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Lee SG, Chae J, Woo SM, Seo SU, Kim HJ, Kim SY, Schlaepfer DD, Kim IS, Park HS, Kwon TK, Nam JO. TGFBI remodels adipose metabolism by regulating the Notch-1 signaling pathway. Exp Mol Med 2023; 55:520-531. [PMID: 36854775 PMCID: PMC10073093 DOI: 10.1038/s12276-023-00947-9] [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] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/17/2022] [Accepted: 01/17/2023] [Indexed: 03/02/2023] Open
Abstract
Extracellular matrix proteins are associated with metabolically healthy adipose tissue and regulate inflammation, fibrosis, angiogenesis, and subsequent metabolic deterioration. In this study, we demonstrated that transforming growth factor-beta (TGFBI), an extracellular matrix (ECM) component, plays an important role in adipose metabolism and browning during high-fat diet-induced obesity. TGFBI KO mice were resistant to adipose tissue hypertrophy, liver steatosis, and insulin resistance. Furthermore, adipose tissue from TGFBI KO mice contained a large population of CD11b+ and CD206+ M2 macrophages, which possibly control adipokine secretion through paracrine mechanisms. Mechanistically, we showed that inhibiting TGFBI-stimulated release of adipsin by Notch-1-dependent signaling resulted in adipocyte browning. TGFBI was physiologically bound to Notch-1 and stimulated its activation in adipocytes. Our findings revealed a novel protective effect of TGFBI deficiency in obesity that is realized via the activation of the Notch-1 signaling pathway.
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Affiliation(s)
- Seul Gi Lee
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu, 41566, Republic of Korea
- Department of Immunology, School of Medicine, Keimyung University, Daegu, 42601, Republic of Korea
| | - Jongbeom Chae
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Seon Min Woo
- Department of Immunology, School of Medicine, Keimyung University, Daegu, 42601, Republic of Korea
| | - Seung Un Seo
- Department of Immunology, School of Medicine, Keimyung University, Daegu, 42601, Republic of Korea
| | - Ha-Jeong Kim
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu, 41944, Republic of Korea
| | - Sang-Yeob Kim
- ASAN Institute for Life Sciences, ASAN Medical Center, Seoul, 05505, Republic of Korea
| | - David D Schlaepfer
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - In-San Kim
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
- Center for Theragnosis, Biomedical Research Institute, Korea Institute Science and Technology (KIST), Seoul, 02792, Republic of Korea
| | - Hee-Sae Park
- School of Biological Sciences and Technology, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Taeg Kyu Kwon
- Department of Immunology, School of Medicine, Keimyung University, Daegu, 42601, Republic of Korea.
- Center for Forensic Pharmaceutical Science, Keimyung University, Daegu, 42601, Republic of Korea.
| | - Ju-Ock Nam
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu, 41566, Republic of Korea.
- Research Institute of Tailored Food Technology, Kyungpook National University, Daegu, 41566, Republic of Korea.
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MM S, JS N, M BC, AP M, MJ F, F M, MJ F, D S, J P, V G, E L, A V, P F, D C. Higher magnesium levels are associated with better glycaemic control and diabetes remission post-bariatric surgery. BMC Endocr Disord 2022; 22:303. [PMID: 36471364 PMCID: PMC9724332 DOI: 10.1186/s12902-022-01210-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Low Magnesium (Mg) dietary intake has been associated with increased risk of type 2 diabetes mellitus (T2DM). Furthermore, in patients with T2DM, hypomagnesemia is associated with worst glycaemic control. Bariatric surgery (BS) remains the most effective treatment in severe obesity and also provides resolution/improvement of T2DM. Our aim is to evaluate the association between Mg supplementation post-BS and Mg serum levels with diabetes status after BS. METHODS We performed an observational study on patients with obesity and T2DM who underwent BS. Data was assessed pre-BS and one-year post-BS. RESULTS We included a total of 403 patients with T2DM. At baseline, 43.4% of the patients had Mg deficiency. Pre-BS, patients with Mg deficiency had poorer glycaemic control - HbA1c 7.2 ± 1.6% vs 6.4 ± 1.0% (p < 0.001), fasting plasma glucose 146.2 ± 58.8 mg/dL vs 117.5 ± 36.6 mg/dL (p < 0.001) and were under a greater number of anti-diabetic drugs 1.0 (IQR 0-2.0) vs 1.0 (IQR 0-1.0) (p = 0.002). These findings persisted at one-year post-BS. At the first-year post-BS, 58.4% of the patients had total remission of T2DM and 4.1% had partial remission. Patients without Mg deficiency at one-year post-BS had higher rates of total and partial remission. Higher serum Mg levels at baseline is an independent predictor of total T2DM remission (p < 0.0001). The optimal cut-off of baseline Mg to predict total T2DM remission was 1.50 mg/dL with a sensitivity of 73% and a specificity of 58% (area under ROC = 0.65). Patients that were under Mg supplementation post-BS had serum Mg values, glycaemic control and total remission of T2DM similar to patients non-supplemented. CONCLUSION In patients with T2DM submitted to BS, higher Mg serum levels at baseline and 1-year after BS were associated with better glycaemic control and higher rates of total T2DM remission at the first year post-BS.
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Affiliation(s)
- Silva MM
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Neves JS
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
- Departamento de Cirurgia E Fisiologia, Faculdade de Medicina da Universidade Do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Borges-Canha M
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
- Departamento de Cirurgia E Fisiologia, Faculdade de Medicina da Universidade Do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Mendes AP
- Medical and Performance Department, Sporting Clube de Portugal, Estrada da Malhada de Meias, Barroca d’Alva, 2890-529 Lisboa, Portugal
| | - Fonseca MJ
- Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal
| | - Mendonça F
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Ferreira MJ
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Salazar D
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Pedro J
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Guerreiro V
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Lau E
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Varela A
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Freitas P
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Carvalho D
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
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Lu Y, Liu Y, Krumholz HM. Racial and Ethnic Disparities in Financial Barriers Among Overweight and Obese Adults Eligible for Semaglutide in the United States. J Am Heart Assoc 2022; 11:e025545. [PMID: 36172953 PMCID: PMC9673703 DOI: 10.1161/jaha.121.025545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Semaglutide holds the promise for weight loss and risk reduction. Less is known about racial and ethnic disparities in financial barriers among the semaglutide-eligible population. Methods and Results We conducted a cross-sectional analysis of adults aged 18 years or older using data from the National Health and Nutrition Examination Survey 2015 to 2020. We analyzed adults eligible for semaglutide based on Food and Drug Administration labeling and assessed financial barriers and social determinants of health among the eligible population overall and by race and ethnicity. A total of 13 711 adults were included in the final analysis. In 2015 to 2020, 51.1% (48.3%-53.2%) of US adults (≈43.3 million) met the Food and Drug Administration eligibility criteria for semaglutide. The percentage of adults eligible for semaglutide was highest among Black adults (56.6% [54.2%-59.1%]), followed by Hispanic adults (55.0% [52.8%-57.3%]). Among adults eligible for semaglutide, 11.9% (10.1%-13.6%) were uninsured, 13.3% (12.1%-14.5%) lacked a usual source of care, 33.6% (30.2%-36.9%) had low family income, and 38.9% (36.5%-41.3%) lacked higher education. Compared with White individuals, significantly larger proportions of Black and Hispanic individuals were uninsured, lacked a usual source of care, had low family income, or lacked higher education (P<0.001 for all). Conclusions Many Americans who were eligible for semaglutide were likely to be unable to afford the medication. Among the eligible population, a larger proportion of Black and Hispanic adults had financial barriers than other subgroups.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and EvaluationYale New Haven HospitalNew HavenCT
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCT
| | - Yuntian Liu
- Center for Outcomes Research and EvaluationYale New Haven HospitalNew HavenCT
| | - Harlan M. Krumholz
- Center for Outcomes Research and EvaluationYale New Haven HospitalNew HavenCT
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCT
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCT
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Magnesium Supplementation Is Associated with a Lower Cardio-Metabolic Risk in Patients Submitted to Bariatric Surgery. Obes Surg 2022; 32:3056-3063. [PMID: 35864288 DOI: 10.1007/s11695-022-06207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Literature has demonstrated an inverse relation between magnesium (Mg) consumption and development of type 2 diabetes mellitus (T2DM), hypertension (HT), and dyslipidemia. After bariatric surgery (BS), micronutrients deficiencies are common, it being important to ensure appropriate supplementation. There is no recommendation about Mg supplementation and to our knowledge, its effect has not been studied to date. Our aim was to evaluate the effect of Mg supplementation in cardio-metabolic risk factors on post-bariatric patients. MATERIALS AND METHODS A retrospective observational study of patients with obesity who underwent BS was performed. Data was assessed preoperatively and yearly (4-year follow-up). RESULTS A total of 3363 patients were included. In the first year of follow-up, 79.8% (n = 2123) of the patients were supplemented with Mg, with evidence of slightly decreased percentages in the following years. Mg deficiency (serum Mg < 1.52 mEq/L) was more common among patients who were not supplemented during each year of follow-up (p < 0.05). Among those who underwent Mg supplementation, the percentage of T2DM, HT, or low-density lipoprotein cholesterol (LDL-C) > 130 mg/dL was significantly lower. In the first year post-surgery, the supplementation group had a lower risk of T2DM (OR = 0.545, p < 0.0001), LDL-C > 130 mg/dL (OR = 0.612, p < 0.0001), and HT (OR = 0.584, p < 0.0001). The OR for having these metabolic comorbidities persisted lower during the 4 years' follow-up. Patients who had Mg deficiency had higher prevalence of T2DM and HT. CONCLUSION Mg supplementation seems to have a protective effect on the development of T2DM, HT, and LDL-C > 130 mg/dL in post-bariatric patients.
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5
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Lau DCW, Batterham RL, le Roux CW. Pharmacological profile of once-weekly injectable semaglutide for chronic weight management. Expert Rev Clin Pharmacol 2022; 15:251-267. [PMID: 35466848 DOI: 10.1080/17512433.2022.2070473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The recent approval in the USA (Food and Drug Administration), Canada (Health Canada), UK (Medicines and Healthcare products Regulatory Agency), and EU (European Medicines Agency) of once-weekly injectable semaglutide 2.4 mg, as an adjunct to a calorie-controlled diet and increased physical activity, for chronic weight management provides health-care practitioners with an additional option when prescribing weight-loss medication. AREAS COVERED We describe the chemistry, mechanism of action, and pharmacological properties of semaglutide (a glucagon-like peptide 1 receptor agonist [GLP-1 RA]) and discuss clinical data and considerations for using once-weekly subcutaneous semaglutide 2.4 mg as treatment for overweight and obesity among patients with and without type 2 diabetes (T2D). EXPERT OPINION Once-weekly subcutaneous semaglutide 2.4 mg is the most efficacious medication approved for chronic weight management among patients with overweight and obesity, with and without T2D, and is the first drug to induce sustained double-digit reductions in percentage body weight over 1- to 2-year treatment periods. It demonstrates a similar safety and tolerability profile to other GLP-1 RAs. Semaglutide 2.4 mg treatment could dramatically improve clinical approaches to weight management, but the relatively high cost might prevent patients accessing treatment. Further research exploring the cost-effectiveness of subcutaneous semaglutide 2.4 mg is required.
