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1.
Adv Exp Med Biol ; 1307: 273-297, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32016913

RESUMEN

The physiological roles of the enteroendocrine system in relation to energy and glucose homeostasis regulation have been extensively studied in the past few decades. Considerable advances were made that enabled to disclose the potential use of gastro-intestinal (GI) hormones to target obesity and type 2 diabetes (T2D). The recognition of the clinical relevance of these discoveries has led the pharmaceutical industry to design several hormone analogues to either to mitigate physiological defects or target pharmacologically T2D.Amongst several advances, a major breakthrough in the field was the unexpected observation that enteroendocrine system modulation to T2D target could be achieved by surgically induced anatomical rearrangement of the GI tract. These findings resulted from the widespread use of bariatric surgery procedures for obesity treatment, which despite initially devised to induce weight loss by limiting the systemic availably of nutrients, are now well recognized to influence GI hormone dynamics in a manner that is highly dependent on the type of anatomical rearrangement produced.This chapter will focus on enteroendocrine system related mechanisms leading to improved glycemic control in T2D after bariatric surgery interventions.


Asunto(s)
Cirugía Bariátrica , Diabetes Mellitus Tipo 2 , Células Endocrinas , Hormonas Gastrointestinales/uso terapéutico , Obesidad/terapia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/cirugía , Humanos
2.
Circulation ; 143(2): 135-144, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33200947

RESUMEN

BACKGROUND: Obesity may contribute to adverse outcomes in coronavirus disease 2019 (COVID-19). However, studies of large, broadly generalizable patient populations are lacking, and the effect of body mass index (BMI) on COVID-19 outcomes- particularly in younger adults-remains uncertain. METHODS: We analyzed data from patients hospitalized with COVID-19 at 88 US hospitals enrolled in the American Heart Association's COVID-19 Cardiovascular Disease Registry with data collection through July 22, 2020. BMI was stratified by World Health Organization obesity class, with normal weight prespecified as the reference group. RESULTS: Obesity, and, in particular, class III obesity, was overrepresented in the registry in comparison with the US population, with the largest differences among adults ≤50 years. Among 7606 patients, in-hospital death or mechanical ventilation occurred in 2109 (27.7%), in-hospital death in 1302 (17.1%), and mechanical ventilation in 1602 (21.1%). After multivariable adjustment, classes I to III obesity were associated with higher risks of in-hospital death or mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.57 [1.29-1.91], 1.80 [1.47-2.20], respectively), and class III obesity was associated with a higher risk of in-hospital death (hazard ratio, 1.26 [95% CI, 1.00-1.58]). Overweight and class I to III obese individuals were at higher risk for mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.54 [1.29-1.84], 1.88 [1.52-2.32], and 2.08 [1.68-2.58], respectively). Significant BMI by age interactions were seen for all primary end points (P-interaction<0.05 for each), such that the association of BMI with death or mechanical ventilation was strongest in adults ≤50 years, intermediate in adults 51 to 70 years, and weakest in adults >70 years. Severe obesity (BMI ≥40 kg/m2) was associated with an increased risk of in-hospital death only in those ≤50 years (hazard ratio, 1.36 [1.01-1.84]). In adjusted analyses, higher BMI was associated with dialysis initiation and with venous thromboembolism but not with major adverse cardiac events. CONCLUSIONS: Obese patients are more likely to be hospitalized with COVID-19, and are at higher risk of in-hospital death or mechanical ventilation, in particular, if young (age ≤50 years). Obese patients are also at higher risk for venous thromboembolism and dialysis. These observations support clear public health messaging and rigorous adherence to COVID-19 prevention strategies in all obese individuals regardless of age.


Asunto(s)
Índice de Masa Corporal , Hospitalización , Obesidad , Sistema de Registros , Factores de Edad , Anciano , American Heart Association , /terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/clasificación , Obesidad/mortalidad , Obesidad/terapia , Estados Unidos/epidemiología
3.
Med Clin North Am ; 105(1): 149-174, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33246516

RESUMEN

Obesity is a chronic disease caused by dysregulated energy homeostasis pathways that encourage the accumulation of adiposity, which in turn results in the development or exacerbation of weight-related comorbidities. Treatment of obesity relies on a foundation of lifestyle modification; weight loss pharmacotherapy, bariatric surgery and devices are additional tools to help patients achieve their health goals. Appropriate management of patients with obesity provides multiple metabolic benefits beyond weight loss.


