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1.
Blood Press Monit ; 26(5): 357-363, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34480473

RESUMO

BACKGROUND: Exaggerated blood pressure response to exercise is a cardiovascular risk factor associated to higher morbidity and mortality. Severely obese patients have an increased risk of exercise-induced hypertension (EIH). We aimed to assess the blood pressure response to exercise in patients with severe obesity who underwent bariatric surgery as well as the main determinants of this response. METHODS: We used data from the ACTIVE clinical trial, in which 60 severely obese patients who underwent bariatric surgery were enrolled. Anthropometric measurements, abdominal and mid-thigh computed tomography scans and maximal exercise testing were performed before bariatric surgery, as well as 3 and 6 months post-surgery. EIH was defined as a maximal SBP ≥210 mmHg for men and ≥190 mmHg for women. RESULTS: At baseline, 62% of patients had EIH. At 6 months, we observed an EIH resolution rate of 39%. The main determinant of EIH resolution was sex. Actually, patients with EIH resolution were mostly women without resting hypertension and a lower amount of visceral adipose tissue. CONCLUSION: These results suggest that bariatric surgery is efficient to resolve EIH, particularly in women with initially a better anthropometric profile.


Assuntos
Cirurgia Bariátrica , Hipertensão , Pressão Sanguínea , Exercício Físico , Feminino , Humanos , Masculino , Obesidade/complicações , Obesidade/cirurgia
2.
Front Endocrinol (Lausanne) ; 12: 726967, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484128

RESUMO

In March 2020, the WHO declared coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a global pandemic. Obesity was soon identified as a risk factor for poor prognosis, with an increased risk of intensive care admissions and mechanical ventilation, but also of adverse cardiovascular events. Obesity is associated with adipose tissue, chronic low-grade inflammation, and immune dysregulation with hypertrophy and hyperplasia of adipocytes and overexpression of pro-inflammatory cytokines. However, to implement appropriate therapeutic strategies, exact mechanisms must be clarified. The role of white visceral adipose tissue, increased in individuals with obesity, seems important, as a viral reservoir for SARS-CoV-2 via angiotensin-converting enzyme 2 (ACE2) receptors. After infection of host cells, the activation of pro-inflammatory cytokines creates a setting conducive to the "cytokine storm" and macrophage activation syndrome associated with progression to acute respiratory distress syndrome. In obesity, systemic viral spread, entry, and prolonged viral shedding in already inflamed adipose tissue may spur immune responses and subsequent amplification of a cytokine cascade, causing worse outcomes. More precisely, visceral adipose tissue, more than subcutaneous fat, could predict intensive care admission; and lower density of epicardial adipose tissue (EAT) could be associated with worse outcome. EAT, an ectopic adipose tissue that surrounds the myocardium, could fuel COVID-19-induced cardiac injury and myocarditis, and extensive pneumopathy, by strong expression of inflammatory mediators that could diffuse paracrinally through the vascular wall. The purpose of this review is to ascertain what mechanisms may be involved in unfavorable prognosis among COVID-19 patients with obesity, especially cardiovascular events, emphasizing the harmful role of excess ectopic adipose tissue, particularly EAT.


Assuntos
COVID-19/metabolismo , Cardiomiopatias/metabolismo , Gordura Intra-Abdominal/metabolismo , Obesidade/metabolismo , Tecido Adiposo/metabolismo , Tecido Adiposo/patologia , Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/complicações , COVID-19/imunologia , Cardiomiopatias/imunologia , Cardiomiopatias/patologia , Cardiopatias/imunologia , Cardiopatias/metabolismo , Cardiopatias/patologia , Humanos , Inflamação , Gordura Intra-Abdominal/patologia , Obesidade/complicações , Obesidade/imunologia , Obesidade/patologia , Pericárdio , Prognóstico , SARS-CoV-2/metabolismo , Serina Endopeptidases/metabolismo
3.
Pan Afr Med J ; 39: 94, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34466196