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Affiliation(s)
- David C W Lau
- Biochemistry and Molecular Biology, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Rachel L Batterham
- Centre for Obesity Research, Department of Medicine, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - Carel W le Roux
- School of Medicine, University College Dublin, Dublin, Ireland
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Davis ME, Blake C, Perrotta C, Cunningham C, O'Donoghue G. Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta-analysis. Obesity (Silver Spring) 2022; 30:300-319. [PMID: 35088563 DOI: 10.1002/oby.23305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to assess the effectiveness of different exercise modalities and determine the optimal exercise prescription for improving cardiorespiratory fitness, body composition, and metabolic health of women with obesity. METHODS A systematic review of randomized controlled trials (RCTs) published between January 1988 and October 2020 was conducted. The RCTs were screened using the following inclusion criteria: 1) participants: women aged 18 to 65 years with BMI > 30 kg/m2 and without comorbidities; 2) intervention: exercise; 3) comparison: non-intervention control; and 4) outcomes measures: cardiorespiratory fitness (maximal oxygen consumption), body composition (i.e., body weight, percentage body fat), and/or metabolic measures (i.e., blood pressure, cholesterol). RESULTS A total of 20 RCTs with a total of 2,062 participants were included. Although the results showed that any form of exercise was more effective than control, improvements in fitness and body composition were modest. Aerobic exercise (vigorous and moderate intensity) appeared most promising for improving fitness and body weight, whereas low-load resistance training resulted in the largest improvements in body fatness. CONCLUSIONS In women living with obesity, aerobic exercise was consistently effective in improving fitness and body composition. Although both resistance training and combined exercise interventions appear promising, more research is needed to evaluate their efficacy and determine an optimal exercise prescription for this population.
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Affiliation(s)
- Mary E Davis
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Espel-Huynh HM, Goldstein CM, Stephens ML, Finnegan OL, Elwy AR, Wing RR, Thomas JG. Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research. Transl Behav Med 2021; 12:214-224. [PMID: 34971381 PMCID: PMC8849001 DOI: 10.1093/tbm/ibab160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Online behavioral obesity treatment is a promising first-line approach to weight management in primary care. However, little is known about contextual influences on implementation. Understand qualitative contextual factors that affect the implementation process, as experienced by key primary care stakeholders implementing the program. Online behavioral obesity treatment was implemented across a 60-clinic primary care practice network. Patients were enrolled by nurse care managers (NCMs; N = 14), each serving 2-5 practices. NCMs were randomized to one of two implementation conditions-"Basic" (standard implementation) or "Enhanced" (i.e., with added patient tracking features and more implementation strategies employed). NCMs completed qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and analyzed via directed content analysis. Emergent categories were summarized by implementation condition and assigned a valence according to positive/negative influence. Individuals in the Enhanced condition viewed two aspects of the intervention as more positively influencing than Basic NCMs: Design Quality & Packaging (i.e., online program aesthetics), and Cost (i.e., no-cost program, clinician time savings). In both conditions, strongly facilitating factors included: Compatibility between intervention and clinical context; Intervention Source (from a trusted local university); and Evidence Strength & Quality supporting effectiveness. Findings highlight the importance of considering stakeholders' perspectives on the most valued types of evidence when introducing a new intervention, ensuring the program aligns with organizational priorities, and considering how training resources and feedback on patient progress can improve implementation success for online behavioral obesity treatment in primary care.
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Affiliation(s)
- Hallie M Espel-Huynh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Correspondence to: H Espel-Huynh,
| | - Carly M Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael L Stephens
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Olivia L Finnegan
- Department of Kinesiology, University of Rhode Island, Kingston, RI, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Twells LK, Harris Walsh K, Blackmore A, Adey T, Donnan J, Peddle J, Ryan D, Farrell A, Nguyen H, Gao Z, Pace D. Nonsurgical weight loss interventions: A systematic review of systematic reviews and meta-analyses. Obes Rev 2021; 22:e13320. [PMID: 34378849 DOI: 10.1111/obr.13320] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022]
Abstract
Access to bariatric surgery to treat obesity is limited and has long wait times. Many adults are seeking nonsurgical weight loss support. Our study objective was to conduct a systematic review of nonsurgical weight loss interventions. PubMed, EMBASE, CINAHL, PsycInfo, and the CochraneLibrary were searched. Inclusion criteria were adults 18 + with a BMI > 25 enrolled in minimum a 3-month nonsurgical weight loss intervention. Studies were independently extracted and assessed for quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2). Pooled analyses were extracted, graded for evidence quality, and summarized. A total of 1065 studies were assessed for eligibility; 815 screened and 236 full-texts assessed. Sixty-four meta-analyses met eligibility criteria: 1180 RCTs with 184,605 study participants. Studies were categorized as diets (n = 13), combination therapies (n = 10), alternative (n = 16), technology (n = 10), behavioral (n = 5), physical activity (n = 6), and pharmacotherapy (n = 3). In 80% of studies, significant weight losses were reported ranging from 0.34-8.73 k in favor of the intervention. The most effective nonsurgical weight loss interventions were diets, either low-carbohydrate or low-fat diets, followed for 6 months; combination therapy including meal replacements plus enhanced support; and pharmacotherapy followed for 12 months. Although significant weight losses were reported for other types of interventions such as physical activity and technology, the majority of studies reported weight losses less than 2 kgs.
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Affiliation(s)
- Laurie K Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Kristin Harris Walsh
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Alicia Blackmore
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Tanis Adey
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Justin Peddle
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Devonne Ryan
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Alison Farrell
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Hai Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Dave Pace
- Faculty of Medicine-Surgery, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Association between Findings in Oral Health Screening and Body Mass Index: A Nation-Wide Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111062. [PMID: 34769582 PMCID: PMC8582665 DOI: 10.3390/ijerph182111062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
Oral diseases, such as periodontitis and dental caries, can cause systemic inflammation as well as local effects, which is an important contributing factor for obesity. We aimed to investigate the change in body mass index (BMI) according to the presence of periodontitis and oral hygiene indicators. This study enrolled 110,068 participants from the national health screening cohort in Korea from 2009–2010 who underwent an oral health checkup. As oral hygiene indicators, the presence of periodontitis, dental caries, tooth loss, and tooth brushing were assessed. We constructed a linear mixed model for BMI. BMI was repeatedly measured in the health examination until 2015. In the multivariate linear mixed model for BMI, the presence of periodontitis (β = 0.0687, standard error (SE) = 0.0225, p = 0.002), dental caries (β = 0.0735, SE = 0.0152, p < 0.001), and tooth loss (β = 0.1328, SE = 0.0175, p < 0.001) were positively associated with BMI. In contrast, frequent tooth brushing (≥3 times/day) was negatively associated with BMI (β = −0.2610, SE = 0.0306, p < 0.001). The presence of periodontitis, dental caries, and tooth loss may be associated with higher BMI, whereas frequent tooth brushing may be related to lower BMI. Better oral hygiene might be associated with lower BMI. Further study is needed to determine the effect of oral health behavior and dental disease on obesity.
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Wang K, Zhu Y, Wong SHS, Chen Y, Siu PMF, Baker JS, Sun F. Effects and dose-response relationship of high-intensity interval training on cardiorespiratory fitness in overweight and obese adults: a systematic review and meta-analysis. J Sports Sci 2021; 39:2829-2846. [PMID: 34399677 DOI: 10.1080/02640414.2021.1964800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aims to quantify the effects of high-intensity interval training (HIIT) on cardiorespiratory fitness (CRF) by considering potential moderators and to characterise dose-response relationships of HIIT variables that could maximise CRF improvements in overweight and obese adults. Following a comprehensive search through four electronic databases, 19 studies met eligibility criteria. Random-effects models were applied to weight all included studies and to compute the weighted mean standardised mean differences (SMDwm). Meta-analysis showed that HIIT was a highly effective approach for improving CRF in overweight and obese adults (SMDwm = 1.13). Effects were modified by sex and baseline CRF level. Dose-response relationship analysis provided some preliminary data regarding the training period, training intensity, and session duration. However, it is still not possible to provide accurate recommendations currently. Further studies are still needed to identify the most appropriate training variables to prescribe effective HIIT programmes for improving CRF in overweight and obese adults.
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Affiliation(s)
- Kangle Wang
- Department Of Health And Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Yuxin Zhu
- Department Of Health And Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Stephen Heung-Sang Wong
- Department Of Sports Science And Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Yajun Chen
- Department Of Maternal And Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Parco Ming-Fai Siu
- Division Of Kinesiology, School Of Public Health, University Of Hong Kong, Hong Kong, China
| | - Julien S Baker
- Department Of Sport And Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Fenghua Sun
- Department Of Health And Physical Education, The Education University of Hong Kong, Hong Kong, China
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11
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Følling IS, Oldervoll LM, Hilmarsen C, Ersfjord EMI. Exploring use of activity monitors for patients with obesity during weight-loss treatment - a qualitative study. BMC Sports Sci Med Rehabil 2021; 13:25. [PMID: 33731190 PMCID: PMC7968213 DOI: 10.1186/s13102-021-00253-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity is a major health concern in western countries. In Norway, patients with obesity can attend weight-loss programmes, which focus on changes in dietary and physical activity habits. Use of self-monitoring is advocated when changing dietary and physical activity habits for adults with obesity. This study aimed to explore the experiences of patients with obesity who used activity monitors while attending a weight-loss programme. METHODS Patients with body mass index (BMI) > 35 kg/m2 with weight related comorbidities or a BMI > 40 kg/m2 referred to an intermittent weight-loss programme were recruited into this study. They were introduced to one of three different activity monitors, Fitbit Zip™, Mio Fuse™, or Mio Slice™. Semi-structured interviews were performed with patients six months into the weight-loss programme. Thematic analysis was applied when analysing the data. RESULTS Of the 29 informants (aged 21 to 66 years) interviewed, 59% were female. Their experience with activity monitors was related to their adherence to the weight-loss programme. Two main themes emerged from the informants stories: 1. "Activity monitors visualize proof of effort or failure to change health habits". 2. "Activity monitors act as a positive or negative enforcer when incorporating change". CONCLUSIONS Using activity monitors either strengthens or undermines patients' attempts to change health habits when attending a weight-loss program. Our findings suggest a need for more individualized weight-loss programmes for patients with obesity.
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Affiliation(s)
- Ingrid S Følling
- Centre for Obesity Research, Department of Surgery, Forsyningssenteret, St. Olavs Hospital, Trondheim, 7006, Norway.
| | - Line M Oldervoll
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, 5020, Norway
| | - Christina Hilmarsen
- Department of Circulation and Medical Imaging Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Ellen M I Ersfjord
- Centre for Obesity Research, Department of Surgery, Forsyningssenteret, St. Olavs Hospital, Trondheim, 7006, Norway
- Centre for eHealth, University of Agder, Campus Grimstad, 4879, Norway
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12
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Sharma T, Morassut RE, Langlois C, Meyre D. Effect of sex/gender on obesity traits in Canadian first year university students: The GENEiUS study. PLoS One 2021; 16:e0247113. [PMID: 33592058 PMCID: PMC7886219 DOI: 10.1371/journal.pone.0247113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While weight gain during first year of university has been well documented in North America, literature on sex-specific effects is scarce and inconsistent. The objective of this investigation was to explore sex-specific changes in obesity traits during first year of university at McMaster University (Ontario, Canada). METHODS 245 first-year students (80.4% females) were followed longitudinally with data collected early in the academic year and towards the end of the year. Obesity parameters including weight, waist and hip circumferences, BMI, and waist to hip ratio were investigated. The Mann-Whitney U test and the Wilcoxon signed-rank test were used for pairwise comparison of traits in the absence of adjustments. Additionally, the repeated-measures ANOVA test was used with covariate adjustments to investigate the interaction between sex and time. RESULTS Overall sample trends indicated a significant increase in mean weight by 1.55 kg (95% CI: 1.24-1.86) over the school year (p<0.001). This was accompanied by significant gains in BMI, and waist and hip circumferences (p<0.001) in the overall sample. At baseline, males presented with higher body weight, BMI, waist and hip circumferences, and WHR, as compared to their females counterparts (p<0.01). Additionally, sex-stratified analysis indicated significant gains in weight, BMI, and waist and hip circumferences in both males and females (p<0.01). However, a comparison of the magnitude of change over time between the two sex groups revealed no significant difference for any of the investigated traits (p>0.05). CONCLUSION While our study confirms significant weight gain in both male and female first year university students in Ontario, Canada, it does not show sex specific differences within this context. Our investigation highlights the importance of accounting for sex and gender in health research and supports the need of further studies in this area.