Asunto(s)
Obesidad/terapia , Sobrepeso/terapia , Fármacos Antiobesidad/uso terapéutico , Cirugía Bariátrica , Terapia Conductista , Dieta Reductora , Medicina Basada en la Evidencia , Terapia por Ejercicio , Ayuno , Estilo de Vida Saludable , Humanos , Obesidad/etiología , Obesidad/fisiopatología , Sobrepeso/etiología , Sobrepeso/fisiopatología , Examen Físico
4.
PLoS One ; 15(12): e0243710, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33320904

RESUMEN

BACKGROUND: Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection. METHODS: We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from health records using a standardised template. We used multivariable logistic regression to analyse the factors associated with ICU survival. RESULTS: Of the 156 patients included, 112 (72%) were male, 89 (57%) were overweight or obese, 68 (44%) were from ethnic minorities, and 89 (57%) were aged over 60 years of age. 136 (87%) received mechanical ventilation, 77 (57% of those intubated) were placed in the prone position and 95 (70% of those intubated) received neuromuscular blockade. 154 (99%) patients required cardiovascular support and 44 (28%) required renal replacement therapy. Of the 130 patients with completed ICU episodes, 38 (29%) died and 92 (71%) were discharged alive from ICU. In multivariable models, age (OR 1.13 [95% CI 1.07-1.21]), obesity (OR 3.06 [95% CI 1.16-8.74]), lowest P/F ratio on the first day of admission (OR 0.82 [95% CI 0.67-0.98]) and PaCO2 (OR 1.52 [95% CI 1.01-2.39]) were independently associated with ICU death. CONCLUSIONS: Age, obesity and severity of respiratory failure were key determinants of survival in this cohort. Multiorgan failure was prevalent. These findings are important for guiding future research and should be taken into consideration during future healthcare planning in the UK.


Asunto(s)
/epidemiología , Enfermedad Crítica/epidemiología , Insuficiencia Multiorgánica/epidemiología , Obesidad/epidemiología , Adulto , Anciano , /terapia , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/complicaciones , Insuficiencia Multiorgánica/virología , Obesidad/complicaciones , Obesidad/terapia , Obesidad/virología , Alta del Paciente , Estudios Prospectivos , Respiración Artificial , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Reino Unido/epidemiología
5.
Medicine (Baltimore) ; 99(49): e23362, 2020 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-33285717

RESUMEN

Binge eating disorder (BED) is a common dietary disorder among obese people. Obesity and eating disorders are related to mental health and physical health. At present, there is no definite and effective method for treatment in clinic. The curative effect of electroacupuncture on obesity is definite. Although there is no conclusive evidence to support its long-term benefits, electroacupuncture has been increasingly used in clinic. This retrospective study determined the prognosis and outcome of electro-acupuncture on obese patients with BED.One hundred forty-three patients with BED and obesity were found from 658 people who participated in the scientific experiment of obesity treatment in Nanjing Hospital of Traditional Chinese Medicine and Nanjing Brain Hospital from March 2015 to June 2018, and 84 patients (aged 18-40 years old) with valid data and uninterrupted treatment were found to be eligible for this retrospective study. According to the intervention methods, the patients were divided into electro-acupuncture combined with cognitive group (n = 32), cognitive therapy group (n = 28), and control group (n = 24). In this study, the 5th edition of Diagnosis and Statistics Manual of Mental Diseases, fasting blood glucose, fasting insulin, total cholesterol (TC), triglyceride, high-density lipoprotein, low-density lipoprotein, body fat rate, muscle mass, visceral index grade, nutrient intake (energy, protein, fat, carbohydrate), body weight, and weight changes before and after treatment were observed.Compared with the cognitive therapy group, negative emotion score, TC, triglyceride, high-density lipoprotein, waist circumference, BW, BMI, body fat percentage of the electroacupuncture combined with cognitive group were lower, while positive emotional scores were higher, and there were significant differences in negative emotional scores, TC, waist circumference and BMI (P < .05). The dietary energy and three major nutrients in the electroacupuncture combined with cognitive group were lower than those in the cognitive group and the blank group (P < .05).The current results suggest that electroacupuncture combined with cognitive therapy is more effective than cognitive therapy alone in treating obese patients with BED. Future prospective studies are necessary to further study the mechanism of electroacupuncture on the obese with BED.


