Role of Brown Adipose Tissue in Metabolic Health and Efficacy of Drug Treatment for Obesity.

(1) Background: Brown adipose tissue (BAT) is responsible for non-shivering thermogenesis, and its activation has become a new object as both a determinant of metabolic health and a target for therapy. This study aimed to identify the relationships between the presence of BAT, parameters that characterize metabolic health (glucose, lipids, blood pressure (BP)), and the dynamics of body mass index (BMI) during weight-reducing therapy. (2) Methods: The study included 72 patients with obesity. We investigated metabolic parameters, anthropometric parameters, and BP. Dual-energy X-ray absorptiometry (DXA) and positron emission tomography and computed tomography (PET/CT) imaging with 18F-fluorodeoxyglucose (18F-FDG) were performed. (3) Results: Before weight-reducing therapy, BAT was revealed only in 19% patients with obesity. The presence of BAT was associated with a lower risk of metabolic deviations that characterize metabolic syndrome: shorter waist circumference (WC) (p = 0.02) and lower levels of glucose (p = 0.03) and triglycerides (p = 0.03). Thereafter, patients were divided into four groups according to the type of therapy (only lifestyle modification or with Liraglutide or Reduxin or Reduxin Forte). We did not find a relationship between the presence of BAT and response to therapy: percent weight reduction was 10.4% in patients with BAT and 8.5% in patients without BAT (p = 0.78) during six months of therapy. But we noted a significant positive correlation between the volume of BAT and the effectiveness of weight loss at 3 months (r = 0.52, p = 0.016). The dynamic analysis of BAT after 6 months of therapy showed a significant increase in the volume of cold-induced metabolically active BAT, as determined by PET/CT with 18F-FDG in the Liraglutide group (p = 0.04) and an increase in the activity of BAT standardized uptake value (SUV mean and SUV max) in the Reduxin (p = 0.02; p = 0.01, respectively) and Liraglutide groups (p = 0.02 in both settings). (4) Conclusions: The presence of brown adipose tissue is associated with a lower risk of metabolic abnormalities. In general, our study demonstrated that well-established drugs in the treatment of obesity (Liraglutide and Reduxin) have one more mechanism for implementing their effects. These drugs have the ability to increase the activity of BAT. A significant positive relationship between the total volume of BAT and the percentage of weight loss may further determine the priority mechanism of the weight-reducing effect of these medicaments.

Prediction scale of response to liraglutide therapy as the method for increase of treatment efficacy in type 2 diabetes.

BACKGROUND: The effects of liraglutide on body weight and hemoglobin A1C (HbA1c) level vary greatly. The cost of this drug negatively affects treatment adherence. AIM: To reveal the baseline patient characteristics, associated with a better response to liraglutide. MATERIALS AND METHODS: A total of 41 patients with BMI of 39.63 ± 7.59 kg/m2 who received liraglutide injection up to 1.8 or 3.0 mg/day for 6 months were enrolled. Demographic and anthropometric data, parameters of glycemic control, food intake, hormones and responses to the eating behavior questionnaire were collected. RESULTS: Weight reduction was dose-dependent (p = 0.007). Liraglutide was not effective in patients with BMI >45 kg/m2. The baseline HbA1c level was a significant factor for HbA1c reduction. Lower leptin and higher glucagon-like-peptide 1 concentrations might predict better weight loss response to liraglutide. CONCLUSION: Drug-specific efficacy predictors were assumed; thus, further studies are needed to prove their significance.