RESUMO
AIMS: To examine longitudinal and dose-d ependent associations between dietary fiber intake and various clinical outcomes over 48 weeks of pharmacological treatment in T2DM patients. METHODS: In this secondary analysis, we used data from the MARCH trial, which was designed to compare the efficacy of acarbose or metformin monotherapy as the initial therapy in Chinese patients newly diagnosed with T2DM. Dietary data were obtained using a 24-h dietary recall method to evaluate the intakes of dietary fiber from different sources as well as the carbohydrate-to-fiber ratio. RESULTS: A total of 551 newly-diagnosed patients with T2DM complete dietary records (286 in the acarbose group and 265 in the metformin group) were included. Higher intake of total fiber and whole grain fiber was positively associated with better ß-cell function, insulin sensitivity and postprandial glycemic control under acarbose treatment. Higher intake of legume fiber was associated with better glycemic control under both acarbose and metformin treatment but with better weight loss only under metformin treatment. A high-carbohydrate-low-fiber diet was associated with worse glycemic control and lower HDL-C under acarbose treatment but with higher insulin sensitivity and better weight loss under metformin treatment. CONCLUSIONS: The notable effects of various dietary fibers when combined with different oral glucose-lowering medications should be considered to maximize therapeutic benefit.
Assuntos
Acarbose , Glicemia , Fatores de Risco Cardiometabólico , Diabetes Mellitus Tipo 2 , Fibras na Dieta , Hipoglicemiantes , Metformina , Redução de Peso , Humanos , Acarbose/uso terapêutico , Fibras na Dieta/administração & dosagem , Fibras na Dieta/uso terapêutico , Metformina/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Redução de Peso/efeitos dos fármacos , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/sangue , Glicemia/análise , Glicemia/metabolismo , Estudos Longitudinais , Resistência à Insulina , Idoso , Controle Glicêmico/métodos , Adulto , ChinaRESUMO
Objective: Circulating microRNAs show cross-sectional associations with overweight and obesity. Few studies provided data to differentiate between a snapshot perspective on these associations versus how microRNAs characterize prodromal risk from disease pathology and complications. This study assessed longitudinal relationships between circulating microRNAs and weight at multiple time-points in the Diabetes Prevention Program trial. Research design and methods: A subset of participants (n=150) from the Diabetes Prevention Program were included. MicroRNAs were measured from banked plasma using a Fireplex Assay. We used generalized linear mixed models to evaluate relationships between microRNAs and changes in weight at baseline, year-1, and year-2. Logistic regression was used to evaluate whether microRNAs at baseline were associated with weight change after 2 years. Results: In fully adjusted models that included relevant covariates, seven miRs (i.e., miR-126, miR-15a, miR-192, miR-23a, and miR-27a) were statistically associated with weight over 2 years. MiR-197 and miR-320a remained significant after adjustment for multiple comparisons. Baseline levels of let-7f, miR-17, and miR-320c were significantly associated with 3% weight loss after 2 years in fully adjusted models. Discussion: This study provided evidence for longitudinal relationships between circulating microRNAs and weight. Because microRNAs characterize the combined effects of genetic determinants and responses to behavioral determinants, they may provide insights about the etiology of overweight and obesity in the context or risk for common, complex diseases. Additional studies are needed to validate the potential genes and biological pathways that might be targeted by these microRNA biomarkers and have mechanistic implications for weight loss and disease prevention.
Assuntos
Diabetes Mellitus Tipo 2 , MicroRNAs , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Longitudinais , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/genética , MicroRNAs/sangue , MicroRNAs/genética , Adulto , Obesidade/genética , Biomarcadores/sangue , Peso Corporal , Sobrepeso/genética , MicroRNA Circulante/sangue , Estudos Transversais , Redução de Peso/genéticaRESUMO
OBJECTIVES: The objective of this study was to evaluate the effectiveness of the combined use of empagliflozin (EMPA) and topiramate (TPM) versus a placebo in overweight/obese individuals without diabetes on a calorie-restricted diet. METHODS: In this study, 44 non-diabetic and overweight/obese subjects who were on a calorie restricted diet were randomly assigned into 2 groups: (1) Participants received a 10 mg EMPA tablet daily plus TPM tablet (at the 1st week 25 mg once a day and from the second week 25 mg twice a day); (2) Participants received an empagliflozin placebo (daily) plus a topiramate placebo (as mentioned for topiramate tablet in group 1), for 12 weeks. At baseline and weeks 4, 8, 12, weight, height, body mass index (BMI), waist circumference (WC), and body composition were evaluated. Before and after the intervention, blood pressure, C reactive protein, and glucose and lipid profile parameters were measured. RESULTS: The EMPA/TPM group, compared to placebo, had a greater percent change of weight at week 12 (- 8.92 ± 1.80 vs. - 4.93 ± 1.17). The intervention group had a greater percent change of fat mass and fat percent at week 12 (P < 0.05). However, there was no difference in the percent of change in fat-free percent between the two groups at week 12 (P = 0.577). Within-group analysis found a significant reduction in SBP, DBP, FBS, insulin, HOMA-IR, TC, LDL, HDL, TG, and CRP in both groups (P < 0.05). At week 12, no statistically significant difference was observed between the two groups in any of mentioned variables (P > 0.05). CONCLUSION: In non-diabetic overweight/obese individuals, the combination of EMPA/TPM and calorie restriction led to a notable decrease in body weight and was generally well-tolerated. Further research is required to evaluate the potential advantages of utilizing this combination for sustained weight management in the long run. LEVEL I: Randomized clinical trial.