RESUMO

Introduction: different studies have shown a relationship between depression and nutrition, but there seems to be no consistent consensus on this. This study therefore investigated the relationship of nutrition status and depression among workers in tertiary educational institutions in Southwestern Nigeria. Methods: this was a cross-sectional study conducted among 399 members of staff of three tertiary educational institutions in Osun State, Southwestern Nigeria. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), while nutritional status was assessed using the body mass index (BMI), waist circumference and waist hip ratio (WHR). The respondents were selected using multi-stage sampling technique, and data were collected using pre-tested structured questionnaires. Analysis was done using IBM SPSS. Results: the mean age of the respondents was 45.8 ± 10.4 years. The prevalence of depression was 23.8%. Concerning the nutritional status of respondents, 2.3% were underweight and 69.7% were overweight/obese. There were statistically significant associations between depression and the nutritional status of the respondents using BMI (p = 0.001), WHR (p = 0.015) and waist circumference (p = 0.036). After controlling for other factors, only the BMI was still significantly associated with depression, such that those underweight were more likely to be depressed (Odds ratio: 7.9; p-value: 0.009). Conclusion: the prevalence of depression among the respondents was relatively high, and this was significantly associated with the BMI, even after controlling for co-founders.


Assuntos
Depressão/epidemiologia , Estado Nutricional , Magreza/complicações , Adulto , Índice de Massa Corporal , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Prevalência , Inquéritos e Questionários , Magreza/epidemiologia , Relação Cintura-Quadril
5.
Int Braz J Urol ; 47(6): 1136-1147, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34469666

RESUMO

PURPOSE: to evaluate the effect of low-calorie diet on 24-hour urinary metabolic parameters of obese adults with idiopathic calcium oxalate kidney stones. MATERIALS AND METHODS: Adult idiopathic calcium oxalate stone formers, with body mass index (BMI) ≥30kg/m2 and a known lithogenic metabolic abnormality, were submitted to low-calorie diet for twelve weeks. After enrolment, anthropometric measures, serum exams, 24-hour urinary metabolic parameters and body impedance were collected one month prior to dietary intervention and at the end of twelve weeks. Correlations between weight loss, waist circumference loss, fat loss and variation in 24-hour urinary lithogenic parameters and calcium oxalate urinary supersaturation (CaOx SS) as per Tiselius equation were analysed. RESULTS: From January 2017 to January 2018, 39 patients were enrolled to participate in this study. Median (range) prescribed diet was 1300 (1100-2100) Kcal/day. Mean age was 51.7±11.0 (29-68) years old and 69.2% were female. 30.8% of the participants shifted from obesity to BMI < 30kg/m2 and none to BMI < 25kg/m2. A significant correlation was found between baseline 24-hour urinary oxalate and weight (p=0.018) and BMI (p=0.026). No correlation was found between variation of weight, waist circumference, fat mass and 24-h urinary stone risk factors or CaOx SS. CONCLUSIONS: Short-term modest weight loss induced by twelve weeks of low-calorie diet is not associated with a decrease of 24-hour urinary lithogenic parameters in idiopathic calcium oxalate stone formers. Calcium oxalate urinary stone formation is probably multifactorial and driven by other factors than weight.


Assuntos
Cálculos Renais , Cálculos Urinários , Adulto , Idoso , Cálcio , Oxalato de Cálcio , Restrição Calórica , Feminino , Humanos , Cálculos Renais/etiologia , Pessoa de Meia-Idade , Obesidade/complicações
6.
Wiad Lek ; 74(8): 1905-1909, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34537741

RESUMO

OBJECTIVE: The aim: To assess the values of endothelial vascular growth factor (VEGF) in blood serum and circulating endothelial microparticles CD32+CD40+ in the peripheral blood of pregnant women depending on the severity of obesity and presence of preeclampsia. PATIENTS AND METHODS: Materials and methods: the study included 122 pregnant women divided into groups in accordance with their height and weight parameters and presence of preeclampsia. We studied the serum VEGF concentration by enzyme-linked immunosorbent assay, carried out the count of CD32+CD40+ circulating endothelial microparticles in the peripheral blood by using flow cytometry. RESULTS: Results: It has been found out the serum VEGF concentration in pregnant women with obesity decreases with rising level of obesity and the preeclampsia manifestation. In contrast to the decrease in this marker, there is an increase in the number of circulating endothelial microparticles CD32+CD40+ in the peripheral blood of pregnant women with obesity and preeclampsia. This pattern of these indicators points out the presence of endothelial dysfunction, which may contribute to occurrence of preeclampsia in pregnant women with concomitant obesity. CONCLUSION: Conclusions: The indicators of VEGF concentration and the count of circulating endothelial microparticles CD32+CD40+ in the blood serum can serve as reliable markers for evaluating the severity of endothelial dysfunction in pregnant women with concomitant obesity and preeclampsia.


