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Weyler J, Verrijken A, Hornemann T, Vonghia L, Dirinck E, von Eckardstein A, Vanwolleghem T, Michielsen P, Peiffer F, Driessen A, Hubens G, Staels B, Francque S, Van Gaal L. Association of 1-deoxy-sphingolipids with steatosis but not steatohepatitis nor fibrosis in non-alcoholic fatty liver disease. Acta Diabetol 2021; 58:319-327. [PMID: 33084982 DOI: 10.1007/s00592-020-01612-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most important cause of chronic liver disease in the western world. Steatosis can be accompanied by inflammation and cell damage (non-alcoholic steatohepatitis, NASH), and even liver fibrosis. Sphingolipids are a heterogeneous class of lipids and essential components of the plasma membrane and plasma lipoproteins. The atypical class of deoxy-sphingolipids has been implicated in the metabolic syndrome and type 2 diabetes. AIM To determine if circulating (deoxy)sphingolipids are associated with NAFLD and its different entities, steatosis, inflammatory changes (inflammation and ballooning) and fibrosis. METHODS Sphingolipids were analysed by LC-MS after hydrolysing the N-acyl and O-linked headgroups in plasma of obese adults who underwent a liver biopsy in suspicion of NAFLD. RESULTS Two-hundred and eighty-eight patients were included. There was no association between typical sphingolipids and NAFLD and its different entities. There was a significant association between the presence of steatosis and the concentrations of deoxy-sphinganine [exp(B) 11.163 with CI (3.432, 36.306) and p < 0.001] and deoxy-sphingosine [exp(B) 8.486 with CI (3.437, 20.949) and p < 0.001]. There was no association between these deoxy-sphingolipids and activity of the steatohepatitis, nor was there any association with fibrosis. Differences in deoxy-sphingolipids also correlated independently with the presence of the metabolic syndrome, but not diabetes. CONCLUSION Deoxy-sphingolipids are elevated in patients with steatosis compared to those without fatty liver, but not different between the different NAFLD subtypes, suggesting that deoxy-sphingolipid bases might be involved in steatogenesis, but not in the further progression of NAFLD to NASH nor in fibrogenesis.
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Affiliation(s)
- J Weyler
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - A Verrijken
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Endocrinology, Diabetology and Metabolic Diseases, Antwerp University Hospital, Edegem, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - T Hornemann
- Institute for Clinical Chemistry, University Hospital Zurich and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Competence Center for Systems Physiology and Metabolic Diseases, University of Zurich, Zurich, Switzerland
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - L Vonghia
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - E Dirinck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Endocrinology, Diabetology and Metabolic Diseases, Antwerp University Hospital, Edegem, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - A von Eckardstein
- Institute for Clinical Chemistry, University Hospital Zurich and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - T Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - P Michielsen
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - F Peiffer
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Endocrinology, Diabetology and Metabolic Diseases, Antwerp University Hospital, Edegem, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - A Driessen
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - G Hubens
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - B Staels
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000, Lille, France
| | - S Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - L Van Gaal
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Endocrinology, Diabetology and Metabolic Diseases, Antwerp University Hospital, Edegem, Belgium
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
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2
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Blanchard C, Ledoux S, Verhaegen A, Wargny M, Letessier E, Stepanian A, Huten N, Jacobi D, Krempf M, Le Bras M, Perrocheau Guillouche M, Arnaud L, Pichelin M, Van Gaal L, Cariou B, Le May C. Roux-en-Y gastric bypass, but not sleeve gastrectomy, decreases plasma PCSK9 levels in morbidly obese patients. Diabetes Metab 2020; 46:480-487. [PMID: 32032671 DOI: 10.1016/j.diabet.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
AIM Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a master regulator of low-density lipoprotein cholesterol (LDL-C) metabolism, acting as an endogenous inhibitor of the LDL receptor. While it has been shown that bariatric surgery differentially affects plasma LDL-C levels, little is known of its effects on plasma PCSK9 concentrations. Therefore, the present study aimed to: (i) investigate the effect of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on plasma PCSK9 concentrations; and (ii) correlate baseline or postoperative plasma PCSK9 concentration variations with anthropometric and metabolic parameters. METHODS Fasting plasma PCSK9 levels were measured by ELISA in morbidly obese patients before and 6 months after bariatric surgery. Patients were recruited from three prospective cohorts (in Nantes and Colombes in France, and Antwerp in Belgium). RESULTS A total of 156 patients (34SG, 122RYGB) were included. Plasma PCSK9, LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) levels were significantly reduced after RYGB (-19.6%, -16.6% and -19.5%, respectively; P<0.0001), but not after SG. In all patients, postoperative PCSK9 change was positively correlated with fasting plasma glucose (FPG; r=0.22, P=0.007), HOMA-IR (r=0.24, P=0.005), total cholesterol (r=0.17, P=0.037) and non-HDL-C (r=0.17, P=0.038) variations, but not LDL-C. In contrast to what was observed for glucose parameters (FPG, HOMA-IR), correlation between PCSK9 and non-HDL-C changes after RYGB was independent of total weight loss. CONCLUSION RYGB, but not SG, promotes a significant reduction in plasma PCSK9 levels, and such changes in circulating PCSK9 levels after RYGB appear to be more associated with glucose improvement than with lipid homoeostasis parameters.
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Affiliation(s)
- C Blanchard
- University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Clinical Department of Digestive and Endocrine Surgery, CHU of Nantes, Nantes, France
| | - S Ledoux
- Department of Functional Explorations, North Francilien Integrated Obesity Centre (CINFO), Hôpital Louis Mourier (AP-HP.7), University of Paris, Paris, France
| | - A Verhaegen
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - M Wargny
- University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France
| | - E Letessier
- Clinical Department of Digestive and Endocrine Surgery, CHU of Nantes, Nantes, France
| | - A Stepanian
- AP-HP, Hôpital Lariboisière, Department of Biological Haematology, Paris, France
| | - N Huten
- Digestive, Endocrine, Oncology and Liver Transplantation Department, CHU of Tours, Tours, France
| | - D Jacobi
- University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Digestive, Endocrine, Oncology and Liver Transplantation Department, CHU of Tours, Tours, France
| | - M Krempf
- Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France; INRA, UMR 1280, Physiology of Nutritional Adaptations, CHU Hôtel-Dieu, 44000 Nantes, France
| | - M Le Bras
- Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France
| | | | - L Arnaud
- University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France
| | - M Pichelin
- University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France
| | - L Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - B Cariou
- University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France; Thorax Institute, Department of Endocrinology, CIC 1413 Inserm, CHU Nantes, Nantes, France
| | - C Le May
- University of Nantes, CNRS, Inserm, Thorax Institute, 44000 Nantes, France.
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Davidson JA, Desouza C, Fonseca V, Frias JP, Van Gaal L, Giorgino F, Chao J, Dex TA, Roberts M, Saremi A, Leiter LA. Glycaemic target attainment in people with Type 2 diabetes treated with insulin glargine/lixisenatide fixed-ratio combination: a post hoc analysis of the LixiLan-O and LixiLan-L trials. Diabet Med 2020; 37:256-266. [PMID: 31365765 PMCID: PMC7003844 DOI: 10.1111/dme.14094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
AIMS Both fasting (FPG) and postprandial plasma glucose (PPG) contribute to HbA1c levels. We investigated the relationship between achievement of American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) recommended FPG and/or PPG targets and glycaemic efficacy outcomes in two trials. METHODS In this post hoc analysis, data from participants with Type 2 diabetes in the phase 3 LixiLan-O (NCT02058147) and LixiLan-L (NCT02058160) trials were evaluated to compare the relationship between achievement of society-recommended FPG and/or PPG targets and efficacy (HbA1c change, HbA1c goal attainment, weight change) and safety outcomes in the treatment groups. RESULTS Across treatment arms, iGlarLixi achieved the highest proportion of participants meeting both ADA- and AACE-recommended FPG and PPG targets at study end in both trials. A higher proportion of participants in the iGlarLixi (fixed-ratio combination of insulin glargine and lixisenatide) vs. insulin glargine alone or lixisenatide alone treatment arms achieved HbA1c goals (P < 0.001 for overall comparisons), irrespective of ADA- or AACE-defined targets. Hypoglycaemia rates [any, documented symptomatic (plasma glucose ≤ 3.9 mmol/l), and clinically important (plasma glucose < 3.0 mmol/l)] were low across all groups. Participants treated with iGlarLixi tended to show weight loss or less weight gain compared with participants receiving insulin glargine alone. No differences were observed in average daily basal insulin dose at week 30 between the two treatment arms or across the different FPG and PPG target groups. CONCLUSION Insulin glargine and lixisenatide as a fixed-ratio combination resulted in more participants reaching both FPG and PPG targets, leading to better HbA1c target attainment.
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Affiliation(s)
- J. A. Davidson
- Touchstone Diabetes Center, Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - C. Desouza
- University of Nebraska Medical CenterOmahaNEUSA
| | - V. Fonseca
- Tulane University Health Sciences CenterNew OrleansLAUSA
| | | | - L. Van Gaal
- Antwerp University HospitalEdegem‐AntwerpBelgium
| | | | | | | | | | | | - L. A. Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of TorontoTorontoONCanada
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Hens W, Vissers D, Annemans L, Gielen J, Van Gaal L, Taeymans J, Verhaeghe N. Health-related costs in a sample of premenopausal non-diabetic overweight or obese females in Antwerp region: a cost-of-illness analysis. ACTA ACUST UNITED AC 2018; 76:42. [PMID: 30069308 PMCID: PMC6065060 DOI: 10.1186/s13690-018-0285-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/13/2018] [Indexed: 11/16/2022]
Abstract
Background People with overweight or obesity are at increased risk for disease later in life which cause important health costs. The aim of this study was to estimate the health status and the corresponding costs in a sample of females with overweight or obesity which were participating in a Randomized Controlled Trial (RCT) exploring the effect of lifestyle habits changes on ectopic adipose tissue. Methods Sixty-two non-diabetic premenopausal females without major comorbidities of overweight and obesity were recruited among patients visiting endocrinologists at the obesity clinic of the University Hospital of Antwerp and the University of Antwerp. A RCT-embedded cost-of-illness approach with societal perspective, based on self-reported questionnaires and cost diaries (3 months recall) was applied to estimate the prevalence of different comorbidities and the related direct and indirect costs in this sample of overweight or obese females. The European Quality-of-Life-5D questionnaire was used to define the health state and the corresponding utility index of the participants. Results The average direct health costs and health utilities observed in this sample were comparable with the general Flemish female population. This may partially be explained by the strict inclusion criteria of the RCT (i.e. overweight or obesity without diabetes type 2 or cardiovascular diseases). However, 15% of the participants had five or more comorbidities resulting in higher average costs and lower average health utility as compared to the general population, only 3 participants were diagnozed with the metabolic syndrome. In this subsample productivity was low due to high average absenteeism, yielding important total costs for the society. Conclusion Secondary prevention to avoid health deterioration in overweight or obese females without major comorbidies is needed to contain health care costs. Trial registration ClinicalTrials.gov: NCT02831621, approval of the ethics committee of the University Hospital of Antwerp (number: 14/17/205 -ref: 7543075363).
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Affiliation(s)
- W Hens
- 1Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - D Vissers
- 1Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - L Annemans
- 2Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium
| | - J Gielen
- 3Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - L Van Gaal
- 4Department of Endocrinology, Antwerp University Hospital, Diabetology and Metabolism, Antwerp, Belgium
| | - J Taeymans
- 5Bern University of Applied Sciences-Health, Bern, Switzerland.,6Faculty of Sport and Rehabilitation Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - N Verhaeghe
- 2Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium
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5
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Boursier J, Anty R, Vonghia L, Moal V, Vanwolleghem T, Canivet CM, Michalak S, Bonnafous S, Michielsen P, Oberti F, Iannelli A, Van Gaal L, Patouraux S, Blanchet O, Verrijken A, Gual P, Rousselet MC, Driessen A, Hunault G, Bertrais S, Tran A, Calès P, Francque S. Screening for therapeutic trials and treatment indication in clinical practice: MACK-3, a new blood test for the diagnosis of fibrotic NASH. Aliment Pharmacol Ther 2018; 47:1387-1396. [PMID: 29577364 DOI: 10.1111/apt.14621] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/23/2017] [Accepted: 03/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The composite histological endpoint comprising nonalcoholic steatohepatitis (NASH) and NAFLD activity score ≥4 and advanced fibrosis (F ≥ 2) ("fibrotic NASH") is becoming an important diagnostic target in NAFLD: it is currently used to select patients for inclusion in phase III therapeutic trials and will ultimately be used to indicate treatment in clinical practice once the new drugs are approved. AIM To develop a new blood test specifically dedicated for this new diagnostic target of interest. METHODS Eight Hundred and forty-six biopsy-proven NAFLD patients from three centres (Angers, Nice, Antwerp) were randomised into derivation and validation sets. RESULTS The blood fibrosis tests BARD, NFS and FIB4 had poor accuracy for fibrotic NASH with respective AUROC: 0.566 ± 0.023, 0.654 ± 0.023, 0.732 ± 0.021. In the derivation set, fibrotic NASH was independently predicted by AST, HOMA and CK18; all three were combined in the new blood test MACK-3 (hoMa, Ast, CK18) for which 90% sensitivity and 95% specificity cut-offs were calculated. In the validation set, MACK-3 had a significantly higher AUROC (0.847 ± 0.030, P ≤ 0.002) than blood fibrosis tests. Using liver biopsy in the grey zone between the two cut-offs (36.0% of the patients), MACK-3 provided excellent accuracy for the diagnosis of fibrotic NASH with 93.3% well-classified patients, sensitivity: 90.0%, specificity: 94.2%, positive predictive value: 81.8% and negative predictive value: 97.0%. CONCLUSION The new blood test MACK-3 accurately diagnoses fibrotic NASH. This new test will facilitate patient screening and inclusion in NAFLD therapeutic trials and will enable the identification of patients who will benefit from the treatments once approved.