Assuntos
Compostos Benzidrílicos , Restrição Calórica , Glucosídeos , Obesidade , Sobrepeso , Topiramato , Humanos , Compostos Benzidrílicos/uso terapêutico , Glucosídeos/uso terapêutico , Masculino , Feminino , Adulto , Obesidade/tratamento farmacológico , Obesidade/dietoterapia , Obesidade/complicações , Sobrepeso/tratamento farmacológico , Sobrepeso/dietoterapia , Topiramato/uso terapêutico , Pessoa de Meia-Idade , Índice de Massa Corporal , Glicemia/metabolismo , Glicemia/efeitos dos fármacos , Quimioterapia Combinada , Método Duplo-Cego , Fármacos Antiobesidade/uso terapêutico , Composição Corporal/efeitos dos fármacos , Circunferência da Cintura/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Resultado do Tratamento , Redução de Peso/efeitos dos fármacos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêuticoRESUMO
PURPOSE: Parental or spousal cohabitating relationships are often targeted in behavioral interventions, but the contribution of cohabitation is poorly understood. This study explored whether cohabitation status moderated the impact of social cognitive theory constructs on adiposity, diet, and exercise in a dyadic, web-based weight loss intervention among cancer survivors and their chosen partners. METHODS: The 24-week weight loss intervention was conducted among 56 dyads, comprised of a cancer survivor and their chosen partner (n = 112). Baseline and 6-month data on social cognitive theory constructs (self-efficacy, social support, and perceived barriers), and study outcomes of adiposity (weight and waist circumference), diet (calories and diet quality), and moderate-to-vigorous physical activity (MVPA) were used to perform moderated-mediation analyses among cohabitating (n = 25) versus non-cohabitating (n = 31) dyads. RESULTS: The intervention was positively associated with dietary social support (path a1: 0.36, 95% CI [0.083, 0.659]) and inversely associated with perceived dietary barriers (path a1: - 10.57, 95% CI [- 19.109, - 3.091]) and perceived exercise barriers (path a1: - 11.29, 95% CI [- 22.098, - 3.500]) among those who did not cohabitate (effects not observed among cohabitating pairs). The intervention's mediating effects through perceived barriers on weight (indirect effect (ab): - 2.21, 95% CI [- 4.794, - 0.548]), waist circumference (ab: - 1.13, 95% CI [- 2.452, - 0.171]), caloric intake (ab: - 5.09 (2.86), 95% CI [- 12.602, - 0.709]), and self-reported MVPA (ab: 0.29 (0.18), 95% CI [0.019, 0.754]) also were stronger among non-cohabitating pairs. CONCLUSIONS: These findings suggest that social support partners outside the home substantially enhance intervention impact, though relationship quality and gender dynamics warrant further exploration. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04132219.
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Sobreviventes de Câncer , Exercício Físico , Apoio Social , Cônjuges , Redução de Peso , Humanos , Masculino , Sobreviventes de Câncer/psicologia , Feminino , Exercício Físico/psicologia , Exercício Físico/fisiologia , Pessoa de Meia-Idade , Cônjuges/psicologia , Dieta Saudável/métodos , Idoso , Adulto , Autoeficácia , Neoplasias/psicologiaRESUMO
BACKGROUND: Green tea (GT) is a common component of supplements known as fat burners. It has gained popularity as an ergogenic aid for weight reduction to assist with obesity management. This systematic review and meta-analysis aim to explore the effect of green tea ingestion coupled with exercise training (EX) on body composition and lipid profile in overweight and obese individuals. METHODS: Two independent researchers systematically searched the electronic databases of PubMed, Web of Science, and Scopus. Studies with a randomized-controlled design to compare the effect of green tea in conjunction with exercise training (EX+GT) versus exercise training alone (EX+P) in overweight or obese participants were included. RESULTS: Of the 1,015 retrieved studies, 24 were identified to undergo full-text review, out of which 10 randomized trials met the inclusion criteria. EX+GT versus EX+P had a small and consistent effect on weight [Standardized mean difference (SMD) = -0.30, CI: -0.53 to -0.07], BMI [SMD = -0.33 CI: -0.64 to -0.02] and fat reduction [SMD = -0.29, CI: -0.57 to -0.01] and there was no evidence of heterogeneity across the trials. When compared to EX+P, EX+GT had no greater effect on lipid profile improvement [triglyceride: SMD = -0.92, CI: -1.30 to 0.49; LDL: SMD = -1.44, CI: -0.73 to 0.82; HDL: SMD = 0.56, CI -0.71 to 0.46; and total cholesterol SMD = -0.54, CI -0.85 to 0.13]. CONCLUSIONS: Current evidence suggests that green tea could have quite minimal additive benefit over exercise-induced weight loss. However, incorporation of green tea into exercise training does not seem to exert additional benefits on lipid profile and it warrants further investigations in the future.
