Pharmaceutical Therapies for the Treatment of Obesity: A Network Meta-analysis.

PURPOSE: Despite the introduction of various pharmaceutical therapies for treating obesity, selecting the optimal treatment remains challenging for both patients and physicians. Therefore, in this network meta-analysis (NMA), we aim to simultaneously compare the available drugs for treating obesity to determine the most effective treatment options. METHODS: International databases, including PubMed, Web of Science, Scopus, Cochrane Library, and Embase, were searched for studies published from database inception to April 2023. The consistency assumption was evaluated using by the loop-specific and design × treatment interaction approaches. The effects of treatment in the NMA were summarized using mean differences based on a change score analysis. The random-effects model was used to report the results. Results were reported with 95% CIs. FINDINGS: Of 9519 retrieved references, 96 randomized controlled trials, including 68 with both men and women, 23 with women only, and 5 with men only, met the eligibility criteria for this study. There were 4 treatment networks in the trials of both men and women, 4 in the trials of women only, and 1 in the trials of men only. The best-ranked treatments in the network in the trials of both men and women were (1) semaglutide, 2.4 mg (P-score = 0.99); (2) hydroxycitric acid, 4667 mg 3 times daily, supervised walking, and 2000-kcal/d diet (P-score = 0.92); (3) phentermine hydrochloride and behavioral therapy (P-score = 0.92); and (4) liraglutide plus advice to diet and exercise (P-score = 1.00). In women, the best-ranked treatments were beloranib (P-score = 0.98) and sibutramine, metformin, and hypocaloric diet (P-score = 0.90). In men, there was no significant difference among treatments. IMPLICATIONS: According to the results of this NMA, semaglutide seems to be an effective treatment option for both men and women, whereas beloranib appears to be particularly effective for women with obesity and overweight, but its production has been stopped since 2016 and is not available.

The Concentration and Risk Assessment of Potentially Toxic Elements (PTEs) in Farmed and Wild Carps (Cyprinus carpio) in Hamadan Province of Iran.

This study focuses on measuring potentially toxic elements (PTEs) including mercury (Hg), lead (Pb), cadmium (Cd), arsenic (As), iron (Fe), copper (Cu), zinc (Zn), manganese (Mn) in farmed and wild carp by inductively coupled plasma-optical emission spectrometry (ICP-OES) and their intake amount and risk assessment. Estimated Daily Intake (EDI), Target Hazard Quotient (THQ) and the total THQ (TTHQ) were calculated for each element. In the present research, the concentration of As in farmed and wild carp samples was below the detection limit of ICP-OES (< 0.005 mg/kg). The mean concentrations of Pb, Cd, Fe, and Cu in farmed carp samples were significantly higher than that in wild carp samples, while Zn level was higher in the wild carp samples (P < 0.05). There is no significant difference between Hg and Mn in both fish (P > 0.05). The Monte Carlo simulation (MCS) results showed that the ranking order of PTEs based on their THQ was Hg > Pb > Zn > Cu > Fe > Cd > Mn. In the worst-case scenario (in the top 95 percentile) for both wild and farmed carp, the THQ of measured metals was less than one except Hg in children. Overall, this study demonstrated that the levels of PTEs in farmed and wild common carp had a potential non-carcinogenic risk for children (TTHQ > 1).

Diet Therapeutics Interventions for Obesity: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Up to now, different diet therapeutics interventions have been introduced for the treatment of obesity. The present study aimed to compare the diet therapeutics interventions for obesity simultaneously. STUDY DESIGN: Systematic review and network meta-analysis METHODS: The major international databases, including Medline (via PubMed), Web of Science, Scopus, Cochrane Library, and Embase, were searched using a predesigned search strategy. Randomized controlled trials (RCTs) that had compared the diet therapy interventions were included. The mean difference with a 95% confidence interval was used to summarize the effect size in the network meta-analysis. The frequentist approach was used for data analysis. RESULTS: In total, 36 RCTs out of 9335 retrieved references met the inclusion criteria in this review. The included RCTs formed nine independent networks. Based on the results, Hypocaloricdiet+Monoselect Camellia (MonCam, P=0.99), energy restriction, behavior modification+exercise (LED) (P=0.99), sweetener at 20% of total calories (HFCS20)+Ex (P=0.67), catechin-richgreentea(650)+inulin (P=0.68), very low calorie diet (VLCD) (P=1.00), normal protein diet+resistance exercise (NPD+RT) (P=0.80), low-calorie diets+exercise (Hyc+Ex) (P=0.85), high-soy-protein low-fat diet (SD) (P=0.75), calorie restriction+behavioral weight loss (Hyc+BWL) (P=0.99) were the better treatments for weight loss in the networks one to nine, respectively. CONCLUSION: Based on the results of network meta-analysis, it seems that Hypocaloricdiet+MonCam, LED, HFCS20+Ex, catechin-rich green tea +inulin, VLCD, NPD+RT, Hyc+Ex, SD, Hyc+BWL, are the better treatments for weight loss in patients with overweight and obesity.