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Hens W, Vissers D, Hansen D, Peeters S, Gielen J, Van Gaal L, Taeymans J. The effect of diet or exercise on ectopic adiposity in children and adolescents with obesity: a systematic review and meta-analysis. Obes Rev 2017; 18:1310-1322. [PMID: 28913977 DOI: 10.1111/obr.12577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/26/2017] [Accepted: 05/14/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Ectopic fat depostion in youth with obesity is associated with an increased cardiovascular disease risk. The aim of this meta-analysis was to summarize the evidence for the use of diet and/or exercise on ectopic adiposity in this population. METHODS A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Clinical trials that assessed ectopic fat deposition and included study arms with diet and/or exercise were searched in PubMed, PEDro and the Cochrane database. RESULTS Hepatic fat content and intramyocellular lipid content were described in nine studies and three studies, respectively. Most studies included teenagers, and study duration ranged between 3 and 12 months without follow-up. Using random-effects weights, the standardized mean difference of the change in hepatic adiposity (totalling 320 subjects) was -0.54 Hedges' g (95% confidence interval: -0.69 to -0.38 with p < 0.0001). By re-expressing this effect size, it is seen that diet and/or exercise results in an absolute reduction of intrahepatic lipid with 2%, which accords with a relative reduction up to 70%. Although there were significant ameliorations of insulin sensitivity, no significant changes in intramyocellular lipid were observed. CONCLUSIONS This meta-analysis showed that diet and/or exercise is effective to reduce hepatic adiposity in youth with obesity.
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Affiliation(s)
- W Hens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - D Vissers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - D Hansen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,REVAL-Rehabilitation Research Centre, Diepenbeek, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - S Peeters
- Flemish Working Group from AXXON, Antwerp, Belgium
| | - J Gielen
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - L Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | - J Taeymans
- Health, Bern University of Applied Sciences-Health, Bern, Switzerland.,Faculty of Sport and Rehabilitation Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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Verhaegen A, Van Gaal L. Do E-cigarettes induce weight changes and increase cardiometabolic risk? A signal for the future. Obes Rev 2017; 18:1136-1146. [PMID: 28660671 DOI: 10.1111/obr.12568] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 04/26/2017] [Indexed: 12/28/2022]
Abstract
The prevalence of non-cigarette tobacco use in electronic cigarettes, also called vaping, is rapidly increasing, especially in adolescents and young adults, due to attractive marketing techniques promoting them as healthier alternatives to conventional tobacco cigarettes. Although smoking is associated with weight loss, it increases insulin resistance and attributes to other features of the metabolic syndrome, increasing the cardiometabolic risk profile. Whether vaping has the same deleterious effects on metabolic parameters as regular cigarette smoke has not yet been studied thoroughly in humans. However, animal model experiments attribute comparable effects of e-cigarette smoking, even without nicotine exposure, on weight and metabolic parameters as compared to smoking cigarettes. In this review paper, we want to give an overview of published data on the effects on weight and cardiometabolic parameters of e-cigarette use and formulate some mechanistic hypotheses.
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Affiliation(s)
- A Verhaegen
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - L Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
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8
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Blüher M, Greenway F, Le Rouge CW, McGowan B, Pi-Sunyer X, Cancino AP, Christensen R, Kienhöfer J, Van Gaal L. 3-year efficacy and safety for liraglutide 3.0 mg in adults with obesity/overweight, prediabetes and baseline BMI < 35 vs. ≥35 kg/m2 in the SCALE Obesity and Prediabetes, double-blind, placebo-controlled trial. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Blüher
- Department of Medicine University of Leipzig, Leipzig, Germany
| | - F Greenway
- Pennington Biomedical Research Center, Baton Rouge, United States
| | | | - B McGowan
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - X Pi-Sunyer
- Columbia University, New York, United States
| | | | | | | | - L Van Gaal
- Antwerp University Hospital, Antwerp, Belgium
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9
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Affiliation(s)
- E. Rillaerts
- Department of Endocrinology and Nutrition, University of Antwerp (U.I.A.), Universiteitsplein 1 (T4), B-2610 Wilrijk, Belgium
| | - G. Vansant
- Department of Endocrinology and Nutrition, University of Antwerp (U.I.A.), Universiteitsplein 1 (T4), B-2610 Wilrijk, Belgium
| | - L. Van Gaal
- Department of Endocrinology and Nutrition, University of Antwerp (U.I.A.), Universiteitsplein 1 (T4), B-2610 Wilrijk, Belgium
| | - I. De Leeuw
- Department of Endocrinology and Nutrition, University of Antwerp (U.I.A.), Universiteitsplein 1 (T4), B-2610 Wilrijk, Belgium
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10
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Osto E, McLoughlin E, Doytcheva P, Charakida M, Van Gaal L, Deanfield J, Lüscher T. Endothelial protective properties of HDL improve early after roux-en-y gastric bypass but not after diet-induced weight loss: the superior cardiometabolic benefits of RYGB. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Wolffenbuttel BHR, Van Gaal L, Durán‐Garcia S, Han J. Relationship of body mass index with efficacy of exenatide twice daily added to insulin glargine in patients with type 2 diabetes. Diabetes Obes Metab 2016; 18:829-33. [PMID: 27027802 PMCID: PMC5111732 DOI: 10.1111/dom.12669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 11/27/2022]
Abstract
This post hoc analysis assessed the evidence behind common reimbursement practices by evaluating the relationship of body mass index (BMI) ranges (<30, 30-35 and >35 kg/m(2) ) with treatment effects of exenatide twice daily among patients with type 2 diabetes. Patients received exenatide twice daily added to insulin glargine in two 30-week studies (exenatide twice daily vs insulin lispro, n = 627; exenatide twice daily vs placebo, n = 259). No association of baseline BMI with changes in efficacy variables was observed. Glycated haemoglobin (HbA1c) reductions were significant (p < 0.0001) and similar across BMI range groups in the lispro-comparator study and greater for exenatide versus placebo in the placebo-controlled study. Significant weight loss occurred with exenatide across BMI range groups (p < 0.0001), while weight increased with both comparators. Achievement of HbA1c <7.0% (<53 mmol/mol) without weight gain was greater for exenatide versus comparators. Systolic blood pressure decreased across BMI range groups with exenatide in the lispro-comparator study (p < 0.0001); changes in lipids were not clinically meaningful. Minor hypoglycaemia was less frequent for exenatide versus insulin lispro. These findings suggest that BMI alone should not limit clinical decision-making or patient access to medication.
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Affiliation(s)
- B. H. R. Wolffenbuttel
- Department of EndocrinologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - L. Van Gaal
- Department of Endocrinology, Diabetology, and MetabolismAntwerp University HospitalAntwerpBelgium
| | - S. Durán‐Garcia
- Unidad de Gestion de Endocrinología y NutriciónHospital Universitario Virgen de ValmeSevilleSpain
| | - J. Han
- Pharmapace, IncSan DiegoCAUSA
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Coremans P, Bouten A, Van Gaal L, Corthouts D, Vermeire P, Van Marck E, De Leeuw I. Abstracts of the meeting of the Belgian Society of Internal Medicine (13 May 1995). Acta Clin Belg 2016. [DOI: 10.1080/17843286.1995.11718456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Trautmann M, Van Gaal L, Han J, Hardy E. Wirksamkeit und Verträglichkeit von wöchentlichem Depot-Exenatide über 3 Jahre: Eine gepoolte Analyse von 3 Studien. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kern W, Wehrhahn T, Le Roux C, Astrup A, Fujioka K, Greenway F, Lau D, Van Gaal L, Violante Ortiz R, Wilding J, Pi-Sunyer X, Skjøth T, Shapiro Manning L. Reduction in the risk of developing type 2 diabetes (T2D) with liraglutide 3.0 mg in people with prediabetes from the SCALE Obesity and Prediabetes randomized, double-blind, placebo-controlled trial. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aberle J, Wehrhahn T, Van Gaal L, Le Roux C, Pi-Sunyer X, Wilding J, Greenway F, Lilleøre S, Claudius B. Effects of treatment with liraglutide 3.0 mg in subjects with BMI < 35 and BMI ≥35 kg/m2: subgroup analysis of the SCALE Obesity and Prediabetes 56-week trial. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Colunga Blanco S, Gonzalez Matos C, Angelis A, Dinis PG, Chinali M, Toth A, Andreassi MG, Rodriguez Munoz D, Reid AB, Park JH, Shetye A, Novo G, De Marchi SF, Cikes M, Smarz K, Illatopa V, Peluso D, Wellnhofer E, De La Rosa Riestra A, Sattarzadeh Badkoubeh R, Mandour Ali M, Azoz A, Pontone G, Krljanac G, Acar R, Nucifora G, Sirtautas A, Roos ST, Qasem MS, Marini C, Fabiani I, Gillis K, Bandera F, Borowiec A, Lim YJ, Chalbia TE, Santos M, Gao SA, Zilberszac R, Farrag AAM, Palmiero G, Aruta P, De Diego Soler O, Fasano D, Tamborini G, Ancona F, Raafat DM, Marchel M, De Gregorio C, Gommans DHF, Godinho AR, Mielczarek M, Bandera F, Kubik M, Cho JY, Tarando F, Lourenco Marmelo BF, Reis L, Domingues K, Krestjyaninov MV, Mesquita J, Ikonomidis I, Ferferieva V, Peluso D, Peluso D, King GJ, D'ascenzi F, Ferrera Duran C, Sormani P, Gonzalez Fernandez O, Tereshina O, Cambronero Cortinas E, Kupczynska K, Carvalho JF, Shivalkar B, Aghamohammadzadeh R, Cifra B, Cifra B, Bandera F, Kuznetsov VA, Van Zalen JJ, Kochanowski J, Goebel B, Ladeiras-Lopes R, Goebel B, Karvandi M, Karvandi M, Alonso Salinas G, Unkun T, Ranjbar S, Hubert A, Enescu OA, Liccardo M, Cameli M, Ako E, Lembo M, Goffredo C, Enache R, Novo G, Wdowiak-Okrojek K, Nemes A, Nemes A, Di Salvo G, Capotosto L, Caravaca P, Maceira Gonzalez AM, Iriart X, Jug B, Garcia Campos A, Capin Sampedro E, Corros Vicente C, Martin Fernandez M, Leon Arguero V, Fidalgo Arguelles A, Velasco Alonso E, Lopez Iglesias F, De La Hera Galarza JM, Chaparro-Munoz M, Recio-Mayoral A, Vlachopoulos C, Ioakeimidis N, Felekos I, Abdelrasoul M, Aznaouridis K, Chrysohoou C, Rousakis G, Aggeli K, Tousoulis D, Faustino AC, Paiva L, Fernandes A, Costa M, Cachulo MC, Goncalves L, Emma F, Rinelli G, Esposito C, Franceschini A, Doyon A, Raimondi F, Schaefer F, Pongiglione G, Mateucci MC, Vago H, Juhasz C, Janosa C, Oprea V, Balint OH, Temesvari A, Simor T, Kadar K, Merkely B, Bruno RM, Borghini A, Stea F, Gargani L, Mercuri A, Sicari R, Picano E, Lozano Granero C, Carbonell San Roman A, Moya Mur JL, Fernandez-Golfin C, Moreno Planas J, Fernandez Santos S, Casas Rojo E, Hernandez-Madrid A, Zamorano Gomez JL, Pearce K, Gamlin W, Miller C, Schmitt M, Seong IW, Kim KH, Kim MJ, Jung HO, Sohn IS, Park SM, Cho GY, Choi JO, Park SW, Nazir SA, Khan JN, Singh A, Kanagala P, Squire I, Mccann GP, Di Lisi D, Meschisi MC, Brunco V, Badalamenti G, Bronte E, Russo A, Novo S, Von Tscharner M, Urheim S, Aakhus S, Seiler C, Schmalholz S, Biering-Sorensen T, Cheng S, Oparil S, Izzo J, Pitt B, Solomon SD, Zaborska B, Jaxa-Chamiec T, Tysarowski M, Budaj A, Cordova F, Aguirre O, Sanabria S, Ortega J, Romeo G, Perazzolo Marra M, Tona F, Famoso G, Pigatto E, Cozzi F, Iliceto S, Badano LP, Kriatselis C, Gerds-Li JH, Kropf M, Pieske B, Graefe M, Martinez Santos P, Batlle Lopez E, Vilacosta I, Sanchez Sauce B, Espana Barrio E, Jimenez Valtierra J, Campuzano Ruiz R, Alonso Bello J, Martin Rios MD, Farrashi M, Abtahi H, Sadeghi H, Sadeghipour P, Tavoosi A, Abdel Rahman TA, Mohamed LA, Maghraby HM, Kora IM, Abdel Hameed FR, Ali MN, Al Shehri A, Youssef A, Gad A, Alsharqi M, Alsaikhan L, Andreini D, Rota C, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Solbiati A, Guaricci AI, Pepi M, Trifunovic D, Sobic Saranovic D, Savic L, Grozdic Milojevic I, Asanin M, Srdic M, Petrovic M, Zlaic N, Mrdovic I, Dogan C, Izci S, Gecmen C, Unkun T, Cap M, Erdogan E, Onal C, Yilmaz F, Ozdemir N, Muser D, Tioni C, Zanuttini D, Morocutti G, Spedicato L, Bernardi G, Proclemer A, Pranevicius R, Zapustas N, Briedis K, Valuckiene Z, Jurkevicius