Assuntos
Micropartículas Derivadas de Células , Pré-Eclâmpsia , Biomarcadores , Feminino , Humanos , Obesidade/complicações , Gravidez , Gestantes
7.
Georgian Med News ; (315): 103-108, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34365434

RESUMO

Osteoarthrosis is a family of pathological processes with multifactorial etiopathogenesis, including genetic, molecular and environmental factors, in particular, biomechanical stress. Obesity is one of the significant risk factors for osteoarthritis, increasing the risk of its development. The purpose of the research is to study the features of compiling an algorithm of physiotherapeutic interventions for patients suffering from knee osteoarthritis and obesity. The research was conducted during 2019-2020 on the basis of the sports & fitness center «Dog & Grand CrossFit¼, Kiev, and in department of radio-induced general and endocrinological pathology of the Scientific Center of Radiation Medicine of the National Academy of Medical Sciences of Ukraine. 68 women with a personal history of: obesity 1-2 degree and arthrosis of the knee joints of the 1st stage were examined. During the study two groups were formed: control (CG, n=33) and the main group (MG, n=35). After сonducting the program of physiotherapeutic interventions in patients with MG and CG, the average statistical indicators of the available range of movements during flexion of the affected limb in the knee joint improved significantly and amounted: MG 121,8±4,70 and CG 110,4±4,30. The difference between the indices in the post-rehabilitation period between the patients of MG and CG is statistically significant. Changes in BMI made it possible to note the clinical effect of weight loss in the main group, in contrast to the dynamics of BMI of KG, which was to a lesser extent. During repeated survey the dynamics of a decrease in the level of pain in MG was more than in CG( MG - 0,64±0,15 points, CG - 2,7±0,5 points). Prevention of obesity by means of individual physiotherapy programs, including lifestyle changes, dietary counseling and kinesiotherapy, is the first step in treating patients with obesity and osteoarthritis of the knee.


Assuntos
Osteoartrite do Joelho , Animais , Cães , Humanos , Articulação do Joelho , Obesidade/complicações , Obesidade/terapia , Osteoartrite do Joelho/terapia , Modalidades de Fisioterapia , Perda de Peso
8.
World J Gastroenterol ; 27(28): 4484-4492, 2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34366619

RESUMO

It is often difficult to explain why ulcerative lesions are found in the small intestine because there are no obvious aggressors such as gastric acid. In particular, the treatment of small intestinal ulcerative lesions in asymptomatic patients with no symptoms, normal physical examinations, and normal blood test findings is not well documented. According to a summary of capsule endoscopy studies in healthy subjects, approximately 10% of subjects have small intestinal mucosal breaks. The number of mucosal breaks in these instances is approximately 1-3. We examined small intestinal mucosal breaks in healthy subjects recruited from our past two studies. Mucosal breaks were observed in approximately 10% of subjects, and the average number was 0.24 ± 1.21. The number of mucosal breaks in the small intestine was correlated with body mass index and was significantly higher in Helicobacter pylori-infected subjects and higher in males. These results indicate that 1-2 small ulcerative lesions, such as erosions in the small intestine, can be considered to be in the normal range, and close examination is not required. It is assumed that a follow-up medical examination is required for such asymptomatic persons. The presence of many small ulcerative lesions or an unequivocal ulcer indicates an abnormality for which close examination is desired. However, in many cases, it is sufficient to scrutinize after detecting anemia, but it is difficult to make a judgment due to insufficient reports, and future studies are required.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Mucosa Gástrica , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Humanos , Intestino Delgado/diagnóstico por imagem , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Fatores de Risco , Úlcera
9.
Spine (Phila Pa 1976) ; 46(17): 1191-1196, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34384097

RESUMO

STUDY DESIGN: Retrospective cohort studying using a national, administrative database. OBJECTIVE: The aim of this study was to determine the postoperative complications and quality outcomes of patients with and without obesity undergoing surgical management for lumbar degenerative disease (LDD). SUMMARY OF BACKGROUND DATA: Obesity is a global epidemic that negatively impacts health outcomes. Characterizing the effect of obesity on LDD surgery is important given the growing elderly obese population. METHODS: This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether the patient had a concurrent diagnosis of obesity at time of surgery. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between patients with and without obesity. Patients who underwent three or more levels surgical correction, were under the age of 18 years, or those with any previous history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined. RESULTS: A total of 67,215 patients underwent primary lumbar degenerative surgery, of which 22,405 (33%) were obese. After propensity score matching, baseline covariates of the two cohorts were similar. The complication rate was 8.3% in the nonobese cohort and 10.4% in the obese cohort (P < 0.0001). Patients with obesity also had longer lengths of stay (2.7 days vs. 2.4 days, P < 0.05), and higher rates of reoperation and readmission at all time-points through the study follow-up period to their nonobese counterparts (P < 0.05). Including payments after discharge, lumbar degenerative surgery in patients with obesity was associated with higher payments throughout the 2-year follow-up period ($68,061 vs. $59,068 P < 0.05). CONCLUSION: Patients with a diagnosis of obesity at time of LDD surgery are at a higher risk for postoperative complications, reoperation, and readmission.Level of Evidence: 4.


