Effects of Rosa multiflora root extract on adipogenesis and lipogenesis in 3T3-L1 adipocytes and SD rat models.

BACKGROUND/OBJECTIVES: Obesity is a major cause of metabolic disorders; to prevent obesity, research is ongoing to develop natural and safe ingredients with few adverse effects. In this study, we determined the anti-obesity effects of Rosa multiflora root extract (KWFD-H01) in 3T3-L1 adipocytes and Sprague-Dawley (SD) rats. MATERIALS/METHODS: The anti-obesity effects of KWFD-H01in 3T3-L1 adipocytes and SD rats were examined using various assays, including Oil Red O staining, gene expression analyses, protein expression analyses, and blood biochemical analyses. RESULTS: KWFD-H01 reduced intracellular lipid accumulation and inhibited the mRNA expression of peroxisome proliferator-activated receptor γ (PPARγ), cytidine-cytidine-adenosine-adenosine-thymidine (CCAAT)/enhancer binding proteins (C/EBPα), sterol regulatory element-binding transcription factor 1 (SREBP-1c), acetyl-CoA carboxylase (ACC), and fatty acid synthase (FAS) in 3T3-L1 cells. KWFD-H01 also reduced body weight, weight gain, and the levels of triglycerides, total and LDL-cholesterol, glucose, and leptin, while increasing high-density lipoprotein-cholesterol and adiponectin in SD rats. PPARγ, C/EBPα, SREBP-1c, ACC, and FAS protein expression was inhibited in the epididymal fat of SD rats. CONCLUSION: Overall, these results confirm the anti-obesity effects of KWFD-H01 in 3T3-L1 adipocytes and SD rats, indicating their potential as baseline data for developing functional health foods or pharmaceuticals to control obesity.

A Composite Blood Biomarker Including AKR1B10 and Cytokeratin 18 for Progressive Types of Nonalcoholic Fatty Liver Disease.

BACKGRUOUND: We aimed to evaluate whether composite blood biomarkers including aldo-keto reductase family 1 member B10 (AKR1B10) and cytokeratin 18 (CK-18; a nonalcoholic steatohepatitis [NASH] marker) have clinically applicable performance for the diagnosis of NASH, advanced liver fibrosis, and high-risk NASH (NASH+significant fibrosis). METHODS: A total of 116 subjects including healthy control subjects and patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) were analyzed to assess composite blood-based and imaging-based biomarkers either singly or in combination. RESULTS: A composite blood biomarker comprised of AKR1B10, CK-18, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) showed excellent performance for the diagnosis of, NASH, advanced fibrosis, and high-risk NASH, with area under the receiver operating characteristic curve values of 0.934 (95% confidence interval [CI], 0.888 to 0.981), 0.902 (95% CI, 0.832 to 0.971), and 0.918 (95% CI, 0.862 to 0.974), respectively. However, the performance of this blood composite biomarker was inferior to that various magnetic resonance (MR)-based composite biomarkers, such as proton density fat fraction/MR elastography- liver stiffness measurement (MRE-LSM)/ALT/AST for NASH, MRE-LSM+fibrosis-4 index for advanced fibrosis, and the known MR imaging-AST (MAST) score for high-risk NASH. CONCLUSION: Our blood composite biomarker can be useful to distinguish progressive forms of NAFLD as an initial noninvasive test when MR-based tools are not available.

Approved Anti-Obesity Medications in 2022 KSSO Guidelines and the Promise of Phase 3 Clinical Trials: Anti-Obesity Drugs in the Sky and on the Horizon.