R, Juffermans LJM, Enait V, Van Royen N, Van Rossum AC, Kamp O, Khalaf HASSEN, Hitham SAKER, Osama AS, Abazid RAMI, Guall RAHIM, Durdan SHAFAT, Mohammed ZYAD, Stella S, Rosa I, Ancona F, Spartera M, Italia L, Latib A, Colombo A, Margonato A, Agricola E, Scatena C, Mazzanti C, Conte L, Pugliese N, Barletta V, Bortolotti U, Naccarato AG, Di Bello V, Bala G, Roosens B, Hernot S, Remory I, Droogmans S, Cosyns B, Generati G, Labate V, Donghi V, Pellegrino M, Carbone F, Alfonzetti E, Guazzi M, Dabrowski R, Kowalik I, Firek B, Chwyczko T, Szwed H, Kawamura A, Kawano S, Zaroui A, Ben Said R, Ben Halima M, Kheder N, Farhati A, Mourali S, Mechmech R, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Polte CL, Lagerstrand K, Johnsson ÅA, Janulewicz M, Bech-Hanssen O, Gabriel H, Wisser W, Maurer G, Rosenhek R, El Aroussy W, Abdel Ghany M, Al Adeeb K, Ascione L, Carlomagno G, Sordelli C, Ferro A, Ascione R, Severino S, Caso P, Muraru D, Janei C, Haertel Miglioranza M, Cavalli G, Romeo G, Peluso D, Cucchini U, Iliceto S, Badano L, Armario Bel X, Garcia-Garcia C, Ferrer Sistach E, Rueda Sobella F, Oliveras Vila T, Labata Salvador C, Serra Flores J, Lopez-Ayerbe J, Bayes-Genis A, Conte E, Gonella A, Morena L, Civelli D, Losardo L, Margaria F, Riva L, Tanga M, Carminati C, Muratori M, Gripari P, Ghulam Ali S, Fusini L, Vignati C, Bartorelli AL, Alamanni F, Pepi M, Rosa I, Stella S, Marini C, Spartera M, Latib A, Montorfano M, Colombo A, Margonato A, Agricola E, Ismaiel A, Ali N, Amry S, Serafin A, Kochanowski J, Filipiak KJ, Opolski G, Speranza G, Ando' G, Magaudda L, Cramer GE, Bakker J, Michels M, Dieker HJ, Fouraux MA, Marcelis CLM, Timmermans J, Brouwer MA, Kofflard MJM, Vasconcelos M, Araujo V, Almeida P, Sousa C, Macedo F, Cardoso JS, Maciel MJ, Voilliot D, Huttin O, Venner C, Olivier A, Villemin T, Deballon R, Manenti V, Juilliere Y, Selton-Suty C, Generati G, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Dabrowska-Kugacka A, Dorniak K, Lewicka E, Szalewska D, Kutniewska-Kubik M, Raczak G, Kim KH, Yoon HJ, Park HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Kim JH, Galli E, Habib G, Schnell F, Lederlin M, Daubert JC, Mabo P, Donal E, Faria R, Magalhaes P, Marques N, Domingues K, Lourenco C, Almeida AR, Teles L, Picarra B, Azevedo O, Lourenco C, Oliveira M, Magalhaes P, Domingues K, Marmelo B, Almeida A, Picarra B, Faria R, Marques N, Bento D, Lourenco C, Magalhaes P, Cruz I, Marmelo B, Reis L, Picarra B, Faria R, Azevedo O, Gimaev RH, Melnikova MA, Olezov NV, Ruzov VI, Goncalves P, Almeida MS, Branco P, Carvalho MS, Dores H, Gaspar MA, Sousa H, Andrade MJ, Mendes M, Makavos G, Varoudi M, Papadavid E, Andreadou I, Gravanis K, Liarakos N, Pavlidis G, Rigopoulos D, Lekakis J, Deluyker D, Bito V, Pigatto E, Romeo G, Muraru D, Cozzi F, Punzi L, Iliceto S, Badano LP, Pigatto E, Romeo G, Muraru D, Cozzi F, Iliceto S, Badano LP, Neilan T, Coen K, Gannon S, Bennet K, Clarke JG, Solari M, Cameli M, Focardi M, Corrado D, Bonifazi M, Henein M, Mondillo S, Gomez-Escalonilla C, De Agustin A, Egido J, Islas F, Simal P, Gomez De Diego JJ, Luaces M, Macaya C, Perez De Isla L, Zancanella M, Rusconi C, Musca F, Santambrogio G, De Chiara B, Vallerio P, Cairoli R, Giannattasio G, Moreo A, Alvarez Ortega C, Mori Junco R, Caro Codon J, Meras Colunga P, Ponz De Antonio I, Lopez Fernandez T, Valbuena Lopez S, Moreno Yanguela M, Lopez-Sendon JL, Surkova E, Bonanad-Lozano C, Lopez-Lereu MP, Monmeneu-Menadas JV, Gavara J, De Dios E, Paya-Chaume A, Escribano-Alarcon D, Chorro-Gasco FJ, Bodi-Peris V, Michalski BW, Miskowiec D, Kasprzak JD, Lipiec P, Morgado G, Caldeira D, Cruz I, Joao I, Almeida AR, Lopes L, Fazendas P, Cotrim C, Pereira H, De Block C, Buys D, Salgado R, Vrints C, Van Gaal L, Mctear C, Irwin RB, Dragulescu A, Friedberg M, Mertens L, Dragulescu A, Friedberg M, Mertens L, Carbone F, Generati G, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Krinochkin DV, Yaroslavskaya EI, Zaharova EH, Pushkarev GS, Sugihara C, Patel NR, Sulke AN, Lloyd GW, Piatkowski R, Scislo P, Grabowski M, Marchel M, Opolski G, Roland H, Hamadanchi A, Otto S, Jung C, Lauten A, Figulla HC, Poerner TC, Sampaio F, Fonseca P, Fontes-Carvalho R, Pinho M, Campos AS, Castro P, Fonseca C, Ribeiro J, Gama V, Heck R, Hamdanchi A, Otto S, Jung C, Lauten A, Figulla HR, Poerner TC, Ranjbar S, Ghaffaripour Jahromi M, Ranjbar S, Hinojar R, Fernandez Golfin C, Esteban A, Pascual-Izco M, Garcia-Martin A, Casas Rojo E, Jimenez-Nacher JJ, Zamorano JL, Gecmen C, Cap M, Izci S, Erdogan E, Onal C, Acar R, Bakal RB, Kaymaz C, Ozdemir N, Karvandi M, Ghaffaripour Jahromi M, Galand V, Schnell F, Matelot D, Martins R, Leclercq C, Carre F, Suran BC, Margulescu AD, Rimbas RC, Siliste C, Vinereanu D, Nocerino P, Urso AC, Borrino A, Carbone C, Follero P, Ciardiello C, Prato L, Salzano G, Marino F, Ruspetti A, Sparla S, Di Tommaso C, Loiacono F, Focardi M, D'ascenzi F, Henein M, Mondillo S, Porter J, Walker M, Lo Iudice F, Esposito R, Santoro C, Cocozza S, Izzo R, De Luca N, De Simone G, Trimarco B, Galderisi M, Gervasi F, Patti G, Mega S, Bono M, Di Sciascio G, Buture A, Badea R, Platon P, Ghiorghiu I, Jurcut R, Coman IM, Popescu BA, Ginghina C, Lunetta M, Spoto MS, Lo Vi AM, Pensabene G, Meschisi MC, Carita P, Coppola G, Novo S, Assennato P, Shim A, Wejner-Mik P, Kasprzak JD, Lipiec P, Havasi K, Domsik P, Kalapos A, Forster T, Piros GA, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Bulbul Z, Issa Z, Al Sehly A, Pergola V, Oufi S, Conde Y, Cimino E, Rinaldi E, Ashurov R, Ricci S, Pergolini M, Vitarelli A, Lujan Valencia JE, Chaparro M, Garcia-Guerrero A, Cristo Ropero MJ, Izquierdo Bajo A, Madrona L, Recio-Mayoral A, Monmeneu JV, Igual B, Lopez Lereu P, Garcia MP, Selmi W, Jalal Z, Thambo JB, Kosuta D, Fras Z. Poster session 5The imaging examinationP1097Correlation between visual and quantitative assessment of left ventricle: intra- and inter-observer agreementP1099Incremental prognostic value of late gadolinium-enhanced by cardiac magnetic resonance in patients with heart failureAnatomy and physiology of the heart and great vesselsP1100Left ventricular geometry and diastolic performance in erectile dysfunction patients; a topic of differential arterial stiffness influenceAssessment of diameters, volumes and massP1101Impact of the percutaneous closure of atrial septal defect on the right heart "remodeling"P1102Left Ventricular Mass Indexation in Infants, Children and Adolescents: a Simplified Approach for the Identification of Left Ventricular Hypertrophy in Clinical PracticeP1103Impact of trabecules while quantifying cardiac magnetic resonance exams in patients with systemic right ventricleP1104Detection of subclinical atherosclerosis by carotid intima-media thickness: correlation with leukocytes telomere shorteningAssessments of haemodynamicsP1105Flow redirection towards the left ventricular outflow tract: vortex formation is not affected by variations in atrio-ventricular delayAssessment of systolic functionP1106Reproducibility and feasibility of cardiac MRI feature tracking in Fabry diseaseP1107Normal left ventricular strain values by two-dimensional strain echocardiography; result of normal (normal echocardiographic dimensions and functions in korean people) studyP1108Test-retest repeatability of global strain following st-elevation myocardial infarction - a comparison of tagging and feature trackingP1109Cardiotoxicity induced by tyrosine kinase inhibitors in patients with gastrointestinal stromal tumors (GIST)P1110Finite strain ellipses for the analysis of left ventricular principal strain directions using 3d speckle tracking echocardiographyP1111Antihypertensive therapy reduces time to peak longitudinal strainP1112Right ventricular systolic function as a marker of prognosis after inferior myocardial infarction - 5-year follow-upP1113Is artery pulmonary dilatation related with right but also early left ventricle dysfunction in pulmonary artery hypertension?P1114Right ventricular mechanics changes according to pressure overload increasing, a 2D-speckle tracking echocardiographic evaluationAssessment of diastolic functionP1115Paired comparison of left atrial strain from P-wave to P-wave and R-wave to R-waveP1116Diagnostic role of Tissue Doppler Imaging echocardiographic criteria in obese heart failure with preserved ejection fraction patientsP1117Evaluation of diastolic function of right ventricle in idiopathic pulmonary arterial hypertensionP1118Severity and predictors of diastolic dysfunction in a non-hypertensive non-ischemic cohort of Egyptian patients with documented systemic autoimmune disease; pilot reportP1119correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarctionIschemic heart diseaseP1120Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)P1121Utility of transmural myocardial mechanic for early infarct size prediction after primary percutaneous coronary intervention in STEMI patientsP1122Progressive Improvements of the echocardiographic deformation parameters in ST Elevation Myocardial Infarction after five years follow-upP1123Long-term prognostic value of left ventricular dyssynchrony as assessed by cardiac magnetic resonance feature-tracking imaging after a first st-segment elevation myocardial infarctionP1124Differences in mitral annulus remodeling in acute anterior ST elevation and acute inferior ST elevation myocardial infarctionP1125Reduction of microvascular injury using a novel theragnostic ultrasound strategy: a first in men feasibility and safety studyP1126Impact of focused echocardiography in clinical decision of patient presented with st elevation myocardial infarction underwent primary angioplastyHeart valve DiseasesP1127Aortic valve area calculation in aortic stenosis: a comparison among conventional and 3D-transesophageal echocardiography and computed tomographyP1128Myocardial fibrosis and microRNA-21 expression in patients with severe aortic valve stenosis and preserved ejection fraction: a 2D speckle tracking echocardiography, tissutal and plasmatic studyP1129Quantification of calcium amount in a new experimental model: a comparison between calibrated integrated backscatter of ultrasound and computed tomographyP1130Altered diffusion capacity in aortic stenosis: role of the right heartP1131Osteoprotegerin predicts all-cause mortality in calcific aortic stenosis patients with preserved left ventricle ejection fraction in long term observationP1132Mitral regurgitation as a risk factor for pulmonary hypertension in patients with aortic stenosisP1133The relationship between the level of plasma B-type natriuretic peptide and mitral stenosisP1134Aortic regurgitation, left ventricle mechanics and vascular load: a single centre 2d derived-speckle tracking studyP1135Feasibility and reproducibility issues limit the usefulness of quantitative colour Doppler parameters in the assessment of chronic aortic and mitral regurgitation severityP1136Predictors of postoperative outcome in degenerative mitral regurgitationP1137Left ventricular mechanical dyssynchrony in patients with severe mitral regurgitation of rheumatic etiology; three dimensional echocardiography studyP1138Functional mitral regurgitation and left atrial dysfunction concur in determining pulmonary hypertension and functional status in subjects with left ventricular systolic dysfunctionP11393D echocardiography allows more effective quantitative assessment of the severity of functional tricuspid regurgitation than conventional 2D/Doppler echocardiographyP1140Prosthetic valve thrombosis: still a severe disease? 