
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25
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Weinstein S, Maor E, Kaplan A, Hod T, Leibowitz A, Grossman E, Shlomai G. Non-Interventional Weight Changes Are Associated with Alterations in Lipid Profiles and in the Triglyceride-to-HDL Cholesterol Ratio. Nutrients 2024; 16:486. [PMID: 38398811 PMCID: PMC10892159 DOI: 10.3390/nu16040486] [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: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Obesity is associated with dyslipidemia, and weight loss can improve obese patients' lipid profile. Here, we assessed whether non-interventional weight changes are associated with alterations in lipid profile, particularly the triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C). METHODS In this retrospective analysis of subjects referred to medical screening, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), TG, and HDL-C levels were measured annually. Patients were divided according to BMI changes between visits. The primary outcomes were the changes in LDL-C, TG, HDL-C, and the TG/HDL-C ratio between visits. RESULTS The final analysis included 18,828 subjects. During the year of follow-up, 9.3% of the study population lost more than 5% of their weight and 9.2% gained more than 5% of their weight. The effect of weight changes on TG and on the TG/HDL-C ratio was remarkable. Patients with greater BMI increases showed greater increases in their TG/HDL-C ratio, and conversely, a decreased BMI level had lower TG/HDL-C ratios. This is true even for moderate changes of more than 2.5% in BMI. CONCLUSIONS Non-interventional weight changes, even modest ones, are associated with significant alterations in the lipid profile. Understanding that modest, non-interventional weight changes are associated with alterations in the TG/HDL-C ratio may aid in better risk stratification and primary prevention of CV morbidity and mortality.
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Affiliation(s)
- Shiri Weinstein
- Internal Medicine D, Sheba Medical Center, Ramat Gan 5262504, Israel; (S.W.); (A.K.); (A.L.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (E.M.); (T.H.)
| | - Elad Maor
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (E.M.); (T.H.)
- Leviev Heart Center, Sheba Medical Center, Ramat Gan 5262504, Israel
| | - Alon Kaplan
- Internal Medicine D, Sheba Medical Center, Ramat Gan 5262504, Israel; (S.W.); (A.K.); (A.L.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (E.M.); (T.H.)
| | - Tammy Hod
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (E.M.); (T.H.)
- Renal Transplant Center, Sheba Medical Center, Ramat Gan 5262504, Israel
- Nephrology Department, Sheba Medical Center, Ramat Gan 5262504, Israel
| | - Avshalom Leibowitz
- Internal Medicine D, Sheba Medical Center, Ramat Gan 5262504, Israel; (S.W.); (A.K.); (A.L.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (E.M.); (T.H.)
- The Hypertension Unit, Sheba Medical Center, Ramat Gan 5262504, Israel
| | - Ehud Grossman
- Adelson School of Medicine, Ariel University, Ariel 407000, Israel
| | - Gadi Shlomai
- Internal Medicine D, Sheba Medical Center, Ramat Gan 5262504, Israel; (S.W.); (A.K.); (A.L.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (E.M.); (T.H.)
- The Hypertension Unit, Sheba Medical Center, Ramat Gan 5262504, Israel
- The Institute of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan 5262504, Israel
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26
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Bull CJ, Hazelwood E, Legge DN, Corbin LJ, Richardson TG, Lee M, Yarmolinsky J, Smith-Byrne K, Hughes DA, Johansson M, Peters U, Berndt SI, Brenner H, Burnett-Hartman A, Cheng I, Kweon SS, Le Marchand L, Li L, Newcomb PA, Pearlman R, McConnachie A, Welsh P, Taylor R, Lean MEJ, Sattar N, Murphy N, Gunter MJ, Timpson NJ, Vincent EE. Impact of weight loss on cancer-related proteins in serum: results from a cluster randomised controlled trial of individuals with type 2 diabetes. EBioMedicine 2024; 100:104977. [PMID: 38290287 PMCID: PMC10844806 DOI: 10.1016/j.ebiom.2024.104977] [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: 07/19/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Type 2 diabetes is associated with higher risk of several cancer types. However, the biological intermediates driving this relationship are not fully understood. As novel interventions for treating and managing type 2 diabetes become increasingly available, whether they also disrupt the pathways leading to increased cancer risk is currently unknown. We investigated the effect of a type 2 diabetes intervention, in the form of intentional weight loss, on circulating proteins associated with cancer risk to gain insight into potential mechanisms linking type 2 diabetes and adiposity with cancer development. METHODS Fasting serum samples from participants with diabetes enrolled in the Diabetes Remission Clinical Trial (DiRECT) receiving the Counterweight-Plus weight-loss programme (intervention, N = 117, mean weight-loss 10 kg, 46% diabetes remission) or best-practice care by guidelines (control, N = 143, mean weight-loss 1 kg, 4% diabetes remission) were subject to proteomic analysis using the Olink Oncology-II platform (48% of participants were female; 52% male). To identify proteins which may be altered by the weight-loss intervention, the difference in protein levels between groups at baseline and 1 year was examined using linear regression. Mendelian randomization (MR) was performed to extend these results to evaluate cancer risk and elucidate possible biological mechanisms linking type 2 diabetes and cancer development. MR analyses were conducted using independent datasets, including large cancer meta-analyses, UK Biobank, and FinnGen, to estimate potential causal relationships between proteins modified during intentional weight loss and the risk of colorectal, breast, endometrial, gallbladder, liver, and pancreatic cancers. FINDINGS Nine proteins were modified by the intervention: glycoprotein Nmb; furin; Wnt inhibitory factor 1; toll-like receptor 3; pancreatic prohormone; erb-b2 receptor tyrosine kinase 2; hepatocyte growth factor; endothelial cell specific molecule 1 and Ret proto-oncogene (Holm corrected P-value <0.05). Mendelian randomization analyses indicated a causal relationship between predicted circulating furin and glycoprotein Nmb on breast cancer risk (odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.67-0.99, P-value = 0.03; and OR = 0.88, 95% CI = 0.78-0.99, P-value = 0.04 respectively), though these results were not supported in sensitivity analyses examining violations of MR assumptions. INTERPRETATION Intentional weight loss among individuals with recently diagnosed diabetes may modify levels of cancer-related proteins in serum. Further evaluation of the proteins identified in this analysis could reveal molecular pathways that mediate the effect of adiposity and type 2 diabetes on cancer risk. FUNDING The main sources of funding for this work were Diabetes UK, Cancer Research UK, World Cancer Research Fund, and Wellcome.
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Affiliation(s)
- Caroline J Bull
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; School of Translational Health Sciences, Dorothy Hodgkin Building, University of Bristol, Bristol, UK
| | - Emma Hazelwood
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Danny N Legge
- School of Translational Health Sciences, Dorothy Hodgkin Building, University of Bristol, Bristol, UK
| | - Laura J Corbin
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom G Richardson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Lee
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France
| | - James Yarmolinsky
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Karl Smith-Byrne
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, UK
| | - David A Hughes
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mattias Johansson
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea; Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | | | - Li Li
- Department of Family Medicine, University of Virginia, Charlottesville, VA, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; School of Public Health, University of Washington, Seattle, WA, USA
| | - Rachel Pearlman
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mike E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma E Vincent
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; School of Translational Health Sciences, Dorothy Hodgkin Building, University of Bristol, Bristol, UK.