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Catequina , Obesidade , Sobrepeso , Ensaios Clínicos Controlados Aleatórios como Assunto , Chá , Redução de Peso , Humanos , Obesidade/terapia , Catequina/administração & dosagem , Catequina/farmacologia , Sobrepeso/terapia , Composição Corporal , Exercício Físico/fisiologia , Lipídeos/sangueRESUMO
OBJECTIVES: Adults with intellectual disabilities will frequently experience sedentary behavior and excessive weight, which may cause or exacerbate a multitude of medical and behavioral problems. This study examined a program to encourage increased activity and weight loss in an outpatient service for adults with intellectual disabilities. METHODS: Behavioral methods were used to treat obesity in 33 male and 21 female adults with intellectual disabilities for a mean of 9 months. They were retrospectively analyzed to determine the effects of treatment on muscle and adiposity using body composition analysis. RESULTS: The 54 participants of the original 122 (44.3%) who did not drop out were divided into three groups: weight loss ≥3 kg/3% (n = 20, 37%), weight loss <3 kg/3% (n = 17, 31.5%), and no weight loss or weight gain (n = 17, 31.5%). Only men and women who lost ≥3 kg/3%, demonstrated significant gain of relative muscle mass. Those who gained weight lost muscle mass. CONCLUSIONS: If motivation remains high and follow-up is reasonably long, then a multicomponent obesity treatment program can lead to significant weight loss with preservation of muscle in adults with intellectual disabilities.
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Deficiência Intelectual , Obesidade , Redução de Peso , Humanos , Masculino , Feminino , Adulto , Obesidade/terapia , Obesidade/complicações , Estudos Retrospectivos , Deficiência Intelectual/complicações , Deficiência Intelectual/terapia , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Composição CorporalAssuntos
Fármacos Antiobesidade , Receptor do Peptídeo Semelhante ao Glucagon 1 , Obesidade , Sobrepeso , Fentermina , Topiramato , Redução de Peso , Humanos , Fentermina/administração & dosagem , Fentermina/efeitos adversos , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Redução de Peso/efeitos dos fármacos , Sobrepeso/complicações , Obesidade/tratamento farmacológico , Obesidade/complicações , Fármacos Antiobesidade/administração & dosagem , Fármacos Antiobesidade/efeitos adversos , Topiramato/administração & dosagem , Adulto , Combinação de Medicamentos , Agonistas do Receptor do Peptídeo 1 Semelhante ao GlucagonRESUMO
Liraglutide, a glucagon-like peptide-1 (GLP-1) analog, is approved for obesity treatment, but the specific neuronal sites that contribute to its therapeutic effects remain elusive. Here, we show that GLP-1 receptor-positive (GLP-1R-positive) neurons in the lateral septum (LSGLP-1R) play a critical role in mediating the anorectic and weight-loss effects of liraglutide. LSGLP-1R neurons were robustly activated by liraglutide, and chemogenetic activation of these neurons dramatically suppressed feeding. Targeted knockdown of GLP-1 receptors within the LS, but not in the hypothalamus, substantially attenuated liraglutide's ability to inhibit feeding and lower body weight. The activity of LSGLP-1R neurons rapidly decreased during naturalistic feeding episodes, while synaptic inactivation of LSGLP-1R neurons diminished the anorexic effects triggered by liraglutide. Together, these findings offer critical insights into the functional role of LSGLP-1R neurons in the physiological regulation of energy homeostasis and delineate their instrumental role in mediating the pharmacological efficacy of liraglutide.