Obesity is a prevalent global health issue affecting approximately half of the world's population. Extensive scientific research highlights the urgent need for effective obesity management to mitigate health risks and prevent complications. While bariatric surgery has proven to be highly effective, providing substantial short-term and long-term weight loss and resolution of obesity-related comorbidities, it is important to recognize its limitations and associated risks. Given the global obesity epidemic and the limitations of surgical interventions, there is high demand for effective and safe anti-obesity medications (AOMs). In Korea, the Korean Society for the Study of Obesity strongly advocates for the use of pharmacotherapy in Korean adults with a body mass index of 25 kg/m2 or higher who have not achieved weight reduction through non-pharmacological treatments. Currently, five AOMs have been approved for long-term weight management: orlistat, naltrexone/bupropion, phentermine/topiramate, liraglutide, and semaglutide. Tirzepatide is awaiting approval, and combination of semaglutide/cagrilintide and oral semaglutide are currently undergoing rigorous evaluation in phase 3 clinical trials. Furthermore, other promising drugs, including orforglipron, BI 456906, and retartrutide, are progressing to phase 3 studies, expanding the therapeutic options for obesity management. In personalized patient care, physicians play a crucial role in accurately identifying individuals who genuinely require pharmacotherapy and selecting appropriate AOMs based on individual patient characteristics. By integrating evidence-based interventions and considering the unique needs of patients, healthcare professionals significantly contribute to the success of obesity management strategies.

Evaluation and Treatment of Obesity and Its Comorbidities: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity.

The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.

Plasma Aldo-Keto Reductase Family 1 Member B10 as a Biomarker Performs Well in the Diagnosis of Nonalcoholic Steatohepatitis and Fibrosis.

We found several blood biomarkers through computational secretome analyses, including aldo-keto reductase family 1 member B10 (AKR1B10), which reflected the progression of nonalcoholic fatty liver disease (NAFLD). After confirming that hepatic AKR1B10 reflected the progression of NAFLD in a subgroup with NAFLD, we evaluated the diagnostic accuracy of plasma AKR1B10 and other biomarkers for the diagnosis of nonalcoholic steatohepatitis (NASH) and fibrosis in replication cohort. We enrolled healthy control subjects and patients with biopsy-proven NAFLD (n = 102) and evaluated the performance of various diagnostic markers. Plasma AKR1B10 performed well in the diagnosis of NASH with an area under the receiver operating characteristic (AUROC) curve of 0.834 and a cutoff value of 1078.2 pg/mL, as well as advanced fibrosis (AUROC curve value of 0.914 and cutoff level 1078.2 pg/mL), with further improvement in combination with C3. When we monitored a subgroup of obese patients who underwent bariatric surgery (n = 35), plasma AKR1B10 decreased dramatically, and 40.0% of patients with NASH at baseline showed a decrease in plasma AKR1B10 levels to below the cutoff level after the surgery. In an independent validation study, we proved that plasma AKR1B10 was a specific biomarker of NAFLD progression across varying degrees of renal dysfunction. Despite perfect correlation between plasma and serum levels of AKR1B10 in paired sample analysis, its serum level was 1.4-fold higher than that in plasma. Plasma AKR1B10 alone and in combination with C3 could be a useful noninvasive biomarker for the diagnosis of NASH and hepatic fibrosis.

Magnetic Resonance-Based Assessments Better Capture Pathophysiologic Profiles and Progression in Nonalcoholic Fatty Liver Disease.

BACKGROUND: Several noninvasive tools are available for the assessment of nonalcoholic fatty liver disease (NAFLD) including clinical and blood biomarkers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). In the present study, we aimed to evaluate whether magnetic resonance (MR)-based examinations better discriminate the pathophysiologic features and fibrosis progression in NAFLD than other noninvasive methods. METHODS: A total of 133 subjects (31 healthy volunteers and 102 patients with NAFLD) were subjected to clinical and noninvasive NAFLD evaluation, with additional liver biopsy in some patients (n=54). RESULTS: MRI-PDFF correlated far better with hepatic fat measured by MR spectroscopy (r=0.978, P<0.001) than with the TE controlled attenuation parameter (CAP) (r=0.727, P<0.001). In addition, MRI-PDFF showed stronger correlations with various pathophysiologic parameters for cellular injury, glucose and lipid metabolism, and inflammation, than the TE-CAP. The MRI-PDFF and TE-CAP cutoff levels associated with abnormal elevation of serum alanine aminotransferase were 9.9% and 270 dB/m, respectively. The MRE liver stiffness measurement (LSM) showed stronger correlations with liver enzymes, platelets, complement component 3, several clinical fibrosis scores, and the enhanced liver fibrosis (ELF) score than the TE-LSM. In an analysis of only biopsied patients, MRE performed better in discriminating advanced fibrosis with a cutoff value of 3.9 kPa than the TE (cutoff 8.1 kPa) and ELF test (cutoff 9.2 kPa). CONCLUSION: Our results suggest that MRI-based assessment of NAFLD is the best non-invasive tool that captures the histologic, pathophysiologic and metabolic features of the disease.