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27
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Gray MP, Vogel B, Mehran R, Leopold JA, Figtree GA. Primary prevention of cardiovascular disease in women. Climacteric 2024; 27:104-112. [PMID: 38197424 DOI: 10.1080/13697137.2023.2282685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/31/2023] [Indexed: 01/11/2024]
Abstract
Ischemic heart disease is the primary cause of cardiovascular disease (CVD) mortality in both men and women. Strategies targeting traditional modifiable risk factors are essential - including hypertension, smoking, dyslipidemia and diabetes mellitus - particularly for atherosclerosis, but additionally for stroke, heart failure and some arrhythmias. However, challenges related to education, screening and equitable access to effective preventative therapies persist, and are particularly problematic for women around the globe and those from lower socioeconomic groups. The association of female-specific risk factors (e.g. premature menopause, gestational hypertension, small for gestational age births) with CVD provides a potential window for targeted prevention strategies. However, further evidence for specific effective screening and interventions is urgently required. In addition to population-level factors involved in increasing the risk of suffering a CVD event, efforts are leveraging the enormous potential of blood-based 'omics', improved imaging biomarkers and increasingly complex bioinformatic analytic approaches to strive toward more personalized early disease detection and personalized preventative therapies. These novel tactics may be particularly relevant for women in whom traditional risk factors perform poorly. Here we discuss established and emerging approaches for improving risk assessment, early disease detection and effective preventative strategies to reduce the mammoth burden of CVD in women.
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Affiliation(s)
- M P Gray
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - B Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J A Leopold
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, USA
| | - G A Figtree
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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28
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Di Fusco SA, Spinelli A, Castello L, Marino G, Maraschi I, Gulizia MM, Gabrielli D, Colivicchi F. Do Pathophysiologic Mechanisms Linking Unhealthy Lifestyle to Cardiovascular Disease and Cancer Imply Shared Preventive Measures? - A Critical Narrative Review. Circ J 2024; 88:189-197. [PMID: 34544961 DOI: 10.1253/circj.cj-21-0459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Growing evidence has shown a bidirectional link between the cardiologic and oncologic fields. Several investigations support the role of unhealthy behaviors as pathogenic factors of both cardiovascular disease and cancer. We report epidemiological and research findings on the pathophysiological mechanisms linking unhealthy lifestyle to cardiovascular disease and cancer. For each unhealthy behavior, we also discuss the role of preventive measures able to affect both cardiovascular disease and cancer occurrence and progression.
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Affiliation(s)
| | | | - Lorenzo Castello
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital
| | - Gaetano Marino
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital
| | - Ilaria Maraschi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital
| | | | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital
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29
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Hankosky ER, Wang H, Neff LM, Kan H, Wang F, Ahmad NN, Griffin R, Stefanski A, Garvey WT. Tirzepatide reduces the predicted risk of atherosclerotic cardiovascular disease and improves cardiometabolic risk factors in adults with obesity or overweight: SURMOUNT-1 post hoc analysis. Diabetes Obes Metab 2024; 26:319-328. [PMID: 37932236 DOI: 10.1111/dom.15318] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023]
Abstract
AIM To assess the effect of tirzepatide on long-term risk of atherosclerotic cardiovascular disease (ASCVD) among people with obesity or overweight without diabetes from SURMOUNT-1. MATERIALS AND METHODS SURMOUNT-1, a phase 3 trial, evaluated the efficacy and safety of tirzepatide in adults with body mass index ≥30 or ≥27 kg/m2 and at least one weight-related complication, excluding diabetes. Participants were randomly assigned to tirzepatide (5/10/15 mg) or placebo. Changes from baseline in cardiometabolic variables were assessed. The predicted 10-year ASCVD risk scores were calculated (American College of Cardiology/American Heart Association risk engine) at baseline, week 24, and week 72 in SURMOUNT-1 participants without a history of ASCVD. Percent change in risk scores from baseline to weeks 24 and 72 was compared between tirzepatide and placebo using mixed model for repeated measures analysis. Analyses were also conducted in participants with intermediate to high risk at baseline. RESULTS Tirzepatide-treated groups demonstrated reductions in cardiometabolic variables over 72 weeks. In participants without a history of ASCVD (N = 2461), the baseline median risk score was low and did not differ across groups (1.5%-1.6%). Relative change in risk from baseline to week 72 was greater for tirzepatide (-23.5% to -16.4%) than placebo (12.7%; P < 0.001). Relative change among participants with intermediate-to-high baseline risk was significantly greater for tirzepatide (P < 0.05). Intermediate-to-high-risk participants demonstrated similar relative change but greater absolute risk reduction compared to the overall population. CONCLUSION Tirzepatide treatment significantly reduced the 10-year predicted risk of ASCVD versus placebo in patients with obesity or overweight without diabetes.
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Affiliation(s)
| | - Hui Wang
- TechData Services Company, King of Prussia, Pennsylvania, USA
| | - Lisa M Neff
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Hong Kan
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Fangyu Wang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Ryan Griffin
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Perin L, Camboim IG, Schneider CD, Lehnen AM. Weight loss associated with low-energy diets with different glycaemic loads does not improve arterial stiffness: a randomised clinical trial. Br J Nutr 2023; 130:1859-1870. [PMID: 37154243 DOI: 10.1017/s0007114523001022] [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] [Indexed: 05/10/2023]
Abstract
We evaluated the effects of two low-energy diets with different glycaemic loads on arterial stiffness in adults with excess weight. This was a 45-day parallel-group, randomised clinical trial including seventy-five participants (20-59 years; BMI 32 kg/m2). They were assigned to two similar low-energy diets (reduction of ∼750 kcal.d-1) with macronutrient composition (55 % carbohydrates, 20 % proteins and 25 % lipids) but different glycaemic loads: high-glycaemic load (HGL 171 g.d-1; n 36) or low-glycaemic load (LGL 67 g.d-1; n 39). We evaluated: arterial stiffness (pulse wave velocity, PWV); augmentation index (AIx@75); reflection coefficient; fasting blood glucose; fasting lipid profile; blood pressure and body composition. We found no improvements in PWV (P = 0·690) and AIx@75 (P = 0·083) in both diet groups, but there was a decrease in the reflection coefficient in the LGL group (P = 0·003) compared with baseline. The LGL diet group showed reductions in body weight (Δ -4·9 kg; P = 0·001), BMI (Δ -1·6 kg/m2; P = 0·001), waist circumference (Δ -3·1 cm; P = 0·001), body fat (Δ -1·8 %; P = 0·034), as well as TAG (Δ -14·7 mg/dl; P = 0·016) and VLDL (Δ -2·8 mg/dl; P = 0·020). The HGL diet group showed a reduction in total cholesterol (Δ -14·6 mg/dl; P = 0·001), LDL (Δ -9·3 mg/dl; P = 0·029) but a reduction in HDL (Δ -3·7 mg/dl; P = 0·002). In conclusion, a 45-day intervention with low-energy HGL or LGL diets in adults with excess weight was not effective to improve arterial stiffness. However, the LGL diet intervention was associated with a reduction of reflection coefficient and improvements in body composition, TAG and VLDL levels.
