RESUMEN
ABBREVIATIONS: PSMF = protein-sparing modified fast; VLCMP = very-low-calorie meal plans.
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Ingestión de Energía , Obesidad , Bariatria , EndocrinologíaRESUMEN
OBJECTIVE: Scarce data exist on pharmacotherapy for obesity in Hispanic individuals. This post hoc analysis of pooled data from 4 phase 3a trials compared the efficacy and safety of liraglutide 3.0 mg versus placebo, as adjunct to a reduced-calorie diet and physical activity, in Hispanic versus non-Hispanic subgroups. METHODS: We conducted the double-blind randomized, placebo-controlled trials in adults with a minimum body mass index (BMI) of 27 kg/m2 with at least 1 comorbidity, or a minimum BMI of 30 kg/m2, at clinical research sites worldwide. In this analysis, we investigated possible differences in treatment effects between 534 Hispanics (10.4% of the population) and 4,597 non-Hispanics (89.6%) through statistical tests of interaction between subgroups and treatment. Variables examined included mean and categorical weight change, cardiovascular risk markers, and safety data. RESULTS: Both subgroups achieved clinically significant mean weight loss at end-of-treatment with liraglutide 3.0 mg versus placebo: Hispanics 7.0% versus 1.5%, treatment difference -5.1% (95% CI, -6.2 to -4.0); non-Hispanics 7.5% versus 2.3%, -5.2% (95% CI, -5.5 to -4.8). More individuals in both subgroups lost ≥5%, >10%, and >15% of their baseline weight with liraglutide 3.0 mg than with placebo. Efficacy endpoints generally did not vary with ethnicity (P>.05). Adverse events were comparable between ethnic subgroups, with more gastrointestinal disorders reported with liraglutide 3.0 mg than placebo. CONCLUSION: Efficacy and safety were largely similar between Hispanic and non-Hispanic subgroups. Results support that liraglutide 3.0 mg, used with a reduced-calorie diet and physical activity, can facilitate weight loss in Hispanic individuals. ABBREVIATIONS: A1c = glycated hemoglobin BMI = body mass index CI = confidence interval FPG = fasting plasma glucose GLP-1 = glucagon-like peptide-1 hsCRP = high-sensitivity C-reactive protein SCALE = Satiety and Clinical Adiposity - Liraglutide Evidence in individuals with and without diabetes T2DM = type 2 diabetes mellitus.
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Hispánicos o Latinos , Hipoglucemiantes/farmacología , Liraglutida/farmacología , Evaluación de Resultado en la Atención de Salud , Sobrepeso/tratamiento farmacológico , Pérdida de Peso/efectos de los fármacos , Adulto , Comorbilidad , Método Doble Ciego , Femenino , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Liraglutida/administración & dosificación , Liraglutida/efectos adversos , Masculino , Persona de Mediana Edad , Obesidad/tratamiento farmacológico , Obesidad/etnología , Sobrepeso/etnología , Factores de RiesgoRESUMEN
ABBREVIATIONS: CKD = chronic kidney disease DM = diabetes mellitus eGFR = estimated glomerular filtration rate FDA = Food & Drug Administration.
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Tasa de Filtración Glomerular , Metformina/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Endocrinología , Humanos , Insuficiencia Renal Crónica/tratamiento farmacológicoAsunto(s)
Ingestión de Energía/fisiología , Promoción de la Salud/organización & administración , Actividad Motora/fisiología , Obesidad/epidemiología , Servicios de Salud Escolar/organización & administración , Servicios de Salud para Estudiantes/organización & administración , Femenino , Humanos , MasculinoRESUMEN
Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity), metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy), and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology-the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements.