Asunto(s)
Trastorno por Atracón/epidemiología , Trastorno por Atracón/terapia , Electroacupuntura/métodos , Obesidad/epidemiología , Obesidad/terapia , Adolescente , Adulto , Trastorno por Atracón/psicología , Glucemia , Índice de Masa Corporal , Pesos y Medidas Corporales , Terapia Cognitivo-Conductual/métodos , Terapia Combinada , Femenino , Humanos , Lípidos/sangre , Masculino , Obesidad/psicología , Estudios Retrospectivos , Adulto Joven
6.
Cochrane Database Syst Rev ; 12: CD012110, 2020 12 11.
Artículo en Inglés | MEDLINE | ID: mdl-33305350

RESUMEN

BACKGROUND: Studies suggest that overweight and obese breast cancer survivors are at increased risk of cancer recurrence and have higher all-cause mortality. Obesity has an impact on breast cancer survivor's quality of life (QOL) and increases the risk of longer-term morbidities such as type 2 diabetes mellitus and cardiovascular disease. Many cancer guidelines recommend survivors maintain a healthy weight but there is a lack of evidence regarding which weight loss method to recommend. OBJECTIVES: To assess the effects of different body weight loss approaches in breast cancer survivors who are overweight or obese (body mass index (BMI) ≥ 25 kg/m2). SEARCH METHODS: We carried out a search in the Cochrane Breast Cancer Group's (CBCG's) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6), MEDLINE (2012 to June 2019), Embase (2015 to June 2019), the World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov on 17 June 2019. We also searched Mainland Chinese academic literature databases (CNKI), VIP, Wan Fang Data and SinoMed on 25 June 2019. We screened references in relevant manuscripts. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials evaluating body weight management for overweight and obese breast cancer survivors (BMI ≥ 25 kg/m2). The aim of the intervention had to be weight loss. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and assessed risk of bias for the included studies, and applied the quality of the evidence using the GRADE approach. Dichotomous outcomes were analysed as proportions using the risk ratio (RR) as the measure of effect. Continuous data were analysed as means with the measure of effect being expressed as the mean differences (MDs) between treatment groups in change from baseline values with 95% confidence intervals (CIs), when all studies reported exactly the same outcomes on the same scale. If similar outcomes were reported on different scales the standardised mean difference (SMD) was used as the measure of effect. Quality of life data and relevant biomarkers were extracted where available. MAIN RESULTS: We included a total of 20 studies (containing 23 intervention-comparisons) and analysed 2028 randomised women. Participants in the experimental groups received weight loss interventions using the core element of dietary changes, either in isolation or in combination with other core elements such as 'diet and exercise', 'diet and psychosocial support' or 'diet, exercise and psychosocial support'. Participants in the controls groups either received usual care, written materials or placebo, or wait-list controls. The duration of interventions ranged from 0.5 months to 24 months. The duration of follow-up ranged from three months to 36 months. There were no time-to-event data available for overall survival, breast cancer recurrence and disease-free survival. There was a relatively small amount of data available for breast cancer recurrence (281 participants from 4 intervention-comparisons with 14 recurrence events; RR 1.95, 95% CI 0.68 to 5.60; low-quality evidence) and the analysis was likely underpowered. Overall, we found low-quality evidence that weight loss interventions for overweight and obese breast cancer survivors resulted in a reduction in body weight (MD: -2.25 kg, 95% CI: -3.19 to -1.3 kg; 21 intervention-comparisons; 1751 women), body mass index (BMI) (MD: -1.08 kg/m2, 95% CI: -1.61 to -0.56 kg/m2; 17 intervention-comparisons; 1353 women), and waist circumference (MD:-1.73 cm, 95% CI: -3.17 to -0.29 cm; 13 intervention-comparisons; 1193 women), and improved overall quality of life (SMD: 0.74; 95% CI: 0.20 to 1.29; 10 intervention-comparisons; 867 women). No increase was seen in adverse events for women in the intervention groups compared to controls (RR 0.94, 95% CI: 0.76 to 1.17; 4 intervention-comparisons; 394 women; high-quality evidence). Subgroup analyses revealed that decreases in body weight, BMI and waist circumference were present in women regardless of their ethnicity and menopausal status. Multimodal weight loss interventions (which referred to 'diet, exercise and psychosocial support') appeared to result in greater reductions in body weight (MD: -2.88 kg, 95% CI: -3.98 to -1.77 kg; 13 intervention-comparisons; 1526 participants), BMI (MD: -1.44 kg/m2, 95% CI: -2.16 to -0.72 kg/m2; 11 studies; 1187 participants) and waist circumference (MD:-1.66 cm, 95% CI: -3.49 to -0.16 cm; 8 intervention-comparisons; 1021 participants) compared to dietary change alone, however the evidence was low quality. AUTHORS' CONCLUSIONS: Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias regarding blinding of participants and assessors. Further research is required to determine the optimal weight loss intervention and assess the impact of weight loss on survival outcomes. Long-term follow-up in weight loss intervention studies is required to determine if weight changes are sustained beyond the intervention periods.