Assuntos
Receptor do Peptídeo Semelhante ao Glucagon 1 , Liraglutida , Neurônios , Liraglutida/farmacologia , Animais , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Receptor do Peptídeo Semelhante ao Glucagon 1/genética , Camundongos , Neurônios/metabolismo , Neurônios/efeitos dos fármacos , Núcleos Septais/metabolismo , Núcleos Septais/efeitos dos fármacos , Masculino , Redução de Peso/efeitos dos fármacos , Depressores do Apetite/farmacologiaRESUMO
BACKGROUND: Cardiovascular disease represents a significant risk factor for mortality in individuals with type 2 diabetes mellitus (T2DM). High-density lipoprotein (HDL) is believed to play a crucial role in maintaining cardiovascular health through its multifaceted atheroprotective effects and its capacity to enhance glycemic control. The impact of dietary interventions and intermittent fasting (IF) on HDL functionality remains uncertain. The objective of this study was to assess the effects of dietary interventions and IF as a strategy to safely improve glycemic control and reduce body weight on functional parameters of HDL in individuals with T2DM. METHODS: Before the 12-week intervention, all participants (n = 41) of the INTERFAST-2 study were standardized to a uniform basal insulin regimen and randomized to an IF or non-IF group. Additionally, all participants were advised to adhere to dietary recommendations that promoted healthy eating patterns. The IF group (n = 19) followed an alternate-day fasting routine, reducing their calorie intake by 75% on fasting days. The participants' glucose levels were continuously monitored. Other parameters were measured following the intervention: Lipoprotein composition and subclass distribution were measured by nuclear magnetic resonance spectroscopy. HDL cholesterol efflux capacity, paraoxonase 1 (PON1) activity, lecithin cholesterol acyltransferase (LCAT) activity, and cholesterol ester transfer protein (CETP) activity were assessed using cell-based assays and commercially available kits. Apolipoprotein M (apoM) levels were determined by ELISA. RESULTS: Following the 12-week intervention, the IF regimen significantly elevated serum apoM levels (p = 0.0144), whereas no increase was observed in the non-IF group (p = 0.9801). ApoM levels correlated with weight loss and fasting glucose levels in the IF group. Both groups exhibited a robust enhancement in HDL cholesterol efflux capacity (p < 0.0001, p = 0.0006) after 12 weeks. Notably, only the non-IF group exhibited significantly elevated activity of PON1 (p = 0.0455) and LCAT (p = 0.0117) following the 12-week intervention. In contrast, the changes observed in the IF group did not reach statistical significance. CONCLUSIONS: A balanced diet combined with meticulous insulin management improves multiple metrics of HDL function. While additional IF increases apoM levels, it does not further enhance other aspects of HDL functionality. TRIAL REGISTRATION: The study was registered at the German Clinical Trial Register (DRKS) on 3 September 2019 under the number DRKS00018070.
Assuntos
Biomarcadores , Glicemia , Diabetes Mellitus Tipo 2 , Jejum , Obesidade , Fosfatidilcolina-Esterol O-Aciltransferase , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Jejum/sangue , Fosfatidilcolina-Esterol O-Aciltransferase/sangue , Resultado do Tratamento , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/dietoterapia , Obesidade/fisiopatologia , Obesidade/terapia , Glicemia/metabolismo , Fatores de Tempo , Biomarcadores/sangue , Restrição Calórica , Arildialquilfosfatase/sangue , HDL-Colesterol/sangue , Proteínas de Transferência de Ésteres de Colesterol/sangue , Redução de Peso , Idoso , Adulto , Dieta Saudável , Hipoglicemiantes/uso terapêutico , Insulina/sangue , Jejum IntermitenteRESUMO
ABSTRACT: Obesity and colorectal cancer are global public health issues, with the prevalence of both conditions increasing over the last 4 decades. In the United States alone, the prevalence of obesity is greater than 40%, and this percentage is projected to increase past 50% by 2030. This review focuses on understanding the association between obesity and the risk of colorectal cancer while also highlighting hypotheses about molecular mechanisms underlying the link between these disease processes. We also consider whether those linkages can be disrupted via weight loss therapies, including lifestyle modifications, pharmacotherapy, bariatric surgery, and endobariatrics.
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Neoplasias do Colo , Obesidade , Humanos , Obesidade/complicações , Obesidade/terapia , Neoplasias do Colo/etiologia , Neoplasias do Colo/prevenção & controle , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/terapia , Fatores de Risco , Cirurgia Bariátrica/métodos , Redução de Peso , Estilo de VidaRESUMO
PURPOSE: We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care. METHODS: This cluster-randomized controlled trial enrolled 19 primary care teams with 63 clinicians; 9 teams were randomized to GEM and 10 to enhanced usual care (EUC). The GEM intervention included 1 in-person and up to 12 telephone-delivered coaching sessions. Coaches supported goal setting and engagement with weight management programs, facilitated by a software tool. Patients in the EUC arm received educational handouts. We enrolled patients who spoke English or Spanish, were aged 18 to 69 years, and either were overweight (body mass index 25-29 kg/m2) with a weight-related comorbidity or had obesity (body mass index ≥30 kg/m2). The primary outcome (weight change at 12 months) and exploratory outcomes (eg, program attendance, diet, physical activity) were analyzed according to intention to treat. RESULTS: We enrolled 489 patients (220 in the GEM arm, 269 in the EUC arm). Their mean (SD) age was 49.8 (12.1) years; 44% were male, 41% Hispanic, and 44% non-Hispanic Black. At 12 months, the mean adjusted weight change (standard error) was -1.4 (0.8) kg in the GEM arm vs -0.8 (1.6) kg in the EUC arm, a nonsignificant difference (P = .48). There were no statistically significant differences in secondary outcomes. Exploratory analyses showed that the GEM arm had a greater change than the EUC arm in mean number of weekly minutes of moderate to vigorous physical activity other than walking, a finding that may warrant further exploration. CONCLUSIONS: The GEM intervention did not achieve clinically important weight loss in primary care. Although this was a negative study possibly affected by health system resource limitations and disruptions, its findings can guide the development of similar interventions. Future studies could explore the efficacy of higher-intensity interventions and interventions that include medication and bariatric surgery options, in addition to lifestyle modification.