Texture and sensory characterization of functional yogurt supplemented with flaxseed during cold storage.

In this study, flaxseed was used as a functional ingredient in yogurt formulations. The goal of this study was to produce prebiotic yogurt supplemented with flaxseed and investigation of its texture and sensory properties. Yogurt samples containing 0%-4% flaxseed was produced and stored at refrigerator (4-5°C) for 28 days. Textural properties were determined by texture analysis, and sensory characteristics were assessed by 26 trained panelists. Addition of flaxseed to yogurt samples increased the hardness, gumminess, chewiness, cohesiveness, and springiness values in produced yogurt samples. However, adhesiveness level was reduced in a sample enriched with flaxseed. By increasing flaxseed concentration, the color of samples was significantly different than the control sample; L* value was diminished and a* and b* value increased. Sensory scores including taste and mouthfeel, appearance, and overall acceptance showed reduction trend in samples containing a high level of flaxseed. In general, results showed that the addition of 2.63% flaxseed into yogurt samples lead to produce functional food with satisfactory texture, sensory characteristics that sustained these properties until 17.17 days after cold storage.

Exposure to heavy metals released to the environment through breastfeeding: A probabilistic risk estimation.

Toxic heavy metals released into the environment through various anthropogenic activities, raising concerns over their potential adverse effects on human health and the environment. Biological monitoring studies are of great value in toxicological research for estimation of such health effects. The aim of this study was to evaluate the concentrations of lead (Pb), arsenic (As), and chromium (Cr) in the breast milk of urban mothers in Hamadan city, Iran and the accompanying health risk to infants. A total of 100 lactating mothers were recruited from public health care centers in Hamadan city and breast milk samples were collected at 2, 6, 8, and 12 months postpartum. Inductively coupled plasma mass spectroscopy (ICP-MS) has been used to measure target heavy metal concentrations. The median breast milk concentrations of Pb, As, and Cr were 41.90, 0.50, and 3.95 µg/L, respectively. The highest levels of Pb were observed after two months of delivery (with the mean of 96.69 µg/L and median of 45.70 µg/L). Up to 94% of the breast milk samples exceeded the WHO limit suggested for lead contamination of breast milk (<5 µg/L). The breast milk As and Cr contents were above the limit of detection (LOD) in 19% and 76% of samples, respectively. Unacceptable non-cancer health risk levels or hazard quotient (HQ) were found for Pb and As in 61% and 10% of the samples, respectively. Nevertheless, HQ from Cr was <1.0 for 100% of breastfeeding infants. Finally, our results indicated that there may be a potential risk of toxic metals, especially lead, for infants in Hamadan via the consumption of mothers' breast milk.

Mercury, Lead, Cadmium, and Barium Levels in Human Breast Milk and Factors Affecting Their Concentrations in Hamadan, Iran.