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Affiliation(s)
- Tanmay Sharma
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Rita E. Morassut
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Christine Langlois
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - David Meyre
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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Sarma S, Sockalingam S, Dash S. Obesity as a multisystem disease: Trends in obesity rates and obesity-related complications. Diabetes Obes Metab 2021; 23 Suppl 1:3-16. [PMID: 33621415 DOI: 10.1111/dom.14290] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
Obesity is a chronic multisystem disease associated with increased morbidity and mortality. The increasing prevalence of obesity makes it a major healthcare challenge across both developed and developing countries. Traditional measures such as body mass index do not always identify individuals at increased risk of comorbidities, yet continue to be used in deciding who qualifies for weight loss treatment. A better understanding of how obesity is associated with comorbidities, in particular non-metabolic conditions, is needed to identify individuals at risk in order to prioritize treatment. For metabolic disorders such as type 2 diabetes (T2D), weight loss can prevent T2D in individuals with prediabetes. It can improve and reverse T2D if weight loss is achieved early in the course of the disease. However, access to effective weight loss treatments is a significant barrier to improved health for people with obesity. In the present paper, we review the rising prevalence of obesity and why it should be classed as a multisystem disease. We will discuss potential mechanisms underlying its association with various comorbidities and how these respond to treatment, with a particular focus on cardiometabolic disease, malignancy and mental health.
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Affiliation(s)
- Shohinee Sarma
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
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谭 健, 崔 前, 顾 翔, 许 淑, 薛 莎, 袁 琨, 陈 伟. [Efficacy of weight management combined with uvulopalatopharyngoplasty for obesityrelated obstructive sleep apnea-hypopnea syndrome]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1668-1672. [PMID: 33243742 PMCID: PMC7704382 DOI: 10.12122/j.issn.1673-4254.2020.11.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the clinical efficacy of weight management combined with pharyngoplasty for treatment of obesity-related obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS Sixty obese patients with OSAHS were randomly assigned into the combined treatment group and control group (n=30) and received treatment with uvulopalatopharyngoplasty (UPPP) combined with cognitive-behavioral-psychological intervention for family weight management and uvulopalatopharyngoplasty with conventional management. At 3 and 6 months of the treatment, the patients were examined for changes in body mass index (BMI), neck circumference, waist circumference, Epworth Sleepiness Scale (ESS) scores, apnea-hypopnea index (AHI), the lowest oxygen saturation (LSaO2) and the percentage of time with oxygen saturation below 90% (CT90). RESULTS After 6 months of treatment, the patients receiving the combined treatment showed significant reductions of BMI, neck circumference and waist circumference as compared with the measurements before treatment and with those in the control group (P < 0.01); these parameters showed no significant changes in the control group (P > 0.05). In the combined treatment group, the ESS score, CT90, AHI, and LSaO2 at 6 months were all superior to those in the control group (P < 0.01) and differed significantly cross different time points during the treatment, and their improvements were the most obvious after 6 months (P < 0.01). After 6 months of treatment, the combined treatment group had a similar cure rate with the control group (6.6% vs 7.1%; χ2=1.66, P > 0.05) but a significantly higher good response (defined as an AHI < 20 h-1 and an AHI reduction by ≥50%) rate (60% vs 35.7%; χ2=8.71, P < 0.01) and a higher overall response (a AHI reduction ≥50%) rate (83.3% vs 53.6%; χ2=10.62, P < 0.01). CONCLUSIONS Weight management combined with uvulopalatopharyngoplasty can produce a good clinical efficacy for treatment of OSAHS with obesity, and the patients should have strengthened continuous family weight management while receiving surgical treatment.
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Affiliation(s)
- 健 谭
- />华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科,湖北 武汉 430014Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - 前波 崔
- />华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科,湖北 武汉 430014Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - 翔 顾
- />华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科,湖北 武汉 430014Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - 淑芳 许
- />华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科,湖北 武汉 430014Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - 莎 薛
- />华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科,湖北 武汉 430014Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - 琨 袁
- />华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科,湖北 武汉 430014Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - 伟 陈
- />华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科,湖北 武汉 430014Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
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15
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Sharma T, Manoharan B, Langlois C, Morassut RE, Meyre D. The effect of race/ethnicity on obesity traits in first year university students from Canada: The GENEiUS study. PLoS One 2020; 15:e0242714. [PMID: 33237969 PMCID: PMC7688123 DOI: 10.1371/journal.pone.0242714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/22/2023] Open
Abstract
Background Little is known about the impact of race/ethnicity on weight change at university. The objective of this study is to determine if ethnicity has an impact on obesity traits in a multiethnic cohort of first-year students at McMaster University in Ontario, Canada. Methods 183 first year students from the three most represented ethnic groups (South Asian, East Asian, and white-Caucasian) in our study sample were followed longitudinally with data collected early in the academic year and towards the end of the year. Obesity parameters including body weight, body mass index (BMI), waist and hip circumference, and waist hip ratio (WHR) were analyzed. The Wilcoxon signed-rank test was used for pairwise comparison of traits from the beginning to the end of the year in the absence of adjustments. Linear regression was used with covariate adjustments to investigate the effect of ethnicity on obesity traits. Results A significant increase in weight by 1.49 kg (95%CI: 1.13–1.85) was observed over the academic year in the overall analyzed sample. This was accompanied by significant gains in BMI, waist and hip circumferences, and WHR. Ethnicity stratified analysis indicated significant increase in all investigated obesity traits in East Asians and all traits, but WHR, in South Asians. White-Caucasians only displayed significant increases in weight and BMI. Body weight and hip circumference were significantly lower in East Asians compared to white-Caucasians at baseline. However, East Asians displayed a significantly larger increase in mean BMI and weight compared to white-Caucasians after first-year. South Asians displayed larger waist circumference at baseline compared to East Asians and larger WHR compared to white-Caucasians. Conclusion Our findings demonstrate that ethnicity has an impact on obesity traits in first-year university students. Universities should take ethnicity into account while implementing effective obesity prevention programs to promote healthy and active lifestyles for students.
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Affiliation(s)
- Tanmay Sharma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Baanu Manoharan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Christine Langlois
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Rita E. Morassut
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- * E-mail:
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16
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Trujillo-Garrido N, Bernal-Jiménez MÁ, Santi-Cano MJ. Evaluation of Obesity Management Recorded in Electronic Clinical History: A Cohort Study. J Clin Med 2020; 9:E2345. [PMID: 32717839 PMCID: PMC7465947 DOI: 10.3390/jcm9082345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide. Because of their close proximity to the population, primary care physicians and nurses are in a unique position to motivate and advise patients with obesity on a healthy diet and increased physical activity. Drawing from information recorded in electronic clinical records, we evaluated how the general recommendations included in obesity guidelines are being implemented in routine clinical practice. METHODS This study drew from the following data from a cohort of 209 patients with obesity that attended primary care consultations: electronic clinical records, body mass index (BMI), waist circumference (WC), cardiovascular risk factors, comorbidities and whether their health professional documented compliance with the recommendations of the evidence-based obesity guidelines in their electronic history. RESULTS Only 25.4% of the clinical records met all the criteria established in the therapeutic guidelines regarding diet prescription, 1.4% for physical activity and 1.5% for behavioral change activities. The patients whose records mentioned diet prescription and physical activity and who received follow-up consultations for both factors had lower average BMI and WC, although this relationship was not significant after adjusting for baseline. CONCLUSIONS We found that only a small number of records in the electronic clinical histories followed the evidence-based obesity guidelines. Recording dietetic prescription and physical exercise in the patient's clinical record is associated with better control of obesity.
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Affiliation(s)
- Nuria Trujillo-Garrido
- Faculty of Nursing, University of Cádiz, 11207 Cádiz, Spain;
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
| | - María Ángeles Bernal-Jiménez
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
| | - María J. Santi-Cano
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
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17
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Vázquez-Moreno M, Locia-Morales D, Perez-Herrera A, Gomez-Diaz RA, Gonzalez-Dzib R, Valdez-González AL, Flores-Alfaro E, Corona-Salazar P, Suarez-Sanchez F, Gomez-Zamudio J, Valladares-Salgado A, Wacher-Rodarte N, Cruz M, Meyre D. Causal Association of Haptoglobin With Obesity in Mexican Children: A Mendelian Randomization Study. J Clin Endocrinol Metab 2020; 105:5822684. [PMID: 32309857 DOI: 10.1210/clinem/dgaa213] [Citation(s) in RCA: 4] [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] [Received: 11/08/2019] [Accepted: 04/16/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Little is known about the association between haptoglobin level and cardiometabolic traits. A previous genome-wide association study identified rs2000999 in the HP gene as the stronger genetic contributor to serum haptoglobin level in European populations. OBJECTIVE AND DESIGN We investigated the association of HP rs2000999 with serum haptoglobin and childhood and adult obesity in up to 540/697 and 592/691 Mexican cases and controls, respectively. Anthropometric and biochemical data were collected. Serum haptoglobin was measured by an immunoturbidimetry assay. HP rs2000999 was genotyped using the TaqMan technology. Mendelian randomization analysis was performed using the Wald and inverse variance weighting methods. RESULTS Haptoglobin level was positively associated with childhood and adult obesity. HP rs2000999 G allele was positively associated with haptoglobin level in children and adults. HP rs2000999 G allele was positively associated with childhood but not adult obesity. The association between HP rs2000999 and childhood obesity was removed after adjusting for haptoglobin level. In a Mendelian randomization analysis, haptoglobin level genetically predicted by HP rs2000999 showed a significant causal effect on childhood obesity by the Wald and inverse variance weighting methods. CONCLUSION Our data provide evidence for the first time for a causal positive association between serum haptoglobin level and childhood obesity in the Mexican population. Our study contributes to the genetic elucidation of childhood obesity and proposes haptoglobin as an important biomarker and treatment target for obesity.
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Affiliation(s)
- Miguel Vázquez-Moreno
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Daniel Locia-Morales
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Laboratorio de Investigación en Epidemiología Clínica y Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, 39090, Mexico
| | - Aleyda Perez-Herrera
- Consejo Nacional de Ciencia y Tecnología, Instituto Politécnico Nacional-Centro Interdisciplinario de Investigación para el Desarrollo Integral-Regional Unidad Oaxaca, Oaxaca, Mexico
| | - Rita A Gomez-Diaz
- Unidad de Investigación en Epidemiología Clínica, Hospital de Especialidades Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Roxana Gonzalez-Dzib
- Servicio de Prestaciones Médicas del Instituto Mexicano del Seguro Social, Delegación Campeche, Campeche, Mexico
| | - Adriana L Valdez-González
- Unidad de Investigación en Epidemiología Clínica, Hospital de Especialidades Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eugenia Flores-Alfaro
- Laboratorio de Investigación en Epidemiología Clínica y Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, 39090, Mexico
| | - Perla Corona-Salazar
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Fernando Suarez-Sanchez
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jaime Gomez-Zamudio
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Adan Valladares-Salgado
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Niels Wacher-Rodarte
- Unidad de Investigación en Epidemiología Clínica, Hospital de Especialidades Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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18
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Lv N, Xiao L, Majd M, Lavori PW, Smyth JM, Rosas LG, Venditti EM, Snowden MB, Lewis MA, Ward E, Lesser L, Williams LM, Azar KMJ, Ma J. Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: Within-treatment analysis in the RAINBOW trial. PLoS One 2020; 15:e0231743. [PMID: 32315362 PMCID: PMC7173791 DOI: 10.1371/journal.pone.0231743] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress. METHODS Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results. RESULTS Among 204 intervention participants (50.9 [SD, 12.2] years, 71% female, 72% non-Hispanic White, BMI 36.7 [6.9], PHQ-9 14.1 [3.2]), 31% (n = 63) had poor engagement, on average completing self-monitored weight in <3 of 46 weeks and <5 of 15 sessions. Among them, 50 (79%) discontinued the intervention by session 6 (week 8). Engaged participants (n = 141; 69%) self-monitored weight for 11-22 weeks, attended almost all 15 sessions, but showed variable treatment progress based on patterns of change in self-monitored weight and PHQ-9 scores over 12 months. Three patterns of weight change (%) represented minimal weight loss (n = 50, linear β1 = -0.06, quadratic β2 = 0.001), moderate weight loss (n = 61, β1 = -0.28, β2 = 0.002), and substantial weight loss (n = 12, β1 = -0.53, β2 = 0.005). Three patterns of change in PHQ-9 scores represented moderate depression without treatment progress (n = 40, intercept β0 = 11.05, β1 = -0.11, β2 = 0.002), moderate depression with treatment progress (n = 20, β0 = 12.90, β1 = -0.42, β2 = 0.006), and milder depression with treatment progress (n = 81, β0 = 7.41, β1 = -0.23, β2 = 0.003). The patterns diverged within 6-8 weeks and persisted throughout the intervention. Objectively measured weight loss and depression outcomes were significantly worse among participants with poor engagement or poor progress on either weight or PHQ-9 than those showing progress on both. CONCLUSIONS Participants demonstrating poor engagement or poor progress could be identified early during the intervention and were more likely to fail treatment at the end of the intervention. This insight could inform individualized and timely optimization to enhance treatment efficacy. TRIAL REGISTRATION ClinicalTrials.gov# NCT02246413.