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Tutoria , Obesidade , Atenção Primária à Saúde , Programas de Redução de Peso , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Tutoria/métodos , Obesidade/terapia , Programas de Redução de Peso/métodos , Idoso , Sobrepeso/terapia , Redução de Peso , Exercício Físico , Índice de Massa Corporal , AdolescenteRESUMO
Objective: To evaluate the 1-year postoperative efficacy and nutritional indicators of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in obese patients. Methods: This retrospective observational study included patients with a body mass index (BMI) of ≥40.0 kg/m2 regardless of other related metabolic diseases and patients with severe type 2 diabetes and a BMI between 27.5 and 40.0 kg/m2. The clinical data of 66 obese patients who underwent SADI-S at the Bariatric and Metabolic Surgery Department of China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were collected, including 53 cases of da Vinci robotic surgery and 13 cases of laparoscopic surgery. The patients comprised 38 men and 28 women with a median age of 35 (18-61) years and a mean preoperative BMI of 42.93 ± 6.82 kg/m2. A total of 38 patients had type 2 diabetes, and 46 had hyperuricemia, 45 had hypertension, 35 had hyperlipidemia, 12 had hypercholesterolemia, and 12 had a high low-density lipoprotein (LDL) level. The main observation indicators were (1) intraoperative and postoperative conditions; (2) weight loss outcomes, including body weight, BMI, excess body weight loss (%EWL), and total body weight loss (%TWL) at 3, 6, and 12 months after surgery; (3) effects of treatment on metabolic disease; and (4) changes in nutrient indicators. Results: (1) Intraoperative and postoperative conditions: All patients successfully underwent SADI-S with neither conversion to laparotomy nor death. Four (6.1%) patients developed postoperative complications, and all of them recovered and were discharged after conservative or surgical treatment. (2) Weight loss outcomes: %EWL at 3, 6, and 12 months after surgery was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65, respectively, and %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89, respectively. Body weight and BMI 3 to 12 months after surgery were significantly lower than those before surgery (all P < 0.001). (3) Effect of treatment on metabolic disease: 3 to 12 months after surgery, fasting blood sugar, HbA1c, uric acid, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL, and other indicators were significantly lower than those before surgery (all P < 0.05). Twelve months after surgery, the remission rates of diabetes, hyperuricemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and high LDL were 100% (38/38), 65.2% (30/46), 62.2% (28/45), 94.3% (33/35), 100% (12/12), and 100% (12/12), respectively. (4) Changes in nutrient indicators: Compared with the preoperative nutrient levels, the hemoglobin and hematocrit levels were lower at 3 to 12 months after surgery, the total protein level was lower at 6 to 12 months after surgery, the albumin level was lower at 6 months after surgery, and the ferritin level was lower at 3 months after surgery. The differences were statistically significant (all P < 0.05). The incidence of anemia was 6.1% (4/66), hypoalbuminemia was 4.5% (3/66), and ferritin deficiency was 4.5% (3/66), all of which were improved or normalized through conservative treatment. Twelve months after surgery, 30 (45.5%) patients had vitamin A deficiency, 17 (25.8%) had vitamin E deficiency, 11 (16.7%) had folic acid deficiency, 2 had potassium deficiency (3.0%), 3 (4.5%) had calcium deficiency, 2 (3.0%) had magnesium deficiency, 9 (13.6%) had iron deficiency, and 16 (24.2%) had zinc deficiency. However, no relevant clinical symptoms occurred. Conclusions: SADI-S has a very significant effect on weight loss and alleviation of metabolic diseases. Nutrient deficiencies after SADI-S mainly involve vitamin A, vitamin E, zinc, and folic acid. The long-term efficacy and safety of SADI-S still need further follow-up observation.
