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2.
Medicine (Baltimore) ; 99(6): e18978, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028407

RESUMEN

RATIONALE: AA amyloidosis (AA) is caused by a wide variety of inflammatory states, but is infrequently associated with Castleman disease (CD). CD describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. CD can present with a solitary enlarged lymph node (unicentric CD, UCD) or with multicentric lymphadenopathy (MCD), constitutional symptoms, cytopenias, and multiple organ dysfunction due to an interleukin-6 driven cytokine storm. PATIENT CONCERNS: We are reporting a case of a 26-year-old woman with no significant past medical history who presented with a 3-month history of fatigue and an unintentional 20-pound weight loss. DIAGNOSIS: A CT-scan of the abdomen and pelvis revealed hepatosplenomegaly and a mesenteric mass. Congo Red staining from a liver biopsy showed apple-green birefringence and serum markers were suggestive of an inflammatory process. Post-excision examination of the resected mass revealed a reactive lymph node with follicular hyperplasia with kappa and lambda stains showing polyclonal plasmacytosis consistent with CD. INTERVENTIONS: The patient underwent surgery to remove the affected lymph node. OUTCOMES: IL-6, anemia, leukocytosis, and thrombocytosis resolved or normalized 2 weeks after resection; creatinine normalized 9 months postsurgery. Twenty two months post-surgery her IFN-γ normalized, her fatigue resolved, her proteinuria was reduced by >90% and she had returned to her baseline weight. LESSONS: Our case and literature review suggest that patients presenting with UCD or MCD along with organ failure should prompt consideration of concurrent AA amyloidosis.


Asunto(s)
Amiloidosis/etiología , Enfermedad de Castleman/complicaciones , Enfermedades Peritoneales/etiología , Adulto , Amiloidosis/sangre , Amiloidosis/diagnóstico , Amiloidosis/diagnóstico por imagen , Enfermedad de Castleman/sangre , Enfermedad de Castleman/diagnóstico , Fatiga/etiología , Femenino , Humanos , Enfermedades Peritoneales/sangre , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/diagnóstico por imagen , Proteína Amiloide A Sérica/análisis , Tomografía Computarizada por Rayos X , Pérdida de Peso
3.
BMJ ; 368: l6775, 2020 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-32005673

RESUMEN

The studyDambha-Miller H, Day AJ, Strelitz J, et al. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med 2019. doi:10.1111/dme.14122This project was funded by the NIHR Health Technology Assessment Programme (project number 08/116/300) as well as the Wellcome Trust (grant number: G061895), the Epidemiology Unit programme (MC_UU_12015/4), and the National Health Service R&D support funding.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000841/weight-loss-after-type-2-diabetes-diagnosis-boosts-chance-of-remission.


Asunto(s)
Diabetes Mellitus Tipo 2 , Pérdida de Peso , Peso Corporal , Humanos , Estudios Prospectivos , Medicina Estatal
5.
Rev Med Suisse ; 16(679): 233-234, 2020 Jan 29.
Artículo en Alemán | MEDLINE | ID: mdl-31995320
6.
Ann R Coll Surg Engl ; 102(1): 54-61, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31891669