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Affiliation(s)
- Lisiane Perin
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande Grande do Sul, Brasil
| | - Isadora G Camboim
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande Grande do Sul, Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande Grande do Sul, Brasil
| | - Cláudia D Schneider
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande Grande do Sul, Brasil
| | - Alexandre M Lehnen
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande Grande do Sul, Brasil
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Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, Hardt-Lindberg S, Hovingh GK, Kahn SE, Kushner RF, Lingvay I, Oral TK, Michelsen MM, Plutzky J, Tornøe CW, Ryan DH. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med 2023; 389:2221-2232. [PMID: 37952131 DOI: 10.1056/nejmoa2307563] [Citation(s) in RCA: 318] [Impact Index Per Article: 318.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Semaglutide, a glucagon-like peptide-1 receptor agonist, has been shown to reduce the risk of adverse cardiovascular events in patients with diabetes. Whether semaglutide can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes is unknown. METHODS In a multicenter, double-blind, randomized, placebo-controlled, event-driven superiority trial, we enrolled patients 45 years of age or older who had preexisting cardiovascular disease and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 27 or greater but no history of diabetes. Patients were randomly assigned in a 1:1 ratio to receive once-weekly subcutaneous semaglutide at a dose of 2.4 mg or placebo. The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in a time-to-first-event analysis. Safety was also assessed. RESULTS A total of 17,604 patients were enrolled; 8803 were assigned to receive semaglutide and 8801 to receive placebo. The mean (±SD) duration of exposure to semaglutide or placebo was 34.2±13.7 months, and the mean duration of follow-up was 39.8±9.4 months. A primary cardiovascular end-point event occurred in 569 of the 8803 patients (6.5%) in the semaglutide group and in 701 of the 8801 patients (8.0%) in the placebo group (hazard ratio, 0.80; 95% confidence interval, 0.72 to 0.90; P<0.001). Adverse events leading to permanent discontinuation of the trial product occurred in 1461 patients (16.6%) in the semaglutide group and 718 patients (8.2%) in the placebo group (P<0.001). CONCLUSIONS In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months. (Funded by Novo Nordisk; SELECT ClinicalTrials.gov number, NCT03574597.).
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Affiliation(s)
- A Michael Lincoff
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Kirstine Brown-Frandsen
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Helen M Colhoun
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - John Deanfield
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Scott S Emerson
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Sille Esbjerg
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Søren Hardt-Lindberg
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - G Kees Hovingh
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Steven E Kahn
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Robert F Kushner
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Ildiko Lingvay
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Tugce K Oral
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Marie M Michelsen
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Jorge Plutzky
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Christoffer W Tornøe
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
| | - Donna H Ryan
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (A.M.L.); Novo Nordisk, Søborg, Denmark (K.B.-F., S.E., S.H.-L., G.K.H., T.K.O., M.M.M., C.W.T.); the Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh (H.M.C.), and the National Institute for Cardiovascular Outcomes Research, University College London, London (J.D.) - both in the United Kingdom; the Department of Biostatistics, University of Washington (S.S.E.), and the Department of Medicine, VA Puget Sound Health Care System and University of Washington (S.E.K.) - both in Seattle; the Department of Vascular Medicine, Academic Medical Center, Amsterdam (G.K.H.); the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago (R.F.K.); the Department of Internal Medicine (Endocrinology Division) and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas (I.L.); the Department of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (J.P.); and Pennington Biomedical Research Center, Baton Rouge, LA (D.H.R.)
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Abstract
Obesity has been recognized to be increasing globally and is designated a disease with adverse consequences requiring early detection and appropriate care. In addition to being related to metabolic syndrome disorders such as type 2 diabetes, hypertension, stroke, and premature coronary artery disease. Obesity is also etiologically linked to several cancers. The non-gastrointestinal cancers are breast, uterus, kidneys, ovaries, thyroid, meningioma, and thyroid. Gastrointestinal (GI) cancers are adenocarcinoma of the esophagus, liver, pancreas, gallbladder, and colorectal. The brighter side of the problem is that being overweight and obese and cigarette smoking are mostly preventable causes of cancers. Epidemiology and clinical studies have revealed that obesity is heterogeneous in clinical manifestations. In clinical practice, BMI is calculated by dividing a person's weight in kilograms by the square of the person's height in square meters (kg/m2). A BMI above 30 kg/m2 (defining obesity in many guidelines) is considered obesity. However, obesity is heterogeneous. There are subdivisions for obesity, and not all obesities are equally pathogenic. Adipose tissue, in particular, visceral adipose tissue (VAT), is endocrine and abdominal obesity (a surrogate for VAT) is evaluated by waist-hip measurements or just waist measures. Visceral Obesity, through several hormonal mechanisms, induces a low-grade chronic inflammatory state, insulin resistance, components of metabolic syndrome, and cancers. Metabolically obese, normal-weight (MONW) individuals in several Asian countries may have BMI below normal levels to diagnose obesity but suffer from many obesity-related complications. Conversely, some people have high BMI but are generally healthy with no features of metabolic syndrome. Many clinicians advise weight loss by dieting and exercise to metabolically healthy obese with large body habitus than to individuals with metabolic obesity but normal BMI. The GI cancers (esophagus, pancreas, gallbladder, liver, and colorectal) are individually discussed, emphasizing the incidence, possible pathogenesis, and preventive measures. From 2005 to 2014, most cancers associated with overweight and Obesity increased in the United States, while cancers related to other factors decreased. The standard recommendation is to offer or refer adults with a body mass index (BMI) of 30 or more to intensive, multicomponent behavioral interventions. However, the clinicians have to go beyond. They should critically evaluate BMI with due consideration for ethnicity, body habitus, and other factors that influence the type of obesity and obesity-related risks. In 2001, the Surgeon General's ``Call to Action to Prevent and Decrease Overweight and Obesity'' identified obesity as a critical public health priority for the United States. At government levels reducing obesity requires policy changes that improve the food and physical activity for all. However, implementing some policies with the most significant potential benefit to public health is politically tricky. The primary care physician, as well as subspecialists, should identify overweight and Obesity based on all the variable factors in the diagnosis. The medical community should address the prevention of overweight and Obesity as an essential part of medical care as much as vaccination in preventing infectious diseases at all levels- from childhood, to adolescence, and adults.
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Affiliation(s)
- Yuntao Zou
- Department of Medicine, Saint Peter's University Hospital, 125 Andover DR, Kendall Park, New Brunswick, NJ 08901, USA
| | - Capecomorin S Pitchumoni
- Department of Medicine, Saint Peter's University Hospital, 125 Andover DR, Kendall Park, New Brunswick, NJ 08901, USA.