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Lan Xiao
- Department of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Marzieh Majd
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Philip W. Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, California, United States of America
| | - Joshua M. Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Lisa G. Rosas
- Department of Health Research and Policy and Medicine, Stanford University, Palo Alto, California, United States of America
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, Washington, United States of America
| | - Elizabeth Ward
- Pacific Coast Psychiatric Associates, San Francisco, California, United States of America
| | - Lenard Lesser
- One Medical, San Francisco, California, United States of America
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
| | - Kristen M. J. Azar
- Sutter Health Research Enterprise, Center for Health Systems Research, Walnut Creek, California, United States of America
| | - Jun Ma
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
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19
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Williams AJ, Barter T, Sharpe RA. Lessons from a publicly funded tier 2 healthy weight programme in Cornwall, UK. J Public Health (Oxf) 2020; 42:e96-e104. [PMID: 31220298 DOI: 10.1093/pubmed/fdz037] [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: 09/16/2018] [Revised: 02/13/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The UK has one of the highest prevalence rates of obesity worldwide. Public health departments have a duty to provide some obesity treatment and prevention services. With evidence of effective programmes lacking, we investigate lessons learned from a healthy weight programme in Cornwall, UK. METHODS Data from the 12-week multi-component adult healthy weight management programme were obtained for 2012-2016. Descriptive statistics and statistical tests were used to describe participants' demographics, health status and anthropometric measures to explore the enrolment and retention of the programme as well as the impact. RESULTS A total of 1872 adults were referred into the programme. Overall, 646 completed the programme and, 48.8% achieved the programme's aim of a >3% reduction in weight. Those who completed and met the programme aim tended to have had healthier outcomes at baseline. CONCLUSIONS For those who engage with the programme the impact can be meaningful. However, <1% of the population of Cornwall with overweight or obesity enroled in the programme, and those who benefitted most might have been in least need. Providing services that meet the needs of the population is challenging when a variety of services is needed, and the evidence base is poor.
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Affiliation(s)
- A J Williams
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK
| | - T Barter
- Wellbeing and Public Health Service, Cornwall Council, Truro TR1 3AY, UK
| | - R A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK.,Wellbeing and Public Health Service, Cornwall Council, Truro TR1 3AY, UK
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20
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Brauer P, Royall D, Li A, Rodrigues A, Green J, Macklin S, Craig A, Pasanen J, Brunelle L, Maitland S, Dhaliwal R, Klein D, Tremblay A, Rheaume C, Mutch DM, Jeejeebhoy K. Nutrient intake and dietary quality changes within a personalized lifestyle intervention program for metabolic syndrome in primary care. Appl Physiol Nutr Metab 2019; 44:1297-1304. [DOI: 10.1139/apnm-2019-0070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A team-based 12-month lifestyle program for the treatment of metabolic syndrome (MetS) (involving physicians, registered dietitians (RDs), and kinesiologists) was previously shown to reverse MetS in 19% of patients (95% confidence interval, 14% to 24%). This work evaluates changes in nutrient intake and diet quality over 12 months (n = 205). Individualized diet counselling was provided by 14 RDs at 3 centres. Two 24-h recalls, the Canadian Healthy Eating Index (HEI-C), and the Mediterranean Diet Score (MDS) were completed at each time point. Total energy intake decreased by 145 ± 586 kcal (mean ± SD) over 3 months with an additional 76 ± 452 kcal decrease over 3–12 months. HEI-C improved from 58 ± 15 to 69 ± 12 at 3 months and was maintained at 12 months. Similarly, MDS (n = 144) improved from 4.8 ± 1.2 to 6.2 ± 1.9 at 3 months and was maintained at 12 months. Changes were specific to certain food groups, with increased intake of fruits, vegetables, and nuts and decreased intake of “other foods” and “commercial baked goods” being the most prominent changes. There was limited change in intake of olive oil, fish, and legumes. Exploratory analysis suggested that poorer diet quality at baseline was associated with greater dietary changes as assessed by HEI-C. Novelty Multiple dietary assessment tools provided rich information on food intake changes in an intervention for metabolic syndrome. Improvements in diet were achieved by 3 months and maintained to 12 months. The results provide a basis for further dietary change implementation studies in the Canadian context.
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Affiliation(s)
- Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Dawna Royall
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Airu Li
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Ariellia Rodrigues
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jennifer Green
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Sharon Macklin
- Edmonton Oliver Primary Care Network, Edmonton, AB T5G 0E5, Canada
| | - Alison Craig
- Edmonton Oliver Primary Care Network, Edmonton, AB T5G 0E5, Canada
| | - Jennifer Pasanen
- Edmonton Oliver Primary Care Network, Edmonton, AB T5G 0E5, Canada
| | - Lucie Brunelle
- Department of Kinesiology, Laval University, Québec, QC G1V 0A6, Canada
| | - Scott Maitland
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | | | - Doug Klein
- Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Angelo Tremblay
- Department of Kinesiology, Laval University, Québec, QC G1V 0A6, Canada
| | - Caroline Rheaume
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC G1V 0A6, Canada
| | - David M. Mutch
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
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21
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Association between impulsivity traits and body mass index at the observational and genetic epidemiology level. Sci Rep 2019; 9:17583. [PMID: 31772290 PMCID: PMC6879509 DOI: 10.1038/s41598-019-53922-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023] Open
Abstract
We investigated the association between impulsivity related traits and BMI at the observational and genetic epidemiology level in a cross-sectional population of healthy young American-European adults. We studied 998 students and university staff of European ancestry recruited from Chicago (Illinois) and Athens (Georgia). We measured 14 impulsivity variables using three broad categories: impulsive choice, action and personality. Weight and height of participants were measured by research assistants. The single-nucleotide polymorphism (SNP) rs3751812 in the fat mass and obesity-associated (FTO) gene was genotyped using the Illumina PsychArray BeadChip platform. Within the three broad domains of impulsivity, 4 parameters (delay discounting of rewards area under the curve and average of k indexes, Conner's continuous performance test, and negative urgency) were associated with BMI. The FTO rs3751812 minor allele T was associated with higher BMI. Of the 14 impulsivity variables, rs3751812 T was associated with more premeditation and perseverance, before and after adjusting for BMI. The association between FTO rs3751812 and BMI adjusted for premeditation remained significant, but disappeared after adjusting for perseverance and for both perseverance and premeditation traits. Our observational and genetic data indicate a complex pattern of association between impulsive behaviors and BMI in healthy young American-European adults.
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22
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Mahutte N, Kamga-Ngande C, Sharma A, Sylvestre C. Obesity and Reproduction. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:950-966. [PMID: 29921431 DOI: 10.1016/j.jogc.2018.04.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a comprehensive review and evidence-based recommendations for the delivery of fertility care to women with obesity. OUTCOMES The impact of obesity on fertility, fertility treatments, and both short and long-term maternal fetal outcomes was carefully considered. EVIDENCE Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and key words. Results included systematic reviews, clinical trials, observational studies, clinical practice guidelines, and expert opinions. VALUES The Canadian Fertility & Andrology Society (CFAS) is a multidisciplinary, national non-profit society that serves as the voice of reproductive specialists, scientists, and allied health professionals working in the field of assisted reproduction in Canada. The evidence obtained for this guideline was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committee of the CFAS under the leadership of the principal authors. BENEFITS, HARMS, AND COSTS The implementation of these recommendations should assist clinicians and other health care providers in counselling and providing reproductive care to women with obesity. VALIDATION This guideline and its recommendations have been reviewed and approved by the membership, the CPG Committee and the Board of Directors of the CFAS. SPONSORS Canadian Fertility & Andrology Society. RECOMMENDATIONS Twenty-one evidence based recommendations are provided. These recommendations specifically evaluate the impact of obesity on natural fertility, fertility treatments, and maternal-fetal outcomes. Strategies to lose weight and BMI cut-offs are also addressed.
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Affiliation(s)
| | - Carole Kamga-Ngande
- Department of Obstetrics and Gynecology, University of Montréal, Montréal, QC
| | | | - Camille Sylvestre
- Department of Obstetrics and Gynecology, University of Montréal, Montréal, QC
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23
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Rhus coriaria L. (Sumac) in Patients Who Are Overweight or Have Obesity: A Placebo-Controlled Randomized Clinical Trial. ACTA ACUST UNITED AC 2019. [DOI: 10.5812/semj.87301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Warschburger P, Zitzmann J. Does an Age-Specific Treatment Program Augment the Efficacy of a Cognitive-Behavioral Weight Loss Program in Adolescence and Young Adulthood? Results from a Controlled Study. Nutrients 2019; 11:nu11092053. [PMID: 31480678 PMCID: PMC6769959 DOI: 10.3390/nu11092053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/27/2022] Open
Abstract
Research on weight-loss interventions in emerging adulthood is warranted. Therefore, a cognitive-behavioral group treatment (CBT), including development-specific topics for adolescents and young adults with obesity (YOUTH), was developed. In a controlled study, we compared the efficacy of this age-specific CBT group intervention to an age-unspecific CBT group delivered across ages in an inpatient setting. The primary outcome was body mass index standard deviation score (BMI-SDS) over the course of one year; secondary outcomes were health-related and disease-specific quality of life (QoL). 266 participants aged 16 to 21 years (65% females) were randomized. Intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. For both group interventions, we observed significant and clinically relevant improvements in BMI-SDS and QoL over the course of time with small to large effect sizes. Contrary to our hypothesis, the age-specific intervention was not superior to the age-unspecific CBT-approach.