Assuntos
Vértebras Lombares , Fusão Vertebral , Idoso , Estudos de Coortes , Humanos , Vértebras Lombares/cirurgia , Obesidade/complicações , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
10.
Biol Aujourdhui ; 215(1-2): 63-72, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34397376

RESUMO

Obesity is considered a pandemic responsible for millions of deaths worldwide for many years. At the end of 2019, the Coronavirus disease 2019 (COVID-19) appeared, causing the death of more than a million people in less than a year. Numerous studies suggest that obesity could be defined as key to the onset of severe forms of this emerging disease. Indeed, SARS-CoV2 infects the host by binding to ACE2 receptors present on the surface of the cells and causes excessive secretion of pro-inflammatory cytokines including IL-1, IL-6 and TNF-α, which lead to developing acute respiratory distress syndrome (ARDS). It therefore seems essential to make up effective preventive strategies to protect this part of the population from the risk of developing a severe form of COVID-19. The ketogenic diet, which is low in sugars and high in fat, has interesting properties, both in the fight against obesity but also against severe infections. This article focuses on the latest scientific advances that make it possible to consider the ketogenic diet as a preventive strategy that simultaneously reduces the development of obesity while strengthening the immune system, two key actions in the fight against SARS-CoV2 infections and severe forms of COVID-19.


Assuntos
COVID-19/prevenção & controle , Dieta Cetogênica , Inflamação/etiologia , Obesidade/prevenção & controle , Pandemias , SARS-CoV-2 , Adipócitos/metabolismo , Animais , COVID-19/complicações , COVID-19/imunologia , COVID-19/fisiopatologia , Síndrome da Liberação de Citocina/etiologia , Dieta Cetogênica/efeitos adversos , Suscetibilidade a Doenças , Humanos , Inflamação/fisiopatologia , Inflamação/prevenção & controle , Leptina/fisiologia , Obesidade/complicações , Obesidade/dietoterapia , Obesidade/epidemiologia , Síndrome do Desconforto Respiratório/etiologia
11.
Nat Commun ; 12(1): 5068, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417460

RESUMO

p53 regulates several signaling pathways to maintain the metabolic homeostasis of cells and modulates the cellular response to stress. Deficiency or excess of nutrients causes cellular metabolic stress, and we hypothesized that p53 could be linked to glucose maintenance. We show here that upon starvation hepatic p53 is stabilized by O-GlcNAcylation and plays an essential role in the physiological regulation of glucose homeostasis. More specifically, p53 binds to PCK1 promoter and regulates its transcriptional activation, thereby controlling hepatic glucose production. Mice lacking p53 in the liver show a reduced gluconeogenic response during calorie restriction. Glucagon, adrenaline and glucocorticoids augment protein levels of p53, and administration of these hormones to p53 deficient human hepatocytes and to liver-specific p53 deficient mice fails to increase glucose levels. Moreover, insulin decreases p53 levels, and over-expression of p53 impairs insulin sensitivity. Finally, protein levels of p53, as well as genes responsible of O-GlcNAcylation are elevated in the liver of type 2 diabetic patients and positively correlate with glucose and HOMA-IR. Overall these results indicate that the O-GlcNAcylation of p53 plays an unsuspected key role regulating in vivo glucose homeostasis.