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Lima do Vale MR, Buckner L, Mitrofan CG, Tramontt CR, Kargbo SK, Khalid A, Ashraf S, Mouti S, Dai X, Unwin D, Bohn J, Goldberg L, Golubic R, Ray S. A synthesis of pathways linking diet, metabolic risk and cardiovascular disease: a framework to guide further research and approaches to evidence-based practice. Nutr Res Rev 2023; 36:232-258. [PMID: 34839838 DOI: 10.1017/s0954422421000378] [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] [Indexed: 11/07/2022]
Abstract
Cardiovascular disease (CVD) is the most common non-communicable disease occurring globally. Although previous literature has provided useful insights into the important role that diet plays in CVD prevention and treatment, understanding the causal role of diets is a difficult task considering inherent and introduced weaknesses of observational (e.g. not properly addressing confounders and mediators) and experimental research designs (e.g. not appropriate or well designed). In this narrative review, we organised current evidence linking diet, as well as conventional and emerging physiological risk factors, with CVD risk, incidence and mortality in a series of diagrams. The diagrams presented can aid causal inference studies as they provide a visual representation of the types of studies underlying the associations between potential risk markers/factors for CVD. This may facilitate the selection of variables to be considered and the creation of analytical models. Evidence depicted in the diagrams was systematically collected from studies included in the British Nutrition Task Force report on diet and CVD and database searches, including Medline and Embase. Although several markers and disorders linked to conventional and emerging risk factors for CVD were identified, the causal link between many remains unknown. There is a need to address the multifactorial nature of CVD and the complex interplay between conventional and emerging risk factors with natural and built environments, while bringing the life course into the spotlight.
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Affiliation(s)
| | - Luke Buckner
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | | | | | | | - Ali Khalid
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Sammyia Ashraf
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Saad Mouti
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
| | - Xiaowu Dai
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
| | | | - Jeffrey Bohn
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
- Swiss Re Institute, Zürich, Switzerland
| | - Lisa Goldberg
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
| | - Rajna Golubic
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Diabetes Trials Unit, University of Oxford, Oxford, UK
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- University of Ulster, School of Biomedical Sciences, Coleraine, UK
- University of Cambridge, School of the Humanities and Social Sciences, Cambridge, UK
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Abbott S, Chan F, Tahrani AA, Wong SH, Campbell FEJ, Parmar C, Pournaras DJ, Denton A, Sinclair AJ, Mollan SP. Weight Management Interventions for Adults With Idiopathic Intracranial Hypertension: A Systematic Review and Practice Recommendations. Neurology 2023; 101:e2138-e2150. [PMID: 37813577 PMCID: PMC10663033 DOI: 10.1212/wnl.0000000000207866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Idiopathic intracranial hypertension (IIH) is associated with obesity; however, there is a lack of clinical consensus on how to manage weight in IIH. The aim of this systematic review was to evaluate weight loss interventions in people with IIH to determine which intervention is superior in terms of weight loss, reduction in intracranial pressure (ICP), benefit to visual and headache outcomes, quality of life, and mental health. METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42023339569). MEDLINE and CINAHL were searched for relevant literature published from inception until December 15, 2022. Screening and quality appraisal was conducted by 2 independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network methodology. RESULTS A total of 17 studies were included. Bariatric surgery resulted in 27.2-27.8 kg weight loss at 24 months (Level 1- to 1++). Lifestyle weight management interventions resulted in between 1.4 and 15.7 kg weight loss (Level 2+ to 1++). Bariatric surgery resulted in the greatest mean reduction in ICP (-11.9 cm H2O) at 24 months (Level 1++), followed by multicomponent lifestyle intervention + acetazolamide (-11.2 cm H2O) at 6 months (Level 1+) and then a very low-energy diet intervention (-8.0 cm H2O) at 3 months (Level 2++). The least ICP reduction was shown at 24 months after completing a 12-month multicomponent lifestyle intervention (-3.5 cm H2O) (Level 1++). Reduction in body weight was shown to be highly correlated with reduction in ICP (Level 2++ to 1++). DISCUSSION Bariatric surgery should be considered for women with IIH and a body mass index (BMI) ≥35 kg/m2 since this had the most robust evidence for sustained weight management (grade A). A multicomponent lifestyle intervention (diet + physical activity + behavior) had the most robust evidence for modest weight loss with a BMI <35 kg/m2 (grade B). Longer-term outcomes for weight management interventions in people with IIH are required to determine whether there is a superior weight loss intervention for IIH.
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Affiliation(s)
- Sally Abbott
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Fiona Chan
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Abd A Tahrani
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Sui Hsien Wong
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Fiona E J Campbell
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Chetan Parmar
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Dimitri J Pournaras
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Amanda Denton
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Alexandra Jean Sinclair
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom
| | - Susan P Mollan
- From the Research Centre for Healthcare and Communities (S.A.), Coventry University; Birmingham Neuro-Ophthalmology (F.C.), University Hospitals Birmingham; Institute of Metabolism and Systems Research (A.A.T.), University of Birmingham, United Kingdom; Novo Nordisk (A.A.T.), Bagsvaerd, Denmark; Department of Neuro-Ophthalmology (S.H.W.), Moorfields Eye Hospital; Medical Eye Unit (S.H.W.), Guy's and St Thomas' NHSFT, London; School of Life Course & Population Sciences (S.H.W.), Kings College London; Department of Clinical and Movement Neurosciences (S.H.W.), University College London; Adult Weight Management (Bariatric Surgery) (F.E.J.C.), NHS Grampian; Department of Surgery (C.P.), University College London Hospitals; Department of Surgery (C.P.), Barts Health NHS Trust, London; Upper Gastrointestinal (D.J.P.), Bariatric and Metabolic Surgery, North Bristol NHS Trust; IIH UK (A.D.), London; Translational Brain Science (A.J.S., S.P.M.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Neuro-Ophthalmology (S.P.M.), University Hospitals Birmingham NHS Trust, United Kingdom.
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Behrooz L, Lenneman CG, Hamburg NM. Emerging Medical Therapies for the Treatment of Obesity in Women with Cardiovascular Diseases. Curr Cardiol Rep 2023; 25:1475-1488. [PMID: 37874468 PMCID: PMC10682277 DOI: 10.1007/s11886-023-01961-z] [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] [Accepted: 09/12/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW In this review, the impact of obesity on cardiovascular disease in women and emerging anti-obesity pharmacologic treatments are discussed. RECENT FINDINGS Robust evidence demonstrates the burden of obesity across the lifespan in women and links obesity to a diverse set of cardiovascular diseases. Female-specific risk factors including sex hormones and pregnancy factors intersect with obesity and cardiovascular risk. Sustained weight loss has potential for cardiovascular benefits. Recent trials demonstrate cardiovascular benefits of emerging agents with weight loss effects including GLP-1 RA and SGLT2 inhibitors in women. Treatment and prevention strategies for cardiovascular disease in obese women should include integration of weight management strategies including the targeted use of emerging pharmacologic therapies.
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Affiliation(s)
- Leili Behrooz
- Whitaker Cardiovascular Institute and Section of Vascular Biology, Boston University Chobanian and Avedisian School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Carrie G Lenneman
- University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute and Section of Vascular Biology, Boston University Chobanian and Avedisian School of Medicine, 72 East Concord St, Boston, MA, 02118, USA.