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Affiliation(s)
- Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany.
| | - Jana Zitzmann
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
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25
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Ehtesham S, Qasim A, Meyre D. Loss-of-function mutations in the melanocortin-3 receptor gene confer risk for human obesity: A systematic review and meta-analysis. Obes Rev 2019; 20:1085-1092. [PMID: 31090190 DOI: 10.1111/obr.12864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 02/06/2023]
Abstract
The association between rare coding loss-of-function (LOF) mutations in the melanocortin receptor 3 (MC3R) gene and human obesity is controversial. To fill this gap of knowledge, we performed a systematic review and meta-analysis of genetic association studies in all ages and ethnicities. Two reviewers independently performed risk of bias assessment and extracted data. We searched Medline, Embase, Web of Science Core Collection, BIOSIS Preview, CINAHL, ProQuest Dissertations & Theses, and reference lists of relevant studies. All case-control, cross-sectional, prospective, and retrospective studies that evaluated prevalence of rare (less than 1% frequency) coding partial/complete LOF mutations in MC3R among individuals with obesity and normal weight were included. Our systematic search identified 1925 references relevant to the present review. Six studies were deemed eligible. Meta-analysis of 2969 individuals with obesity and 2572 with normal weight showed a positive association between rare heterozygous coding partial/complete LOF mutations in MC3R and obesity in children and adults of European, North African, and Asian ancestries (odds ratio = 3.07; 95% CI, 1.48-7.00; P = 4.2 × 10-3 ). Our data demonstrates that rare partial/complete LOF mutations in the coding region of MC3R confer three-time increased risk of obesity in humans, and implies that rare genetic variants with intermediate effects contribute to the missing heritability of obesity.
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Affiliation(s)
- Sahar Ehtesham
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anila Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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26
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Abstract
UNLABELLED In many wealthy countries, fatness is stigmatized as a sign of personal failure. Health care interactions can enact fat-related stigmatization, which can worsen health outcomes. The present analysis highlights how stigmatizing discourses about fat bodies emerge in primary care appointments, and examines immediate conversational effects. METHODS Observational study in three primary care clinics in Canada, using conversation and discourse analytic methods on transcripts of 29 audio-recorded appointments with adults. Talk about weight and blood pressure are contrasted. RESULTS During measurement and review of measurements, clinicians routinely interpreted the blood pressure result but rarely interpreted weight. Patients of varied ages and body sizes often filled the interpretative vacuum, and focused on behaviors. Overall, neither patients nor clinicians challenged the stigmatizing discourses associated with fat bodies, but sometimes agreed that the "personal failure" frame associated with fatness does not apply to the particular patient. Physicians rarely raised other determinants of weight, but often did so when talking about blood pressure. CONCLUSIONS Across most body types and ages, weight-related talk spurred stigma management from adult patients. Patients' interpretations were consistent with accepting or avoidant strategies to manage stigma. The findings challenge clinicians and researchers to frame patients' defensiveness or sensitivity as a predictable response to mitigate stigma, and consider how clinical care might be better structured to avoid stigmatization. Recognizing the range of determinants of weight with interpretation of weight may help, particularly if combined with other methods to de-stigmatize care. The results have implications for clinical weight management and behavior change support.
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Affiliation(s)
- Patricia Thille
- a The Wilson Centre , University Health Network/University of Toronto
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27
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Wang DX, Kaur Y, Alyass A, Meyre D. A Candidate-Gene Approach Identifies Novel Associations Between Common Variants in/Near Syndromic Obesity Genes and BMI in Pediatric and Adult European Populations. Diabetes 2019; 68:724-732. [PMID: 30692245 DOI: 10.2337/db18-0986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/24/2019] [Indexed: 11/13/2022]
Abstract
We hypothesized that monogenic syndromic obesity genes are also involved in the polygenic variation of BMI. Single-marker, tag single nucleotide polymorphism (tagSNP) and gene-based analysis were performed on common variants near 54 syndromic obesity genes. We used publicly available data from meta-analyses of European BMI genome-wide association studies conducted by the Genetic Investigation of ANthropometric Traits (GIANT) Consortium and the UK Biobank (UKB) (N = 681,275 adults). A total of 33 loci were identified, of which 19 of 33 (57.6%) were located at SNPs previously identified by the GIANT Consortium and UKB meta-analysis, 11 of 33 (33.3%) were located at novel SNPs, and 3 of 33 (9.1%) were novel genes identified with gene-based analysis. Both single-marker and tagSNP analyses mapped the previously identified 19 SNPs by the GIANT Consortium and UKB meta-analysis. Gene-based analysis confirmed 15 of 19 (78.9%) of the novel SNPs' associated genes. Of the 11 novel loci, 8 were identified with single-marker analysis and the remaining 3 were identified with tagSNP analysis. Gene-based analysis confirmed 4 of 11 (36.3%) of these loci. Meta-analysis with the Early Growth Genetics (EGG) Consortium (N = 35,668 children) was conducted post hoc for top SNPs, confirming 17 of 33 (51.5%) loci, of which 5 were novel. This study supports evidence for a continuum between rare monogenic syndromic and common polygenic forms of obesity.
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Affiliation(s)
- Dominic X Wang
- Department of Health Research, Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Yuvreet Kaur
- Department of Health Research, Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Akram Alyass
- Department of Health Research, Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Meyre
- Department of Health Research, Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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28
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Ma J, Rosas LG, Lv N, Xiao L, Snowden MB, Venditti EM, Lewis MA, Goldhaber-Fiebert JD, Lavori PW. Effect of Integrated Behavioral Weight Loss Treatment and Problem-Solving Therapy on Body Mass Index and Depressive Symptoms Among Patients With Obesity and Depression: The RAINBOW Randomized Clinical Trial. JAMA 2019; 321:869-879. [PMID: 30835308 PMCID: PMC6439596 DOI: 10.1001/jama.2019.0557] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
Importance Coexisting obesity and depression exacerbate morbidity and disability, but effective treatments remain elusive. Objective To test the hypothesis that an integrated collaborative care intervention would significantly improve both obesity and depression at 12 months compared with usual care. Design, Setting, and Participants The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial enrolled 409 adults with body mass indices (BMIs) of 30 or greater (≥27 for Asian adults) and 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater. Primary care patients at a health system in Northern California were recruited from September 30, 2014, to January 12, 2017; the date of final 12-month follow-up was January 17, 2018. Interventions All participants randomly assigned to the intervention (n = 204) or the usual care control group (n = 205) received medical care from their personal physicians as usual, received information on routine services for obesity and depression at their clinic, and received wireless physical activity trackers. Intervention participants also received a 12-month intervention that integrated a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression and, if indicated, antidepressant medications. Main Outcomes and Measures The co-primary outcome measures were BMI and 20-item Depression Symptom Checklist (SCL-20) scores (range, 0 [best] to 4 [worst]) at 12 months. Results Among 409 participants randomized (mean age of 51.0 years [SD, 12.1 years]; 70% were women; mean BMI of 36.7 [SD, 6.4]; mean PHQ-9 score of 13.8 [SD, 3.1]; and mean SCL-20 score of 1.5 [SD, 0.5]), 344 (84.1%) completed 12-month follow-up. At 12 months, mean BMI declined from 36.7 (SD, 6.9) to 35.9 (SD, 7.1) among intervention participants compared with a change in mean BMI from 36.6 (SD, 5.8) to 36.6 (SD, 6.0) among usual care participants (between-group mean difference, -0.7 [95% CI, -1.1 to -0.2]; P = .01). Mean SCL-20 score declined from 1.5 (SD, 0.5) to 1.1 (SD, 1.0) at 12 months among intervention participants compared with a change in mean SCL-20 score from 1.5 (SD, 0.6) to 1.4 (SD, 1.3) among usual care participants (between-group mean difference, -0.2 [95% CI, -0.4 to 0]; P = .01). There were 47 adverse events or serious adverse events that involved musculoskeletal injuries (27 in the intervention group and 20 in the usual care group). Conclusions and Relevance Among adults with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improved weight loss and depressive symptoms at 12 months compared with usual care; however, the effect sizes were modest and of uncertain clinical importance. Trial Registration ClinicalTrials.gov Identifier: NCT02246413.
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Affiliation(s)
- Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois, Chicago
| | - Lisa Goldman Rosas
- Department of Health Research and Policy and Medicine, Stanford University, Palo Alto, California
| | - Nan Lv
- Department of Medicine and Institute of Health Research and Policy, University of Illinois, Chicago
| | - Lan Xiao
- Department of Medicine, Stanford University, Palo Alto, California
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, Washington
| | | | - Philip W. Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, California
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29
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Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, Kim BY, Kim YH, Kim WJ, Kim EM, Kim HS, Shin YA, Shin HJ, Lee KR, Lee KY, Lee SY, Lee SK, Lee JH, Lee CB, Chung S, Cho YH, Choi KM, Han JS, Yoo SJ. 2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea. J Obes Metab Syndr 2019; 28:40-45. [PMID: 31089578 PMCID: PMC6484940 DOI: 10.7570/jomes.2019.28.1.40] [Citation(s) in RCA: 357] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/12/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023] Open
Abstract
Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m2. Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m2 and for Korean patients with BMI ≥30 kg/m2 who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.
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Affiliation(s)
- Mi Hae Seo
- Division of Endocrinology, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi,
Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Sung Soo Kim
- Department of Family Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon,
Korea
| | - Kyoung Kon Kim
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Won-Jun Kim
- Department of Endocrinology and Metabolism, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung,
Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul,
Korea
| | - Hyun Soo Kim
- Department of Sport Science, Seoul National University of Science and Technology, Seoul,
Korea
| | - Yun-A Shin
- Department of Exercise Prescription and Rehabilitation, Dankook University, Cheonan,
Korea
| | - Hye-Jung Shin
- Department of Pediatrics, National Medical Center, Seoul,
Korea
| | - Kyu Rae Lee
- Department of Family Medicine, Dongincheon Gil Hospital, Gachon University of Medicine and Science, Incheon,
Korea
| | - Ki Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Sang Yeoup Lee
- Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan,
Korea
| | - Seong-Kyu Lee
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon,
Korea
| | - Joo Ho Lee
- Department of Surgery, Ewha Medical Center, Seoul,
Korea
| | - Chang Beom Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
| | - Young Hye Cho
- Family Medicine Clinic and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan,
Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Jung Soon Han
- Research Institute of Human Ecology, Korea University, Seoul,
Korea
| | - Soon Jib Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
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He J, Stryjecki C, Reddon H, Peralta-Romero J, Karam-Araujo R, Suarez F, Gomez-Zamudio J, Burguete-Garcia A, Alyass A, Cruz M, Meyre D. Adiponectin is associated with cardio-metabolic traits in Mexican children. Sci Rep 2019; 9:3084. [PMID: 30816311 PMCID: PMC6395686 DOI: 10.1038/s41598-019-39801-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/31/2018] [Indexed: 02/07/2023] Open
Abstract
The adipocyte-derived adiponectin hormone bridges obesity and its cardio-metabolic complications. Genetic variants at the ADIPOQ locus, in ADIPOR1, and ADIPOR2 have been associated with adiponectin concentrations and cardio-metabolic complications in diverse ethnicities. However, no studies have examined these associations in Mexican children. We recruited 1 457 Mexican children from Mexico City. Six genetic variants in or near ADIPOQ (rs182052, rs2241766, rs266729, rs822393), ADIPOR1 (rs10920533), and ADIPOR2 (rs11061971) were genotyped. Associations between serum adiponectin, genetic variants, and cardio-metabolic traits were assessed using linear and logistic regressions adjusted for age, sex, and recruitment center. Serum adiponectin concentration was negatively associated with body mass index, waist to hip ratio, low-density lipoprotein cholesterol, total cholesterol, triglycerides, fasting glucose, fasting insulin, homeostatic model assessment of insulin resistance, dyslipidemia and overweight/obesity status (7.76 × 10−40 ≤ p ≤ 3.00 × 10−3). No significant associations between genetic variants in ADIPOQ, ADIPOR1, and ADIPOR2 and serum adiponectin concentration were identified (all p ≥ 0.30). No significant associations between the six genetic variants and cardio-metabolic traits were observed after Bonferroni correction (all p < 6.9 × 10−4). Our study suggests strong associations between circulating adiponectin concentration and cardio-metabolic traits in Mexican children.