Current Long-Term Pharmacotherapies for the Management of Obesity.

Obesity is a serious and growing worldwide health challenge associated with type 2 diabetes mellitus, cardiovascular disease, osteoarthritis, some cancers, sleep apnea, asthma, and nonalcoholic fatty liver. The Korean Society for the Study of Obesity recommends that pharmacotherapy should be considered when intensive lifestyle modifications fail to achieve a weight reduction in obese patients with a body mass index ≥25 kg/m2. Long-term medications for obesity have traditionally fallen into two major categories: centrally acting anorexiant medications and peripherally acting medications, such as orlistat. In this paper, we provide an overview of the anti-obesity medications currently available for the long-term and individualized treatment of obesity.

2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea.

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m2. Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m2 and for Korean patients with BMI ≥30 kg/m2 who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.

Understanding the Mechanism of Action and Clinical Implications of Anti-Obesity Drugs Recently Approved in Korea.

The Korean Ministry of Food and Drug Safety has approved three anti-obesity drugs for long-term management in the past decade. In addition, since 2019, bariatric surgery has been financially supported by National Health Insurance Service in Korea. In this review, the mechanisms of action and the clinical implications of the recently approved anti-obesity drugs, lorcaserin, naltrexone/bupropion, and liraglutide are explained. Lorcaserin stimulates proopiomelanocortin (POMC)/cocaine- and amphetamine-regulated transcript (CART) neurons and inhibits neuropeptide Y (NPY)/agouti-related peptide (AgRP) neurons, which results in the activation of melanocortin 3/4 receptors. Naltrexone/bupropion stimulates POMC neurons through bupropion; this stimulation is augmented by blocking the autoinhibitory mechanism of POMC with naltrexone. The hypophagic effect of liraglutide is mediated through the direct activation of POMC/CART neurons and the indirect suppression of NPY/AgRP neurons through γ-aminobutyric acid-dependent signaling, with adjunctive suppression of the mesolimbic dopamine reward system. In addition to liraglutide, another glucagon-like peptide-1 receptor agonist, semaglutide, is expected to be added to the list of anti-obesity drugs in the near future. In patients with obesity and high cardiovascular risk, lorcaserin was considered neutral and liraglutide was considered favorable, whereas inconclusive results were obtained for naltrexone/bupropion.

Effects of central obesity on maternal complications in Korean women of reproductive age.

BACKGROUND: Considering the obesity-related complications in pregnancy and during delivery, prepregnancy central obesity may also affect pregnancy-related complications. This study aimed to assess the relationship between prepregnancy central obesity and adverse maternal outcomes in Korean women, by using the Korean National Health Insurance Service (NHIS) cohort. METHODS: In this population-based retrospective cohort study, we used data from the NHIS database, which contains information of health-care utilisation, diagnosis and prescription, and mortality for almost the whole Korean population, together with data from the NHIS health checkup database from 2005 to 2015. The NHIS health checkup data (645-280 days before childbirth) of mothers who had deliveries (total, 783,406 deliveries) from 2006 to 2015 were collected. For maternal adverse outcome data, we searched for diagnoses of maternal complications made during the period of 280 days before each delivery. The odds for maternal complications according to 8 body mass index (BMI) and 10 waist circumference (WC) categories were analysed using logistic regression. RESULTS: The incidence rates of eclampsia/preeclampsia, caesarean section, multiple gestation, and polycystic ovary syndrome (PCOS) increased according to the increase of BMI and WC. In contrast, the incidence rate of premature rupture of membrane (PROM) was inversely correlated with BMI and WC. In the low BMI (<17.5 and 17.5-19.9 kg/m2) and low WC (<60 and 60.0-64.0 cm) groups, the odds of threatened abortion were elevated. CONCLUSION: Prepregnancy WC was closely linked to some maternal complications, including eclampsia/preeclampsia, cesarean section, PCOS, and PROM, in a manner similar to prepregnancy BMI.