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Sobczyk MK, Zheng J, Davey Smith G, Gaunt TR. Systematic comparison of Mendelian randomisation studies and randomised controlled trials using electronic databases. BMJ Open 2023; 13:e072087. [PMID: 37751957 PMCID: PMC10533809 DOI: 10.1136/bmjopen-2023-072087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To scope the potential for (semi)-automated triangulation of Mendelian randomisation (MR) and randomised controlled trials (RCTs) evidence since the two methods have distinct assumptions that make comparisons between their results invaluable. METHODS We mined ClinicalTrials.Gov, PubMed and EpigraphDB databases and carried out a series of 26 manual literature comparisons among 54 MR and 77 RCT publications. RESULTS We found that only 13% of completed RCTs identified in ClinicalTrials.Gov submitted their results to the database. Similarly low coverage was revealed for Semantic Medline (SemMedDB) semantic triples derived from MR and RCT publications -36% and 12%, respectively. Among intervention types that can be mimicked by MR, only trials of pharmaceutical interventions could be automatically matched to MR results due to insufficient annotation with Medical Subject Headings ontology. A manual survey of the literature highlighted the potential for triangulation across a number of exposure/outcome pairs if these challenges can be addressed. CONCLUSIONS We conclude that careful triangulation of MR with RCT evidence should involve consideration of similarity of phenotypes across study designs, intervention intensity and duration, study population demography and health status, comparator group, intervention goal and quality of evidence.
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Affiliation(s)
- Maria K Sobczyk
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jie Zheng
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Stefil M, Gaudino M, Benedetto U, Gerry S, Gray A, Lees B, Podesser B, Krzych L, Sajja LR, Taggart D, Flather M. Influence of diabetes and obesity on ten-year outcomes after coronary artery bypass grafting in the arterial revascularisation trial. Clin Res Cardiol 2023:10.1007/s00392-023-02284-3. [PMID: 37741811 DOI: 10.1007/s00392-023-02284-3] [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: 12/13/2022] [Accepted: 08/07/2023] [Indexed: 09/25/2023]
Abstract
AIMS Diabetes and obesity are common conditions which can influence outcomes after coronary artery bypass graft (CABG) surgery. The aim of this study was to evaluate the influence of diabetes and obesity, and their interactions, on ten-year outcomes following CABG. METHODS AND RESULTS Patients enrolled in the Arterial Revascularisation Trial (ART) were stratified by diabetes and obesity at baseline. Diabetes was further stratified into insulin and non-insulin dependent. The primary outcome was all-cause mortality at 10 years of follow-up. Secondary outcomes were the composite of all-cause mortality, myocardial infarction or stroke at 10 years, and sternal wound complications at 6 months follow-up. A total of 3096 patients were included in the analysis (24% with diabetes, 30% with obesity). Patients in the "diabetes/no obesity" group had a higher risk of all-cause mortality following CABG (adjusted hazard ratio [aHR] 1.33, 95% confidence interval [CI] 1.08-1.64, p = 0.01) compared to the reference group of "no diabetes/no obesity". No excess risk was observed in the "no diabetes/obesity" or "diabetes/obesity" groups. Patients with insulin dependent diabetes had a significantly higher ten-year mortality risk compared to no diabetes (aHR 1.85, 95% CI 1.41-2.44, p = 0.00). Patients in the "diabetes/no obesity" and "diabetes/obesity groups" had a higher risk of sternal wound complications (HR 2.29, 95% CI 1.39-3.79, p < 0.001 and HR 3.21, 95% CI 1.89-5.45, p < 0.001 respectively). The composite outcome results were consistent with the mortality results. CONCLUSION Diabetes, especially insulin dependent diabetes, is associated with a higher ten-year mortality risk after CABG, in contrast to obesity which does not appear to increase long term mortality compared to non-obese. The interaction between diabetes and obesity shows an apparent "protective" effect of obesity irrespective of diabetes on mortality. Both conditions are associated with a higher risk of post-operative sternal wound infections.
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Affiliation(s)
- Maria Stefil
- Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, USA
| | - Umberto Benedetto
- School of Clinical Sciences, University of Bristol and Bristol Royal Infirmary, Bristol, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Belinda Lees
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Bruno Podesser
- Landesklinikum, St. Polten and Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Lukasz Krzych
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Banjara Hills, Hyderabad, India
| | - David Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Marcus Flather
- Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK
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Maki KC, Kirkpatrick CF, Allison DB, Gadde KM. Pharmacotherapy for obesity: recent evolution and implications for cardiovascular risk reduction. Expert Rev Endocrinol Metab 2023; 18:307-319. [PMID: 37199542 DOI: 10.1080/17446651.2023.2209176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Obesity is highly prevalent in the U.S. and is associated with an increased risk of major adverse cardiovascular events (MACE). Modalities for the management of obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery. AREAS COVERED This review describes the evidence on the effects of weight loss therapies on MACE risk. Lifestyle interventions and older antiobesity pharmacotherapies have been associated with <12% body weight reduction and no clear benefit to reduce MACE risk. Bariatric surgery is associated with substantial weight reduction (20-30%) and markedly lower subsequent risk for MACE. Newer antiobesity pharmacotherapies, particularly semaglutide and tirzepatide, have shown greater efficacy for weight reduction compared with older medications and are being evaluated in cardiovascular outcomes trials. EXPERT OPINION Current practice for cardiovascular risk reduction in patients with obesity is lifestyle intervention for weight loss, combined with the treatment of obesity-related cardiometabolic risk factors individually. The use of medications to treat obesity is relatively rare. In part, this reflects concerns about long-term safety and weight loss effectiveness, possible provider bias, as well as lack of clear evidence of MACE risk reduction. If ongoing outcomes trials demonstrate the efficacy of newer agents in reducing MACE risk, this will likely lead to expanded use in obesity management.
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Affiliation(s)
- Kevin C Maki
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
- Midwest Biomedical Research, Addison, IL, USA
| | - Carol F Kirkpatrick
- Midwest Biomedical Research, Addison, IL, USA
- Idaho State University, Pocatello, ID, USA
| | - David B Allison
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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Yeh CL, Wu JM, Chen KY, Wu MH, Yang PJ, Lee PC, Chen PD, Kuo TC, Yeh SL, Lin MT. Potential therapeutic implications of calcitriol administration and weight reduction on CD4 T cell dysregulation and renin angiotensin system-associated acute lung injury in septic obese mice. Biomed Pharmacother 2023; 165:115127. [PMID: 37423172 DOI: 10.1016/j.biopha.2023.115127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023] Open
Abstract
This study investigated the effects of weight reduction and/or calcitriol administration on regulating CD4 T cell subsets and renin-angiotensin system (RAS)-associated acute lung injury (ALI) in obese mice with sepsis. Half of the mice were fed a high-fat diet for 16 weeks, half of them had high-fat diet for 12 weeks then were transferred to a low-energy diet for 4 weeks. After feeding the respective diets, cecal ligation and puncture (CLP) were performed to induce sepsis. There were four sepsis groups: OSS group, obese mice injected with saline; OSD group, obese mice given calcitriol; WSS group, mice with weight reduction and saline; WSD group, mice with weight reduction and calcitriol. Mice were sacrificed after CLP. The findings showed that CD4 T subsets distribution did not differ among the experimental groups. Calcitriol-treated groups had higher RAS-associated AT2R, MasR, ACE2, and angiopoietin 1-7 (Ang(1-7)) levels in the lungs. Also, higher tight junction proteins were noted 12 h after CLP. At 24 h post-CLP, weight reduction and/or calcitriol treatment reduced plasma inflammatory mediator production. Calcitriol-treated groups had higher CD4/CD8, T helper (Th)1/Th2 and lower Th17/regulatory T (Treg) ratios than the groups without calcitriol. In the lungs, calcitriol-treated groups had lower AT1R levels, whereas the RAS anti-inflammatory protein levels were higher than those groups without calcitriol. Lower injury scores were also noted at this time point. These findings suggested weight reduction decreased systemic inflammation. However, calcitriol administration produced a more-balanced Th/Treg distribution, upregulated the RAS anti-inflammatory pathway, and attenuated ALI in septic obese mice.