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Affiliation(s)
- Juehua He
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Carolina Stryjecki
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Hudson Reddon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jesus Peralta-Romero
- Medical Research Unit in Biochemistry, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Roberto Karam-Araujo
- Health Promotion Division, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Fernando Suarez
- Medical Research Unit in Biochemistry, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jaime Gomez-Zamudio
- Medical Research Unit in Biochemistry, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ana Burguete-Garcia
- Centro de investigación sobre enfermedades infecciosas. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
| | - Akram Alyass
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Miguel Cruz
- Medical Research Unit in Biochemistry, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. .,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
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Kesztyüs D, Erhardt J, Schönsteiner D, Kesztyüs T. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:40. [PMID: 30832765 DOI: 10.3238/arztebl.2019.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hui F, Zhang Y, Ren T, Li X, Zhao M, Zhao Q. Role of metformin in overweight and obese people without diabetes: a systematic review and network meta-analysis. Eur J Clin Pharmacol 2018; 75:437-450. [DOI: 10.1007/s00228-018-2593-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022]
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Thille P. Knowledge brokering: (mis)aligning population knowledge with care of fat bodies. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:643-652. [PMID: 30465284 PMCID: PMC6964535 DOI: 10.17269/s41997-018-0147-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 10/10/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Two prominent Canadian knowledge brokers aim to influence how primary care clinicians address obesity, through the dissemination of texts: the Canadian Task Force on Preventive Health Care (guideline) and the Canadian Obesity Network (5As). While written for the same clinician and adult patient population, the recommendations differ. This analysis highlights active decisions that produced the difference. METHODS Frame analysis of the guideline and 5As texts. RESULTS The brokers both frame obesity as a chronic and pathological threat to health, at least to a point. The guideline texts frame obesity primarily as a sign of a behavioural problem, discrediting or ignoring many complicating sources of knowledge. In contrast, the 5As frames obesity as complex through diversifying the knowledge foundation embedded in the texts (e.g., including fat-related stigmatisation; health status differences among those classified as obese). Both de-emphasize social and environmental determinants of weight and health. CONCLUSION Frames of problems used by brokers are not neutral, nor are decisions about how knowledge is excluded and included. Knowledge brokering, no matter how scientific and systematic, is limited by its frame. Recognizing the limits of each frame supports reflexivity in knowledge brokering and interventions taken to enhance health.
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Affiliation(s)
- Patricia Thille
- Department of Physical Therapy, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
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Hilbert A, Blume M, Petroff D, Neuhaus P, Smith E, Hay PJ, Hübner C. Group cognitive remediation therapy for adults with obesity prior to behavioural weight loss treatment: study protocol for a randomised controlled superiority study (CRT study). BMJ Open 2018; 8:e022616. [PMID: 30224391 PMCID: PMC6144388 DOI: 10.1136/bmjopen-2018-022616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/01/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Individuals with obesity show deficits in executive functioning which have been implicated in decreased weight loss outcome. Preliminary evidence suggests that cognitive remediation therapy (CRT) improves executive functioning and weight loss in obesity. However, confirmatory support, especially for pre-weight loss use, is lacking. The CRT study aims at determining the efficacy of CRT versus no treatment control in patients with obesity before entering behavioural weight loss (BWL) treatment. It is hypothesised that individuals who receive CRT will show better weight loss outcome, improved executive functioning, greater weight loss-related behavioural changes and higher attendance of BWL treatment, 6 and 12 months after cessation of CRT. METHODS AND ANALYSIS In a single-centre, assessor-blinded, randomised, two-armed parallel-group superiority trial, 260 adults with body mass index ≥35.0 kg/m2 are centrally randomised to 8-week group-based CRT versus no treatment, before entering BWL treatment. Primary outcome is the amount of weight loss (%) at 6-month follow-up, compared with pre-treatment, derived from measured body weight. Secondary outcomes include improvement in executive functioning post-treatment and in weight loss-related behaviour, mental and physical health, and attendance to BWL treatment at 6-month and 12-month follow-up. Maintenance of weight loss at 12-month follow-up will be determined. Mixed model analyses based on intent-to-treat will be used to compare the CRT and control groups with respect to differences in weight change between pre-treatment and 6-month follow-up. Similar models will be used for analysing 12-month follow-up data and secondary outcomes. Further analyses will include additional covariates to identify predictors of treatment outcome. ETHICS AND DISSEMINATION The study was approved by the Ethical Committee of the University of Leipzig (256-15-13072015, version 'Final 1.0 from 28 May 2015). The study results will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER DRKS00009333; Pre-results.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Centre AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Marie Blume
- Integrated Research and Treatment Centre AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Centre AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Petra Neuhaus
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Evelyn Smith
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Phillipa J Hay
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Claudia Hübner
- Integrated Research and Treatment Centre AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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Khosravi ZS, Kafeshani M, Tavasoli P, Zadeh AH, Entezari MH. Effect of Vitamin D Supplementation on Weight Loss, Glycemic Indices, and Lipid Profile in Obese and Overweight Women: A Clinical Trial Study. Int J Prev Med 2018; 9:63. [PMID: 30123437 PMCID: PMC6071442 DOI: 10.4103/ijpvm.ijpvm_329_15] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/15/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Vitamin D (vit D) deficiency has defined as a health problem worldwide. World Health Organization (WHO) has declared that obesity is an epidemic of the 21st century. Previous studies have shown that obesity may increase the risk of Vit D deficiency. Furthermore, other studies have demonstrated that vit D insufficiency was accompanied with higher risk of type 2 diabetes, cardiovascular diseases, hypertension, and obesity. The aim of this study was to survey the effect of vit D supplementation on weight loss among overweight and obese women aged 20-40 years in Isfahan. Methods This double-blind clinical trial was done on 50 overweight and obese women who were divided into two groups, in which one group received vit D supplements and the other group received placebo. Intervention group received vit D with dozes 50,000 IU/w for 6 weeks. The levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting blood sugar (FBS), insulin (ins), homeostasis model assessment of ins resistance (IR), C-reactive protein (CRP), height, weight (WT), waist circumference (WC), hip circumference (HC), and blood pressure (BP) were measured before and after intervention. Results After using vit D supplementation for 6 weeks, WT, WC, and body mass index (BMI) were decreased significantly and serum vit D increased significantly compared to control group (P < 0.001). Other factors including TC, TG, LDL-c, HDL-c, FBS, CRP, ins, IR, and waist to hip ratio (WHR) did not change significantly (P > 0.05). Conclusions After 6 weeks of intervention, the means of WT, BMI, WC, and HC decreased significantly. Previous studies have shown that vit D deficiency was more prevalence in obese people and there was an inverse association among vit D with BMI and WC. The relationship between vit D and lipid profiles such as glycemic indexes, anthropometric indexes, CRP, and BP is not clear and needs more study in the future.
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Affiliation(s)
- Zahra Sadat Khosravi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Kafeshani
- Clinical Nutrition/Community Nutrition/Food Science and Technology, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parastoo Tavasoli
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassan Zadeh
- Department of Epidemiology and Biostatic, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hassan Entezari
- Clinical Nutrition/Community Nutrition/Food Science and Technology, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim JS, Lee SG, Min K, Kwon TK, Kim HJ, Nam JO. Eupatilin inhibits adipogenesis through suppression of PPARγ activity in 3T3-L1 cells. Biomed Pharmacother 2018; 103:135-139. [PMID: 29649628 DOI: 10.1016/j.biopha.2018.03.073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 01/18/2023] Open
Abstract
Eupatilin (5,7-dihydroxy-3',4',6-trimethoxyflavone) is a flavonoid compound from Artemisia species that possesses beneficial biological activities such as anti-cancer, anti-oxidation, and anti-inflammatory activities. However, an anti-adipogenic effect has not yet been reported. In this study, we found that eupatilin significantly inhibited the adipogenesis of 3T3-L1 adipocytes. Eupatilin decreased intracellular lipid accumulation and suppressed the expression level of key adipogenic regulators in 3T3-L1 adipocytes, including peroxisome proliferator-activated receptor gamma (PPARγ) and CCAAT-enhancer-binding protein alpha (C/EBPα), in a concentration-dependent manner. These results show that eupatilin significantly inhibits 3T3-L1 cell differentiation and suggest that it has potential as a novel anti-obesity therapy.
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Affiliation(s)
- Jin Soo Kim
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, South Korea
| | - Seul Gi Lee
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, South Korea
| | - Kyoungjin Min
- Department of Immunology, School of Medicine, Keimyung University, 2800 Dalgubeoldaero, Dalseo-Gu, Daegu 704-701, South Korea
| | - Taeg Kyu Kwon
- Department of Immunology, School of Medicine, Keimyung University, 2800 Dalgubeoldaero, Dalseo-Gu, Daegu 704-701, South Korea
| | - Ha-Jeong Kim
- Department of Physiology, Cell and Matrix Research Institute, BK21 Plus KNU Biomedical Convergence Program, Tumor Heterogeneity and Network (THEN) Research Center, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Ju-Ock Nam
- Department of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, South Korea; Institute of Agricultural Science & Technology, Kyungpook National University, Daegu 41566, South Korea.
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Mandøe MJ, Hansen KB, Windeløv JA, Knop FK, Rehfeld JF, Rosenkilde MM, Holst JJ, Hansen HS. Comparing olive oil and C4-dietary oil, a prodrug for the GPR119 agonist, 2-oleoyl glycerol, less energy intake of the latter is needed to stimulate incretin hormone secretion in overweight subjects with type 2 diabetes. Nutr Diabetes 2018; 8:2. [PMID: 29330461 PMCID: PMC6199285 DOI: 10.1038/s41387-017-0011-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 08/01/2017] [Accepted: 11/06/2017] [Indexed: 02/08/2023] Open
Abstract
Background/objective After digestion, dietary triacylglycerol stimulates incretin release in humans, mainly through generation of 2-monoacylglycerol, an agonist for the intestinal G protein-coupled receptor 119 (GPR119). Enhanced incretin release may have beneficial metabolic effects. However, dietary fat may promote weight gain and should therefore be restricted in obesity. We designed C4-dietary oil (1,3-di-butyryl-2-oleoyl glycerol) as a 2-oleoyl glycerol (2-OG)-generating fat type, which would stimulate incretin release to the same extent while providing less calories than equimolar amounts of common triglycerides, e.g., olive oil. Subjects and methods We studied the effect over 180 min of (a) 19 g olive oil plus 200 g carrot, (b) 10.7 g C4 dietary oil plus 200 g carrot and (c) 200 g carrot, respectively, on plasma responses of gut and pancreatic hormones in 13 overweight patients with type 2 diabetes (T2D). Theoretically, both oil meals result in formation of 7.7 g 2-OG during digestion. Results Both olive oil and C4-dietary oil resulted in greater postprandial (P ≤ 0.01) glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) responses (incremental area under curve (iAUC)): iAUCGLP−1: 645 ± 194 and 702 ± 97 pM × min; iAUCGIP: 4,338 ± 764 and 2,894 ± 601 pM × min) compared to the carrot meal (iAUCGLP−1: 7 ± 103 pM × min; iAUCGIP: 266 ± 234 pM × min). iAUC for GLP-1 and GIP were similar for C4-dietary oil and olive oil, although olive oil resulted in a higher peak value for GIP than C4-dietary oil. Conclusion C4-dietary oil enhanced secretion of GLP-1 and GIP to almost the same extent as olive oil, in spite of liberation of both 2-OG and oleic acid, which also may stimulate incretin secretion, from olive oil. Thus, C4-dietary oil is more effective as incretin releaser than olive oil per unit of energy and may be useful for dietary intervention.