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Índice de Massa Corporal , Diabetes Mellitus Tipo 2 , Gastrectomia , Humanos , Masculino , Feminino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Gastrectomia/métodos , Diabetes Mellitus Tipo 2/cirurgia , Redução de Peso , Laparoscopia/métodos , Adulto Jovem , Duodeno/cirurgia , Íleo/cirurgia , Anastomose Cirúrgica/métodos , Adolescente , Resultado do Tratamento , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Estado NutricionalRESUMO
BACKGROUND: Weight misperceptions are common in children and adolescents, which is related to the engagement of weight loss behaviors. The aim of this study was to investigate the association between body weight perception and weight loss behaviors of lower-calorie diets and increased levels of physical activity (PA). METHODS: The Ningbo Youth Risk Behavior Survey was conducted from 2007 to 2022. A multistage, stratified cluster sampling procedure was utilized to draw target adolescents aged 12 to 18 years participating in each survey wave (2007, 2012, 2017, 2022). Data of anthropometry, weight perception, and weight loss behaviors were collected through self-administered questionnaires. A binary generalized linear model was used to examine associations between body weight perception and weight loss behaviors of lower calorie diets and increased levels of PA. RESULTS: The sample sizes for each survey wave were 777, 885, 1588 and 2638. The prevalence of overweight (OW)/obesity (OB), self-perception of OW/OB and overestimated perception increased from 7.6%, 27.0% and 29.1% in 2007 to 16.3%, 39.9% and 41.4% in 2022, respectively. Adolescents that perceived themselves as OW/OB had higher odds of lower-calorie diets (OR: 4.2, 3.3-5.4) and increased level of PA (OR: 3.8, 2.9-5.0), whereas adolescents that perceived themselves as underweight had lower odds of lower-calorie diets (OR: 0.371, 0.253-0.542) and increased levels of PA (OR: 0.381, 0.295-0.559). CONCLUSION: OW, self-perception of OW/OB and overestimated perception were prevalent in Chinese adolescents. Self-perception of OW/OB was positively associated with lower-calorie diets and increased levels of PA. The results can support public health specialists to promote health education of body perception and improve self-esteem in Chinese children and adolescents.
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Imagem Corporal , Redução de Peso , Humanos , Adolescente , Feminino , Masculino , China/epidemiologia , Criança , Imagem Corporal/psicologia , Exercício Físico/psicologia , Percepção de Peso , Obesidade Infantil/epidemiologia , Obesidade Infantil/psicologia , Autoimagem , Peso Corporal , Dieta Redutora/psicologia , Dieta Redutora/estatística & dados numéricos , Comportamento do Adolescente/psicologia , Inquéritos e Questionários , População do Leste AsiáticoRESUMO
BACKGROUND: Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers. OBJECTIVE: The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)-based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI's counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics. METHODS: NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI's fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants' general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants' confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI's usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview. RESULTS: NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025. CONCLUSIONS: If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/60361.
Assuntos
Aconselhamento , Estudos de Viabilidade , Entrevista Motivacional , Obesidade , Humanos , Aconselhamento/métodos , Entrevista Motivacional/métodos , Obesidade/terapia , Obesidade/psicologia , Adulto , Masculino , Feminino , Redução de Peso , Pessoa de Meia-Idade , Programas de Redução de Peso/métodosRESUMO
BACKGROUND: Weight recurrence, suboptimal clinical response and functional disorder (such as reflux) after a Sleeve Gastrectomy (SG) are problems that may require conversional surgery. For reflux, conversion to Roux-en-Y Gastric Bypass (RYGB) is considered effective. Regarding treatment for suboptimal clinical response, the technique of choice remains a subject of debate. This study aims to evaluate the safety and effectiveness of conversion from SG to Ring-augmented RYGB ( RaRYGB). METHODS: All laparoscopic SG to RaRYGB conversions performed between January 2016 and January 2022 were included. Primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of cumulative %TWL, complications (with a focus on ring-related complications), and resolution of medical-associated problems. RESULTS: We included 50 patients of whom 44 were female. Mean pre-conversion BMI was 37.6 kg/m2. All patients have reached the 1-year follow-up point, however 10 were lost to follow-up. After 1-year mean TWL was 17.8% while mean cumulative TWL, calculated from primary SG, was 32%. A total of 10 complications occurred in 8 patients within 30 days, 6 of which were ≤ CD3a and 4 ≥ CD3b. One MiniMizer was removed for complaints of severe dysphagia. Of the 35 medical-associated problems present at screening 5 remained unchanged(14.2%), 15 improved(42.9%) and 15 achieved remission(42.9%). CONCLUSION: Our series of 50 patients undergoing conversion from SG to RaRYGB is adequate and successful regarding additional weight loss 1 year after conversion, cumulative weight loss, complication rate and achievement of improvement or remission of medical-associated problems.
Assuntos
Gastrectomia , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Redução de Peso , Humanos , Feminino , Derivação Gástrica/métodos , Derivação Gástrica/efeitos adversos , Masculino , Gastrectomia/métodos , Gastrectomia/efeitos adversos , Adulto , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Seguimentos , Reoperação/estatística & dados numéricosRESUMO
The era of modern antiretroviral therapy (ART) has markedly improved health and survival among persons with human immunodeficiency virus (HIV) (PWH). In the pre-ART era, wasting was associated with HIV disease progression to acquired immunodeficiency syndrome and death. Effective ART has reduced the prevalence and incidence of this pre-ART form of HIV-associated wasting. However, a subgroup of ART-treated virally suppressed PWH continue to lose weight, often accompanied by aging-related comorbidities and/or functional deficits. For this subgroup of patients, the older definition of HIV-associated wasting (HIVAW) cannot and should not be applied. An expert panel comprising the authors of this white paper convened to review the existing definition of HIVAW and to create an updated definition that they termed HIV-associated weight loss, based on clinically defined parameters among contemporary PWH receiving ART. Here, clinical features and laboratory biomarkers associated with HIV-associated weight loss are reviewed and approaches to screening and treatment are considered. Available management approaches, including the use of current US Food and Drug Administration-approved medications for HIVAW and other available therapies are discussed. The expert panel also identified knowledge gaps and provided recommendations for clinicians, payers, and researchers.