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Affiliation(s)
- Chiu-Li Yeh
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan; Nutrition Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Po-Jen Yang
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Po-Chu Lee
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Po-Da Chen
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Sung-Ling Yeh
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan.
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Kupila SKE, Joki A, Suojanen LU, Pietiläinen KH. The Effectiveness of eHealth Interventions for Weight Loss and Weight Loss Maintenance in Adults with Overweight or Obesity: A Systematic Review of Systematic Reviews. Curr Obes Rep 2023; 12:371-394. [PMID: 37354334 PMCID: PMC10482795 DOI: 10.1007/s13679-023-00515-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE OF REVIEW: The purpose of this study is to evaluate the effectiveness of eHealth interventions for weight loss and weight loss maintenance among adults with overweight or obesity through a systematic review of systematic reviews. RECENT FINDINGS: This study included 26 systematic reviews, covering a total of 338 original studies, published between 2018 and 2023. The review indicates that eHealth interventions are more effective than control interventions or no care and comparable to face-to-face interventions. The effect sizes remain relatively small when comparing eHealth interventions to any control conditions, with mean differences of weight loss results from - 0.12 kg (95% CI - 0.64 to 0.41 kg) in a review comparing eHealth interventions to face-to-face care to - 4.32 kg (- 5.08 kg to - 3.57 kg) in a review comparing eHealth interventions to no care. The methodological quality of the included studies varies considerably. However, it can be concluded that interventions with human contact work better than those that are fully automated. In conclusion, this systematic review of systematic reviews provides an updated understanding of the development of digital interventions in recent years and their effectiveness for weight loss and weight loss maintenance among adults with overweight or obesity. The findings suggest that eHealth interventions can be a valuable tool for delivering obesity care to more patients economically. Further research is needed to determine which specific types of eHealth interventions are most effective and how to best integrate them into clinical practice.
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Affiliation(s)
- Sakris K E Kupila
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Anu Joki
- HealthyWeightHub, Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura-U Suojanen
- HealthyWeightHub, Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- HealthyWeightHub, Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Kang SC, Kang M, Ryu H, Kim S, Kim JH, Kang E, Jeong Y, Kim J, Kim YS, Kim SW, Kim YH, Oh KH. Measured sodium excretion is associated with cardiovascular outcomes in non-dialysis CKD patients: results from the KNOW-CKD study. FRONTIERS IN NEPHROLOGY 2023; 3:1236177. [PMID: 37675361 PMCID: PMC10479682 DOI: 10.3389/fneph.2023.1236177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
Background There are insufficient studies on the effect of dietary salt intake on cardiovascular (CV) outcomes in chronic kidney disease (CKD) patients, and there is no consensus on the sodium (Na) intake level that increases the risk of CV disease in CKD patients. Therefore, we investigated the association between dietary salt intake and CV outcomes in CKD patients. Methods In the Korean cohort study for Outcome in patients with CKD (KNOW-CKD), 1,937 patients were eligible for the study, and their dietary Na intake was estimated using measured 24h urinary Na excretion. The primary outcome was a composite of CV events and/or all-cause death. The secondary outcome was a major adverse cardiac event (MACE). Results Among 1,937 subjects, there were 205 (10.5%) events for the composite outcome and 110 (5.6%) events for MACE. Compared to the reference group (urinary Na excretion< 2.0g/day), the group with the highest measured 24h urinary Na excretion (urinary Na excretion ≥ 8.0g/day) was associated with increased risk of both the composite outcome (hazard ratio 3.29 [95% confidence interval 1.00-10.81]; P = 0.049) and MACE (hazard ratio 6.28 [95% confidence interval 1.45-27.20]; P = 0.013) in a cause-specific hazard model. Subgroup analysis also showed a pronounced association between dietary salt intake and the composite outcome in subgroups of patients with abdominal obesity, female, lower estimated glomerular filtration rate (< 60 ml/min per 1.73m2), no overt proteinuria, or a lower urinary potassium-to-creatinine ratio (< 46 mmol/g). Conclusion A high-salt diet is associated with CV outcomes in non-dialysis CKD patients.
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Affiliation(s)
- Seong Cheol Kang
- Department of Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minjung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seonmi Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hye Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Kook-Hwan Oh
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Taghat N, Mossberg K, Lingström P, Petzold M, Östberg AL. Impact of Medical and Surgical Obesity Treatment on Dental Caries: A 2-Year Prospective Cohort Study. Caries Res 2023; 57:231-242. [PMID: 37586350 DOI: 10.1159/000533609] [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: 10/31/2022] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
The objective was to study the long-term effects on oral health of bariatric surgery compared with medical treatment of obesity. Swedish females with morbid obesity (n = 66; 18-35 years at baseline) were followed prospectively from before obesity treatment until 2 years after treatment. The main response variable was dental caries registered according to the ICDAS-II system. Possible confounding factors, such as sociodemographic characteristics, general health, oral health habits, and oral hygiene, were controlled for. The statistical methods included χ2 tests, Student's t tests, one-way ANOVA, Wilcoxon's nonparametric tests, and linear regression models. In the surgically treated patients (n = 40), a significant increase over time in enamel caries (mean increase 4.13 tooth surfaces ICDAS1-2), dentine caries (mean increase 2.18 tooth surfaces ICDAS3-6), and total caries (mean increase 6.30 tooth surfaces ICDAS1-6) was registered (all p < 0.001), which was not seen in the medically treated patients (n = 26). However, the difference between the treatment groups (surgical or medical) was only statistically significant for enamel caries (crude β 4.89, p = 0.003) and total caries (crude β 6.53, p < 0.001). The relationships were stable and independent of differences in confounders as socioeconomy, general health, and oral health behaviors. In conclusion, 2 years after obesity treatment, a significant increase in dental caries was registered in the surgically treated but not in the medically treated women. The dental service should intensify its preventive efforts in individuals undergoing obesity treatment.