Asunto(s)
Neoplasias de la Mama/complicaciones , Supervivientes de Cáncer , Obesidad/terapia , Sobrepeso/terapia , Pérdida de Peso , Índice de Masa Corporal , Neoplasias de la Mama/epidemiología , Terapia Combinada/métodos , Ejercicio Físico , Femenino , Humanos , Recurrencia Local de Neoplasia/epidemiología , Psicoterapia , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Circunferencia de la Cintura , Programas de Reducción de Peso
8.
Front Immunol ; 11: 576818, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33335527

RESUMEN

COVID-19 is a disease caused by the coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2), known as a highly contagious disease, currently affecting more than 200 countries worldwide. The main feature of SARS-CoV-2 that distinguishes it from other viruses is the speed of transmission combined with higher risk of mortality from acute respiratory distress syndrome (ARDS). People with diabetes mellitus (DM), severe obesity, cardiovascular disease, and hypertension are more likely to get infected and are at a higher risk of mortality from COVID-19. Among elderly patients who are at higher risk of death from COVID-19, 26.8% have DM. Although the reasons for this increased risk are yet to be determined, several factors may contribute to type-2 DM patients' increased susceptibility to infections. A possible factor that may play a role in increasing the risk in people affected by diabetes and/or obesity is the impaired innate and adaptive immune response, characterized by a state of chronic and low-grade inflammation that can lead to abrupt systemic metabolic alteration. SARS patients previously diagnosed with diabetes or hyperglycemia had higher mortality and morbidity rates when compared with patients who were under metabolic control. Similarly, obese individuals are at higher risk of developing complications from SARS-CoV-2. In this review, we will explore the current and evolving insights pertinent to the metabolic impact of coronavirus infections with special attention to the main pathways and mechanisms that are linked to the pathophysiology and treatment of diabetes.


Asunto(s)
Inmunidad Adaptativa , Complicaciones de la Diabetes , Inmunidad Innata , Obesidad , Factores de Edad , /inmunología , /terapia , Complicaciones de la Diabetes/inmunología , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus Tipo 2/inmunología , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Humanos , Obesidad/inmunología , Obesidad/mortalidad , Obesidad/terapia , /inmunología , /terapia
9.
Cas Lek Cesk ; 159(3-4): 118-124, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33297686

RESUMEN

Obesity is a metabolic disorder conditioned by several factors with the individual genetic proneness to accumulation of body fat with a positive energetic balance. If such definition describes the essential nature of obesity aptly, the treatment thereof ought to be the realm of somatic medicine and somatically oriented physicians, which is, unfortunately, frequently the case. Yet, not only being a disorder concerning improper body composition, but also a difference in cognitive processes and emotions of the obese, obesity needs to be considered in a more complex manner. The life of the obese consists of periods of strict, starvation diets on one hand and total loss of control and excessive calorie intake. Therefore, the corresponding therapy also needs to be provided in a more complex fashion, i.e. it is not solely the somatic disorder that should be addressed, but also the emotions and cognitions which induce the undesirable behaviour. Generally, it is possible to summarise that cognition and emotions are likely to be anticipated, directed and controlled by affecting the stimuli promoting the erratic attitude. Thanks to the achievements which relate not only to loss of weight, but also to higher self-esteem, more gratifying feelings aroused by the patients self, improvement of both physical and mental conditions and enhancement of the quality of life as a whole, the new behaviour patterns are established, strengthened and sustained on a long-term basis. Several psychotherapeutic attitudes/methods may be used with cognitive-behavioral therapy, existential therapy and, recently, psychodynamic approach. The psychologists role is essential and fundamental in both conservative and the metabolic-bariatric treatment of obesity. The most common character traits of obese patients include predominantly neuroticism, which comprises anxiety, depressions, impulsiveness, anger and hostility. Likewise, obesity is often suffered from by children and adolescents and its treatment relies on, in like manner as with adults, an active change of unsuitable dietary and movement habits with the family of the patient and their motivation of the patient to make the desirable change. It needs to be noted, however, that except for the changes in lifestyle, treatment of psychological difficulties accompanying obesity is a part of psychotherapy of such a group of young and adolescent patients.