10-years experience in a university hospitalP1141Validity of echocardiography in the hospital course of patients with feverP1142Do baseline 3DTEE characteristics of mitral valve apparatus predict long term result in patients undergoing percutaneous valve repair for degenerative regurgitation?P1143Influence of baseline aortic regurgitation on mitral regurgitation change after transcatheter aortic valve replacement for aortic stenosisP1144Prevalence of echocardiography detected significant valvular regurge in subclinical rheumatic carditis in assiut childrenCardiomyopathiesP1145Can we early detect left ventricular systolic dysfunction in patients with Duchenne muscular dystrophy using global longitudinal strain assessment?P1146Prevalence of isolated papillary muscle hypertrophy in young competitive athletesP1147Troponin release after exercise in patients with hypertrophic cardiomyopathy: associations with clinical and mr imaging characteristicsP1148Atrial fibrillation in hypertrophic cardiomyopathy: can we score the risk?P1149Impact of hypertrophy on multiple layer longitudinal deformation in hypertrophy cardiomyopathy and cardiac amyloidosis compared to controlsP1150Functional evaluation in hypertrophic cardiomyopathy combining cardiopulmonary exercise testing combined with exercise-echocardiographyP1151Refinement of the old diagnostic criteria of left ventricular noncompaction cardiomyopathy (LVNC) based on cardiac magnetic resonance (CMR)P1152Differences of clinical characteristics and outcomes between acute myocarditis with preserved and reduced left ventricular systolic functionP1153Value of longitudinal strain for distinguishing left ventricular non-compaction from idiopathic dilated cardiomyopathyP1154Speed of recovery of left ventricular function is not related to the prognosis of Takotsubo cardiomyopathy. A Portuguese multicentre studyP1155Predictors of in-hospital left ventricular systolic function recovery after admission with takotsubo cardiomyopathy. Portuguese multicentre studyP1156Mid-ventricular takotsubo detected by initial echocardiogram associates with recurrence of takotsubo cardiomyopathy - a portuguese multicentre studySystemic diseases and other conditionsP1157Relations between left ventricle remodelling and expression of angiotensin 2 AT2R1 geneP1158Impact of renal denervation on long-term blood pressure variability and surrogate markers of target organ damage in individuals with drug-resistant arterial hypertensionP1159Greater improvement of coronary artery function, left ventricular deformation and twisting by IL12/23 compared to TNF-a inhibition in psoriasisP1160Advanced glycation end products play a role in adverse LV remodeling following MIP1161Incidence of subclinical myocardial dysfunction in patients with systemic sclerosis and normal left ventricular systolic and diastolic functionP1162Left atrial remodeling and dysfunction occur early in patients with systemic sclerosis and normal left ventricular functionP1163Intrinsic vortex formation : a unique performance indicatorP1164P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletesP1165Usefulness of transthoracic echocardiography in diagnosis of young patients with ischemic strokeP1166Primary cardiac lymphoma: role of echocardiography in the clinical managementP1167Abnormal echocardiographic findings in cancer patients before chemotherapyMasses, tumors and sources of embolismP1168Three-dimensional transesophageal echocardiography of the left atrial appendage reduces rate of postpone electrical cardioversionP1169Detection of ventricular thrombus by cmr after reperfused st-segment elevation myocardial infarction correlated with echocardiographyP1170Clinical and transthoracic echocardiographic predictors of left atrial appendage thrombus in patients with atrial fibrillationStress echocardiographyP1171Pharmacological stress echocardiography complications: a 4-year single center experienceP1172Myocardial functional and perfusion reserve in type I diabetesP1173Feasibility of incorporating 3D Dobutamine stress echocardiography into routine clinical practiceP1174Right ventricular isovolumic acceleration at rest and during exercise in children after heart transplantP1175Right ventricular systolic and diastolic response to exercise in children after heart transplant -a bicycle exercise studyP1176Determinants of functional capacity in heart failure patients with reduced ejection fractionP1177Handgrip stress echocardiography with emotional component compared to conventional isometric exercise in coronary artery disease diagnosisP1178The relationship between resting transthoracic echocardiography and exercise capacity in patients with paroxysmal atrial fibrillationP1179Correlation between NT-proBNP and selected echocardiography parameters at rest and after exercise in patients with functional ischemic mitral regurgitation qualified for cardiosurgical treatmentReal-time three-dimensional TEEP1180Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A study based on transesophageal 3D colour Doppler in 419 patientsP1181Proximal flow convergence by 3D echocardiography in the evaluation of mitral valve area in rheumatic mitral stenosisP1182Quantification of valve dimensions by transesophageal 3D echocardiography in patients with functional and degenerative mitral regurgitationTissue Doppler and speckle trackingP1183Automatic calculation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reductionP1184Effect of the mitral valve repairs on the left ventricular blood flow formationP1185Quantification of left atrial strain using cardiovascular magnetic resonance. a comparison between hypertrophic cardiomyopathy and healthy controlsP1186The role of early systolic lengthening in patients with non-ST elevation acute coronary syndrome and its relation to syntax scoreP1187Different standard two dimensional strain methods to quantity left ventricular mechanicsP1188Atrial function and electrocardiography caracteristics in sportsmen with or without paroxysmal atrial fibrillationP1189Right ventricular outflow premature contractions induce regional left ventricular dysfunctionP1190Ultrasound guided venous access for pacemaker and defibrillators. Randomized TrialP1191Atrial function analysis correlates with symptoms and quality of life of heart failure patientsP1192The use of tissue doppler echocardiography in myocardial iron overload in patients with thalassaemia majorP1193Independent association between pulse pressure and left ventricular global longitudinal strainP1194Global and regional longitudinal strain identifies the presence of coronary artery disease in patients with suspected reduction of coronary flow reserve and absence of wall motion abnormalitiesP1195Prognostic value of invasive and noninvasive parameters of right ventricular function in patients with pulmonary arterial hypertension receiving specific vasodilator therapyP1196Myocardial deformation analysis to improve arrhythmic risk stratificationP1197Quantitative assessment of regional systolic and diastolic function parameters for detecting prior transient ischemia in normokinetic segmentsP1198Left atrial function in patients with corrected tetralogy of Fallot - a three-dimensional speckle-tracking echocardiographic studyP1199Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiographyP1200Acute angulation of the aortic arch late after the arterial switch operation for transposition of the great arteries: impact on cardiac mechanicsP1201Circumferential deformation of the ascending thoracic aorta in hypertensive patients by three-dimensional speckle tracking echocardiographyCardiac Magnetic ResonanceP1202The incremental value of cardiac magnetic resonance on diagnosis myocardial infarction and non-obstructed coronary arteriesP1204Reference ranges of global and regional myocardial T1 values derived from MOLLI and shMOLLI at 3TComputed Tomography & Nuclear CardiologyP1205Deformation of the left atrial appendage after percutaneous closure with the Amplatzer cardiac plugP1206Prognostic impact of non-obstructive coronary artery disease on coronary computed tomographic angiography: A single-center study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van Eyck A, Van Hoorenbeeck K, De Winter B, Van Gaal L, De Backer W, Verhulst S. Sleep-disordered breathing and pulmonary function in obese children and adolescents. Sleep Med 2014; 15:929-33. [DOI: 10.1016/j.sleep.2014.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/27/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
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Cheung K, Meulemans E, Wouters K, de Clercq M, Bartholomeeussen L, Sels M, Pallemans S, Wellens C, Ysebaert D, de Keersmaecker S, Verschueren C, de Clerck L, Baert D, Vandoninck C, Kindt S, Schelfaut S, Vankerkhove M, Troch A, Ceulemans L, Vandenbergh H, Leys S, Pauwels J, Rondou T, Dewitte E, Maes K, de Winter B, Vandewoude M, Van Gaal L, Van Aken P, Peeters M. Feasibility of cachexia screening in ambulatory cancer patients: A multicenter pilot study. NUTR CLIN METAB 2014. [DOI: 10.1016/j.nupar.2014.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Verrijken A, Beckers S, Francque S, Hilden H, Caron S, Zegers D, Ruppert M, Hubens G, Van Marck E, Michielsen P, Staels B, Taskinen MR, Van Hul W, Van Gaal L. A gene variant of PNPLA3, but not of APOC3, is associated with histological parameters of NAFLD in an obese population. Obesity (Silver Spring) 2013; 21:2138-45. [PMID: 23512881 DOI: 10.1002/oby.20366] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 10/18/2012] [Accepted: 12/28/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Mechanisms explaining the relationship in non-alcoholic fatty liver disease (NAFLD), obesity, and insulin resistance are poorly understood. A genetic basis has been suggested. We studied the association between the genes patatin-like phospholipase domain-containing protein 3 (PNPLA3) and apolipoprotein C3 (APOC3) and metabolic and histological parameters of NAFLD in obese patients. DESIGN AND METHODS Overweight and obese patients underwent a metabolic and liver assessment. If NAFLD was suspected, liver biopsy was proposed. APOC3 variant rs2854117 and PNPLA3 variant rs738409 were genotyped. RESULTS Four hundred seventy patients were included (61.1% had liver biopsy). The percentage of patients with non-alcoholic steatohepatitis (NASH) was significantly different according to the PNPLA3 variant. After adjustment for age and body mass index, the PNPLA3 variant was associated with alanine aminotransferase (P < 0.001) and aspartate aminotransferase (P < 0.001). The PNPLA3 variant was associated with more severe features of steatohepatitis: steatosis (P < 0.001), lobular inflammation (P < 0.001), and ballooning (P = 0.002), but not with liver fibrosis, anthropometry, or insulin resistance. No significant difference in liver histology, anthropometric, or metabolic parameters was found between carriers and non-carriers of the APOC3 variant. CONCLUSIONS PNPLA3 polymorphism rs738409 was associated with NASH and the severity of necroinflammatory changes independently of metabolic factors. No association between APOC3 gene variant rs2854117 and histological or metabolic parameters of NAFLD was found.
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Affiliation(s)
- A Verrijken
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Belgium
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20
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Lean MEJ, Carraro R, Finer N, Hartvig H, Lindegaard ML, Rössner S, Van Gaal L, Astrup A. Tolerability of nausea and vomiting and associations with weight loss in a randomized trial of liraglutide in obese, non-diabetic adults. Int J Obes (Lond) 2013; 38:689-97. [PMID: 23942319 PMCID: PMC4010971 DOI: 10.1038/ijo.2013.149] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/23/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Liraglutide 3.0 mg, with diet and exercise, produced substantial weight loss over 1 year that was sustained over 2 years in obese non-diabetic adults. Nausea was the most frequent side effect. OBJECTIVE To evaluate routinely collected data on nausea and vomiting among individuals on liraglutide and their influence on tolerability and body weight. DESIGN A randomized, placebo-controlled, double-blind 20-week study with an 84-week extension (sponsor unblinded at 20 weeks, open-label after 1 year) in eight European countries (Clinicaltrials.gov: NCT00422058). SUBJECTS After commencing a 500-kcal/day deficit diet plus exercise, 564 participants (18-65 years, body mass index (BMI) 30-40 kg m(-2)) were randomly assigned (after a 2-week run-in period) to once-daily subcutaneous liraglutide (1.2, 1.8, 2.4 or 3.0 mg), placebo or open-label orlistat (120 mg × 3 per day). After 1 year, participants on liraglutide/placebo switched to liraglutide 2.4 mg, and subsequently, to liraglutide 3.0 mg (based on 20-week and 1-year results, respectively). RESULTS The intention-to-treat population comprised 561 participants (n=90-98 per arm, age 45.9±10.3 years, BMI 34.8±2.7 kg m(-2) (mean±s.d.)). In year 1, more participants reported ⩾1 episode of nausea/vomiting on treatment with liraglutide 1.2-3.0 mg (17-38%) than with placebo or orlistat (both 4%, P⩽0.001). Most episodes occurred during dose escalation (weeks 1-6), with 'mild' or 'moderate' symptoms. Among participants on liraglutide 3.0 mg, 48% reported some nausea and 13% some vomiting, with considerable variation between countries, but only 4 out of 93 (4%) reported withdrawals. The mean 1-year weight loss on treatment with liraglutide 3.0 mg from randomization was 9.2 kg for participants reporting nausea/vomiting episodes, versus 6.3 kg for those with none (a treatment difference of 2.9 kg (95% confidence interval 0.5-5.3); P=0.02). Both weight losses were significantly greater than the respective weight losses for participants on placebo (P<0.001) or orlistat (P<0.05). Quality-of-life scores at 20 weeks improved similarly with or without nausea/vomiting on treatment with liraglutide 3.0 mg. CONCLUSION Transient nausea and vomiting on treatment with liraglutide 3.0 mg was associated with greater weight loss, although symptoms appeared tolerable and did not attenuate quality-of-life improvements. Improved data collection methods on nausea are warranted.