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Affiliation(s)
- Negin Taghat
- Department of Behavioural and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Mossberg
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Lingström
- Department of Cariology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Lena Östberg
- Department of Behavioural and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lee V. Introduction to the dietary management of obesity in adults. Clin Med (Lond) 2023; 23:304-310. [PMID: 38614642 PMCID: PMC10541054 DOI: 10.7861/clinmed.2023-0157] [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] [Indexed: 08/02/2023]
Abstract
Obesity is a multifaceted and complex condition that requires holistic management. It currently affects nearly one in four adults in the UK, with the UK ranked 10th globally for the highest obesity rates. Obesity is projected to have an economic burden of ∼£2 billion per year by 2030 in the UK.1 Excess weight gain can coincide with myriad health concerns and multiple health conditions, which can be physical, metabolic or psychosocial. This includes type 2 diabetes mellitus (T2DM), hypertension, coronary heart disease, osteoarthritis, obstructive sleep apnoea, reproductive disorders, depression and cancer2; hence, there has been a significant emphasis on obesity prevention. Obesity is often associated with weight stigma, impacting psychological wellbeing and quality of life. This can influence an individual's likelihood of seeking support, delaying appropriate input from healthcare professionals, with a knock-on effect on pre-existing health conditions. This review explores the management of obesity from a nutritional perspective, because modifying dietary intake is essential to reduce the risk of non-communicable diseases, including those associated with obesity.
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Raiman L, Amarnani R, Abdur-Rahman M, Marshall A, Mani-Babu S. The role of physical activity in obesity: let's actively manage obesity. Clin Med (Lond) 2023; 23:311-317. [PMID: 38614643 PMCID: PMC10541051 DOI: 10.7861/clinmed.2023-0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Obesity, physical inactivity and sedentary behaviour are major public health concerns. A complex interaction of many factors leads to obesity, which requires an individualised multicomponent management strategy. As new interventions become available to help individuals manage obesity, it is essential that physical activity remains a core part of the approach. Here, we summarise current evidence regarding the benefits of physical activity as part of a management strategy of obesity. Additionally, we discuss current methods for increasing physical activity levels in individuals with obesity and outline the role of sport and exercise medicine physicians as part of the multidisciplinary team.
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Affiliation(s)
- Lewis Raiman
- Imperial College Healthcare NHS Trust, London, UK
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Garcia MB, Schadler KL, Chandra J, Clinton SK, Courneya KS, Cruz-Monserrate Z, Daniel CR, Dannenberg AJ, Demark-Wahnefried W, Dewhirst MW, Fabian CJ, Hursting SD, Irwin ML, Iyengar NM, McQuade JL, Schmitz KH, Basen-Engquist K. Translating energy balance research from the bench to the clinic to the community: Parallel animal-human studies in cancer. CA Cancer J Clin 2023; 73:425-442. [PMID: 36825928 PMCID: PMC11225601 DOI: 10.3322/caac.21773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/12/2022] [Accepted: 01/06/2023] [Indexed: 02/25/2023] Open
Abstract
Advances in energy balance and cancer research to date have largely occurred in siloed work in rodents or patients. However, substantial benefit can be derived from parallel studies in which animal models inform the design of clinical and population studies or in which clinical observations become the basis for animal studies. The conference Translating Energy Balance from Bench to Communities: Application of Parallel Animal-Human Studies in Cancer, held in July 2021, convened investigators from basic, translational/clinical, and population science research to share knowledge, examples of successful parallel studies, and strong research to move the field of energy balance and cancer toward practice changes. This review summarizes key topics discussed to advance research on the role of energy balance, including physical activity, body composition, and dietary intake, on cancer development, cancer outcomes, and healthy survivorship.
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Affiliation(s)
- Miriam B. Garcia
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keri L. Schadler
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, TexasHouston, USA
| | - Joya Chandra
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, TexasHouston, USA
| | - Steven K. Clinton
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Kerry S. Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Carrie R. Daniel
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark W. Dewhirst
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carol J. Fabian
- Department of Medicine, Division of Medical Oncology, The University of Kansas Medical Center, Westwood, Kansas, USA
| | - Stephen D. Hursting
- Department of Nutrition Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melinda L. Irwin
- Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Neil M. Iyengar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer L. McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathryn H. Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen Basen-Engquist
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Barkas F, Bathrellou E, Nomikos T, Panagiotakos D, Liberopoulos E, Kontogianni MD. Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention. Nutrients 2023; 15:2845. [PMID: 37447172 DOI: 10.3390/nu15132845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the major mortality cause in developed countries with hypercholesterolaemia being one of the primary modifiable causes. Lifestyle intervention constitutes the first step in cholesterol management and includes dietary modifications along with the use of functional foods and supplements. Functional foods enriched with plant sterols/stanols have become the most widely used nonprescription cholesterol-lowering approach, despite the lack of randomized trials investigating their long-term safety and cardiovascular efficacy. The cholesterol-lowering effect of plant-sterol supplementation is well-established and a potential beneficial impact on other lipoproteins and glucose homeostasis has been described. Nevertheless, experimental and human observational studies investigating the association of phytosterol supplementation or circulating plant sterols with various markers of atherosclerosis and ASCVD events have demonstrated controversial results. Compelling evidence from recent genetic studies have also linked elevated plasma concentrations of circulating plant sterols with ASCVD presence, thus raising concerns about the safety of phytosterol supplementation. Thus, the aim of this review is to provide up-to-date data on the effect of plant sterols/stanols on lipid-modification and cardiovascular outcomes, as well as to discuss any safety issues and practical concerns.
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Affiliation(s)
- Fotios Barkas
- Department of Hygiene & Epidemiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
| | - Tzortzis Nomikos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
| | - Evangelos Liberopoulos
- 1st Propaedeutic Department of Medicine, General Hospital of Atherns 'Laiko', School of Medicine, National and Kapodistrιan University of Athens, 11527 Athens, Greece
| | - Meropi D Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
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Cachero K, Mollard R, Myrie S, MacKay D. A clinically managed weight loss program evaluation and the impact of COVID-19. Front Nutr 2023; 10:1167813. [PMID: 37396123 PMCID: PMC10311994 DOI: 10.3389/fnut.2023.1167813] [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: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction With the prevalence of obesity increasing, many weight-loss programs were created to aid in combating the trend. The Weight Loss Clinic (WLC) was created to provide personalized support for lifestyle changes using a multidisciplinary team with medical oversight. This study evaluated the clinically-managed weight loss program at the Wellness Institute. Methods This was a prospective evaluation of a newly established program between January 2019-August 2020. Participants who entered the weight loss program were approached to learn about the evaluation. A total of 41 participants were included. The primary outcomes included changes in body weight and achievement of more than 5% initial body weight loss. Outcome measures were collected pre-and post-program and the data was analyzed through paired t-tests on R studio. Results Greater body weight-loss was seen in completers pre-COVID-19 compared to those who completed during the pandemic (Mean, ±SD; 7.51 ± 6.24 kg n = 13 p < 0.001 vs. 1.75 ± 4.43 kg n = 9, p = 0.02). Completers pre-COVID-19 demonstrated improvements in waist circumference, Framingham risk score, blood pressure, hemoglobin A1C, and body fat percentage. Conclusions and implications Though the sample size was small to show definitve evidence, the results may suggest the program worked well prior to the pandemic but the pandemic created barriers to weight-loss for participants.