Assuntos
Acetilglucosamina/metabolismo , Glucose/metabolismo , Fígado/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Animais , Sequência de Bases , Restrição Calórica , Linhagem Celular , Colforsina/farmacologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Epinefrina/metabolismo , Glucagon/metabolismo , Glucocorticoides/metabolismo , Gluconeogênese/efeitos dos fármacos , Glicosilação , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Humanos , Hidrocortisona/metabolismo , Hiperglicemia/complicações , Hiperglicemia/metabolismo , Resistência à Insulina , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Fígado/efeitos dos fármacos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Obesidade/complicações , Obesidade/metabolismo , Fosfoenolpiruvato Carboxiquinase (GTP)/metabolismo , Regiões Promotoras Genéticas/genética , Ligação Proteica/efeitos dos fármacos , Estabilidade Proteica/efeitos dos fármacos , Ácido Pirúvico/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Transcrição Genética/efeitos dos fármacos , Proteína Supressora de Tumor p53/genética
12.
Medicina (Kaunas) ; 57(8)2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34441028

RESUMO

Non-alcoholic fatty liver disease (NAFLD), or metabolic dysfunction-associated fatty liver disease (MAFLD), is a metabolic condition distinguished by fat deposition in the hepatocytes. It has a prevalence of about 25% worldwide and is associated with other conditions such as diabetes mellitus, obesity, hypertension, etc. Background and Objectives: There is currently no approved drug therapy for NAFLD. Current measures in the management of NAFLD include lifestyle modification such as an increase in physical activity or weight loss. Development of NAFLD involves a number of parallel hits: including genetic predisposition, insulin resistance, disordered lipid metabolism, mitochondrial dysfunction, lipotoxicity, oxidative stress, etc. Herbal therapy may have a role to play in the treatment of NAFLD, due to their numerous bioactive constituents and the multiple pharmacological actions they exhibit. Therefore, this systematic review aims to investigate the potential multi-targeting effects of plant-derived extracts in experimental models of NAFLD. Materials and Methods: We performed a systematic search on databases and web search engines from the earliest available date to 30 April 2021, using relevant keywords. The study included articles published in English, assessing the effects of plant-derived extracts, fractions, or polyherbal mixtures in the treatment of NAFLD in animal models. These include their effects on at least disordered lipid metabolism, insulin resistance/type 2 diabetes mellitus (T2DM), and histologically confirmed steatosis with one or more of the following: oxidative stress, inflammation, hepatocyte injury, obesity, fibrosis, and cardiometabolic risks factors. Results: Nine articles fulfilled our inclusion criteria and the results demonstrated the ability of phytomedicines to simultaneously exert therapeutic actions on multiple targets related to NAFLD. Conclusions: These findings suggest that herbal extracts have the potential for effective treatment or management of NAFLD.


Assuntos
Diabetes Mellitus Tipo 2 , Resistência à Insulina , Hepatopatia Gordurosa não Alcoólica , Animais , Fígado , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Obesidade/complicações , Obesidade/tratamento farmacológico , Fitoterapia
13.
In Vivo ; 35(5): 2521-2529, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410938

RESUMO

BACKGROUND/AIM: High-flow nasal cannula (HFNC), a new method for postoperative oxygenation, has increasingly received attention during postoperative care. However, its importance for obese patients undergoing cardiac surgery remains controversial. This systematic review and meta-analysis compared and evaluated HFNC and conventional oxygen therapy (COT) in this patient group. MATERIALS AND METHODS: Literature was retrieved by searching eight public databases. Randomized controlled trials (RCTs) were selected. RevMan 5.3 was used to analyze the results and any potential bias. The primary outcome included atelectasis score at 24 h postoperatively. The secondary outcomes included PaO2/FiO2 (ratio), dyspnea score at 24 h postoperatively, intensive care unit (ICU) length of stay, and reintubation. RESULTS: The search strategy yielded 382 studies after duplicates were removed. Finally, 3 RCTs with a total of 526 patients were included in the present study. Compared with COT, there was no significant difference in atelectasis score, dyspnea score, reintubation, and ICU length of stay. CONCLUSION: For obese patients undergoing cardiac surgery, postoperative use of HFNC can maintain patient's oxygenation. Additional clinical studies are needed to investigate the role of HFNC in this patient group.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência Respiratória , Cânula , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Tempo de Internação , Obesidade/complicações , Obesidade/terapia , Oxigênio , Oxigenoterapia , Insuficiência Respiratória/terapia
14.
Lancet Diabetes Endocrinol ; 9(9): 595-605, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34358471