Association of Circulating Irisin Concentrations with Weight Loss after Roux-en-Y Gastric Bypass Surgery.

Irisin is a myokine with potential anti-obesity properties that has been suggested to increase energy expenditure in obese patients. However, there is limited clinical information on the biology of irisin in humans, especially in morbidly obese patients undergoing bariatric surgery. We aimed to assess the association of circulating irisin concentrations with weight loss in obese patients undergoing bariatric surgery. This was a pilot, single-centre, longitudinal observational study. We recruited 25 morbidly obese subjects who underwent Roux-en-Y gastric bypass surgery (RYGBP), and blood samples from 12 patients were taken to measure serum irisin concentrations before, and one and nine months after surgery. Their clinical characteristics were measured for one year. The preoperative serum irisin concentration (mean 1.01 ± 0.23 µg/mL, range 0.73⁻1.49) changed bidirectionally one month after RYGBP. The mean concentration at nine months was 1.11 ± 0.15 µg/mL (range 0.92⁻1.35). Eight patients had elevated irisin levels compared with their preoperative values, but four did not. Elevations of irisin levels nine months, but not one month, after surgery, were associated with lower preoperative levels (p = 0.016) and worse weight reduction rates (p = 0.006 for the percentage excess weight loss and p = 0.032 for changes in body mass index). The preoperative serum irisin concentrations were significantly correlated with the percentage of excess weight loss for one year (R² = 0.612; p = 0.04) in our study. Our results suggest that preoperative circulating irisin concentrations may be at least in part associated with a weight loss effect of bariatric surgery in morbidly obese patients. Further large-scale clinical studies are needed to ratify these findings.

Endoscopic Treatment of Diverse Complications Caused by Laparoscopic Adjustable Gastric Banding: A Study in Eastern Asia.

BACKGROUND/AIMS: The use of laparoscopic adjustable gastric banding (LAGB) is increasing proportionally with the obesity epidemic. However, some postoperative complications have been highlighted as major problems associated with LAGB. There is no consensus concerning the endoscopic management of these adverse events. The aim of this study was to retrospectively review the feasibility and effectiveness of endoscopic treatment for LAGB complications. METHODS: We retrospectively evaluated 352 patients who underwent LAGB between 2011 and 2015. LAGB-associated complications developed in 26 patients (7.4%). This study involved six patients (1.7%) who received endoscopic treatment. RESULTS: Types of LAGB-induced complications in our series included intragastric migration (n=3), gastric leaks (n=2), and gastric fistulas (n=1). The endoscopic treatment of these complications was successful in four of the six patients. Endoscopic band removal was successful in two patients. All gastric leaks were successfully closed via an endoscopic procedure. In two cases (intragastric migration and gastric fistula), endoscopic treatment was not sufficient, and surgery was performed. CONCLUSIONS: Endoscopic procedures afforded acceptable treatment of band migration and gastric leaks after LAGB. However, the results were poor in patients with gastric fistula.

Genomic health status assessed by a cytokinesis-block micronucleus cytome assay in a healthy middle-aged Korean population.