Asunto(s)
Obesidad , Calidad de Vida , Adolescente , Adulto , Peso Corporal , Niño , Dieta , Humanos , Estilo de Vida , Obesidad/terapia
10.
Cas Lek Cesk ; 159(3-4): 131-135, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33297688

RESUMEN

Setting the right eating habits is one of the basic pillars of non-pharmacological treatment of obese patient. Nutritional interventions led by dietitians are a key part of obesity management. The principle of modern nutritional therapy is not the transmission of general information about nutrition, but individualized recommendations. The task of a dietitian is to provide information that is specific, requested, at the right time and in the right form, information that is understandable to the patient and can be included in his/her life. Dietitian creates a therapeutic relationship with the patient based on trust and accompanies them on his path to mastering the principle of a diet for weight loss. There is thus a shift from a rigid approach to dietary treatment of obese patients, where instead of prescribing a diet aiming at weight loss, the patient is given space for their own active involvement. Emphasis is placed on the long-term sustainability of the newly set regime. Therefore, not only the present comorbidities of obesity, but also other factors such as the patient's daily routine, level of physical activity and individual habits are considered in a well-performed nutritional intervention.


Asunto(s)
Nutricionistas , Dieta , Ejercicio Físico , Femenino , Humanos , Masculino , Obesidad/terapia , Pérdida de Peso
11.
Cas Lek Cesk ; 159(3-4): 136-140, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33297689

RESUMEN

Increasing prevalence of obesity and its complications in practically all developed countries worldwide is one of the most cardinal problems of current healthcare. Obesity is an important risk factor for the development of type 2 diabetes mellitus and it is closely interconnected with arterial hypertension, dyslipidemia and other diseases commonly referred to as metabolic syndrome or insulin resistance syndrome. Overall, this combination of diseases markedly increases risk of cardiovascular morbidity and mortality. In this paper, we provide a review of current possibilities of pharmacological modulation of body weight in patients with obesity both with and without diabetes. We also briefly mention the treatment possibilities using bariatric surgery and endoscopy, and discuss the perspectives of pharmacological modulation of body weight in patients with diabetes in the context of ongoing research programmes.


Asunto(s)
Cirugía Bariátrica , Diabetes Mellitus Tipo 2 , Dislipidemias , Síndrome Metabólico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Humanos , Obesidad/complicaciones , Obesidad/terapia
12.
Zhen Ci Yan Jiu ; 45(11): 875-81, 2020 Nov 25.
Artículo en Chino | MEDLINE | ID: mdl-33269830

RESUMEN

OBJECTIVE: To investigate the effect of electroacupuncture (EA) on gastrointestinal motility and expression of leptin(LEP) and cholecystokinin(CCK) in the small intestine in obese rats,so as to explore the mechanism of EA underlying improvement of obesity. METHODS: Male Wistar rats were randomized into 5 groups: normal control, obesity model, abdominal acupoints ["Guanyuan" (CV4), "Zhongwan" (CV12) and bilateral "Tianshu" (ST25)], lower-leg acupoints [bilateral "Zusanli" (ST36) and bilateral "Fenglong" (ST40)], and abdominal+ lower-leg acupoints (n=10 rats in each group). The obesity model was established by feeding the animals with high-fat diet for 8 weeks. EA was applied to the abovementioned acupoints for 20 min every time, 3 times a week for 8 weeks. The food intake and body mass were recorded. The white adipose tissue around the testicles and in the abdominal region was weighed. The serum total cholesterol (TC), triglyceride (TG) and non-esterified fatty acid(NEFA) were detected by using automatic biochemical analyzer. The gastric empty rate and intestinal propulsive rate were calculated. The contents of serum CCK and LEP were detected by using ELISA, and the expression levels of CCK and LEP proteins in the small intestine were detected by using Western blot. RESULTS: Following modeling, the food intake, body mass, weight of white adipose around the testicles and abdomen, the gastric empty rate, and serum TC, TG, NEFA and LEP contents as well as intestinal LEP expression were significantly increased (P<0.05, P<0.01), while the intestinal propulsive rate, serum CCK content and intestinal CCK expression were evidently decreased (P<0.01) in the model group relevant to the normal control group. After EA interventions and compared with the model group, the increased levels of food intake, body mass, white adipose weight, gastric empty rate, TC, TG, and LEP in serum and small intestine, and the decreased levels of intestinal propulsive rate, CCK in the serum and intestine were reversed in the abdominal acupoints, lower-leg acupoints and abdominal+lower-leg acupoints groups (P<0.05, P<0.01). No significant differences were found in the effects of the three EA groups in down-regulating food intake, body mass, white adipose weight, gastric empty rate, serum TC, TG and LEP levels (except NEFA) and in up-regulating intestinal propulsive rate and CCK level (P>0.05). CONCLUSION: EA stimulation of the abdominal and lower-leg acupoints or both can reduce body weight on obesity rats, which is associated with its functions in regulating intestinal motility, food intake, and secretion of LEP and CCK.


