Infertility Improvement after Medical Weight Loss in Women and Men: A Review of the Literature.

Infertility is a modern health problem. Obesity is another expanding health issue associated with chronic diseases among which infertility is also included. This review will focus on the effects of weight loss by medical therapy on fertility regarding reproductive hormonal profile, ovulation rates, time to pregnancy, implantation rates, pregnancy rates, normal embryo development, and live birth rates. We comprised medicine already used for weight loss, such as orlistat and metformin, and emerging medical treatments, such as Glucagon-Like Peptide-1 receptor agonists (GLP-1 RA). Their use is not recommended during a planned pregnancy, and they should be discontinued in such cases. The main outcomes of this literature review are the following: modest weight loss after medication and the duration of the treatment are important factors for fertility improvement. The fecundity outcomes upon which medical-induced weight loss provides significant results are the female reproductive hormonal profile, menstrual cyclicity, ovulation and conception rates, and pregnancy rates. Regarding the male reproductive system, the fertility outcomes that feature significant alterations after medically induced weight loss are as follows: the male reproductive hormonal profile, sperm motility, movement and morphology, weight of reproductive organs, and sexual function. The newer promising GLP-1 RAs show expectations regarding fertility improvement, as they have evidenced encouraging effects on improving ovulation rates and regulating the menstrual cycle. However, more human studies are needed to confirm this. Future research should aim to provide answers about whether medical weight loss therapies affect fertility indirectly through weight loss or by a possible direct action on the reproductive system.

New Incretin Combination Treatments under Investigation in Obesity and Metabolism: A Systematic Review.

The worldwide upward trend in obesity in adults and the increased incidence of overweight children suggests that the future risk of obesity-related illnesses will be increased. The existing anti-obesity drugs act either in the central nervous system (CNS) or in the peripheral tissues, controlling the appetite and metabolism. However, weight regain is a common homeostatic response; current anti-obesity medications show limited effectiveness in achieving long-term weight loss maintenance; in addition to being linked to various side effects. Combined anti-obesity medications (per os or injectable) target more than one of the molecular pathways involved in weight regulation, as well as structures in the CNS. In this systematic review, we conducted a search of PubMed and The ClinicalTrials.gov up to February 2021. We summarized the Food and Drug Administration (FDA)-approved medications, and we focused on the combined pharmacological treatments, related to the incretin hormones, currently in a clinical trial phase. We also assessed the mechanism of action and therapeutic utility of these novel hybrid peptides and potential interactions with other regulatory hormones that may have beneficial effects on obesity. As we improve our understanding of the pathophysiology of obesity, we hope to identify more novel treatment strategies.

Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010.

BACKGROUND: In children, abdominal obesity is a better predictor of the presence of cardiovascular risk factors than body mass index (BMI)-defined obesity. We aimed to evaluate the prevalence of abdominal obesity in the Greek pediatric population and to assess the impact of residence on the prevalence of both BMI-defined and abdominal obesity. METHODS: In the context of the Childhood Obesity Surveillance Initiative of the World Health Organization (WHO) Regional Office for Europe, a national representative sample of 7.0-7.9 and 9.0-9.9-year-old children was evaluated (n = 2,531 and 2,700, respectively). Overweight and obesity according to BMI were estimated using both the WHO and International Obesity Task Force cut-off points. Abdominal obesity was defined as waist circumference/height ratio >0.5. RESULTS: The prevalence of abdominal obesity did not differ between 7-year-old boys and girls (25.2 and 25.3%, respectively; p = NS). Among 9-year-old children, abdominal obesity was more prevalent in boys than in girls (33.2 and 28.2%, respectively; p = 0.005). Among normal weight and overweight children, the prevalence of abdominal obesity was 1.6-6.8 and 21.8-49.1%, respectively. The prevalence of abdominal and BMI-defined obesity did not differ between children living in the mainland, in Crete and in other islands except in 7-year-old girls, where the prevalence of BMI-defined obesity was highest in those living in Crete, intermediate in those living in other islands and lowest in those living in the mainland. In 9-year-old boys and in 7- and 9-year-old girls, the prevalence of abdominal obesity was highest in children living in Athens and lowest in children living in Thessaloniki, whereas children living in other cities and in villages showed intermediate rates. The prevalence of abdominal obesity in 7-year-old boys and the prevalence of BMI-defined obesity did not differ between children living in cities and villages. CONCLUSIONS: The prevalence of pediatric abdominal obesity in Greece is among the highest worldwide. Boys and children living in the capital are at higher risk for becoming obese. Given that abdominal obesity is more prevalent than BMI-defined obesity and appears to be more sensitive in identifying cardiovascular risk, measurement of waist circumference might have to be incorporated in the screening for childhood obesity.