The aim of this study was to determine the typical incidence of micronuclei (MNi) in the peripheral blood lymphocytes of healthy middle-aged Koreans using the cytokinesis-block micronucleus cytome (CBMN-Cyt) assay. Non-smoking, low-risk alcohol-drinking healthy Korean men and women aged 30 to 59 years were recruited. Participants were divided into three groups according to age, i.e., 30 to 39, 40 to 49, and 50 to 59 years. Fifty participants were included in each age group, for a total of 300 participants. DNA damage was measured based on the number of binucleated (BN) cells with MNi, nucleoplasmic bridges (NPBs), and nuclear buds (NBUDs) using the CBMN-Cyt assay. The frequencies of BN cells with MNi in men were 14.0±4.9 (mean±SD) in 30-39year olds, 20.0±6.1 in 40-49year olds, and 21.7±7.6 in 50-59year olds. In women, they were 19.7±7.1 in 30-39year olds, 28.7±11.2 in 40-49year olds, and 31.9±12.9 in 50-59year olds. MNi and NPBs scores were higher in females than in males. The elder groups showed higher MNi frequencies for both genders, and the NPB frequency was higher in elder groups than younger groups, but only for males. Based on a regression analysis of the CBMN-Cyt parameters, MNi frequencies showed a positive relationship with age for both genders. BMI and blood vitamin B concentration were not significantly associated with CBMN-Cyt parameters, except vitamin B6 levels, which were positively associated with MNi scores in males. These results provide the standard frequencies of MNi, NPBs, and NBUDs in peripheral blood lymphocytes in middle-aged Korean individuals with healthy lifestyles. In this group, CBMN-Cyt assay parameters varied according to gender and age; however, BMI and micronutrient levels were not significantly associated with assay parameters.

Association between blood lead levels and blood pressures in a non-smoking healthy Korean population.

OBJECTIVE: The Korea National Health and Nutrition Examination Survey (KNHANES) has been performed every 3 years in Korea to help prevent cardiovascular mortality in the general population. Previous studies showed an association between blood lead levels and cardiovascular mortality. In order to assess the relationship between blood lead concentration and blood pressure in the healthy general population, we investigated whether blood lead levels were related to blood pressure in a non-smoking healthy population without any known medical diseases in the 2013 KNHANES. METHODS: 896 (mean age 40.55±13.83 years; body mass index 23.06±3.33 kg/m2) subjects who had no known diseases were included among 8018 subjects. Exclusion criteria were: hypertension, diabetes, hyperlipidaemia, cerebrovascular events, renal insufficiency, liver cirrhosis, thyroid dysfunction, any cardiovascular or renal disease, and any malignancy. Blood pressures were measured three times by sphygmomanometers, 5 min apart. Blood pressures were then expressed as the average between the second and third values. Height, weight, waist circumferences and blood pressure, as well as total cholesterol, high density lipoprotein cholesterol, triglycerides, low density lipoprotein cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell count and blood lead levels were measured. In addition, dietary components were analysed by 24 hour recall. RESULTS: The association between log blood lead levels and systolic/diastolic pressure was stronger after it was controlled for age, sex, education, body mass index (BMI), waist circumference and fasting plasma glucose (FPG) (p=0.048, 0.002). Furthermore, the association between log blood lead levels and systolic pressure (p=0.048) and diastolic pressure (p=0.002) was more evident when controlled for age, sex, education, BMI, waist circumference, FPG, AST and ALT. CONCLUSIONS: Blood lead levels are significant determinants of systolic and diastolic blood pressure in a healthy Korean population, irrespective of sociodemographic factors and metabolic derangements.

Governmental or Social Support of Bariatric Surgery in the Asia-Pacific Region.