Asunto(s)
Electroacupuntura , Puntos de Acupuntura , Animales , Colecistoquinina/genética , Motilidad Gastrointestinal , Intestinos , Leptina/genética , Lípidos , Masculino , Obesidad/genética , Obesidad/terapia , Ratas , Ratas Wistar
13.
Eur J Prev Cardiol ; 27(2_suppl): 46-51, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33238736

RESUMEN

The prognostic stratification of heart failure remains an urgent need for correct clinical management of the affected patients. In fact, due to the high mortality and morbidity rates, heart failure constantly requires an updated and careful management of all aspects that characterise the disease. In addition to the well-known clinical, laboratory and instrumental characteristics that affect the prognosis of heart failure, gender, age and body mass index have a different impact and deserve specific insights and clarifications. At this scope, the metabolic exercise cardiac kidney index score research group has produced several works in the past, trying to identify the role of these specific factors on the prognosis of heart failure. In particular, the different performances in the cardiopulmonary exercise test of specific categories of heart failure patients, such as women, elderly and obese or overweight individuals, have requested dedicated evaluations of metabolic exercise cardiac kidney index score power.


Asunto(s)
Índice de Masa Corporal , Técnicas de Apoyo para la Decisión , Insuficiencia Cardíaca/diagnóstico , Obesidad/diagnóstico , Factores de Edad , Biomarcadores/sangre , Ecocardiografía , Prueba de Esfuerzo , Femenino , Disparidades en el Estado de Salud , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatología , Obesidad/terapia , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Medición de Riesgo , Factores Sexuales
14.
Health Psychol ; 39(12): 1037-1047, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33252929

RESUMEN

OBJECTIVE: There are two types of patient supporters, peers (two individuals initiating health behavior change who support one another) and mentors (a previously successful patient who supports incoming patients). Social comparison theory suggests that peers and mentors may elicit social comparison processes (patients may compare their progress to that of their peer/mentor), and these social comparisons could impact treatment outcomes. This randomized controlled trial is the first to examine the differential impact of peers and mentors on obesity treatment outcomes and social comparison processes when added to reduced intensity treatment. METHOD: Participants (N = 278) were randomly assigned to reduced intensity behavioral weight loss treatment alone (rBWL), rBWL plus peer e-support (rBWL + Peer), or rBWL plus mentor e-support (rBWL + Mentor). rBWL involved periodic group sessions that decreased over time; when group sessions decreased, intensity of peer/mentor e-support increased. Weight and social comparison processes were assessed throughout the 12-month intervention. RESULTS: There was a significant treatment effect; when group sessions became less frequent and peer/mentor e-support became more frequent, rBWL + Peer had significantly greater weight loss than rBWL alone, and rBWL + Mentor was not significantly different from the other two. Social comparison processes differed by treatment arm; rBWL + Peer participants tended to report more lateral social comparisons ("my weight loss progress is 'similar' to my peer's"), whereas rBWL + Mentor participants reported more upward comparisons ("my weight loss progress is 'worse than' my mentor's"). Upward comparisons were associated with poorer weight loss outcomes. CONCLUSIONS: Peer e-support may be an effective, low-cost, sustainable method for improving longer-term weight loss outcomes in reduced intensity obesity treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Obesidad/terapia , Telemedicina/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Resultado del Tratamiento
15.
PLoS One ; 15(11): e0242088, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33170898