Breast milk is considered the best source of nutrition for all infants. However, exposure of newborns to toxic metals is of special interest due to their potential harmful effects. Thus, the primary aims of this study were to determine the concentration of toxic heavy metals including lead, mercury, cadmium, and barium in breast milk samples from Hamadan, Iran, in relation to some sociodemographic variables. A total of 100 breast milk samples were collected and their heavy metal contents were measured by inductively coupled plasma mass spectroscopy (ICP-MS). The median breast milk concentrations of Pb, Hg, and Ba were 41.9, 2.8, and 1.95 µg/L, respectively. Cd levels were < 1 µg/L in all samples. The Pb level in 94% of the samples was higher than the recommended Pb limit of < 5 µg/L in breast milk suggested by World Health Organization (WHO). Hg levels in 54% of the breast milk samples were higher than the normal mean concentration (1.7 µg/L) suggested by WHO. We found no correlation between Hg levels in breast milk and sociodemographic factors. Ba levels in all the breast milk samples were lower than the WHO's proposed health-based drinking water guideline (0.7 mg/L). Considering the results of the present study and the vulnerability of infants, along with the well-known toxicity of these metals, further studies are warranted to identify the main sources of exposure that contribute their concentration in breast milk, establish harmless intake values of toxic metals in breast milk, and develop preventive measures.

Analysis of aluminum, minerals and trace elements in the milk samples from lactating mothers in Hamadan, Iran.

The present cross-sectional study is aimed at analyzing the breast milk of lactating mothers in Hamadan, Iran for aluminum and several minerals and trace elements. Ten governmental health care centers were utilized to facilitate collection of breast milk samples. The breast milk samples were collected at 1, 2, 6, 7, and 12 months postpartum from one hundred healthy lactating women, who delivered full-term newborns. Detection of sodium (Na), zinc (Zn), calcium (Ca), iron (Fe), copper (Cu), magnesium (Mg) and aluminum (Al) levels was conducted with the use of Inductively Coupled Plasma Mass Spectrometry (ICP-MS). This method has shown high accuracy, precision, sensitivity, and linearity for the wide range of concentrations. The accumulated data were not normally distributed; thus, the non-parametric Mann-Whitney U test was used in the statistical analysis of the results. Mean concentrations of Fe, Zn, Cu, Ca, Mg, and Na were 0.75, 1.38, 0.35, 255, 34.58, and 155.72 µg/mL, respectively. The mean level of Al, a well-known neurotoxic metal, was determined to be an alarming 0.191 µg/mL. Moreover, 95% of participants contained very harmful concentrations of Al in their milk. This study also revealed Zn deficiency in about 50% of milk samples. Further investigation is needed to elucidate sources of exposure and factors that may influence maternal and fetal exposure to aluminum.

Effect of Astaxanthin, Vitamin E, and Vitamin C in Combination with Calorie Restriction on Sperm Quality and Quantity in Male Rats.

The aim of this study was to investigate the effect of calorie restriction and dietary antioxidant supplementation, separately or in combination, on the quality and quantity of sperm in male rats. Forty male rats were randomly allocated to four groups of 10 animals each, and fed for at least 86 days with an ad libitum diet (group 1), a restricted diet (group 2), an ad libitum diet and astaxanthin, vitamin E, and vitamin C supplements (group 3), or a restricted diet with astaxanthin, vitamin E, and vitamin C supplements (group 4). At the end of the study period, sperm count and motility were determined with a hemocytometer, and differences between the groups were analyzed by analysis of variance. In addition, total antioxidant capacity and 8-epi prostaglandin F2 alpha were measured at the beginning and end of the study period with an enzyme-linked immunosorbent assay method. After 86 days, a significantly higher sperm count was seen in group 4 compared to other groups. The percentage of immotile sperm was significantly decreased in groups 2, 3, and 4 compared to group 1. A significant increase in total antioxidant capacity was observed in group 3 (p = 0.02) and group 4 (p = 0.02) compared to groups 1 and 2. Antioxidant supplementation with or without calorie restriction had no significant effect on the serum isoprostane level in any group. Astaxanthinin, combined with vitamin E, vitamin C, and calorie restriction, was able to ameliorate, in part, infertility in male rats.

Dietary supplementation with astaxanthin may ameliorate sperm parameters and DNA integrity in streptozotocin-induced diabetic rats.