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Enfermedades del Sistema Endocrino/tratamiento farmacológico , Enfermedades del Sistema Endocrino/prevención & control , Endocrinología/métodos , Enfermedades Metabólicas/tratamiento farmacológico , Enfermedades Metabólicas/prevención & control , Directrices para la Planificación en Salud , Humanos , Sociedades Médicas , Estados UnidosRESUMEN
The term "fat" may refer to lipids as well as the cells and tissue that store lipid (ie, adipocytes and adipose tissue). "Lipid" is derived from "lipos," which refers to animal fat or vegetable oil. Adiposity refers to body fat and is derived from "adipo," referring to fat. Adipocytes and adipose tissue store the greatest amount of body lipids, including triglycerides and free cholesterol. Adipocytes and adipose tissue are active from an endocrine and immune standpoint. Adipocyte hypertrophy and excessive adipose tissue accumulation can promote pathogenic adipocyte and adipose tissue effects (adiposopathy), resulting in abnormal levels of circulating lipids, with dyslipidemia being a major atherosclerotic coronary heart disease risk factor. It is therefore incumbent upon lipidologists to be among the most knowledgeable in the understanding of the relationship between excessive body fat and dyslipidemia. On September 16, 2012, the National Lipid Association held a Consensus Conference with the goal of better defining the effect of adiposity on lipoproteins, how the pathos of excessive body fat (adiposopathy) contributes to dyslipidemia, and how therapies such as appropriate nutrition, increased physical activity, weight-management drugs, and bariatric surgery might be expected to impact dyslipidemia. It is hoped that the information derived from these proceedings will promote a greater appreciation among clinicians of the impact of excess adiposity and its treatment on dyslipidemia and prompt more research on the effects of interventions for improving dyslipidemia and reducing cardiovascular disease risk in overweight and obese patients.
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Adiposidad/fisiología , Dislipidemias/fisiopatología , Obesidad/fisiopatología , Adiposidad/efectos de los fármacos , Conferencias de Consenso como Asunto , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Dislipidemias/sangre , Dislipidemias/tratamiento farmacológico , Humanos , Resistencia a la Insulina/fisiología , Obesidad/sangre , Obesidad/tratamiento farmacológico , Triglicéridos/sangreAsunto(s)
Atención Dental para Enfermos Crónicos , Diabetes Mellitus/terapia , Glucemia/análisis , Candidiasis Bucal/complicaciones , Atención Odontológica Integral , Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus/sangre , Diabetes Mellitus/prevención & control , Humanos , Educación del Paciente como Asunto , Enfermedades Periodontales/complicaciones , Enfermedades Periodontales/prevención & controlRESUMEN
Collaborations between physicians, particularly those in academic medicine, and industries that develop pharmaceutical products, medical devices, and diagnostic tests have led to substantial advances in patient care. At the same time, there is a strong awareness that these relationships, however beneficial they may be, should conform to established principles of ethical professional practice. Through a writing committee drawn from diverse disciplines across several institutions, the Association of Clinical Researchers and Educators (ACRE) has written a code of conduct to provide guidance to physicians in observing these principles. Our recommendations are not intended to be prescriptive or inflexible, but rather to be of assistance to physicians in making their own personal decisions on whether, or how, to be involved in research, education, or other collaborations with industry.
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Ética Profesional , Sector de Atención de Salud/ética , Relaciones Interprofesionales/ética , Médicos/ética , Códigos de Ética , Educación Médica Continua/ética , Humanos , Edición/ética , Investigadores/éticaRESUMEN
BACKGROUND: Glucagon like peptide-1 (GLP-1) receptor agonist treatment may improve endothelial function via direct and indirect mechanisms. We compared the acute and chronic effects of the GLP-1 receptor agonist exenatide vs. metformin on endothelial function in patients with obesity and pre-diabetes. METHODS: We performed a randomized, open-label, clinical trial in 50 non-diabetic individuals (mean age 58.5 ± 10.0; 38 females) with abdominal obesity and either impaired fasting glucose, elevated HbA1c, or impaired glucose tolerance (IGT) who were randomized to receive 3-months of exenatide or metformin. Microvascular endothelial function, assessed by digital reactive hyperemia (reactive hyperemic index: RHI), C-reactive protein (CRP), circulating oxidized LDL (oxLDL), and vascular cell adhesion molecule-1 (VCAM-1) were measured at baseline and 3-months. Seven subjects with IGT participated in a sub-study comparing the effects of pre-administration of exenatide and metformin on postprandial endothelial function. RESULTS: There were no differences for the change in RHI (Δ exenatide: 0.01 ± 0.68 vs. Δ metformin: -0.17 ± 0.72, P = 0.348), CRP, oxLDL, or VCAM-1 between exenatide and metformin treatment. Triglycerides were reduced more with exenatide compared to metformin (Δ exenatide: -25.5 ± 45.7 mg/dL vs. Δ metformin: -2.9 ± 22.8 mg/dL, P = 0.032). In the sub-study, there was no difference in postprandial RHI between exenatide and metformin. CONCLUSIONS: Three months of exenatide therapy had similar effects on microvascular endothelial function, markers of inflammation, oxidative stress, and vascular activation, as metformin, in patients with obesity and pre-diabetes. CLINICAL TRIALS REGISTRATION: This study is registered on http://www.clinicaltrials.gov/: NCT00546728.