RESUMEN

BACKGROUND: Isotemporal substitution evaluates hypothetical time replacement scenarios of physical movement on health, with few studies conducted among ethnically diverse preschool-aged populations. This study examines the reallocation of waking movement behaviors on adiposity, cardiovascular, and quality of life indicators among low-income, majority Hispanic preschool-aged youth (2-5 years) with overweight. METHODS: Participants wore an ActiGraph monitor (waist) and completed adiposity, cardiovascular, and health-related quality of life health assessments. Covariates included age, sex, ethnicity, and socioeconomic status. The isotemporal substitution approach was employed to address study aims. RESULTS: Complete data were available for 131 preschoolers. For boys, reallocating 5 minutes of stationary time with light intensity, moderate to vigorous intensity, or total physical activity showed a relation with beneficial reductions in adiposity indicators; for girls, these relations were statistically null. For boys and girls, reallocating 5 minutes of stationary time [-2.2 (95% CI: -3.7, -0.7) mmHg], light intensity [-2.1 (95% CI: -3.7, -0.7) mmHg], or moderate intensity activity [-2.7 (95% CI: -5.0, -0.4) mmHg] to vigorous intensity activity was related to favorable systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.0, -0.1) mmHg] or total physical activity [-0.2 (95% CI: -0.3, -0.01) mmHg] was related to lowered systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.1, -0.02) bpm] was related to lowered resting heart rate. No significant results for quality of life were found. CONCLUSION: Reallocation of time from stationary time to other movement behaviors is associated with several favorable adiposity and cardiovascular health outcomes among preschool children with overweight and obesity.


Asunto(s)
Ejercicio Físico/fisiología , Obesidad/terapia , Sobrepeso/fisiopatología , Acelerometría , Adiposidad/fisiología , Presión Sanguínea , Enfermedades Cardiovasculares/sangre , Fenómenos Fisiológicos Cardiovasculares , Sistema Cardiovascular , Preescolar , Análisis de Datos , Femenino , Humanos , Masculino , Obesidad/sangre , Sobrepeso/sangre , Calidad de Vida/psicología , Conducta Sedentaria , Sueño/fisiología , Triglicéridos/sangre , Circunferencia de la Cintura
16.
Artículo en Inglés | MEDLINE | ID: mdl-33153188

RESUMEN

While obesity is recognized as a key global public health issue, there has been no research to date on the perceptions of care for people with this condition held by individuals in positions of organizational power. The aim of this study was therefore to describe the perceptions and experiences of clinical leaders and managers of providing care to inpatients with obesity at a metropolitan public health service. This study applied an interpretative phenomenological analysis (IPA) approach to qualitative research, conducting interviews with 17 participants. Their perceptions of care for inpatients with obesity encompassed both their personal understanding as an individual, and their observations about the organizational, patient and carer perspectives. Three overall themes were identified: (1) the problem of inpatients with obesity, (2) inpatients with obesity as sources of risk and (3) personal and professional perceptions of inpatients with obesity. While clinical leaders and managers were aware of the potential impact of stigma and weight bias on care given to this cohort, elements of implicit bias, stereotyping, "othering" and ambivalence were frequently present in the data. Ongoing efforts to improve care for patients with obesity must therefore include efforts to address perceptions and attitudes at all organisational levels of the workforce.


Asunto(s)
Pacientes Internos , Liderazgo , Obesidad , Actitud Frente a la Salud , Australia , Humanos , Obesidad/terapia , Investigación Cualitativa
17.
Medicine (Baltimore) ; 99(48): e23390, 2020 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-33235115

RESUMEN

BACKGROUND: Catgut implantation at acupoints (CIA) is a subtype of acupuncture that has been widely used to treat simple obesity, but evidence for its effectiveness remains scarce. The aim of this study is to evaluate the efficacy and safety of treating simple obesity with CIA. OBJECTIVE: This clinical trial aims to evaluate the effectiveness and safety of CIA used for treatment of simple obesity. METHODS: This is a multicentre, randomized, parallel, sham-controlled clinical trial. A total of 216 patients with simple obesity will be recruited. They will be randomly assigned in a 1:1 ratio to either the CIA group or the sham control group. All treatments will be given once every 2 weeks. The primary outcome measure is the rate of waistline reduction. Secondary outcome measures are the rates of reduction of body measurements, including weight, body mass index (BMI), hipline, waist-hip-ratio (WHR) and body fat percentage (BFP), the changes in scores on scales, including the Impact of Weight on Quality of Life Questionnaire (IWQOL-Lite), Short Form 36 (SF-36), the Hospital Anxiety and Depression Scale (HAD) and the Self-Esteem Scale (SES), Outcomes will be evaluated at baseline and at weeks 4, 8, 12, 16, 28, and 40, respectively. All adverse events that occur during this study will be recorded. If any participant withdraws from the trial, an intention-to-treat analysis (ITT) will be performed. CONCLUSION: This is a randomized, sham-controlled trial of CIA treatment for simple obesity. The results of this trial will provide more evidence on whether CIA is efficacious and safe for treating obesity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02936973. Registered on October 18, 2016.