RESUMEN

INTRODUCTION: Studies have attempted to identify prognostic indicators for successful outcomes following bariatric surgery for obesity. The aim of this study was to determine whether the degree of obesity affects outcomes in patients who are morbidly obese (basal metabolic index, BMI, 40-49.9 kg/m2), super-obese (BMI 50-59.9 kg/m2) and super-super-obese (BMI greater than 60 kg/m2) undergoing restrictive or malabsorptive bypass procedures. MATERIAL AND METHODS: Retrospective analysis of a prospectively maintained database was undertaken to include all consecutive laparoscopic adjustable gastric bands (LAGB), laparoscopic sleeve gastrectomies (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures since 2010. Patients with at least two years of follow-up were included. At each visit, the patient's weight, BMI, excess weight loss and comorbidity status were recorded. RESULTS: A total of 353 patients (75% women) were included in the analysis; 65 (18.4%) underwent LAGB; 70 (19.8%) LSG and 218 (61.8%) LRYGB. At presentation, the median BMI for the morbidly obese sub-group was 47.2 kg/m2 for LAGB, 46.4 kg/m2 for LSG and 46.6 kg/m2 for LRYGB (P = 0.625); for the super-obese sub-group it was 53.2 kg/m2 for LAGB, 52.9 kg/m2 for LSG and 52.4 kg/m2 for LRYGB (P = 0.481); and for the super-super-obese sub-group 66.9 kg/m2 for (LAGB, 66.7 kg/m2 for LSG and 61.5 kg/m2 for LRYGB (P = 0.169). Percentage of excess weight loss at the end of two years was significantly higher in the morbidly obese and super-morbidly obese sub-groups undergoing LRYGB (median 68.5% and 69.5%, respectively; P < 0.001) than in the sub-groups undergoing LAGB and LSG. This was also reflected in the reduction of BMI achieved with bypass in the two sub-groups (P < 0.001). Complete diabetes remission was significantly higher in the morbidly obese and super-morbidly obese sub-groups undergoing LRYGB treatment (P < 0.05). Sleep apnoea, asthma and exercise tolerance had significantly improved in the super-morbidly obese undergoing LRYGB (P < 0.05). There was no significant difference between the three treatment groups in remission of hypertension; dyslipidaemia; gastro-oesophageal reflux disease and depression in all three BMI sub-groups. CONCLUSION: The mid-term results for weight loss and resolution of obesity-related comorbidities is best achieved in super-obese patients undergoing LRYGB, without any significant increase in complications with this procedure as compared with LAGB and LSG.


Asunto(s)
Cirugía Bariátrica/métodos , Peso Corporal/fisiología , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adulto , Cirugía Bariátrica/estadística & datos numéricos , Femenino , Humanos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Pérdida de Peso/fisiología
10.
Expert Rev Clin Pharmacol ; 13(1): 53-64, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31770497

RESUMEN

Introduction: Obesity poses a significant increase in morbidity and mortality and thus five anti-obesity drugs have been approved currently by US FDA. Several phase 3 trials have shown a significant improvement in cardio-metabolic profile including significant weight reduction with these agents compared to placebo.Areas covered: We systematically searched the database of PubMed, Embase, The Cochrane Library and The ClinicalTrials.gov up to 30 September 2019 and retrieved all the randomized controlled trials (RCTs) that were conducted with these five drugs for ≥1 year and explicitly reported their efficacy versus placebo. Subsequently, we have conducted the meta-analysis to primarily study the effect of these anti-obesity drugs on weight reduction. We additionally reviewed the effect of these drugs on other cardio-metabolic parameters including key adverse events.Expert opinion: This meta-analysis finds a significant reduction in body weight with orlistat (N = 10,435; ∆ -3.07 Kg, 95% CI, -3.76 to -2.37), phentermine plus topiramate (N = 2985; ∆ -9.77 Kg; 95% CI, -11.73 to -7.81), lorcaserin (N = 16,856; ∆ -3.08 Kg; 95% CI, -3.49 to -2.66), naltrexone plus bupropion (N = 3239; ∆ -4.39 Kg; 95% CI, -5.05 to -3.72) and liraglutide (N = 4978; ∆ -5.25 Kg; 95% CI, -6.17 to -4.32), compared to placebo (all p < 0.00001).