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Affiliation(s)
- M E J Lean
- Life-Course Nutrition and Health, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - R Carraro
- Department of Endocrinology, University Hospital La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - N Finer
- National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK
| | | | | | - S Rössner
- Obesity Unit, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - L Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | - A Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Frederiksberg, Denmark
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Smith J, Nazare JA, Borel AL, Aschner P, Barter PJ, Van Gaal L, Matsuzawa Y, Kadowaki T, Ross R, Brulle-Wohlhueter C, Alméras N, Haffner SM, Balkau B, Després JP. Assessment of cardiometabolic risk and prevalence of meeting treatment guidelines among patients with type 2 diabetes stratified according to their use of insulin and/or other diabetic medications: results from INSPIRE ME IAA. Diabetes Obes Metab 2013; 15:629-41. [PMID: 23356633 DOI: 10.1111/dom.12075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/01/2012] [Accepted: 01/20/2013] [Indexed: 01/21/2023]
Abstract
AIM Visceral adipose tissue (VAT) and liver fat (LF) are strongly associated with type 2 diabetes. It is not known, however, how diabetes treatment and/or risk factor management modulates the association between VAT, LF and diabetes. The aim was to determine the level of VAT and LF in patients with type 2 diabetes according to their treatment status and achievement of the American Diabetes Association's (ADA) diabetes management goals. METHODS We performed a cross-sectional analysis of the baseline data of the International Study of the Prediction of Intra-Abdominal Adiposity and its Relationship with Cardiometabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA), a 3-year prospective cardiometabolic imaging study conducted in 29 countries. Patients (n = 3991) were divided into four groups: (i) those without type 2 diabetes (noT2D n = 1003 men, n = 1027 women); (ii) those with type 2 diabetes but not treated with diabetes medications (T2Dnomeds n = 248 men, n = 198 women); (iii) those with type 2 diabetes and treated with diabetes medications but not yet using insulin (T2Dmeds-ins n = 591 men, n = 484 women) and (iv) those with type 2 diabetes and treated with insulin (T2Dmeds+ins n = 233 men, n = 207 women). Abdominal and liver adiposity were measured by computed tomography. RESULTS Fewer patients with high VAT or LF achieved the ADA's goals for high-density lipoprotein cholesterol (HDL-C) or triglycerides compared to patients with low VAT or LF. Visceral adiposity (p = 0.02 men, p = 0.003 women) and LF (p = 0.0002 men, p = 0.0004 women) increased among patients who met fewer of the ADA treatment criteria, regardless of type 2 diabetes treatment. CONCLUSION Residual cardiometabolic risk exists among patients with type 2 diabetes characterized by elevated VAT and LF.
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Affiliation(s)
- J Smith
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
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22
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Descamps OS, Tenoutasse S, Stephenne X, Gies I, Beauloye V, Lebrethon MC, De Beaufort C, De Waele K, Scheen A, Rietzschel E, Mangano A, Panier JP, Ducobu J, Langlois M, Balligand JL, Legat P, Blaton V, Muls E, Van Gaal L, Sokal E, Rooman R, Carpentier Y, De Backer G, Heller FR. Management of familial hypercholesterolemia in children and young adults: consensus paper developed by a panel of lipidologists, cardiologists, paediatricians, nutritionists, gastroenterologists, general practitioners and a patient organization. Atherosclerosis 2011; 218:272-80. [PMID: 21762914 DOI: 10.1016/j.atherosclerosis.2011.06.016] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 06/08/2011] [Accepted: 06/09/2011] [Indexed: 01/06/2023]
Abstract
UNLABELLED Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a clear consensus on the management of this disease in young patients is necessary. In Belgium, a panel of paediatricians, specialists in (adult) lipid management, general practitioners and representatives of the FH patient organization agreed on the following common recommendations. 1. Screening for HeFH should be performed only in children older than 2 years when HeFH has been identified or is suspected (based on a genetic test or clinical criteria) in one parent.2. The diagnostic procedure includes, as a first step, the establishment of a clear diagnosis of HeFH in one of the parents. If this precondition is satisfied, a low-density-lipoprotein cholesterol (LDL-C) levelabove 3.5 mmol/L (135 mg/dL) in the suspected child is predictive for differentiating affected from non-affected children. 3. A low saturated fat and low cholesterol diet should be started after 2 years, under the supervision of a dietician or nutritionist.4. The pharmacological treatment, using statins as first line drugs, should usually be started after 10 years if LDL-C levels remain above 5 mmol/L (190 mg/dL), or above 4 mmol/L (160 mg/dL) in the presence of a causative mutation, a family history of early cardiovascular disease or severe risk factors. The objective is to reduce LDL-C by at least 30% between 10 and 14 years and, thereafter, to reach LDL-C levels of less than 3.4 mmol/L (130 mg/dL). CONCLUSION The aim of this consensus statement is to achieve more consistent management in the identification and treatment of children with HeFH in Belgium.
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Affiliation(s)
- O S Descamps
- Département de Médecine Interne et Centre de Recherche Médicale de Jolimont, Hôpital de Jolimont, Haine Saint-Paul, Belgium
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Francque S, Verrijken A, Mertens I, Hubens G, Van Marck E, Pelckmans P, Michielsen P, Van Gaal L. Visceral adiposity and insulin resistance are independent predictors of the presence of non-cirrhotic NAFLD-related portal hypertension. Int J Obes (Lond) 2010; 35:270-8. [PMID: 20661251 DOI: 10.1038/ijo.2010.134] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We previously demonstrated in an animal model that steatosis, in the absence of fibrosis, induces a significant rise in portal pressure, indicating substantial changes in liver hemodynamics. As assessment of portal pressure is an invasive procedure, non-invasive parameters are needed to identify patients at risk. AIMS To study the portal pressure in nonalcoholic fatty liver disease patients and to identify factors that are possibly related to steatosis-induced changes in liver hemodynamics. MATERIALS AND METHODS Patients presenting with a problem of overweight or obesity, and in whom non-invasive investigations showed signs of liver involvement, were proposed for transjugular hepatic vein catheterization and liver biopsy. The biopsy was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network Scoring System. RESULTS A total of 50 consecutive patients were studied. Their mean age was 47.9 ± 1.8 years; 31 (62%) were female. Hepatic venous pressure gradient was normal in 36 (72%) and elevated in 14 (28%) patients. The degree of steatosis was the only histological parameter that differed significantly between the two groups (P=0.016), and was a predictor of the presence of portal hypertension (PHT) in regression analysis (P=0.010). Comparing normal versus portal hypertensive patients, waist circumference (117 ± 2 versus 128 ± 4 cm, P=0.005), waist-hip ratio (0.96 ± 0.06 versus 1.04 ± 0.03, P=0.003), visceral fat (229 ± 15 versus 292 ± 35 cm(2), P=0.022), fasting insulin (15.4 ± 1.7 versus 21.8 ± 2.4 μU ml(-1), P=0.032), fasting c-peptide (1.22 ± 0.06 versus 1.49 ± 0.09 nmol l(-1), P=0.035) and homeostasis model assessment-insulin resistance (HOMA IR) (3.28 ± 0.29 versus 4.81 ± 0.57, P=0.019) were significantly higher. Age, gender, liver enzymes, ferritin and high-sensitive C-reactive protein were not significantly different. In regression analysis, waist circumference (P=0.008) and HOMA IR (P=0.043) were independent predictors of PHT. CONCLUSIONS Estimates of both visceral adiposity and IR are predictors for the presence of PHT, related to the degree of steatosis, and may help in identifying patients who are at risk of developing steatosis-related complications.
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Affiliation(s)
- S Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.
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Verrijken A, Francque S, Mertens I, Talloen M, Peiffer F, Van Gaal L. Visceral adipose tissue and inflammation correlate with elevated liver tests in a cohort of overweight and obese patients. Int J Obes (Lond) 2010; 34:899-907. [PMID: 20142825 DOI: 10.1038/ijo.2010.4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To study the relationship between elevated liver tests and high sensitive C-reactive protein (hs-CRP), as potential markers of liver inflammation and non-alcoholic steatohepatitis (NASH), with anthropometric and laboratory parameters in overweight patients, especially the relationship with visceral adipose tissue (VAT). METHODS Patients presenting to the obesity clinic were prospectively included. Detailed anthropometry, computed tomography (CT)-measured VAT, liver tests (aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT)) and hs-CRP were assessed, along with an extended series of biochemical parameters. RESULTS All 480 patients (gender distribution male (M)/female (F) (10/90%)) with complete data were included. Mean age was 39+/-13 years, mean BMI 34.5+/-6.0 kg m(-2). In 37.3% of the patients one or more of the liver tests were elevated. VAT was positively related to AST (r=0.18, P<0.001), ALT (r=0.29, P<0.001), ALP (r=0.16, P<0.01) and GGT (r=0.39, P<0.001). Comparing subjects with high (VAT>or=113 cm(2)) vs low (VAT<113 cm(2)) VAT levels, significant differences were noted for AST (26+/-12 vs 24+/-12 U l(-1), P=0.003), ALT (37+/-21 vs 31+/-21 U l(-1), P<0.001), ALP (76+/-20 vs 71+/-18 U l(-1), P=0.008), GGT (33+/-20 vs 25+/-15 U l(-1), P<0.001) and hs-CRP (0.62+/-0.43 vs 0.52+/-0.48 mg dl(-1), P<0.001). After correction for BMI the difference in AST and ALP between the high vs low VAT group disappeared. The differences for ALT and GGT remained significant (P=0.008 and P<0.001 respectively). After correction for hs-CRP the four different liver tests remained significantly higher in the high VAT group. A stepwise multiple regression analysis revealed that every single liver test has his own most important determinant; VAT and hs-CRP for AST, insulin resistance calculated with homeostasis model assessment (HOMA-IR) and hs-CRP for ALT and ALP, and triglycerides and VAT for GGT. CONCLUSION In overweight and obese patients, liver tests, especially ALT and GGT, are associated with visceral fat mass. After correction for BMI and hs-CRP, ALT and GGT are significantly higher in patients with increased VAT, thereby supporting evidence for a potential key role of VAT in the pathogenesis of non-alcoholic fatty liver disease (NAFLD).
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Affiliation(s)
- A Verrijken
- Department of Endocrinology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
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25
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Annemans L, Marbaix S, Webb K, Van Gaal L, Scheen A. Cost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population. Clin Drug Investig 2010; 30:133-42. [PMID: 20067331 DOI: 10.2165/11531910-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with type 2 diabetes mellitus have a high risk of developing cardiovascular (CV) disease. The clinical benefit of use of statins in patients with type 2 diabetes has been demonstrated in several randomized, controlled trials, including the CARDS clinical trial. Based on the clinical CARDS data, the favourable cost effectiveness of atorvastatin 10 mg in patients with type 2 diabetes has been demonstrated in countries such as the UK and France. This study aimed to estimate the cost effectiveness in the Belgian setting of atorvastatin 10 mg compared with no treatment for the primary prevention of CV events in type 2 diabetes patients without a history of CV disease. METHODS A Markov model with 1-year cycles was developed to simulate the CV event and death risk according to the therapeutic approach initiated. The transition probabilities for CV events in the 'no statin treatment' group were derived from the risk equations reported from the large UKPDS. Risk reductions from the CARDS clinical trial were used to adjust these CV event probabilities in the atorvastatin 10 mg treatment group. The characteristics of type 2 diabetes patients without a CV history were derived from the Belgian OCAPI survey. The public healthcare payers' perspective was taken into account for costing. The direct medical costs of CV events were based on the Public Health Authorities' hospital database for acute care costs and on the literature for the follow-up costs. The impact on the reimbursement system of generic entry to the market was considered in the drug cost. Costs were valued as at year 2009; costs and outcomes were discounted at 3% and 1.5%, respectively. RESULTS Based on a 5-year time horizon, atorvastatin was demonstrated to be cost effective with an incremental cost/quality-adjusted life-year (QALY) of euro 16,681. Over a lifetime horizon (25 years), atorvastatin was demonstrated to be a cost-saving therapeutic intervention. At a threshold of euro 30,000/QALY, atorvastatin had a 98.8% probability of being cost effective. CONCLUSION Compared with 'no treatment', use of atorvastatin 10 mg as a primary prevention intervention in Belgian type 2 diabetes patients not only improves CV outcomes, but also appears to be cost saving over a lifetime horizon.