OBJECTIVE: Diabetes mellitus (DM) is known to cause many systemic complications as well as male infertility. Astaxanthin (ASTX) is a powerful antioxidant that is involved in a variety of biologically active processes, including those with anti-diabetes effects. The present study investigates the effect of ASTX on the spermatozoa function in streptozotocin (STZ)-induced diabetic rats. METHODS: We divided 30 adult rats into three groups (10 rats per group), with a control group that received corn oil mixed with chow. DM was induced by intra-peritoneal injection of STZ. Eight weeks after the STZ injection, half of the diabetic animals were used as diabetic controls, and the rest were treated with ASTX for 56 days. Then the parameters and chromatin integrity of the epididymal sperm were analyzed using chromomycin A3, toluidine blue (TB), and acridine orange (AO) staining. RESULTS: The count, viability, and motility of the epididymal sperm were decreased significantly in the STZ group in comparison with the control group (count and viability, p<0.001; motility, p<0.001;0.01). ASTX increased normal morphology and viable spermatozoa compared to the STZ group (morphology, p=0.001; viability, p<0.001;0.05). The percentage of abnormal chromatins in TB and AO staining was higher in the STZ group compared to the control group (p<0.001;0.001). The mean percentage of TB and AO positive spermatozoa in STZ rats was significantly lower in the STZ+ASTX group (TB, p=0.001; AO, p<0.001;0.05). CONCLUSION: This study observed that in vivo ASTX treatment partially attenuates some detrimental effect of diabetes. Conversely, ASTX improved sperm viability, normal morphology, and DNA integrity.

Effect of a high fat diet on ovary morphology, in vitro development, in vitro fertilisation rate and oocyte quality in mice.

INTRODUCTION: The aim of this study was to determine the effect of a high-fat diet (HFD) on oocyte maturation and quality in a mouse model. METHODS: Female BALB/c mice were allocated to one of the following groups: (a) control group (n = 40), which received a controlled diet; or (b) HFD group (n = 40), which received an HFD for 12 weeks. Sections of the ovary were examined histologically. The number of follicles and corpora lutea were counted. In vitro maturation and in vitro fertilisation (IVF) were assessed in germinal vesicle (GV) and metaphase II (MII) oocytes, respectively. The expression of bone morphogenetic protein 15 (BMP15) and leptin receptor genes in GV and MII oocytes was evaluated using reverse transcription real-time polymerase chain reactions. RESULTS: In the HFD group, there was a decreased number of primordial and Graafian follicles, as well as corpora lutea (p < 0.05). The rate of oocyte development to the MII stage was also reduced (p < 0.001). Cumulus expansion was observed more frequently in the control group than the HFD group (p < 0.05). The IVF rate in the HFD group was lower than that in the control group (p < 0.05). In the HFD group, BMP15 and leptin receptor genes were upregulated in the GV stage (p > 0.05) and MII stage (p < 0.05), compared to the control group. CONCLUSION: An HFD reduces folliculogenesis in the primordial and Graafian stages, in vitro maturation and in vitro fertilisation rates, as well as oocyte quality in mice.

The effect of garlic consumption on Th1/Th2 cytokines in phytohemagglutinin (PHA) activated rat spleen lymphocytes.

The balance and regulation of T helper 1 (Th1) and Th2-type cytokines are important in the effective immune response to different diseases. To clarify the effect of garlic (Allium sativum L.) consumption on the Th1/Th2 balance, the secretion of gamma interferon (IFN-gamma) and interleukin-4 (IL-4), as two prototypes of Th1/Th2 cytokines, were compared in serum and supernatant of in vitro phytohemagglutinin activated rat spleen lymphocytes. Thirty male rats were divided equally into two groups. The treatment group received garlic solution in water (600 mg/kg/4 mL) and controls received distilled water by gavage. After 1 month, serum and supernatant of PHA activated spleen lymphocytes were analysed for IFN-gamma and IL-4 by the enzyme-linked immunosorbent assay test and thymus and spleen weights were measured. The garlic treatment group showed significantly decreased production of IFN-gamma from 101.73 +/- 4.62 to 74.64 +/- 4.64 pg/mL and significantly increased IL-4 production from 26.75 +/- 3.35 to 83.92 +/- 6.56 pg/mL (p < 0.001) in the supernatant of PHA induced spleen lymphocytes. The serum level of these cytokines was undetectable. The mean weight of thymuses in the garlic fed animals was significantly reduced from 0.456 +/- 0.016 to 0.368 +/- 0.023 g compared with the control group (p < 0.005). There were no significant differences between the spleen weights in the two groups. In conclusion, oral garlic treatment may favor a Th2 or humoral immune response.