Asunto(s)
Fármacos Antiobesidad/administración & dosificación , Obesidad/tratamiento farmacológico , Pérdida de Peso/efectos de los fármacos , Fármacos Antiobesidad/efectos adversos , Humanos , Obesidad/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
Expert Opin Investig Drugs ; 29(1): 63-71, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31847611

RESUMEN

Introduction: Obesity is compounded by a neurobiology that is resistant to weight loss. Therefore, the development of pharmacotherapies to address the pathology underlying the dysregulation of energy homeostasis is critical.Areas covered: This review examines selected clinical trial evidence for the pharmacologic treatment of obesity and provides an expert opinion on anti-obesity drug development. The article includes the outcomes of anti-obesity medications that have been evaluated in clinical trials but have not yet received approval from the U.S. Food and Drug Administration. The mechanisms of action of glucagon-like peptide-1 agonists and co-agonists, diabetes medications being investigated for weight loss, and medications acting on the central nervous system as well as peripherally are reviewed. A search was conducted on PubMed using the terms 'Obesity AND Medications' restricted to clinical trials reported in English. Using similar terms, a search was also conducted on ClinicalTrials.gov.Expert opinion: The goal of anti-obesity therapy is finding compounds that are effective and have minimal side effects. Combining medications targeting more than one of the redundant mechanisms driving obesity increases efficacy. However, targeting peripheral mechanisms to overcome the trickle-down effects of centrally acting drugs may be the key to success in treating obesity.


Asunto(s)
Fármacos Antiobesidad/administración & dosificación , Desarrollo de Medicamentos , Obesidad/tratamiento farmacológico , Animales , Fármacos Antiobesidad/efectos adversos , Fármacos Antiobesidad/farmacología , Metabolismo Energético/fisiología , Humanos , Obesidad/fisiopatología , Pérdida de Peso/efectos de los fármacos
14.
J Assoc Physicians India ; 67(12): 52-56, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31801332

RESUMEN

The intricate relationship between obesity and T2DM is well recognised, as evidenced by the coining of the term 'diabesity' by Dr Ethan Sims that encompasses the two.Most patients with type 2 diabetes are obese and the global rise in obesity largely explains the epidemic rise in incidence and prevalence of type 2 diabetes(T2DM) over the last few decades. Obesity has been linked to insulin resistance and predisposes to metabolic abnormalities including prediabetes, type diabetes and the metabolic syndrome.Weight reduction is an essential component to prevent progression from prediabetes to T2DM in obese individuals and also forms an essential component of all T2DM management strategies in association with other lifestyle modifications, diet and pharmacotherapy. Obesity management today is a high priority preventive as well as treatment intervention for diabetes and various chronic diseases. Achieving effective weight loss and sustaining it is a huge practical challenge for all obese individuals, more so for the obese type 2 diabetic individuals who many times are prescribed various antihyperglycemic therapies that may be associated with weight gain. This chapter focusses on current treatment strategies for patients with coexisting obesity and T2DM and the role of different anti-obesity agents in the medical management of diabesity.


Asunto(s)
Fármacos Antiobesidad , Diabetes Mellitus Tipo 2 , Obesidad , Humanos , Hipoglucemiantes , Pérdida de Peso
15.
Medicine (Baltimore) ; 98(47): e18060, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764835

RESUMEN

OBJECTIVE: A retrospective chart review was conducted to explore the effect of Gambisan, a granular extract of novel herbal medicine, for short-term (≤16 weeks) weight loss in adults who are overweight and those with obesity. METHODS: Outpatients of Kyung Hee University Korean Medicine Hospital (Seoul, Korea) who took Gambisan and underwent bioelectric impedance analysis were selected (Jan 2011 to Dec 2015); their electronic medical records and clinical charts were retrospectively reviewed. The effectiveness of Gambisan was primarily evaluated by comparing body weight (BW) at baseline and endpoint, using paired t tests; the safety of Gambisan was evaluated on the basis of adverse events (AEs) experienced by patients. RESULTS: Two hundred five patients were included in this study. The study population exhibited a significant reduction in BW (73.69 ±â€Š14.49 kg to 69.01 ±â€Š13.20 kg, P < .001) as well as percentage body fat (37.38 ±â€Š5.38% to 34.50 ±â€Š5.83%, P < .001). Moreover, 111 (54.1%) patients achieved modest weight loss (≥5%), while 35 (17.1%) achieved ≥10% weight loss. Furthermore, Gambisan induced significant reduction of BW in all subgroups (body mass index, sex, prescribed duration, and dosage). Among 139 patients with available data, 79 (56.8%) reported loss-of-appetite. In addition, 120 (mostly mild) AEs were reported in 69 (49.6%) patients, and the most frequent AEs were nausea, palpitation, and insomnia. DISCUSSION: Despite limitations in interpreting the results of this retrospective medical record review, Gambisan induced statistically and clinically meaningful weight loss with a tolerable level of AEs. Based on the findings of this review, further well-designed clinical trials are warranted.