Assuntos
Infecções por HIV , Redução de Peso , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Fármacos Anti-HIV/uso terapêutico , Síndrome de Emaciação por Infecção pelo HIV/tratamento farmacológico , ConsensoRESUMO
BACKGROUND: Most of the worldwide population is overweight and suffers from the resulting musculoskeletal comorbidities such as knee osteoarthritis or back pain. Practice guidelines recommend weight loss interventions for individuals suffering from these conditions. This systematic review investigated whether including a weight loss intervention in the musculoskeletal therapy of these individuals was cost-effective compared to administering the musculoskeletal therapy alone. METHODS: This study followed the PRISMA guidelines to systematically and independently search six databases and select full health economic evaluations published up to May 2024 from health care or societal perspectives according to predefined eligibility criteria. Cost data were standardised to 2023 Belgium Euros. The methodological quality was assessed using two health economic-specific checklists. RESULTS: The searches produced 5'305 references, of which 8 studies were selected for a total of 1'726 participants. The interventions consisted of different exercise plans and nutritional targets. Six values were in the north-eastern; leading to increased quality-adjusted life year (QALY) and higher costs; and two in the south-eastern quadrant of the cost-utility plane; leading to increased QALYs and lower costs. Two studies observed no differences in QALYs. Incremental cost utility ratios (ICUR) ranged from 13'580.10 to 34'412.40 per additional QALY from a healthcare perspective. From a societal perspective, the ICUR was 30'274.84. The included studies fulfilled 86 percent of the criteria in trial-based economic evaluations and 57 percent in model-based economic evaluations. The most common limitations of the studies were related to appropriate cost measures' specifications, research questions, time horizon choices, and sensitivity analyses. CONCLUSIONS: This systematic review showed weak but consistent evidence of cost-effectiveness for adding a weight loss intervention to musculoskeletal therapy for individuals with overweight, from either perspective. Further economic evaluations should evaluate the long-term cost-effectiveness of the intervention. TRIAL REGISTRATION: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY (2022,110,122).
Assuntos
Análise Custo-Benefício , Obesidade , Sobrepeso , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Obesidade/terapia , Obesidade/economia , Obesidade/diagnóstico , Sobrepeso/terapia , Sobrepeso/economia , Redução de Peso , Doenças Musculoesqueléticas/terapia , Doenças Musculoesqueléticas/economia , Doenças Musculoesqueléticas/diagnóstico , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Terapia por Exercício/economia , Terapia por Exercício/métodosRESUMO
Combining pharmacotherapy with lifestyle intervention is recommended for obese class II patients who fail lifestyle therapy and for obese class I patients. Diethylpropion, an obesity medication, has been approved for use in Indonesia, which is an Asia-Pacific country. This retrospective study aimed to assess the short-term effects of diethylpropion on weight and fat loss in obese patients in Indonesia. Secondary data were collected from 142 patients' medical records with a body mass indexâ ≥â 25â kg/m2 who underwent short-term diethylpropion treatment for 84 days between January 2022 and November 2023 at the Kimia Farma Nutrition Clinic in Bandung, Indonesia. Blood pressure, body weight, height, waist circumference, and body composition were assessed at each follow-up visit to determine the fat and muscle mass. Patients were prescribed diethylpropion 25â mg 3 times daily every 2 weeks together with dietary intervention. Kruskal-Wallis test was used to analyze the changes in body weight, skeletal muscle, fat mass, and waist circumference after the diethylpropion therapy. Mann-Whitney test was used for the relation between age, sex, and body mass index with weight loss on the last day of follow-up. Simple linear regression analysis was also performed to identify the correlation between weight loss and therapy duration. This study showed body weight reduction of up to 9.5â ±â 3â kg (10â ±â 0.0%) (Pâ =â .008) on 84 days of treatment. Significant fat loss 11.5â ±â 4.6â kg (20.5â ±â 0.0%) (Pâ =â .005) was also reported in our study without significant loss of muscle mass -2.4â ±â 4.6â kg (3.6â ±â 1.3%) (Pâ =â .58). Waist circumference was insignificantly reduced by 5.6â ±â 0.0â cm (4.9â ±â 2.8%) (Pâ =â .21) after 84 days of diethylpropion therapy. This study revealed no significant changes in patient systolic and diastolic pressures despite showing mild increases after 70 days. The combination of diethylpropion and an appropriate diet resulted in weight loss accompanied by significant fat loss and preserved muscle mass without an increase in blood pressure during the 12-week treatment period.