Herein we review the management status of governmental financial support of bariatric surgeries in several Asia-Pacific areas of Japan, Singapore, and Australia, which were discussed in the 2016 International Congress on Obesity and Metabolic Syndrome (ICOMES). Patient's body mass index criteria of bariatric surgery for public support are different one another in the three countries. Whereas laparoscopic sleeve gastrectomy (LSG), Roux-en Y gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) are applicable in both Singapore and Australia, the coverage of insurance is limited to LSG in Japan. In addition, the surgical fees and equipment costs are not fully covered by public health insurance for performing sleeve gastrectomy in Japan, but patients with morbid obesity can still use public health insurance. In Singapore, the waiting time for surgery in public hospitals is longer on average than for private hospitals. However, patients can obtain subsidies of up to 80% of the costs of surgery in public hospitals, while particularly needy patients may even be able to obtain completely free bariatric surgery through Medifund. In Australia, bariatric surgeries in public sectors are publicly funded, but most bariatric surgeries occur in the private sector and Medicare only reimburses surgical costs in the private sector. Although certain characteristics need to be improved, the access to bariatric surgery has shown steady progress through public support in each of these countries.

Lipid-lowering effects of Zanthoxylum schinifolium Siebold & Zucc. seed oil (ZSO) in hyperlipidemic rats and lipolytic effects in 3T3-L1 adipocytes.

On the basis of the antiatherosclerotic effect of Zanthoxylum schinifolium, the therapeutic potential of Zanthoxylum schinifolium seed oil (ZSO) was tested in terms of the blood lipid profile and obesity in rats. The lipolytic effects of ZSO were determined in adipocytes and the total body and liver weight were decreased in rats. Compared with the high-cholesterol high-fat (HCHF) group, the rats in the HCHF+ZSO group showed improved levels of hyperlipidemia indicators. Furthermore, western blot analysis confirmed that the improvement of hyperlipidemia indicators was induced by stimulation of lipoprotein lipase expression. Additional results indicated that the reduction in body weight was likely caused by phosphorylation of hormone-sensitive lipase (HSL) via the protein kinase A pathway, ultimately leading to lipolysis. In conclusion, the results of the in vivo experiment showed that ZSO improved the lipid profiles in the blood, lowering cardiovascular disease and arteriosclerosis and degrading cellular lipids by activating HSL.

Antiobesity effects of the water-soluble fraction of the ethanol extract of Smilax china L. leaf in 3T3-L1 adipocytes.

BACKGROUND/OBJECTIVES: Several medicinal properties of Smilax china L. have been studied including antioxidant, anti-inflammatory, and anti-cancer effects. However, the antiobesity activity and mechanism by which the water-soluble fraction of this plant mediates its effects are not clear. In the present study, we investigated the lipolytic actions of the water-soluble fraction of Smilax china L. leaf ethanol extract (wsSCLE) in 3T3-L1 adipocytes. MATERIALS/METHODS: The wsSCLE was identified by measuring the total polyphenol and flavonoid content. The wsSCLE was evaluated for its effects on cell viability, lipid accumulation, glycerol, and cyclic adenosine monophosphate (cAMP) contents. In addition, western blot analysis was used to evaluate the effects on protein kinase A (PKA), PKA substrates (PKAs), and hormone-sensitive lipase (HSL). For the lipid accumulation assay, 3T3-L1 adipocytes were treated with different doses of wsSCLE for 9 days starting 2 days post-confluence. In other cell experiments, mature 3T3-L1 adipocytes were treated for 24 h with wsSCLE. RESULTS: Results showed that treatment with wsSCLE at 0.05, 0.1, and 0.25 mg/mL had no effect on cell morphology and viability. Without evidence of toxicity, wsSCLE treatment decreased lipid accumulation compared with the untreated adipocyte controls as shown by the lower absorbance of Oil Red O stain. The wsSCLE significantly induced glycerol release and cAMP production in mature 3T3-L1 cells. Furthermore, protein levels of phosphorylated PKA, PKAs, and HSL significantly increased following wsSCLE treatment. CONCLUSION: These results demonstrate that the potential antiobesity activity of wsSCLE is at least in part due to the stimulation of cAMP-PKA-HSL signaling. In addition, the wsSCLE-stimulated lipolysis induced by the signaling is mediated via activation of the ß-adrenergic receptor.

Initial Experiences of Laparoscopic Gastric Greater Curvature Plication in Korea-A Review of 64 Cases.