Asunto(s)
Sobrepeso/tratamiento farmacológico , Fitoterapia , Extractos Vegetales/farmacología , Extractos Vegetales/uso terapéutico , Pérdida de Peso/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/tratamiento farmacológico , Estudios Retrospectivos , Factores de Tiempo
16.
Adv Clin Exp Med ; 28(11): 1569-1570, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31756064

RESUMEN

As the prevalence of type 2 diabetes mellitus and obesity increases worldwide, scientifically rigorous research is needed in this field to determine effective interventions for the prevention and treatment of these chronic diseases. In a recent study published in this journal, Zhou et al. conclude that metformin, a drug used for treatment of type 2 diabetes mellitus, can be used effectively for weight loss, and that this effect is even more pronounced in individuals who weigh more at baseline. Unfortunately, we believe these results to be due to the regression to the mean (RTM) phenomenon, which weakens the causal inference proposed in this study. The conclusions of Zhou et al. that metformin is an effective strategy for weight loss in individuals with type 2 diabetes mellitus are not substantiated due to the lack of a control group and failure to consider other factors that may have confounded these results.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Glucemia , Índice de Masa Corporal , Hemoglobina A Glucada , Humanos , Pérdida de Peso
17.
Presse Med ; 48(12): 1496-1501, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31757727

RESUMEN

Nonalcoholic fatty liver disease (NAFLD) is strongly associated with obesity and insulin resistance. There is currently no pharmacological treatment validated in steatosis. The combination of weight loss and adequate physical activity can improve liver steatosis. In randomized trials and cohort studies, a weight loss of at least 7% and a diet approaching the Mediterranean diet have been associated with an improvement in hepatic fat content, an improvement in hepatic biomarkers, and regression of histological signs of steatosis. Bariatric surgery by losing weight can lead to an improvement in hepatic fat content.


Asunto(s)
Hígado Graso/dietoterapia , Enfermedad del Hígado Graso no Alcohólico/dietoterapia , Terapia Nutricional/métodos , Cirugía Bariátrica/métodos , Ejercicio/fisiología , Hígado Graso/cirugía , Humanos , Enfermedad del Hígado Graso no Alcohólico/cirugía , Pérdida de Peso/fisiología
18.
BMC Public Health ; 19(1): 1422, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666040

RESUMEN

BACKGROUND: A key objective of this study was to examine obesity care attitudes and behaviors of people with obesity (PwO) and determine independent factors associated with a self-reported sustained weight loss success outcome. METHODS: An online survey was conducted in 2015 among 3008 U.S. adult PwO (BMI > 30 through self-reported height and weight). Multivariate logistic models explained variation in weight loss success, defined as ≥ 10% weight loss in previous 3 years and maintained for > 1 year. RESULTS: Controlling for weight changes over time, we found significant associations between self-reported weight history and weight loss success. PwO who had personal motivation to lose weight, were willing to talk to a diabetes educator about their weight, who had their weight loss attempts recognized by a healthcare provider, and were diagnosed with "obesity" or "overweight" were more likely to report having success losing weight. CONCLUSIONS: This study does not determine causality, but suggests motivation and engagement with PwO may impact weight loss, and presents a basis for assessing the mechanism involved. Determining such mechanisms may identify important targets to improve obesity treatment outcomes. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov , number NCT03223493, https://clinicaltrials.gov/ct2/show/NCT03223493 . Registered July 17, 2017 (retrospectively registered).