Neonatal birth waist is positively predicted by second trimester maternal active ghrelin, a pro-appetite hormone, and negatively associated with third trimester maternal leptin, a pro-satiety hormone.

INTRODUCTION: In pregnancy physiological mechanisms activated by maternal appetite contribute to adequate energy intake for the mother and for the fetus. The role of maternal appetite-related peptides and their possible association with neonatal energy stores and glucose metabolism have not been investigated as yet. The aim was to investigate, during pregnancy, the association of fasting maternal appetite-related hormones levels [ghrelin (active), GLP1 (active), total PYY and leptin] with neonatal waist, percent total body fat and insulin levels at birth. METHODS: Forty-two normal and thirty eight overweight women (mean±SD; age: 26.9±2.5years; pre-pregnancy BMI 26±2.2kg/m(2)) were seen during each of the three trimesters, had blood sampling and a 75g oral glucose tolerance test. At birth, neonates underwent anthropometry and cord blood sampling for c-peptide, glucose, insulin. RESULTS: During all three trimesters maternal weight correlated positively with percent total neonatal body fat while during the second and third trimesters it correlated positively with birth weight. The second trimester maternal active ghrelin levels correlated positively with neonatal waist and were its best positive predictor. The third trimester maternal active ghrelin levels correlated positively with neonatal waist and negatively with percent total neonatal body fat, fetal cord blood insulin levels and were the best negative predictor of the latter. The third trimester maternal leptin levels correlated negatively with neonatal waist. CONCLUSIONS: During pregnancy circulating maternal active ghrelin, a pro-appetite hormone, is associated with neonatal visceral energy storage (as expressed by neonatal waist). By inhibiting glucose-driven maternal insulin secretion, ghrelin might ensure adequate fasting glucose and nutrient supplies to the fetus while limiting overall fetal adipose tissue deposition.

First trimester maternal BMI is a positive predictor of cord blood c-peptide levels while maternal visfatin levels is a negative predictor of birth weight.

OBJECTIVE: The role of first trimester maternal body mass index (BMI) and adipocytokines in cord blood c-peptide and birth weight in pregnancy was investigated. DESIGN: Seventy non-diabetic pregnant Caucasian women were recruited. Anthropometry and measurements of fasting adipocytokines (visfatin, leptin, adiponectin), insulin and glucose were performed in each of the three trimesters. At birth, birth weight and cord blood c-peptide, glucose, insulin, visfatin, leptin, adiponectin and IL6 in each neonate were measured. RESULTS: First trimester maternal BMI correlated positively with cord blood c-peptide (p=0.035, r=0.74) and negatively with cord blood visfatin (p=0.049, r=-0.67). First trimester HOMAR was negatively correlated with cord blood visfatin (p=0.037, r=-0.90) and negatively with cord blood leptin (p=0.031, r=0.90). First trimester maternal BMI was a positive predictor of cord blood c-peptide (p=0.007). First trimester maternal visfatin levels were negative predictors of birth weight (p=0.017). CONCLUSIONS: We conclude that first trimester maternal BMI and serum visfatin seem to be strongly associated with fetal insulin secretion and final birth weight, respectively, suggesting a role of early-pregnancy maternal adipose tissue in the pregnancy metabolic environment.