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Affiliation(s)
- Mette Johannsen Mandøe
- The Novo Nordisk Foundation Center for Basal Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - Katrine Bagge Hansen
- The Novo Nordisk Foundation Center for Basal Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - Johanne Agerlin Windeløv
- The Novo Nordisk Foundation Center for Basal Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip Krag Knop
- The Novo Nordisk Foundation Center for Basal Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Frederik Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mette Marie Rosenkilde
- Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- The Novo Nordisk Foundation Center for Basal Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. .,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Harald Severin Hansen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Flodgren G, Gonçalves‐Bradley DC, Summerbell CD. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity. Cochrane Database Syst Rev 2017; 11:CD000984. [PMID: 29190418 PMCID: PMC6486102 DOI: 10.1002/14651858.cd000984.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing globally, an increase which has major implications for both population health and costs to health services. This is an update of a Cochrane Review. OBJECTIVES To assess the effects of strategies to change the behaviour of health professionals or the organisation of care compared to standard care, to promote weight reduction in children and adults with overweight or obesity. SEARCH METHODS We searched the following databases for primary studies up to September 2016: CENTRAL, MEDLINE, Embase, CINAHL, DARE and PsycINFO. We searched the reference lists of included studies and two trial registries. SELECTION CRITERIA We considered randomised trials that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in children and adults with overweight or obesity. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane when conducting this review. We report the results for the professional interventions and the organisational interventions in seven 'Summary of findings' tables. MAIN RESULTS We identified 12 studies for inclusion in this review, seven of which evaluated interventions targeting healthcare professional and five targeting the organisation of care. Eight studies recruited adults with overweight or obesity and four recruited children with obesity. Eight studies had an overall high risk of bias, and four had a low risk of bias. In total, 139 practices provided care to 89,754 people, with a median follow-up of 12 months. Professional interventions Educational interventions aimed at general practitioners (GPs), may slightly reduce the weight of participants (mean difference (MD) -1.24 kg, 95% confidence interval (CI) -2.84 to 0.37; 3 studies, N = 1017 adults; low-certainty evidence).Tailoring interventions to improve GPs' compliance with obesity guidelines probably leads to little or no difference in weight loss (MD 0.05 (kg), 95% CI -0.32 to 0.41; 1 study, N = 49,807 adults; moderate-certainty evidence).It is uncertain if providing doctors with reminders results in a greater weight reduction than standard care (men: MD -11.20 kg, 95% CI -20.66 kg to -1.74 kg, and women: MD -1.30 kg, 95% CI [-7.34, 4.74] kg; 1 study, N = 90 adults; very low-certainty evidence).Providing clinicians with a clinical decision support (CDS) tool to assist with obesity management at the point of care leads to little or no difference in the body mass index (BMI) z-score of children (MD -0.08, 95% CI -0.15 to -0.01 in 378 children; moderate-certainty evidence), CDS tools may lead to little or no difference in weight loss in adults: MD -0.095 kg (-0.21 lbs), P = 0.47; 1 study, N = 35,665; low-certainty evidence. Organisational interventions Adults with overweight or obesity may lose more weight if the care was provided by a dietitian (by -5.60 kg, 95% CI -4.83 kg to -6.37 kg) or by a doctor-dietitian team (by -6.70 kg, 95% CI -7.52 kg to -5.88 kg; 1 study, N = 270 adults; low-certainty evidence). Shared care leads to little or no difference in the BMI z-score of children with obesity (adjusted MD -0.05, 95% CI -0.14 to 0.03; 1 study, N = 105 children; low-certainty evidence).Organisational restructuring of the delivery of primary care (i.e. introducing the chronic care model) may result in a slightly lower increase in the BMI of children who received care at intervention clinics (BMI change: adjusted MD -0.21, 95% CI -0.50 to 0.07; 1 study, unadjusted MD -0.18, 95% CI -0.20 to -0.16; N=473 participants; moderate-certainty evidence).Mail and phone interventions probably lead to little or no difference in weight loss in adults (mean weight change (kg) using mail: -0.36, 95% CI -1.18 to 0.46; phone: -0.44, 95% CI -1.26 to 0.38; 1 study, N = 1801 adults; moderate-certainty evidence). Care delivered by a nurse at a primary care clinic may lead to little or no difference in the BMI z-score in children (MD -0.02, 95% CI -0.16 to 0.12; 1 study, N = 52 children; very low-certainty evidence).Two studies reported data on cost effectiveness: one study favoured mail and standard care over telephone consultations, and the other study achieved weight loss at a modest cost in both intervention groups (doctor and doctor-dietitian). One study of shared care reported similar adverse effects in both groups. AUTHORS' CONCLUSIONS We found little convincing evidence for a clinically-important effect on participants' weight or BMI of any of the evaluated interventions. While pooled results from three studies indicate that educational interventions targeting healthcare professionals may lead to a slight weight reduction in adults, the certainty of these results is low. Two trials evaluating CDS tools (unpooled results) for improved weight management suggest little or no effect on weight or BMI change in adults or children with overweight or obesity. Evidence for all the other interventions evaluated came mostly from single studies. The certainty of the included evidence varied from moderate to very low for the main outcomes (weight and BMI). All of the evaluated interventions would need further investigation to ascertain their strengths and limitations as effective strategies to change the behaviour of healthcare professionals or the organisation of care. As only two studies reported on cost, we know little about cost effectiveness across the evaluated interventions.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthDivision for Health ServicesPilestredet Park 7OsloNorway0176
| | | | - Carolyn D Summerbell
- Queen's Campus, Durham UniversitySchool of Medicine, Pharmacy and Health, Wolfson Research InstituteUniversity BoulevardThornabyStockton‐on‐TeesUKTS17 6BH
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Hale I. Long-term benefits of weight loss? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:429-430. [PMID: 28615390 PMCID: PMC5471078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Alfadda AA, Al-Dhwayan MM, Alharbi AA, Al Khudhair BK, Al Nozha OM, Al-Qahtani NM, Alzahrani SH, Bardisi WM, Sallam RM, Riva JJ, Brożek JL, Schünemann HJ, Moore A. The Saudi clinical practice guideline for the management of overweight and obesity in adults. Saudi Med J 2017; 37:1151-62. [PMID: 27652370 PMCID: PMC5075383 DOI: 10.15537/smj.2016.10.14353] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: To assist healthcare providers in evidence-based clinical decision-making for the management of overweight and obese adults in Saudi Arabia. Methods: The Ministry of Health, Riyadh, Kingdom of Saudi Arabia assembled an expert Saudi panel to produce this clinical practice guideline in 2015. In collaboration with the methodological working group from McMaster University, Hamilton, Canada, using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, which describes both the strength of recommendation and the quality of evidence Results: After identifying 11 questions, corresponding recommendations were agreed upon as guidance for the management of overweight and obese adults. These included strong recommendations in support of lifestyle interventions rather than usual care alone, individualized counseling interventions rather than generic educational pamphlets, physical activity rather than no physical activity, and physical activity in addition to diet rather than diet alone. Metformin and orlistat were suggested as conditional recommendations for the management of overweight and obesity in adults. Bariatric surgery was recommended, conditionally, for the management of obese adults (body mass index of ≥40 or ≥35 kg/m2 with comorbidities). Conclusions: The current guideline includes recommendation for the non-pharmacological, pharmacological, and surgical management of overweight and obese adults. In addition, the panel recommends conducting research priorities regarding lifestyle interventions and economic analysis of drug therapy within the Saudi context, as well as long term benefits and harms of bariatric surgery.
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Affiliation(s)
- Assim A Alfadda
- Obesity Research Center,College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Royall D, Brauer P, Atta-Konadu E, Dwyer JJM, Edwards AM, Hussey T, Kates N. Eliciting Provider and Patient Perspectives on New Obesity Management Services in a Team-Based Primary Care Organization. CAN J DIET PRACT RES 2017; 78:109-116. [PMID: 28333557 DOI: 10.3148/cjdpr-2017-005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Both providers and patients may have important insights to inform the development of obesity prevention and management services in Canadian primary care settings. In this formative study, insights for new obesity management services were sought from both providers and patients in 1 progressive citywide organization (150 physicians, team services, separate offices). METHODS Seven focus groups with interprofessional health providers (n = 56) and 4 focus groups with patients (n = 34) were conducted. Two clinical vignettes (adult, child) were used to focus discussion. Four analysts coded for descriptive content and interpretative themes on possible tools and care processes using NVivo. RESULTS Participants identified numerous strategies for care processes, most of which could be categorized into 1 or more of 11 themes: 6 directed at clinical care of patients (raising awareness, screening, clinical care, skill building, ongoing support, and social/peer support) and 5 directed at the organization (coordination/collaboration, creating awareness among health professionals, adding new expertise to the team, marketing, and lobbying/advocacy). CONCLUSIONS The approach was successful in generating an extensive list of diverse activities to be considered for implementation studies. Both patients and providers identified that multiple strategies and systems approaches will be needed to address obesity management in primary care.
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Affiliation(s)
- Dawna Royall
- a Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - Paula Brauer
- a Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - Edwoba Atta-Konadu
- a Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - John J M Dwyer
- a Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - A Michelle Edwards
- b Data Librarian and Academic Director of the Research Data Centre, University of Guelph, Guelph, ON
| | | | - Nick Kates
- c Hamilton Family Health Team, Hamilton, ON
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Ladouceur R. Family physicians and obese patients. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:92. [PMID: 28209663 PMCID: PMC5395368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Study sponsorship and the nutrition research agenda: analysis of randomized controlled trials included in systematic reviews of nutrition interventions to address obesity. Public Health Nutr 2016; 20:1306-1313. [DOI: 10.1017/s1368980016003128] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AbstractObjectiveTo categorize the research topics covered by a sample of randomized controlled trials (RCT) included in systematic reviews of nutrition interventions to address obesity; to describe their funding sources; and to explore the association between funding sources and nutrition research topics.DesignCross-sectional study.SubjectsRCT included in Cochrane Reviews of nutrition interventions to address obesity and/or overweight.ResultsTwo hundred and thirteen RCT from seventeen Cochrane Reviews were included. Funding source and authors’ conflicts of interest were disclosed in 82·6 and 29·6 % of the studies, respectively. RCT were more likely to test an intervention to manipulate nutrients in the context of reduced energy intake (44·2 % of studies) than food-level (11·3 %) and dietary pattern-level (0·9 %) interventions. Most of the food industry-sponsored studies focused on interventions involving manipulations of specific nutrients (66·7 %). Only 33·1 % of the industry-funded studies addressed dietary behaviours compared with 66·9 % of the non-industry-funded ones (P=0·002). The level of food processing was poorly considered across all funding sources.ConclusionsThe predominance of RCT examining nutrient-specific questions could limit the public health relevance of rigorous evidence available for systematic reviews and dietary guidelines.
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de Vries HJ, Kooiman TJM, van Ittersum MW, van Brussel M, de Groot M. Do activity monitors increase physical activity in adults with overweight or obesity? A systematic review and meta-analysis. Obesity (Silver Spring) 2016; 24:2078-91. [PMID: 27670401 DOI: 10.1002/oby.21619] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/18/2016] [Accepted: 06/27/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To systematically assess contemporary knowledge regarding behavioral physical activity interventions including an activity monitor (BPAI+) in adults with overweight or obesity. METHODS PubMed/MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, and PEDro were searched for eligible full-text articles up to 1 July 2015. Studies eligible for inclusion were (randomized) controlled trials describing physical activity outcomes in adults with overweight or obesity. Methodological quality was independently assessed employing the Cochrane Collaboration's tool for risk of bias. RESULTS Fourteen studies (1,157 participants) were included for systematic review and 11 for meta-analysis. A positive trend in BPAI+ effects on several measures of physical activity was ascertained compared with both wait list or usual care and behavioral physical activity interventions without an activity monitor (BPAI-). No convincing evidence of BPAI+ effectiveness on weight loss was found compared with BPAI-. CONCLUSIONS Behavioral physical activity interventions with an activity monitor increase physical activity in adults with overweight or obesity. Also, adding an activity monitor to behavioral physical activity interventions appears to increase the effect on physical activity, although current evidence has not yet provided conclusive evidence for its effectiveness.
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Affiliation(s)
- Herman J de Vries
- Clinical Health Sciences, Utrecht University/University Medical Center Utrecht, The Netherlands.