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Endotelio Vascular/efectos de los fármacos , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Microcirculación/efectos de los fármacos , Obesidad Abdominal/complicaciones , Péptidos/uso terapéutico , Estado Prediabético/tratamiento farmacológico , Extremidad Superior/irrigación sanguínea , Ponzoñas/uso terapéutico , Anciano , Análisis de Varianza , Biomarcadores/sangre , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Proteína C-Reactiva/metabolismo , Endotelio Vascular/metabolismo , Endotelio Vascular/fisiopatología , Exenatida , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Hiperemia/fisiopatología , Mediadores de Inflamación/sangre , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Obesidad Abdominal/sangre , Obesidad Abdominal/fisiopatología , Estado Prediabético/sangre , Estado Prediabético/complicaciones , Estado Prediabético/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Molécula 1 de Adhesión Celular Vascular/sangreRESUMEN
The authors hypothesized that carvedilol controlled-release plus lisinopril combination therapy (C+L) would increase endothelial function and decrease oxidative stress to a greater extent than hydrochlorothiazide plus lisinopril combination therapy (H+L) in obese patients with hypertension. Twenty-five abdominally obese patients (aged 54.4±7.3 years; 14 women) with hypertension/prehypertension were enrolled in a 7-month (two 3-month treatment periods separated by a 1-month washout), randomized, double-blind, controlled, crossover clinical trial comparing C+L vs H+L. Endothelial function, measured by digital reactive hyperemic index (RHI), circulating oxidized low-density lipoprotein (oxLDL), 8-isoprostane, and asymmetric dimethylarginine (ADMA) were obtained at baseline, post-period 1, post-washout, and post-period 2. Analyses were adjusted for baseline measurements by analysis of covariance, with robust variance estimation for confidence intervals and P values. C+L treatment compared to H+L treatment significantly improved RHI (0.74, 95% confidence interval, 0.31-1.19, P =.001). This difference persisted after adjustment for the change in systolic blood pressure. No significant treatment differences were observed for oxLDL, 8-isoprostane, or ADMA. These data provide evidence that independent of blood pressure-lowering, C+L therapy improves endothelial function to a greater extent than H+L therapy. Levels of oxidative stress were not significantly different between treatments, suggesting that other mechanisms may be responsible for the improvement in endothelial function.