Association of physical activity and sedentary lifestyle patterns with obesity and cardiometabolic comorbidities in Greek adults: data from the National Epidemiological Survey.

OBJECTIVE: To investigate the association between physical activity (PA) and sedentary lifestyle (SL) patterns with overweight (OW), obesity (OB), abdominal obesity (AO) and cardiometabolic comorbidities in Greek adults based on data from the National Epidemiological Survey for the prevalence of obesity. DESIGN: Cross-sectional epidemiological survey. Participants were selected via stratified sampling. 17,887 men and women, 20-70 years old, underwent anthropometric measurements for the estimation of OW, OB and AO prevalence. Assessment of PA, SL patterns and metabolic comorbidities was performed using an in-home questionnaire allowing self-evaluation of diverse activities and self-report for the presence of hypercholesterolemia (HCE), type 2 diabetes mellitus (T2DM) or hypertension (HTN). RESULTS: In men, even small amounts of walking were associated with decreased risk of being OW and AO, while larger amounts were associated with decreased risk of being OB. In women, engagement in entertainment activities for more than 4 hours per week was associated with less risk of being OW. Concerning cardiometabolic comorbidities, substantial improvement was evident mainly for men, e.g. signfiicantly reduced risk for HCE, T2DM and HTN by frequent engagement in exercise. On the other hand, frequent TV watching and long hours of office work significantly increased the risk of HCE and HTN in men. CONCLUSIONS: In Greek adults, and men in particular, walking activity was significantly associated with lower risk for obesity. In addition, frequent exercise and less sedentary behaviour were associated with reduced risk for cardiometabolic factors, mainly hypercholesterolemia and hypertension.

Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents.

OBJECTIVE: The increasing prevalence of obesity worldwide is a major health concern. Our study, which is part of the First National Epidemiological Study of Obesity in Greece, aimed to assess (i) breakfast habits and their relationship to BMI in Greek adolescents, as well as (ii) breakfast skipping in relation to other health behaviours. DESIGN: Epidemiological survey throughout Greece. Participants completed a questionnaire concerning breakfast habits and many lifestyle parameters. SETTING: The survey was conducted in schools throughout Greece. SUBJECTS: Anthropometric measurements were performed on 6500 boys and 7778 girls, aged 13-19 years, from schools throughout Greece. RESULTS: Among both boys and girls, breakfast consumers had a lower BMI than breakfast skippers. Moreover, breakfast skippers among both boys and girls were found to smoke more than breakfast consumers. The proportion of boys and girls who ate breakfast was found to be greater among those who had never been on a diet than among those who had already experienced dieting. Leisure-time activity was greater in breakfast consumers than breakfast skippers; among boys, 71.8 % of breakfast consumers walked compared with 66.4 % of breakfast skippers, whereas 38.4 % and 35.0 %, respectively, exercised. Among girls, these percentages were 73.1 % v. 68.7 % for walking and 36.7 % v. 31.5 % for exercising. CONCLUSIONS: We found that breakfast skipping can be part of a constellation of several unhealthy lifestyle parameters and is related to higher BMI in Greek adolescents.

Marital status and educational level associated to obesity in Greek adults: data from the National Epidemiological Survey.