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Affiliation(s)
- L Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
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Moulin P, de Champvallins M, Bruckert E, Rousset H, Senn S, Serusclat A, Servan E, Van Gaal L, Derumeaux G. P161 Comparaison à 1 an de Benfluorex et Pioglitazone dans le diabète de type 2 : etude regulate. Diabetes & Metabolism 2010. [DOI: 10.1016/s1262-3636(10)70309-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Van Gaal L. Metabolic syndrome--from controversies to ectopic fat syndrome. Bull Mem Acad R Med Belg 2010; 165:159-160. [PMID: 21166267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Van den Driessche A, Eenkhoorn V, Van Gaal L, De Block C. Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review. Neth J Med 2009; 67:376-387. [PMID: 20009114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Type 1 diabetes mellitus (T1DM) results from autoimmune destruction of insulin-producing beta cells and is characterised by the presence of insulitis and &and beta-cell autoantibodies. Up to one third of patients develop an autoimmune polyglandular syndrome. Fifteen to 30% of T1DM subjects have autoimmune thyroid disease (Hashimoto's or Graves' disease), 5 to 10% are diagnosed with autoimmune gastritis and/or pernicious anaemia (AIG /PA), 4 to 9% present with coeliac disease (CD), 0.5% have Addison's disease (AD), and 2 to 10% show vitiligo. These diseases are characterised by the presence of autoantibodies against thyroid peroxidase (for Hashimoto's thyroiditis), TSH receptor (for Graves' disease), parietal cell or intrinsic factor (for AIG /PA), tissue transglutaminase (for CD), and 21-hydroxylase (for AD). Early detection of antibodies and latent organ-specific dysfunction is advocated to alert physicians to take appropriate action in order to prevent full-blown disease. Hashimoto's hypothyroidism may cause weight gain, hyperlipidaemia, goitre, and may affect diabetes control, menses, and pregnancy outcome. In contrast, Graves' hyperthyroidism may induce weight loss, atrial fibrillation, heat intolerance, and ophthalmopathy. Autoimmune gastritis may manifest via iron deficiency or vitamin B12 deficiency anaemia with fatigue and painful neuropathy. Clinical features of coeliac disease include abdominal discomfort, growth abnormalities, infertility, low bone mineralisation, and iron deficiency anaemia. Adrenal insufficiency may cause vomiting, anorexia, hypoglycaemia, malaise, fatigue, muscular weakness, hyperkalaemia, hypotension, and generalised hyperpigmentation. Here we will review prevalence, pathogenetic factors, clinical features, and suggestions for screening, follow-up and treatment of patients with T1DM and/or autoimmune polyglandular syndrome.
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Affiliation(s)
- A Van den Driessche
- Department of Diabetology and Endocrinology, Antwerp University Hospital, Edegem, Belgium
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Ducobu J, Scheen AJ, Legat P, De Backer G, Van Gaal L, Velkeniers B, Kartounian J, Maes M, Hermans M. [Place of fibrates for the treatment of patients with atherogenic dyslipidemia]. Rev Med Liege 2009; 64:512-518. [PMID: 19911665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The demography of dyslipidemia has changed towards a more complex atherogenic dyslipidemia involving increased levels of LDL cholesterol, in particular highly atherogenic small dense particles, hypertriglyceridemia and low HDL cholesterol, together with increased levels of markers of inflammation, thrombogenesis and endothelial dysfunction. Statins were shown to significantly lower cardiovascular morbidity and mortality, but treated patients are still left with a high residual risk, in particular for those with metabolic syndrome, type 2 diabetes, or low HDL cholesterol levels. Fibrates have been shown to reduce plasma triglycerides and increase HDL cholesterol, while improving inflammation, thrombogenesis and endothelial dysfunction. Clinical trials with fibrates have demonstrated their potential to reduce cardiovascular morbidity and mortality too, often through other mechanisms than those of statins. Combination trials of statins with fibrates have shown a more complete improvement of lipid profile and risk markers than each class separately. In contrast with gemfibrozil, fenofibrate does not interact significantly with the pharmacokinetics of statins, and its combination with statins has been shown to have a low risk of muscular side-effects or liver toxicity. The ACCORD outcome trial is exploring possible benefits of the combination of fenofibrate with statins on morbidity and mortality of patients with type 2 diabetes.
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Affiliation(s)
- J Ducobu
- Service de Université Mons Hainaut, Belgique.
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30
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Sharma AM, Caterson ID, Coutinho W, Finer N, Van Gaal L, Maggioni AP, Torp-Pedersen C, Bacher HP, Shepherd GM, James WPT. Blood pressure changes associated with sibutramine and weight management - an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes trial (SCOUT). Diabetes Obes Metab 2009; 11:239-50. [PMID: 18671798 DOI: 10.1111/j.1463-1326.2008.00930.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore vital sign changes among patient subgroups during the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial. METHODS SCOUT is an ongoing, double-blind, randomized, placebo-controlled outcome trial in overweight/obese patients at high risk of a cardiovascular event. During the 6-week lead-in period, 10,742 patients received sibutramine and weight management. Vital sign changes were assessed post hoc by initial blood pressure (mmHg) categorized as normal (<130/<85), high-normal (130 to <140/85 to <90) or hypertensive (>or=140/>or=90); weight change categories (weight gain/no weight change, >0 to 2.5% weight loss, >2.5 to 5% weight loss and >5% weight loss) and current antihypertensive medication class use (none, one, or two or more). To assess the impact of sibutramine on blood pressure and pulse rate, only patients (N = 10,025) who reported no change in the class of antihypertensive medication used and who did not report an increase in antihypertensive medication use were analysed. RESULTS At entry, approximately 50% of patients were hypertensive and 26% were high-normal. In hypertensive patients, blood pressure changes (mmHg) decreased by median [5th, 95th percentile] of -6.5 systolic [-27.0, 8.0] and -2.0 diastolic [-15.0, 8.0] (p < 0.001). Hypertensive patients with no weight loss or with weight gain had median decreases of -3.5 systolic [-26.0, 10.0] and -1.5 diastolic [-16.0, 9.0] (p < 0.001). Normotensive patients had median increases of 1.5 systolic [-15.0, 19.5] and 1.0 diastolic [-10.5, 13.0] (p < 0.001) attenuated with increasing weight loss. Approximately 43% of patients initially categorized as hypertensive had a lower blood pressure category at end-point. Concomitant antihypertensive medication classes did not affect blood pressure reductions. Pulse rates were uniformly elevated (median 1-4 bpm, p < 0.001) across blood pressure and weight change categories. CONCLUSIONS In hypertensive patients (>or=140/>or=90), blood pressure decreases were observed during 6-week treatment with sibutramine even when body weight was unchanged. In patients with normal blood pressure (<130/<85), weight loss of >5% induced decreases in systolic blood pressure; otherwise, small increases were observed. Small pulse rate increases were observed regardless of blood pressure or weight change status.
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Affiliation(s)
- A M Sharma
- Royal Alexandra Hospital, University of Alberta, Alberta, Canada.
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Verhulst SL, Schrauwen N, Haentjens D, Rooman RP, Van Gaal L, De Backer WA, Desager KN. Sleep-disordered breathing and systemic inflammation in overweight children and adolescents. ACTA ACUST UNITED AC 2009; 3:234-9. [PMID: 18608625 DOI: 10.1080/17477160802113548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess if the severity of sleep-disordered breathing (SDB) and mainly intermittent hypoxia is associated with increased peripheral leukocytes in overweight children and adolescents, controlling for adiposity and obesity-related metabolic abnormalities. METHODS Consecutive subjects were recruited at a pediatric obesity clinic. All subjects underwent polysomnography and a fasting blood sample. RESULTS In total, 95 subjects were included (<age> =11.1+/-2.6, 43 boys, body mass index, <BMI z-score>=2.3+/-0.5, 29 subjects were overweight and 66 obese). Total white blood cell count increased significantly by worsening of intermittent hypoxia. Total white blood cell count was correlated with the maximal degree of desaturation, independent of puberty, HOMA and HDL-cholesterol. Neutrophil levels were associated with the degree of desaturation, while controlling for puberty and HOMA. CONCLUSION This study supports the hypothesis of an independent interaction between intermittent hypoxia and nocturnal desaturation during sleep, and increased white blood cell and neutrophil levels in overweight and obese children and adolescents. This finding may contribute to the mechanisms linking SDB with increased cardiovascular morbidity.
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Affiliation(s)
- S L Verhulst
- Department of Pediatrics, Antwerp University Hospital, Belgium.
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Verhulst SL, Van Hoeck K, Schrauwen N, Haentjens D, Rooman R, Van Gaal L, De Backer W, Desager KN. Sleep-disordered breathing and proteinuria in overweight and obese children and adolescents. Horm Res 2008; 70:224-9. [PMID: 18772595 DOI: 10.1159/000151594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 11/29/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess whether sleep-disordered breathing (SDB) in overweight children and adolescents has an additional effect on the spectrum of urinary albumin to protein loss, as markers of early kidney dysfunction. METHODS Prospective study in a clinical sample of overweight children and adolescents. Each subject underwent anthropometry, blood sampling, oral glucose tolerance test and polysomnography. From a 24-hour urine collection, albumin excretion rate and total urinary protein to creatinine ratio (UPCR) were calculated. RESULTS 94 nondiabetic subjects were included (mean age = 11.0 +/- 2.5, 42 boys). Average BMI z-score was 2.25 +/- 0.47 (26 overweight subjects and 68 obese subjects). There was no difference in albumin excretion rate or UPCR between subjects with and without SDB. None of the SDB parameters correlated with the transformed albumin excretion rate or UPCR. Albumin excretion rate significantly correlated with fasting insulin and C-peptide and with post-challenge glucose, insulin and C-peptide levels, while UPCR correlated with fasting and post-challenge C-peptide levels. Multiple regression indicated that post-challenge glucose levels were the most important predictors of albumin excretion rate. CONCLUSION Insulin resistance, and not SDB, was associated with increased levels of albuminuria, indicating early renal dysfunction, in this clinical sample of overweight children and adolescents.
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Affiliation(s)
- S L Verhulst
- Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium.
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Verhulst SL, Schrauwen N, Haentjens D, Rooman RP, Van Gaal L, De Backer WA, Desager KN. Sleep-disordered breathing: a new risk factor of suspected fatty liver disease in overweight children and adolescents? Eur Respir Rev 2008. [DOI: 10.1183/09059180.00010809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Verhulst SL, Schrauwen N, Haentjens D, Rooman RP, Van Gaal L, De Backer WA, Desager KN. Sleep duration and metabolic dysregulation in overweight children and adolescents. Arch Dis Child 2008; 93:89-90. [PMID: 18156481 DOI: 10.1136/adc.2007.124768] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Verrijken A, Francque S, Van Gaal L. The metabolic syndrome and the liver. Acta Gastroenterol Belg 2008; 71:48-59. [PMID: 18396752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Together with the worldwide epidemic proportions of obesity the incidence of 'the metabolic syndrome' is rising across countries. The metabolic syndrome is described as a complex condition that is linked to (intra-abdominal) obesity and is characterized by insulin resistance, dyslipidaemia and hypertension. Several definitions for the metabolic syndrome have been suggested, all trying to identify individuals at high risk for both type 2 diabetes and cardiovascular disease. The primary hepatic complication of obesity and insulin resistance is nonalcoholic fatty liver disease (NAFLD). NAFLD is not included as a component of the metabolic syndrome as it is currently defined; however, data suggest an association. Although the data are mainly epidemiological, the pathogenesis of NAFLD and the metabolic syndrome show common components, with the focus on insulin resistance as a key factor. Even so the treatment of patients with the metabolic syndrome and NAFLD shows a certain degree of similarity, and should focus on the management of associated conditions including obesity, glucose and lipid abnormalities. Lifestyle modifications comprising healthy eating habits and regular exercise are the primary interventions recommended to patients with the metabolic syndrome and those with NAFLD. A pharmacological approach like insulin-sensitizing agents, lipid lowering drugs, antihypertensive drugs and antiobesity agents can be successful in the treatment of certain risk factors that are currently clustering with both the metabolic syndrome and NAFLD. In some cases bariatric surgery may be necessary.