Assuntos
Obesidade , Redução de Peso , Humanos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Obesidade/dietoterapia , Obesidade/terapia , Pessoa de Meia-Idade , Índice de Massa Corporal , Indonésia , Circunferência da Cintura , Músculo Esquelético/efeitos dos fármacos , Composição Corporal , Terapia Combinada , Fármacos Antiobesidade/uso terapêutico , Peso CorporalRESUMO
Weight loss improves metabolic dysfunction-associated steatohepatitis (MASH). We investigated whether there were associated changes in intestinal permeability, short-chain fatty acids (SCFAs), and gut microbiota, which are implicated in the pathophysiology of MASH. Sixteen adults with MASH, moderate fibrosis, and obesity received a low-energy total diet replacement program for 12 weeks and stepped food re-introduction over the following 12 weeks (ISRCTN12900952). Intestinal permeability, fecal SCFAs, and fecal microbiota were assessed at 0, 12, and 24 weeks. Data were analyzed using mixed-effects linear regression and sparse partial least-squares regression. Fourteen participants completed the trial, lost 15% (95% CI: 11.2-18.6%) of their weight, and 93% had clinically relevant reductions in liver disease severity markers. Serum zonulin concentrations were reduced at both 12 and 24 weeks (152.0 ng/ml, 95% CI: 88.0-217.4, p < 0.001). Each percentage point of weight loss was associated with a 13.2 ng/mL (95% CI: 3.8-22.5, p < 0.001) reduction in zonulin. For every 10 ng/mL reduction in zonulin, there was a 6.8% (95% CI: 3.5%-10.2, p < 0.001) reduction in liver fat. There were reductions in SCFA and alpha diversity evenness as well as increases in beta diversity of the gut microbiota at 12 weeks, but the changes did not persist at 24 weeks. In conclusion, substantial dietary energy restriction is associated with significant improvement in MASH markers alongside reduction in intestinal permeability. Changes in gut microbiota and SCFA were not maintained with sustained reductions in weight and liver fat, suggesting that microbiome modulation may not explain the relationship between weight loss and improvements in MASH.
Assuntos
Fezes , Microbioma Gastrointestinal , Haptoglobinas , Cirrose Hepática , Permeabilidade , Redução de Peso , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Cirrose Hepática/microbiologia , Cirrose Hepática/metabolismo , Adulto , Haptoglobinas/metabolismo , Fezes/microbiologia , Fezes/química , Precursores de Proteínas/metabolismo , Precursores de Proteínas/sangue , Ácidos Graxos Voláteis/metabolismo , Obesidade/microbiologia , Obesidade/metabolismo , Obesidade/dietoterapia , Fígado Gorduroso/metabolismo , Fígado Gorduroso/microbiologia , Dieta Redutora , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiologia , Toxina da Cólera/metabolismo , Toxina da Cólera/sangue , Idoso , Função da Barreira IntestinalRESUMO
BACKGROUND: Previous research has suggested a correlation between postnatal maximum weight loss (MWL) and both neonatal mortality and morbidities in extremely preterm infants. However, the relationship between MWL and neurodevelopmental outcomes remains underexplored. METHODS: In a single-center, retrospective cohort study at Okayama Medical Center, we evaluated data from extremely preterm infants admitted to the neonatal intensive care unit from 2010 to 2020. Infants who died within the first 10 days of life were excluded. MWL in the first 10 days was the main exposure, categorized into three groups: >15%, 5-15%, and < 5%. The primary outcome evaluated was the occurrence of death or neurodevelopmental impairment (NDI) at age 3 years, defined as developmental impairments (developmental quotient [DQ] < 85), cerebral palsy, hearing impairments, or visual impairments. Data analysis involved robust Poisson regression, adjusted for perinatal confounders, with a restricted cubic spline function to examine the dose-response relationship. We also conducted a sensitivity analysis using a DQ of < 70 to define developmental impairment. RESULTS: Among 135 infants assessed for neurodevelopmental outcomes, 40 were in the > 15% MWL group, 71 in the 5-15% group, and 24 in the < 5% group. Median gestational ages and birth weights were 25.9 weeks and 821 g for > 15% MWL; 26.1 weeks and 818 g for 5-15% MWL; and 26.0 weeks and 734 g for < 5% MWL. Compared with the 5-15% MWL group, the < 5% group exhibited a higher risk of death or NDI at age 3 years (62.8% vs. 80.8%, risk ratio [RR] 1.36, 95% confidence interval [CI] 1.04-1.79) and NDI alone (59.2% vs. 79.2%, RR 1.43, 95% CI 1.06-1.94). Furthermore, higher risks of developmental impairment were also noted in the > 15% (RR 1.32, 95% CI 1.00-1.75) and < 5% (RR 1.46, 95% CI 1.08-1.98) groups. These associations were confirmed by spline analyses. In contrast, the associations between MWL and neurodevelopmental outcomes using a DQ of < 70 were not apparent. CONCLUSIONS: MWL within the first 10 days of life may be associated with increased risks of NDI and developmental impairments by age 3 years in extremely preterm infants.