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Affiliation(s)
- Katrina Cachero
- Department of Food and Human Nutritional Sciences, University of Manitoba and the Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Rebecca Mollard
- Department of Food and Human Nutritional Sciences, University of Manitoba and the Chronic Disease Innovation Centre, Winnipeg, MB, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Semone Myrie
- Department of Food and Human Nutritional Sciences, University of Manitoba and the Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Dylan MacKay
- Department of Food and Human Nutritional Sciences, University of Manitoba and the Chronic Disease Innovation Centre, Winnipeg, MB, Canada
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Fujihara K, Yamada Harada M, Horikawa C, Iwanaga M, Tanaka H, Nomura H, Sui Y, Tanabe K, Yamada T, Kodama S, Kato K, Sone H. Machine learning approach to predict body weight in adults. Front Public Health 2023; 11:1090146. [PMID: 37397751 PMCID: PMC10308016 DOI: 10.3389/fpubh.2023.1090146] [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: 11/08/2022] [Accepted: 05/10/2023] [Indexed: 07/04/2023] Open
Abstract
Background Obesity is an established risk factor for non-communicable diseases such as type 2 diabetes mellitus, hypertension and cardiovascular disease. Thus, weight control is a key factor in the prevention of non-communicable diseases. A simple and quick method to predict weight change over a few years could be helpful for weight management in clinical settings. Methods We examined the ability of a machine learning model that we constructed to predict changes in future body weight over 3 years using big data. Input in the machine learning model were three-year data on 50,000 Japanese persons (32,977 men) aged 19-91 years who underwent annual health examinations. The predictive formulas that used heterogeneous mixture learning technology (HMLT) to predict body weight in the subsequent 3 years were validated for 5,000 persons. The root mean square error (RMSE) was used to evaluate accuracy compared with multiple regression. Results The machine learning model utilizing HMLT automatically generated five predictive formulas. The influence of lifestyle on body weight was found to be large in people with a high body mass index (BMI) at baseline (BMI ≥29.93 kg/m2) and in young people (<24 years) with a low BMI (BMI <23.44 kg/m2). The RMSE was 1.914 in the validation set which reflects ability comparable to that of the multiple regression model of 1.890 (p = 0.323). Conclusion The HMLT-based machine learning model could successfully predict weight change over 3 years. Our model could automatically identify groups whose lifestyle profoundly impacted weight loss and factors the influenced body weight change in individuals. Although this model must be validated in other populations, including other ethnic groups, before being widely implemented in global clinical settings, results suggested that this machine learning model could contribute to individualized weight management.
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Affiliation(s)
- Kazuya Fujihara
- Department of Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Mayuko Yamada Harada
- Department of Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Chika Horikawa
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata, Japan
| | - Midori Iwanaga
- Department of Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | | | | | | | | | - Takaho Yamada
- Department of Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Satoru Kodama
- Department of Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Kiminori Kato
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University, Niigata, Japan
| | - Hirohito Sone
- Department of Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
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Gaebel R, Lang C, Vasudevan P, Lührs L, de Carvalho KAT, Abdelwahid E, David R. New Approaches in Heart Research: Prevention Instead of Cardiomyoplasty? Int J Mol Sci 2023; 24:ijms24109017. [PMID: 37240361 DOI: 10.3390/ijms24109017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiovascular diseases are the leading cause of death in industrialized nations. Due to the high number of patients and expensive treatments, according to the Federal Statistical Office (2017) in Germany, cardiovascular diseases account for around 15% of total health costs. Advanced coronary artery disease is mainly the result of chronic disorders such as high blood pressure, diabetes, and dyslipidemia. In the modern obesogenic environment, many people are at greater risk of being overweight or obese. The hemodynamic load on the heart is influenced by extreme obesity, which often leads to myocardial infarction (MI), cardiac arrhythmias, and heart failure. In addition, obesity leads to a chronic inflammatory state and negatively affects the wound-healing process. It has been known for many years that lifestyle interventions such as exercise, healthy nutrition, and smoking cessation drastically reduce cardiovascular risk and have a preventive effect against disorders in the healing process. However, little is known about the underlying mechanisms, and there is significantly less high-quality evidence compared to pharmacological intervention studies. Due to the immense potential of prevention in heart research, the cardiologic societies are calling for research work to be intensified, from basic understanding to clinical application. The topicality and high relevance of this research area are also evident from the fact that in March 2018, a one-week conference on this topic with contributions from top international scientists took place as part of the renowned "Keystone Symposia" ("New Insights into the Biology of Exercise"). Consistent with the link between obesity, exercise, and cardiovascular disease, this review attempts to draw lessons from stem-cell transplantation and preventive exercise. The application of state-of-the-art techniques for transcriptome analysis has opened new avenues for tailoring targeted interventions to very individual risk factors.
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Affiliation(s)
- Ralf Gaebel
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Cajetan Lang
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Praveen Vasudevan
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Larissa Lührs
- Advanced Therapy and Cellular Biotechnology in Regenerative Medicine Department, Pelé Pequeno Prίncipe Research Institute & Pequeno Prίncipe Faculties, Ave. Silva Jardim, P.O. Box 80240-020, Curitiba 1632, Brazil
| | - Katherine Athayde Teixeira de Carvalho
- Advanced Therapy and Cellular Biotechnology in Regenerative Medicine Department, Pelé Pequeno Prίncipe Research Institute & Pequeno Prίncipe Faculties, Ave. Silva Jardim, P.O. Box 80240-020, Curitiba 1632, Brazil
| | - Eltyeb Abdelwahid
- Feinberg School of Medicine, Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL 60611, USA
| | - Robert David
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
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50
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Koutoukidis DA, Barron E, Stevens R, Aveyard P, Valabhji J, Jebb SA. Association between the month of starting a weight management program and weight change in people at high risk of type 2 diabetes: A prospective cohort study. Obesity (Silver Spring) 2023; 31:1707-1716. [PMID: 37157117 DOI: 10.1002/oby.23762] [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: 09/09/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Weight loss is one of the most common New Year's resolutions, but it is unclear whether attempting to lose weight in January is more successful than attempting it at other times of the year. METHODS In this prospective cohort study from the English National Health Service (NHS) Diabetes Prevention Program, adults with nondiabetic hyperglycemia were enrolled in a structured behavioral weight management program. Repeated measures models assessed the mean difference between baseline and follow-up weight adjusting for monthly variation in weight among those with ≥1 weight measurement. RESULTS Among 85,514 participants with a mean baseline BMI of 30.3 kg/m2 (range: 13.4 to 84.2), mean weight change at the end of the program after an average 7.9 (SD: 4.5) sessions over 6.4 (SD: 5.6) months was -2.00 kg (95% CI: -2.02 to -1.97 kg) or -2.33% (95% CI: -2.35% to -2.32%). Compared with participants starting in January, participants starting in other months lost less weight, ranging between 0.28 kg (95% CI: 0.10 to 0.45 kg) less weight in those starting in March and 0.71 kg (95% CI: 0.55 to 0.87 kg) less weight in those starting in November. April and May were the only exceptions, in which the estimates followed the same direction but were not statistically significant. Higher session attendance mediated the effects, with participants starting in January attending, on average, 0.2 to 0.7 more sessions than those starting in other months. CONCLUSIONS People starting a weight management program in January lost 12% to 30% more weight than people starting it at other times of the year.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Valabhji
- NHS England and NHS Improvement, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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