Asunto(s)
Actitud , Motivación , Obesidad/terapia , Pérdida de Peso , Adulto , Anciano , Peso Corporal , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Sobrepeso , Aceptación de la Atención de Salud , Estudios Retrospectivos , Autoinforme , Encuestas y Cuestionarios , Resultado del Tratamiento
19.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 35(4): 355-358, 2019 Jul 28.
Artículo en Chino | MEDLINE | ID: mdl-31701722

RESUMEN

OBJECTIVE: To investigate the therapeutic effects of puerarin on rats with type 2 diabetes mellitus (T2DM). METHODS: T2DM models were established by high fat and high glucose feeding combined with a one-time intraperitoneal injection of streptozotocin (STZ, 60 mg/kg). Then the rats were randomly divided into normal group, model group, metformin group (MET, 40 mg/kg), puerarin low-dose group, medium-dose group and high-dose group (40, 80, 160 mg/kg), n=10. After the model was successfully established, rats were treated with corresponding drug intervention by intragastrical administration for 4 weeks. The body weight and fasting blood glucose (FBG) were measured per week, and blood samples were collected 24 h after the last administration, and serum levels of blood glucose, serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholestrol (HDL-C), serum enzyme activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), serum creatinine (SCr), and blood uric acid (UA) were measured. RESULTS: As compared with normal group, the body weight was decreased after 4 weeks-intervention in the model group, and the levels of FBG, TC, TG, LDL-C, ALT, AST, BUN, SCr and UA were all increased,while HDL-C level was decreased (P<0.05). As compared with model group,the body weight was increased after 4 weeks-intervention in metformin group and puerarin groups, and the levels of FBG, TC, TG, LDL-C, ALT, AST, BUN, SCr and UA were decreased (P<0.01); meanwhile, HDL-C level was increased significantly (P<0.05). CONCLUSION: Puerarin can reduce the weight loss of T2DM rats, decrease the blood lipid and blood glucose levels of T2DM rats, which can be used to control T2DM.


Asunto(s)
Diabetes Mellitus Experimental/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Isoflavonas/farmacología , Animales , Glucemia , Lípidos/sangre , Distribución Aleatoria , Ratas , Estreptozocina , Pérdida de Peso
20.
Prog Cardiovasc Dis ; 62(5): 436-443, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31707063

RESUMEN

In recent years, health professionals and laypersons have disseminated misinformation regarding the consumption of coconut oil. Those encouraging the supplementation of coconut oil argue that it provides health benefits and protective cardiovascular effects. Our article examines the effects of coconut oil intake on the cardiometabolic profile by exploring various lipid indices, as well as potential non-lipid effects, such as weight loss. The majority of randomized controlled trials show that coconut oil intake or its supplementation increases low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDLC), and total cholesterol when compared with other vegetable oils. Lauric acid, a medium-chain fatty acid and the main constituent of coconut oil, increases LDL-C and HDL-C concentrations, since it plays a main role as a substrate for apolipoprotein (apo)A1 and apoB synthesis, which are the key molecules in HDL-C and LDL-C particles, respectively.Despite some findings demonstrating an increase in HDL-C, definitive long-term clinical trials are imperative to ascertain whether this effect is clinically relevant. In addition, coconut oil intake has failed as a weight loss strategy and should not be considered as a supplementation strategy to increase satiety and/or thermogenesis.If one desires to include coconut oil in the diet, then we suggest that it should be limited and encompassed within the current recommendations of SFA intake, which are up to 10% of total caloric intake.


Asunto(s)
Aceite de Coco/administración & dosificación , Grasas de la Dieta/administración & dosificación , Valor Nutritivo , Animales , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Aceite de Coco/efectos adversos , Grasas de la Dieta/efectos adversos , Grasas de la Dieta/sangre , Ingestión de Energía , Humanos , Obesidad/dietoterapia , Obesidad/epidemiología , Obesidad/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto , Ingesta Diaria Recomendada , Factores de Riesgo , Pérdida de Peso
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