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Antagonistas Adrenérgicos beta/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Carbazoles/administración & dosificación , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiopatología , Hipertensión/epidemiología , Hipertensión/fisiopatología , Lisinopril/administración & dosificación , Obesidad Abdominal/epidemiología , Obesidad Abdominal/fisiopatología , Estrés Oxidativo/efectos de los fármacos , Propanolaminas/administración & dosificación , Carvedilol , Estudios Cruzados , Preparaciones de Acción Retardada , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estrés Oxidativo/fisiologíaRESUMEN
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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Cirugía Bariátrica/métodos , Obesidad/cirugía , Atención Perioperativa/métodos , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/psicología , Tracto Gastrointestinal/metabolismo , Humanos , Apoyo Nutricional/métodos , Selección de Paciente , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapiaRESUMEN
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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Cirugía Bariátrica , Terapia Nutricional/normas , Atención Perioperativa/normas , Cuidados Posoperatorios/normas , Cirugía Bariátrica/efectos adversos , Comorbilidad , Derivación Gástrica , Humanos , Síndromes de Malabsorción/complicaciones , Síndromes de Malabsorción/metabolismo , Síndromes de Malabsorción/fisiopatología , Evaluación Nutricional , Obesidad Mórbida/complicaciones , Obesidad Mórbida/epidemiología , Obesidad Mórbida/metabolismo , Obesidad Mórbida/cirugía , Síndromes de la Apnea del Sueño/epidemiologíaRESUMEN
When caloric intake exceeds caloric expenditure, the positive caloric balance and storage of energy in adipose tissue often causes adipocyte hypertrophy and visceral adipose tissue accumulation. These pathogenic anatomic abnormalities may incite metabolic and immune responses that promote Type 2 diabetes mellitus, hypertension and dyslipidemia. These are the most common metabolic diseases managed by clinicians and are all major cardiovascular disease risk factors. 'Disease' is traditionally characterized as anatomic and physiologic abnormalities of an organ or organ system that contributes to adverse health consequences. Using this definition, pathogenic adipose tissue is no less a disease than diseases of other body organs. This review describes the consequences of pathogenic fat cell hypertrophy and visceral adiposity, emphasizing the mechanistic contributions of genetic and environmental predispositions, adipogenesis, fat storage, free fatty acid metabolism, adipocyte factors and inflammation. Appreciating the full pathogenic potential of adipose tissue requires an integrated perspective, recognizing the importance of 'cross-talk' and interactions between adipose tissue and other body systems. Thus, the adverse metabolic consequences that accompany fat cell hypertrophy and visceral adiposity are best viewed as a pathologic partnership between the pathogenic potential adipose tissue and the inherited or acquired limitations and/or impairments of other body organs. A better understanding of the physiological and pathological interplay of pathogenic adipose tissue with other organs and organ systems may assist in developing better strategies in treating metabolic disease and reducing cardiovascular disease risk.
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Adipocitos/citología , Diabetes Mellitus Tipo 2/fisiopatología , Grasa Intraabdominal/metabolismo , Síndrome Metabólico/fisiopatología , Obesidad/fisiopatología , Adipocitos/fisiología , Adipogénesis/fisiología , Tejido Adiposo/metabolismo , Tejido Adiposo/patología , Adiposidad , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/complicaciones , Progresión de la Enfermedad , Dislipidemias/metabolismo , Dislipidemias/fisiopatología , Femenino , Humanos , Grasa Intraabdominal/patología , Masculino , Síndrome Metabólico/metabolismo , Obesidad/metabolismo , Medición de Riesgo , Sensibilidad y EspecificidadRESUMEN
We compared the vascular effects of rosiglitazone versus glyburide and evaluated asymmetric dimethylarginine (ADMA) and oxidative stress as potential mechanisms associated with changes in vascular health in patients with type 2 diabetes mellitus (T2DM). Patients were randomized to 6 months of either rosiglitazone (n = 20) or glyburide (n = 16) in addition to metformin. The following variables were measured pre- and post-treatment: glucose, insulin, homeostasis model assessment (HOMA), hemoglobin A1c (HbA1c), C-peptide, blood pressure, lipids, C-reactive protein (CRP), ADMA, 8-isoprostane, oxidized LDL cholesterol, brachial artery flow-mediated dilation (FMD), endothelium-independent dilation (EID), and brachial and carotid artery stiffness. Rosiglitazone and glyburide treatment resulted in significant and equivalent decreases in glucose (p < 0.0001) and HbA1c (p < 0.0001), with a trend toward decreased HOMA (p = 0.09). Rosiglitazone significantly decreased C-peptide (p < 0.01) with a strong trend toward decreased fasting insulin (p = 0.05). Rosiglitazone reduced CRP compared with glyburide (p = 0.001), but no differences were observed between groups for ADMA or the markers of oxidative stress. Rosiglitazone significantly improved FMD (p < 0.05) with trends toward improvements in carotid artery distension (p = 0.099) and distensibility (p = 0.078). In conclusion, compared with glyburide, rosiglitazone improves endothelial function and CRP in patients with T2DM. These improvements are not associated with reductions in ADMA or markers of oxidative stress.