PURPOSE: Laparoscopic gastric greater curvature plication (LGGCP) is an emerging, alternative form of restrictive weight loss surgery. We present our experiences of LGGCP with the primary focus on surgical techniques and weight loss. In addition, an investigation was performed on the food tolerance of LGGCP patients. MATERIALS AND METHODS: This study was conducted by retrospectively reviewing the prospectively collected data of patients who underwent LGGCP from March 2013 to February 2015. RESULTS: Of the 64 patients were eligible for the study, 59 (92.2%) were female. Mean (range) patient age was 34 (21-49) years. Mean ± standard deviation (SD) preoperative body mass index was 31.4 ± 4.3 kg/m(2). There were no mortalities or postoperative complications. Immediate postoperative nausea and vomiting occurred in 58 patients (90.6%), mean postoperative hospital stay duration was 2.3 days (range, 1-7 days), and mean percentage excess body mass index losses at 1, 3, 6, 12, and 18 months were 34.7% (n = 64), 50.8% (n = 60), 61.1% (n = 40), 82.1% (n = 19), and 82.9% (n = 12), respectively. Follow-up endoscopy was performed at 12 months postoperatively in 19 patients, and reflux esophagitis of grade LA-M was observed in 16 patients (84.2%), LA-A in 2 patients (10.5%), and LA-B in 1 patient (5.3%). Mean ± SD satisfaction score with current eating and total food tolerance score was 4.27 ± 0.55 and 20.95 ± 4.30, respectively. CONCLUSIONS: LGGCP is an intervention that may be comparable with sleeve gastrectomy or adjustable gastric banding, especially for Class I or II obesity in an Asian population. Furthermore, quality of eating, as determined using food tolerance scores, was excellent.

Analysis of factors influencing general practitioners' decision to refer obese patients in Australia: a qualitative study.

BACKGROUND: Referral for both lifestyle and surgical interventions are recommended as part of the clinical management of obesity in general practice. However, current practice falls short of this. This qualitative study aimed to describe the factors influencing general practitioners' (GPs) referral intentions for their obese patients. METHODS: Semi-structured qualitative interviews were conducted with 24 GPs from four geographically different areas in New South Wales, Australia about the management of their obese patients. A qualitative analysis was applied using inductive thematic analysis. RESULTS: The predominant factors influencing GPs' referral were their own attitudes and experience, and their patient's motivation. Lifestyle intervention Referrals were usually initiated by GPs and influenced by their patients and the local health system. Referrals to conduct bariatric surgery were frequently initiated by the patient and influenced by GPs' limited previous experience, patients' expectations and ability to pay, as well as professional and legal issues. There was no strong link between referral and the remoteness of areas or the availability of surgical referral services. CONCLUSION: There were differences between GPs reported referral behaviour for lifestyle and surgical interventions. GPs' attitudes to referral were often formed by their limited case experience rather than by a review of more systematic evidence, especially for surgical interventions. These patterns may be improved by educating and better communicating with GPs about the outcomes for their patients when they are referred.

Gaps in health-related quality of life among survivors of cancer and cardiovascular disease: the Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III).

Few studies performed so far have weighed the health-related quality of life (HRQoL) of cancer survivors against that of cardiovascular disease (CVD) survivors. This study was based on data obtained from the Third Korean National Health and Nutrition Examination Survey. Of adults with available EuroQoL (EQ) information, a total 23 370 individuals (658 CVD survivors, 389 cancer survivors, and 22 323 controls) remained in the final analysis. Cancer survivors have the lowest HRQoL scales among the 3 groups, independent of age. The HRQoL of young cancer survivors was as impaired as that of older cancer survivors, whereas the HRQoL of CVD survivors and controls decreased with increasing age. Cancer survivors also have more problems in all domains of EQ-5D, especially domains of pain/discomfort and anxiety/depression. The study suggests that cancer survivors should receive more intensive attention to develop means of identifying them and to improve their quality of life.