- Paramedics PT Center, Assen, The Netherlands.
| | - Thea J M Kooiman
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Miriam W van Ittersum
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, The Netherlands
- Physiotherapy Department, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Marco van Brussel
- Clinical Health Sciences, Utrecht University/University Medical Center Utrecht, The Netherlands
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Martijn de Groot
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, The Netherlands
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Igel LI, Sinha A, Saunders KH, Apovian CM, Vojta D, Aronne LJ. Metformin: an Old Therapy that Deserves a New Indication for the Treatment of Obesity. Curr Atheroscler Rep 2016; 18:16. [PMID: 26888066 DOI: 10.1007/s11883-016-0568-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Metformin is not currently used for weight loss or diabetes prevention because it lacks an FDA indication for obesity and/or pre-diabetes treatment. Based on the evidence, metformin has been shown to decrease the incidence of type 2 diabetes, and compares favorably to other weight-loss medications in terms of efficacy as well as safety. Thus, metformin should be considered for a treatment indication in patients with these conditions.
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Affiliation(s)
- L I Igel
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York, NY, USA.
| | - A Sinha
- Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - K H Saunders
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York, NY, USA
| | - C M Apovian
- Departments of Medicine and Pediatrics, Nutrition and Weight Management Center and Nutrition Support Service, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - D Vojta
- UnitedHealth Center for Health Reform and Modernization, UnitedHealth Group, Minnetonka, MN, USA
| | - L J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York, NY, USA
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Graff SK, Mario FM, Ziegelmann P, Spritzer PM. Effects of orlistat vs. metformin on weight loss-related clinical variables in women with PCOS: systematic review and meta-analysis. Int J Clin Pract 2016; 70:450-61. [PMID: 27228266 DOI: 10.1111/ijcp.12787] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS The aim of this study was to assess the effects of orlistat on weight loss-related clinical variables in overweight/obese women with polycystic ovary syndrome (PCOS) and to compare treatment with orlistat vs. metformin in this group. METHODS We conducted a systematic review and meta-analysis of the evidence about the use of orlistat in women with PCOS. We searched the literature published until May 2015 in MEDLINE, Cochrane Central Register of Controlled Trials and LILACS. RESULTS Of 3951 studies identified, nine were included in the systematic review (three prospective, non-randomised studies and six randomised control trials). Eight studies used the Rotterdam criteria and 1 used NIH criteria to diagnose PCOS. Data suggest that orlistat promotes a significant reduction in BMI/weight in overweight/obese PCOS women. Eight studies evaluated orlistat impact on testosterone. Seven reported an improvement in testosterone levels. Eight studies evaluated impact on insulin resistance, and five reported improvement. Finally, five studies evaluated impact on lipid profile, and four reported improvement. Three randomised control trials were included in the fixed effects model meta-analysis for a total of 121 women with PCOS. Orlistat and metformin had similar positive effects on BMI (-0.65%, 95% CI: -2.03 to 0.73), HOMA (-3.60%, 95% CI: -16.99 to 9.78), testosterone (-2.08%, 95% CI: -13.08 to 8.93) and insulin (-5.51%, 95% CI: -22.27 to 11.26). CONCLUSION(S) The present results suggest that orlistat leads to significant reduction in BMI/body weight in PCOS. In addition, the available evidence indicates that orlistat and metformin have similar effects in reducing BMI, HOMA, testosterone and insulin in overweight/obese PCOS women. This study was registered in PROSPERO under number CRD42014012877.
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Affiliation(s)
- S K Graff
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - F M Mario
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Federal Institute of Education, Science and Technology of Rio Grande do Sul, Porto Alegre, Brazil
| | - P Ziegelmann
- Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - P M Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratory of Molecular Endocrinology, Department of Physiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Fuller NR, Sainsbury A, Caterson ID, Enarsson M, Denyer G, Manns C, Swinbourne J, Q da Luz F, Fong M, Markovic TP. Examining mindfulness as a predictor of weight loss - Findings from the DIABEGG study. Obes Res Clin Pract 2016; 11:88-96. [PMID: 27050109 DOI: 10.1016/j.orcp.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/26/2015] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Identifying individuals who are less likely to respond to a weight loss intervention allows better allocation or focus of resources to achieve better weight loss results. The current study investigated whether baseline levels of mindfulness would predict weight loss during a 12-month diet and exercise intervention. METHODS The Five Facet Mindfulness Questionnaire (FFMQ) was administered and body weight measured, at baseline, three, six and 12 months in 140 participants with pre-diabetes or type 2 diabetes mellitus and a body mass index of ≥25kg/m2. 137 of 140 participants completed the FFMQ at baseline and were included in this study. RESULTS There was no correlation between baseline mindfulness scores and weight loss. Mean baseline total FFMQ score was 112.2 [95% confidence interval: 109.4, 115.1] which did not change over the course of the study. Mean baseline body weight was 95.1kg (standard deviation (19.1kg)). There was a significant decrease in weight at month 12 (-3.8kg (±standard deviation 5.8kg)). This is comparable to the weight loss achieved by participants in other interventions of the same duration. CONCLUSIONS The findings suggest that baseline dispositional mindfulness does not predict the amount of weight loss in a lifestyle (diet and exercise) intervention.
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Affiliation(s)
- Nicholas R Fuller
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Ian D Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Malin Enarsson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Gareth Denyer
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Clare Manns
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Jessica Swinbourne
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - Mackenzie Fong
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Tania P Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
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Corona G, Giagulli VA, Maseroli E, Vignozzi L, Aversa A, Zitzmann M, Saad F, Mannucci E, Maggi M. THERAPY OF ENDOCRINE DISEASE: Testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol 2016; 174:R99-116. [PMID: 26537862 DOI: 10.1530/eje-15-0262] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/19/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The role of testosterone (T) in regulating body composition is conflicting. Thus, our goal is to meta-analyse the effects of T supplementation (TS) on body composition and metabolic outcomes. METHODS All randomized controlled trials (RCTs) comparing the effect of TS on different endpoints were considered. RESULTS Overall, 59 trials were included in the study enrolling 3029 and 2049 patients in TS and control groups respectively. TS was associated with any significant modification in body weight, waist circumference and BMI. Conversely, TS was associated with a significant reduction in fat and with an increase in lean mass as well as with a reduction of fasting glycaemia and insulin resistance. The effect on fasting glycaemia was even higher in younger individuals and in those with metabolic diseases. When only RCTs enrolling hypogonadal (total T <12 mol/l) subjects were considered, a reduction of total cholesterol as well as triglyceride (TGs) levels were also detected. Conversely, an improvement in HDL cholesterol levels as well as in both systolic and diastolic blood pressure was not observed. CONCLUSION Our data suggest that TS is able to improve body composition and glycometabolic profile particularly in younger subjects and in those with metabolic disturbances. Specifically designed studies are urgently needed to confirm this point.
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Affiliation(s)
| | - Vito A Giagulli
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Elisa Maseroli
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Linda Vignozzi
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Antonio Aversa
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Michael Zitzmann
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Farid Saad
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Edoardo Mannucci
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Mario Maggi
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
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Jay M, Mateo KF, Squires AP, Kalet AL, Sherman SE. Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration. BMC OBESITY 2016; 3:5. [PMID: 26855786 PMCID: PMC4736653 DOI: 10.1186/s40608-016-0087-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Obesity affects 37 % of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10 % of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans' experiences with weight management and determine whether and how to develop a primary care-based weight management intervention to both improve obesity counseling and increase attendance to MOVE!, we conducted a qualitative study to assess: 1) Veterans' personal experiences with healthy weight-related behavior change (including barriers and facilitators to behavior change and experiences with primary care providers, staff, and the MOVE! program), and 2) potential new approaches to improve weight management within primary care at the VHA including goal setting and technology. METHODS Overweight/obese VHA patients (aged 18-75, BMI greater than 30 or greater than 25 with at least 1 co-morbidity) were recruited for focus group sessions stratified by gender, MOVE! referral, and attendance. Each session was facilitated by a trained moderator, audio-recorded, and professionally transcribed. Using an iterative coding approach, two coders separately reviewed and coded transcripts, and met frequently to negotiate codes and synthesize emerging themes. RESULTS Of 161 eligible patients, 54 attended one of 6 focus groups (2 female, 4 male, 9-11 participants per session): 63 % were male, 46 % identified as African-American, 32 % White/Caucasian, 74 % were college-educated or higher, and 61 % reported having attended MOVE!. We identified two major themes: Impact of Military Service and Promotion and Sustainability of Healthy Behaviors. After service in a highly structured military environment, Veterans had difficulty maintaining weight on their own. They perceived physical activity as having more impact than diet, but chronic pain was a barrier. We identified individual/interpersonal-, community/environment-, and healthcare system-related factors affecting healthy behaviors. We also received input about Veteran's preferences and experiences with technology and setting health goals. CONCLUSIONS Unique factors influence weight management in Veterans. Findings will inform development of a technology-assisted weight management intervention with tailored counseling and goal-setting within primary care at the VHA.
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Affiliation(s)
- Melanie Jay
- VHA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010 USA ; NYU School of Medicine, 550 1st Avenue, New York, NY 10016 USA
| | - Katrina F Mateo
- VHA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010 USA ; NYU School of Medicine, 550 1st Avenue, New York, NY 10016 USA
| | - Allison P Squires
- NYU College of Nursing, 285 Mercer St, New York, NY 10003 USA ; NYU School of Medicine, 550 1st Avenue, New York, NY 10016 USA
| | - Adina L Kalet
- NYU School of Medicine, 550 1st Avenue, New York, NY 10016 USA
| | - Scott E Sherman
- VHA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010 USA ; NYU School of Medicine, 550 1st Avenue, New York, NY 10016 USA
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Warren R, Kenny M, Bennett T, Fitzpatrick-Lewis D, Ali MU, Sherifali D, Raina P. Screening for developmental delay among children aged 1-4 years: a systematic review. CMAJ Open 2016; 4:E20-7. [PMID: 27226967 PMCID: PMC4866933 DOI: 10.9778/cmajo.20140121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Existing guidelines on screening children less than 5 years of age for developmental delay vary. In this systematic review, we synthesized the literature on the effectiveness and harms of screening for developmental delay in asymptomatic children aged 1-4 years. METHODS We searched MEDLINE, Embase and PsychINFO for relevant articles published to June 16, 2015. We identified studies that included children aged 1-4 years who were not at high risk of developmental delay, screened in a primary care setting. Randomized trials and controlled cohort studies were considered for benefits (cognitive, academic and functional outcomes); no restrictions on study design were imposed for the review of harms. RESULTS Two studies were included. One used the Ages and Stages Questionnaire II for screening and reported significantly more referrals to early intervention in the intervention groups than in the control group (relative risk [RR] 1.95, 95% confidence interval [CI] 1.49-2.54, in the intervention group with office support and RR 1.71, 95% CI 1.30-2.25, in the intervention group without office support). The time to referral was 70% shorter in the intervention group with office support (rate ratio 0.30, 95% CI 0.19-0.48) and 64% shorter in the intervention group without office support (rate ratio 0.36, 95% CI 0.23-0.59), compared with the control group. The other study used the VroegTijdige Onderkenning Ontwikkelingsstoornissen Language Screening instrument to screen children aged 15 months at enrolment for language delay. It reported no differences between groups in academic performance outcomes at age 8 years. INTERPRETATION The evidence on screening for developmental delay in asymptomatic children aged 1-4 years is inconclusive. Further research with longer-term outcomes is needed to inform decisions about screening and screening intervals.
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Affiliation(s)
- Rachel Warren
- Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont
| | - Meghan Kenny
- Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont
| | - Teresa Bennett
- Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont
| | - Donna Fitzpatrick-Lewis
- Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont
| | - Muhammad Usman Ali
- Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont
| | - Diana Sherifali
- Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont
| | - Parminder Raina
- Evidence Review and Synthesis Centre, and Offord Centre for Child Studies, McMaster University, Hamilton, Ont
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