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Affiliation(s)
- A Verrijken
- Division of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
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Weets I, Rooman R, Coeckelberghs M, De Block C, Van Gaal L, Kaufman JM, Keymeulen B, Mathieu C, Weber E, Pipeleers DG, Gorus FK. The age at diagnosis of type 1 diabetes continues to decrease in Belgian boys but not in girls: a 15-year survey. Diabetes Metab Res Rev 2007; 23:637-43. [PMID: 17631647 DOI: 10.1002/dmrr.758] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The age at clinical onset of type 1 diabetes is decreasing. Preliminary Belgian data suggested that this anticipation occurred preferentially in boys. We investigated whether this gender-specific anticipation could be confirmed over a 15-year observation period. METHODS In Antwerp, we studied incidence trends between 1989 and 2003 in 746 type 1 diabetic patients under age 40. For 2928 antibody-positive patients diagnosed nationwide during the same period, age at diagnosis was analysed according to gender and calendar year. RESULTS In Antwerp, the incidence of type 1 diabetes under age 15 increased significantly with time from 10.9/100 000/year in 1989-1993 to 15.8/100 000/year in 1999-2003 (p = 0.008). The rising incidence in children was largely restricted to boys under age 10 where the incidence more than doubled during the 15-year period (6.8/100 000/year in 1989-1993 vs 17.2/100 000/year in 1999-2003; p < 0.001). Such an increase was not found in girls under age 10 (p = 0.54). This selective trend toward younger age at diagnosis in boys was confirmed in the larger group of Belgian patients where the median age at diagnosis decreased in boys-but not in girls-from 20 years in 1989-1993 to 15 years in 1999-2003 (p < 0.001). CONCLUSIONS Over a 15-year observation period, a selective anticipation of clinical onset of type 1 diabetes was found in boys but not in girls. This suggests that an environmental factor may preferentially accelerate the sub-clinical disease process in young boys.
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Affiliation(s)
- I Weets
- Diabetes Research Center, Free University Brussels, Belgium.
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Truyen I, De Grijse J, Van Schravendijk C, De Smet D, Decochez K, Vandemeulebroucke E, Giri M, Keymeulen B, Mathieu C, Van Gaal L, De Pauw P, Weets I, Pipeleers DG, Gorus FK. Adiponectin levels do not predict clinical onset of type 1 diabetes in antibody-positive relatives. Diabetologia 2007; 50:2143-6. [PMID: 17687539 DOI: 10.1007/s00125-007-0774-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 06/29/2007] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS Insulin resistance has been proposed as a risk factor for type 1 diabetes. We investigated whether adiponectin, an insulin sensitiser, can serve as an additional predictive marker for type 1 diabetes in first-degree relatives of known patients. METHODS Adiponectin was followed in 211 persistently islet antibody-positive (Ab+) first-degree relatives of type 1 diabetic patients and in 211 age- and sex-matched persistently antibody-negative relatives, and correlated with antibody status, random proinsulin:C-peptide ratio and HLA-DQ genotype. During follow-up, 37 Ab+ relatives developed type 1 diabetes. RESULTS In the group of 422 relatives, baseline adiponectin correlated inversely with age and BMI and was lower in male than in female participants, especially after 15 years of age (p < 0.001). There was no correlation with antibody status or later development of diabetes. In 24 Ab+ relatives sampled fasted, adiponectin levels correlated significantly with homeostasis model assessment of insulin sensitivity (p = 0.006). In Ab+ relatives (n = 211), adiponectin levels could not predict type 1 diabetes nor complement risk assessment based on islet antibodies, HLA-DQ genotype and pancreatic hormones in Cox regression analysis. CONCLUSIONS/INTERPRETATION Adiponectin levels do not contribute to the prediction of type 1 diabetes in Ab+ relatives.
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Affiliation(s)
- I Truyen
- Diabetes Research Center, Brussels Free University-VUB, Laarbeeklaan 103, 1090, Brussels, Belgium
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Verhulst SL, Schrauwen N, Haentjens D, Rooman RP, Van Gaal L, De Backer WA, Desager KN. Sleep-disordered breathing and the metabolic syndrome in overweight and obese children and adolescents. J Pediatr 2007; 150:608-12. [PMID: 17517244 DOI: 10.1016/j.jpeds.2007.01.051] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 11/13/2006] [Accepted: 01/31/2007] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess whether sleep-disordered breathing (SDB) is a risk factor of the metabolic syndrome (MS) in children and adolescents who are overweight and to examine whether the severity of SDB was independently associated with glucose intolerance, insulin resistance, and/or dyslipidemia. STUDY DESIGN Consecutive subjects who were overweight or obese underwent polysomnography, fasting blood sample, and oral glucose tolerance test (for calculation of area under the curve [AUC]). SDB was defined as a respiratory disturbance index > or = 2. MS was present when > or = 3 of these factors were present: waist circumference > or = 90th percentile; fasting glucose level > or = 110 mg/dL; triglyceride level > or = 110 mg/dL; high-density lipoprotein cholesterol level < or = 40 mg/dL; blood pressure > or = 90th percentile. RESULTS A total of 104 subjects were included in the study (44% boys; 58% prepubertal; mean age, 11.1 +/- 2.6 years; 69% obese). Mean SaO2 (odds ratio, 0.54) and SaO2nadir (odds ratio, 0.89) were independent, significant predictors of the presence of MS. Multiple regression showed significant associations between SaO2nadir and high-density lipoprotein cholesterol level, mean SaO2 and both AUC glucose and triglyceride levels, and between the percentage of total sleep time with SaO2 > or = 95% and cholesterol level, while controlling for adiposity and sex, puberty, or both. CONCLUSION This study supports the hypothesis of an interaction between SDB and metabolic abnormalities, independent of estimates of body fat distribution, in children and adolescents who are overweight and obese.
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Affiliation(s)
- S L Verhulst
- Department of Pediatrics, Antwerp University Hospital, Wilrijk, Belgium.
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Truyen I, De Grijse J, Weets I, Kaufman L, Pipeleers L, Nanos N, Decochez K, Hilbrands R, Kaufman JM, Keymeulen B, Mathieu C, Van Gaal L, Pipeleers DG, Gorus FK. Identification of prediabetes in first-degree relatives at intermediate risk of type I diabetes. Clin Exp Immunol 2007; 149:243-50. [PMID: 17521324 PMCID: PMC1941942 DOI: 10.1111/j.1365-2249.2007.03416.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Prevention trials of type I diabetes are limited by recruitment of individuals at high risk of the disease. We investigated whether demographic and biological characteristics can identify rapid progressors among first-degree relatives of known patients at intermediate (< 10%) 5-year risk. Diabetes-associated antibodies, random proinsulin : C-peptide (PI/C) ratio and HLA DQ genotype were determined (repeatedly) in 258 islet antibody-positive IA-2Antibody-negative (Abpos/IA-2Aneg) normoglycaemic first-degree relatives. During follow-up (median 81 months), 14 of 258 Abpos/IA-2Aneg relatives developed type I diabetes; 13 (93%) of them had persistent antibodies conferring a 12% [95% confidence interval (CI): 5-19%] 5-year risk of diabetes. In Abpos/IA-2Aneg relatives with persistent antibodies (n = 126), the presence of >/= 1 HLA DQ susceptibility haplotype in the absence of a protective haplotype (P = 0.033) and appearance on follow-up of a high PI/C ratio (P = 0.007) or IA-2A-positivity (P = 0.009) were identified as independent predictors of diabetes. In persistently antibody-positive relatives with HLA DQ risk a recurrently high PI/C ratio or development of IA-2A identified a subgroup (n = 32) comprising 10 of 13 (77%) prediabetic relatives and conferred a 35% (95% CI: 18-53%) 5-year risk. Under age 15 years, 5-year progression (95% CI) was 57% (30-84%) and sensitivity 62%. In the absence of IA-2A, the combination of antibody persistence, HLA DQ risk and elevated PI/C ratio or later development of IA-2A and young age defines a subgroup of relatives with a high risk of type I diabetes (>/= 35% in 5 years). Together with initially IA-2A-positive relatives these individuals qualify for standardized beta cell function tests in view of prevention trials.
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Affiliation(s)
- I Truyen
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium
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De Nayer A, De Hert M, Scheen A, Van Gaal L, Peuskens J. Troubles métaboliques associés aux antipsychotiques atypiques : consensus belge sur la conduite à tenir. Encephale 2007; 33:197-202. [PMID: 17675915 DOI: 10.1016/s0013-7006(07)91550-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current literature supports that schizophrenia (and bipolar disorders) appear to be associated with a higher prevalence of type 2 diabetes. Because of the silent nature of diabetes mellitus, and the fact that schizophrenic patients are not screened comprehensively for the disease, the true prevalence of hyperglycemia and diabetes may be substantially underestimated. Notably, it has been suggested that schizophrenia as such carries an increased risk, as certain characteristics of schizophrenic patients such as unhealthy life style promote the diabetes risk. LITERATURE FINDINGS This risk may be increased by antipsychotic drug treatment, as was already suggested for first-generation antipsychotics (FGA). The amount of literature on the association of SGA and metabolic disorders is much larger however, although well-controlled prospective data are sparse. Reports comprise abnormal glucose regulation, exacerbation of existing type 1 and 2 diabetes, new-onset pseudo-type 1 or type 2 diabetes, diabetic ketoacidosis, coma and death. In large-scale studies (mostly retrospective), reviews and meta-analyses, the association was not found for all drugs. NEW DATA According to recent reviews, the risk of developing diabetes was highest for clozapine and olanzapine, followed by quetiapine and risperidone. The hierarchy of liability of weight gain, or differential effects on insulin resistance was also in the described order. Apart from disturbances in glucose metabolism, further frequent metabolic abnormalities in schizophrenic patients on SGA include features of the metabolic syndrome. Antipsychotics such as clozapine and olanzapine have also been associated with hypertriglyceridemia, while agents such as haloperidol, risperidone and ziprasidone were associated with reductions in plasma triglycerides. Amisulpride, aripiprazole and ziprasidone seem to carry the lowest risk for weight gain, diabetes and effects on insulin resistance. CONCLUSION As a consequence, there is a shift in attention toward physical health monitoring in patients with mental health disorders. The APA and ADA as well a British working group have recently published the findings on SGA and metabolic abnormalities in a joint statement (table I).
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Affiliation(s)
- A De Nayer
- Hôpital Sainte-Thérèse, B-6061 Montignies-sur-Sambres
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Verhulst SL, Schrauwen N, Haentjens D, Van Gaal L, De Backer WA, Desager KN. Reference values for sleep-related respiratory variables in asymptomatic European children and adolescents. Pediatr Pulmonol 2007; 42:159-67. [PMID: 17186545 DOI: 10.1002/ppul.20551] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM Only a limited number of studies, designed to establish normal values for sleep-related respiratory variables in children, have been reported, and all are non-European. The aim of this study was to expand the knowledge on normative data in children. METHODS Subjects ranging from 6 to 16 years were recruited and underwent full polysomnography. Only subjects without sleep disordered breathing or other sleep problems as assessed by clinical history were included. RESULTS Sixty subjects were studied (<age> = 11.7 +/- 2.6 years; 28 boys; <relBMI> = 118.8 +/- 30.6%). <Central apnea index> was 0.85 +/- 1.06 (range: 0.0-5.5). <Obstructive apnea index> was 0.06 +/- 0.16 (range: 0.0-0.9); 11 patients had a total of 31 obstructive apneas. Only five obstructive hypopneas were detected with <obstructive apnea hypopnea index> = 0.08 +/- 0.17 (range: 0.0-0.9). <Respiratory disturbance index> was 1.98 +/- 1.39 (range: 0.1-7.2). <SaO2> was 97.0 +/- 0.6% (range: 96.0-98.0); <SaO2nadir> was 91.8 +/- 2.7% (range: 82.0-96.0); <% of total sleep time with SaO2 >or= 95%> was 98.7 +/- 2.1% (range: 90.8-100.0); <oxygen desaturation index> was 0.8 +/- 0.9 (range: 0.0-4.9) and <arousal index> was 6.1 +/- 1.8 (range: 2.7-10.9). Snoring was detected in 15 patients (4 overweight subjects), with no difference in patient characteristics and sleep-related respiratory variables between snorers and non-snorers. Subjects in the overweight group (n = 22) had a lower SaO2nadir (90.8 +/- 2.7 vs. 92.4 +/- 2.6; P = 0.01) and a higher ODI (1.3 +/- 1.3 vs. 0.4 +/- 0.4; P = 0.0002) than their normal weight peers. CONCLUSION Our data are in agreement with other non-European studies, designed to establish normal values in children.