BACKGROUND: Obesity is an important public health issue and its prevalence is reaching epidemic proportions in both developed and developing countries. The aim of the present study was to determine associations of overweight (OW), obesity (OB) and abdominal obesity (AO) with marital status and educational level in Greek adults of both genders based on data from the National Epidemiological Survey on the prevalence of obesity. METHODS: The selection was conducted by stratified sampling through household family members of Greek children attending school during 2003. A total of 17,341 Greek men and women aged from 20 to 70 years participated in the survey and had anthropometric measurements (height, weight, and waist circumference) for the calculation of prevalence of OW, OB and AO. WHO cut-offs were used to define overweight and obesity categories. Waist circumference of more than 102 cm in men and 88 cm in women defined AO. Marital status and educational level were recorded using a specially designed questionnaire and were classified into 4 categories. RESULTS: The overall prevalence of OB was 22.3% (25.8% in men, 18.4% in women), that of OW 35.2% (41.0% in men, 29.8% in women) and that of AO 26.4% in men and 35.9% in women. A higher risk of OB was found in married men (OR: 2.28; 95% CI: 1.85-2.81) and married women (OR: 2.31; 95% CI: 1.73-3.10) than in the respective unmarried ones. Also, a higher risk of AO was found in married men (OR: 3.40; 95% CI: 2.86-4.03) and in married women (OR: 2.40; 95% CI 2.00-2.88) compared to unmarried ones. The risk for being obese was lower among educated women (primary school, OR: 0.76; 95% CI: 0.60-0.96, high school, OR: 0.58; 95% CI: 0.46-0.74 and University, OR: 0.64; 95% CI: 0.49-0.81) than among illiterates. No significant differences were found among men. CONCLUSIONS: In Greek adults, marital status was significantly associated with obesity and abdominal obesity status in both genders while educational level was inversely associated with obesity status only in women.

Epidemiological survey for the prevalence of overweight and abdominal obesity in Greek adolescents.

This study was designed to provide estimates of overweight (OW), obesity (OB), and abdominal OB (AO) in a representative sample of adolescents throughout the whole of Greece. A total of 14,456 adolescents aged 13-19 years (6,677 boys and 7,779 girls) had direct measurements (height, weight, waist circumference (WC)) taken at school during 2003. The overall prevalence of OW including OB in the population studied was 29.4% in boys and 16.7% in girls. OB prevalence was also higher in boys than in girls (6.1% vs. 2.7%), whereas prevalence of AO was higher in girls than in boys (21.7% vs. 13.5%). Rates of OW, OB, and AO were significantly more prevalent in the Greek than in the foreign male population (immigrants). OW% in adolescent girls was independently associated with smoking and alcohol consumption. The prevalence of OW and OB in Greek adolescents is high, particularly in boys, comparable with that reported for most Mediterranean European countries. AO, mainly in adolescent girls, also appears high. Preventive and treatment strategies are urgently needed to combat this OB epidemic in Greece.

Insulin resistance, growth factors and cytokine levels in overweight women with breast cancer before and after chemotherapy.

OBJECTIVE: To evaluate insulin values, insulin resistance, growth factors and cytokine levels in women suffering from breast cancer and the effect of chemotherapy on these parameters. DESIGN: In a prospective study, glucose and insulin values were determined in ten previously undiagnosed diabetic postmenopausal women with stage IV breast cancer (hepatic metastases excluded) during an oral glucose tolerance test (OGTT) carried out after a glucose load of 75 g. At baseline, leptin, Interleukin-1 (IL-1), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Insulin-Growth Factor-1 (IGF-1), Tumor-Necrosis-Factor-alpha (TNF-alpha), Vascular Endothelial Growth Factor (VEGF) and Platelet Derived Growth Factor (PDGF) levels were also determined using appropriate methodolody. Insulin resistance and beta-cell function were calculated (HOMA-model). All women were evaluated prior to and after chemotherapy applied for 6 months. RESULTS: 1) Insulin levels at 120 minutes of the OGTT were higher before compared to post-chemotherapy (Mean+/-SD: 170.39+/-78.07 vs 111.75+/-76.19, p=0.037). 2) Body mass index (BMI) was an important predictor of post-glucose load insulin levels both before (coefficient=1.051, p=0.004) and after chemotherapy (coefficient=0.711, p=0.003). 3) Before chemotherapy BMI values were positively related to PDGF levels (rs=0.685, p=0.029), while after chemotherapy this relationship became non-significant (rs=0.188, p=0.603). Before chemotherapy there was a negative relationship between VEGF and waist circumference (coefficient= -0.542, p=0.023). CONCLUSIONS: Post-glucose load insulin values significantly decrease after chemotherapy. There is a positive relationship between BMI and post-glucose load insulin before and after chemotherapy. The contribution of the reduction in insulin, a known growth factor, to the outcome of chemotherapy in these patients remains speculative at present.