Asunto(s)
Puntos de Acupuntura , Catgut , Obesidad/terapia , China , Humanos , Estilo de Vida , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Programas de Reducción de Peso
18.
JAMA ; 324(17): 1737-1746, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33141209

RESUMEN

Importance: Online programs may help with weight loss but have not been widely implemented in routine primary care. Objective: To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care. Design, Setting, and Participants: Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019. Interventions: Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach. Main Outcomes and Measures: The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome. Results: Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001). Conclusions and Relevance: Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02656693.


Asunto(s)
Intervención basada en la Internet , Obesidad/terapia , Pérdida de Peso , Programas de Reducción de Peso/métodos , Adulto , Anciano , Índice de Masa Corporal , Terapia Combinada/métodos , Diabetes Mellitus Tipo 2/terapia , Femenino , Humanos , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Sobrepeso/terapia , Satisfacción del Paciente , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Adulto Joven
19.
Afr Health Sci ; 20(2): 897-902, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33163057

RESUMEN

Background: Activation of immunological and systemic inflammation markers are common in obesity and asthma. Objective: The target of this study was to assess impact of weight reduction on immunological and systemic inflammation markers in obese asthma patients. Material and methods: Eighty asthmatic patients of both sex; their age and body mass index (BMI) mean were 38.72 ± 7.14 year and 32.65 ± 3.18 Kg/m2 respectively. Exclusion criteria included smokers, infections, vaccinations, cancer, surgery, immune system disorders and medications that may influence immune system function as anti-inflammatory medications, analgesics and anti-depressant. All subjects were randomly enrolled in weight reduction group (group A) or control group (group B). Results: The main findings in the present study indicated that weight reducing program in group (A) was associated with significant reduction in the mean values of IL6, TNF-α, and IL8 in addition to significant increase in the mean values of CD4 and CD8 cell count . However, findings of group (B) showed no significant changes. Moreover, Comparison between both groups at the end of the study revealed significant differences. Conclusion: Weight reduction improved immunological and systemic inflammation markers in obese asthma patients.


Asunto(s)
Asma/inmunología , Citocinas/sangre , Dieta Reductora , Ejercicio Físico , Obesidad/terapia , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Pérdida de Peso/inmunología , Adulto , Asma/sangre , Asma/diagnóstico , Biomarcadores/sangre , Biomarcadores/metabolismo , Índice de Masa Corporal , Femenino , Citometría de Flujo , Humanos , Sistema Inmunológico , Inflamación/sangre , Inflamación/complicaciones , Inflamación/inmunología , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/inmunología , Resultado del Tratamiento , Programas de Reducción de Peso
20.
Artículo en Inglés | MEDLINE | ID: mdl-33008106

RESUMEN

This study examined the effect of Pilates training under hypoxia, a novel treatment method, for obesity. Thirty-two Korean women with obesity (age: 34-60 (47.5 ± 7.5) years) were randomly assigned to control (CON; n = 10), normoxic Pilates training (NPTG; n = 10), and hypoxic Pilates training groups (HPTG; n = 12). The NPTG and HPTG performed 50 min of Pilates training using a tubing band for 12 weeks (3 days/week) in their respective environmental conditions (NPTG: normoxic condition, inspired oxygen fraction (FiO2) = 20.9%; HPTG: moderate hypoxic condition, FiO2 = 14.5%). The CON maintained their daily lifestyle without intervention. All subjects underwent body composition, blood pressure, arterial stiffness, vascular endothelial function, cardiometabolic biomarker, hemorheological function, and aerobic performance measurements before and after the intervention. The HPTG showed a significant improvement in diastolic blood pressure, total cholesterol and triglyceride concentrations, flow-mediated dilation, and erythrocyte deformability and aggregation (all p < 0.05) compared with the CON and NPTG. However, compared with the CON and NPTG, the HPTG did not show improvement in other parameters. Hypoxic Pilates intervention is a novel and successful method for promoting endothelial and hemorheological functions in women with obesity.


Asunto(s)
Composición Corporal , Técnicas de Ejercicio con Movimientos , Obesidad , Adulto , Presión Sanguínea , Femenino , Humanos , Hipoxia , Persona de Mediana Edad , Obesidad/terapia , Triglicéridos
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