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Affiliation(s)
- S L Verhulst
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
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Beckers S, Mertens I, Peeters A, Van Gaal L, Van Hul W. Screening for melanocortin-4 receptor mutations in a cohort of Belgian morbidly obese adults and children. Int J Obes (Lond) 2006; 30:221-5. [PMID: 16231025 DOI: 10.1038/sj.ijo.0803126] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate whether pathogenic melanocortin-4 receptor (MC4R) mutations are a common cause of obesity in Belgium. DESIGN Cross-sectional mutation analysis. SUBJECTS In total, 95 morbidly obese adults (mean age 44.02+/-11.35 years; mean BMI 47.87+/-4.17 kg/m2 and 123 obese children and adolescents were screened for mutations in MC4R (mean age 16.56+/-2.58 years; BMI>95th percentile for age and sex; mean % overweight 170.86 +/- 23.63). MEASUREMENTS A series of anthropometric (e.g. weight, height, waist, hip), biochemical and clinical measurements were performed on all subjects. The entire coding region of MC4R was screened using DHPLC, a highly sensitive and specific method for mutation analysis. Direct sequencing was performed when the chromatogram deviated from the WT pattern. RESULTS Mutation screening of a cohort of Belgian obese adults and children did not detect any pathogenic mutations as only the previously described polymorphisms Val103Ile, Thr112Met and Ile251Leu were detected. CONCLUSION Pathogenic mutations in MC4R are not a common cause of obesity in a Belgian population of obese adults, children and adolescents.
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Affiliation(s)
- S Beckers
- Department of Medical Genetics, University and University Hospital Antwerp, Wilrijk, Belgium
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Weets I, Truyen I, Verschraegen I, Van der Auwera B, De Schepper J, Dorchy H, Lebrethon MC, Van Gaal L, Van Rooy P, Pipeleers DG, Gorus FK. Sex- and season-dependent differences in C-peptide levels at diagnosis of immune-mediated type 1 diabetes. Diabetologia 2006; 49:1158-62. [PMID: 16570164 DOI: 10.1007/s00125-006-0191-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 12/14/2005] [Indexed: 01/15/2023]
Abstract
AIMS/HYPOTHESIS The incidence of type 1 diabetes varies according to age, sex and season of diagnosis. We investigated whether these and other clinical, biological and anthropometric parameters were correlated with residual beta cell function in newly diagnosed patients, since it is possible that the nature of external and/or genetic disease accelerators may be (partly) reflected in the inaugural disease presentation. MATERIALS AND METHODS The correlates of random C-peptide levels sampled shortly after diagnosis (median [interquartile range]: 3 [0-14] days) were studied by multivariate analysis in 1,883 islet-antibody-positive diabetic patients aged <40 years who were diagnosed between 1989 and 2000. RESULTS Higher C-peptide levels (above percentile 50 of patients) were associated with older age at diagnosis, female sex, diagnosis in the high-incidence season (October to March), less-decreased BMI (expressed as a standard deviation score), lower insulin requirements after stabilisation, lower prevalence of ketonuria and a less-increased glycaemia at diagnosis (all p < 0.001). C-peptide levels were not correlated with calendar year at diagnosis, duration of symptoms prior to diagnosis, HLA-DQ2/DQ8 genotype or islet antibody status. CONCLUSIONS/INTERPRETATION Sex- and season-dependent differences in residual functional beta cell mass and/or insulin resistance have been identified at diagnosis of type 1 diabetes. They may reflect differences in disease-precipitating external or lifestyle factors and should be further investigated longitudinally in prediabetes to further identify putative aetiological factors, which may provide targets for prevention.
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Affiliation(s)
- I Weets
- Diabetes Research Centre, Brussels Free University, Laarbeeklaan 103, 1090 Brussels, Belgium.
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Després J, Van Gaal L, Scheen A, Pi-Sunyer F. We-W42:3 Rimonabant improves cardiometabolic risk factors in overweight/obese patients irrespective of treatment with statins: Pooled data from the RIO program. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81311-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wittchen HU, Pieper L, Haffner S, Balkau B, Després JP, Van Gaal L. Die IDEA (International Day for the Evaluation of Abdominal obesity) Studie: Weltweite Prävalenz der abdominellen Fettleibigkeit und ihr Status als kardio-metabolischer Marker. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Toplak H, Ziegler O, Keller U, Hamann A, Godin C, Wittert G, Zanella MT, Zúñiga-Guajardo S, Van Gaal L. X-PERT: weight reduction with orlistat in obese subjects receiving a mildly or moderately reduced-energy diet: early response to treatment predicts weight maintenance. Diabetes Obes Metab 2005; 7:699-708. [PMID: 16219013 DOI: 10.1111/j.1463-1326.2005.00483.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the effect of two different levels of energy deficit on weight loss in obese patients treated with orlistat. METHODS Patients (n=430) were randomized in a 1-year, multicentre, open-label, parallel group study conducted at 23 hospital centres and university medical departments worldwide. Obese outpatients (body mass index 30--43 kg/m(2)) aged 18--70 years with a body weight of >or=90 kg and a waist circumference of >or=88 cm (women) or >or=102 cm (men) were treated with orlistat 120 mg three times daily plus a diet that provided an energy deficit of either 500 or 1,000 kcal/day for 1 year. Orlistat treatment was discontinued in patients who did not achieve >or=5% weight loss after assessment at 3 and 6 months. The primary outcome measure was change in body weight from baseline at week 52. RESULTS Reported mean difference in energy intake between the two groups (500-1,000 kcal/day deficit) at weeks 24 and 52 was actually 111 and 95 kcal/day respectively. Of the 430 patients involved in the study, 295 achieved >or=5% weight loss at both 3 and 6 months. In this population, at week 52, weight loss from baseline was similar for patients randomized to either the 500 or the 1,000 kcal/day deficit diet (-11.4 kg vs. -11.8 kg, respectively; p=0.778). After 12 months of treatment with orlistat, 84% (n=118/141) and 85% (n=131/154) of patients in the 500 and 1,000 kcal/day deficit groups, respectively, achieved >or=5% weight loss, and 50% (n=70/141) and 53% (n=82/154) of patients, respectively, achieved >or=10% weight loss. Patients in both the diet treatment groups showed similar significant improvements in blood pressure, lipid levels and waist circumference at week 52. CONCLUSIONS Treatment with orlistat was associated with a clinically beneficial weight loss, irrespective of the prescribed dietary energy restriction (-500 or -1000 kcal/day). Patients who achieved >or=5% weight loss at 3 months achieved long-term, clinically beneficial weight loss with orlistat plus either diet. Therefore, identifying patients who lose at least 5% weight after 3 months and who maintain this weight loss up to 6 months is a valuable treatment algorithm to select patients who will benefit most from orlistat treatment in combination with diet.
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Affiliation(s)
- H Toplak
- Department of Medicine, Medical University, Graz, Austria.
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Engelen W, Manuel-y-Keenoy B, Vertommen J, De Leeuw I, Van Gaal L. Effects of micronized fenofibrate and vitamin E on in vitro oxidation of lipoproteins in patients with type 1 diabetes mellitus. Diabetes Metab 2005; 31:197-204. [PMID: 15959426 DOI: 10.1016/s1262-3636(07)70186-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary objective was to compare the antioxidant activity of micronised fenofibrate 200 mg to 400 IU of vitamin E and placebo, on the LDL and VLDL particles of patients with type 1 diabetes. The secondary objective was to investigate the possible synergy between micronized fenofibrate and vitamin E and to compare the efficacy of these treatments on lipids. METHODS A double-blind, placebo-controlled trial in which patients were randomised into three treatment groups after a wash-out period of 8 weeks: the placebo group (Pla/Pla-group) in which patients received placebo during two consecutive periods of 8 weeks, the vitamin E group (Vit E/Vit E-group) in which patients received Vitamin E during two consecutive periods, and the fenofibrate/Vitamin E group (Fen/Fen + Vit E-group) in which patients received fenofibrate during the first period, followed by fenofibrate and vitamin E during the consecutive period. Blood samples taken at each visit, were analysed for routine biochemistry, blood lipids and copper mediated lipid peroxidation in vitro. RESULTS The lag time of the non-HDL lipoprotein oxidation increased in the group given fenofibrate. The lag-time increased further when fenofibrate and vitamin E were given in association. (This reached significance in the intention-to-treat population, P = 0.034). The AUC of TBARS formation in the Vit E/Vit E group decreased after the first period, but this effect was not enhanced by continuing vitamin E for another 8 weeks. The AUC of TBARS formation did not change significantly after the administration of fenofibrate. Only after the second period, when vit E was given in association, the AUC of TBARS formation decreased significantly (P = 0.004). Fenofibrate caused a significant decrease in total and LDL-cholesterol and triglycerides (P < 0.05). In contrast, vitamin E had no effect on lipids. CONCLUSIONS The combination of micronized fenofibrate 200 mg/day and vitamin E 400 IU/day tended to increase the resistance of non-HDL lipoproteins to copper-mediated oxidation, shown by a prolongation of the lag-time. Vitamin E administration only, decreased the oxidation of non-HDL lipoproteins shown by a reduction of TBARS formation. This protective effect of vitamin E tended to be amplified by micronized fenofibrate.
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Affiliation(s)
- W Engelen
- Department of Diabetology, Metabolism and Clinical Nutrition, Faculty of Medicine, University Hospital of Antwerp, UZA, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium
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De Nayer A, De Hert M, Scheen A, Van Gaal L, Peuskens J, On Behalf Of The Consensus Group, De Nayer A, De Hert M, Scheen A, Van Gaal L, Peuskens J, On Behalf Of The Consensus Group. Belgian consensus on metabolic problems associated with atypical antipsychotics. Int J Psychiatry Clin Pract 2005; 9:130-7. [PMID: 24930795 DOI: 10.1080/13651500510018310] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A workshop was convened by a panel of psychiatrists, diabetologists and pharmacists from major Belgian hospitals to review the latest information relating to the risks with second-generation antipsychotics (SGA) for the development of metabolic disorders, especially impaired glucose tolerance, diabetes mellitus and dyslipidemia. The panelists sought to formulate recommendations for practising psychiatrists when initiating and maintaining therapy with SGA, and for the switch of SGA or initiation of further treatment if metabolic complications occur. In addition, recommendations for counselling of the patient and for the cooperation between the psychiatrist and the general physician or diabetologist, respectively, were provided.
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Affiliation(s)
- A De Nayer
- Hôpital Sainte-Thérèse, Montignie sur Sambre, Belgium
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Wilding J, Van Gaal L, Rissanen A, Vercruysse F, Fitchet M. A randomized double-blind placebo-controlled study of the long-term efficacy and safety of topiramate in the treatment of obese subjects. Int J Obes (Lond) 2004; 28:1399-410. [PMID: 15486569 DOI: 10.1038/sj.ijo.0802783] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treatment of obese subjects with topiramate has recently been associated with significant weight loss in a 6-month dose-ranging study. OBJECTIVE To investigate the long-term efficacy and safety of topiramate in obese subjects. DESIGN Randomised, double-blind, placebo-controlled study investigating three doses of topiramate: 96, 192, and 256 mg/day. All subjects also participated in a nonpharmacological weight-loss programme. SUBJECTS The study included 1289 subjects 18-75 y with a body mass index >/=30 kg/m(2) and <50 kg/m(2) in the absence of comorbidities, or >/=27 kg/m(2) and <50 kg/m(2) in the presence of controlled hypertension and/or dyslipidaemia. DURATION The original study design was for a 6-week, single-blind, placebo run-in phase followed by an 8-week titration phase and 2 y of maintenance at the assigned dose. Sponsor ended study early in order to develop a new controlled-release formulation with the potential to enhance tolerability and simplify dosing in this patient population. Therefore, none of the subjects completed the full 2 y of treatment. Efficacy results are based on subjects who were enrolled early enough to have had an opportunity to complete 1 y at their assigned dose (modified intent-to-treat population, MITT) before learning of the decision to terminate the study. Safety results are based on all subjects who took at least one dose of study medication. RESULTS The safety population consisted of 1282 subjects, and the MITT efficacy population was 854 subjects. At 60 weeks, subjects in the placebo group lost 1.7% of their baseline body weight, while subjects in the topiramate 96, 192, and 256 mg/day treatment groups lost 7.0, 9.1, and 9.7%, respectively (P<0.001, MITT, last observation carried forward). Weight loss >/=5% of baseline weight was achieved by 18% of subjects in the placebo arm vs 54, 61, and 67% of subjects receiving topiramate 96, 192, and 256 mg/day, respectively; weight loss >/=10% was achieved by 6 vs 29, 40, and 44%, respectively (P<0.001). Weight loss was accompanied by significant improvements in blood pressure (systolic/diastolic changes of +0.4/+1.0, -3.1/-1.3, -5.7/-3.4, and -4.6/-2.4 mmHg were observed for placebo, topiramate 96 mg/day, 192 mg/day, and 256 mg/day, respectively, P<0.001) and glucose and insulin. The most common adverse events more frequently observed in topiramate-treated subjects occurred mostly during the titration phase and were related to the central or peripheral nervous system and included paresthesia, difficulty with concentration/attention, depression, difficulty with memory, language problems, nervousness, and psychomotor slowing. CONCLUSION Topiramate treatment of obese subjects over the course of 1 y resulted in clinically significant weight loss. Improvements were also observed in blood pressure and glucose tolerance.
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Affiliation(s)
- J Wilding
- Diabetes and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
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