RESUMO

BACKGROUND: Visceral and ectopic fat are key drivers of adverse cardiometabolic outcomes in obesity. We aimed to evaluate the effects of injectable liraglutide 3·0 mg daily on body fat distribution in adults with overweight or obesity without type 2 diabetes at high cardiovascular disease risk. METHODS: In this randomised, double-blind, placebo-controlled, phase 4, single centre trial, we enrolled community-dwelling adults, recruited from the University of Texas Southwestern Medical Center, with BMI of at least 30 kg/m2 or BMI of at least 27 kg/m2 with metabolic syndrome but without diabetes and randomly assigned them, in a 1:1 ratio, to 40 weeks of treatment with once-daily subcutaneous liraglutide 3·0 mg or placebo, in addition to a 500 kcal deficient diet and guideline-recommended physical activity counselling. The primary endpoint was percentage reduction in visceral adipose tissue (VAT) measured with MRI. All randomly assigned participants with a follow-up imaging assessment were included in efficacy analyses and all participants who received at least one dose of study drug were included in the safety analyses. The trial is registered on ClinicalTrials.gov: NCT03038620. FINDINGS: Between July 20, 2017 and Feb 21, 2020 from 235 participants assessed for eligibility, 185 participants were randomly assigned (n=92 liraglutide, n=93 placebo) and 128 (n=73 liraglutide, n=55 placebo) were included in the final analysis (92% female participants, 37% Black participants, 24% Hispanic participants, mean age 50·2 years (SD 9·4), mean BMI 37·7 kg/m2). Mean change in VAT over median 36·2 weeks was -12·49% (SD 9·3%) with liraglutide compared with -1·63% (SD 12·3%) with placebo, estimated treatment difference -10·86% (95% CI -6·97 to -14·75, p<0·0001). Effects seemed consistent across subgroups of age, sex, race-ethnicity, BMI, and baseline prediabetes. The most frequently reported adverse events were gastrointestinal-related (43 [47%] of 92 with liraglutide and 12 [13%] of 93 with placebo) and upper respiratory tract infections (10 [11%] of 92 with liraglutide and 14 [15%] of 93 with placebo). INTERPRETATION: In adults with overweight or obesity at high cardiovascular disease risk, once-daily liraglutide 3·0 mg plus lifestyle intervention significantly lowered visceral adipose tissue over 40 weeks of treatment. Visceral fat reduction may be one mechanism to explain the benefits seen on cardiovascular outcomes in previous trials with liraglutide among patients with type 2 diabetes. FUNDING: NovoNordisk.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Gordura Intra-Abdominal/efeitos dos fármacos , Liraglutida/administração & dosagem , Obesidade/complicações , Sobrepeso/complicações , Adulto , Composição Corporal , Doenças Cardiovasculares , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
15.
Braz J Med Biol Res ; 54(10): e11409, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34406210

RESUMO

Obesity has been associated with an increased risk of breast cancer recurrence and death. Some readily available biomarkers associated with systemic inflammation have been receiving attention as potential prognostic indicators in cancer, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This study aimed to explore the correlation between body mass index (BMI) and invasive breast cancer and the association of NLR, PLR, and BMI with breast cancer outcomes. We undertook a retrospective study to evaluate patients treated for breast cancer over 14 years. Clinicopathological data was obtained before receiving any treatment. Of the 1664 patients included with stage I-III, 567 (34%) were obese (BMI≥30 kg/m2). Obese patients had larger tumors compared to non-obese patients. Higher BMI was associated with recurrence and worse survival only in patients with stage I disease. NLR and PLR were classified into high and low level groups. The NLRhigh (NLR>4) was found to be an independent prognostic factor for recurrence and mortality, while the PLRhigh (PLR>150) group had no impact on survival. A subgroup of patients with NLRhigh and BMIhigh had the worst disease-free survival (P=0.046), breast cancer-specific survival (P<0.001), and overall survival (P=0.006), compared to the other groups. Patients with early-stage breast cancer bearing NLRhigh and BMIhigh had worse outcomes, and this might be explained by the dysfunctional milieu of obesity in adipose tissue and its effects on the immune system. This study highlights the importance of lifestyle measures and the immune system interference with clinical outcomes in the early breast cancer setting.


Assuntos
Neoplasias da Mama , Neutrófilos , Feminino , Humanos , Linfócitos , Recidiva Local de Neoplasia , Obesidade/complicações , Prognóstico , Estudos Retrospectivos
16.
Nutrients ; 13(8)2021 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-34445049

RESUMO

Vitamin D deficiency is highly prevalent in patients with overweight/obesity and type 2 diabetes (T2DM). Herein, we investigated the relationship between vitamin D status and overweight/obesity status, insulin resistance (IR), systemic inflammation as well as oxidative stress (OS). Anthropometric and laboratory assessments of 25-hydroxyvitamin D (25(OH)D) and glycemic, pro-inflammatory and OS biomarkers were performed in a sample of 47 patients with T2DM who were divided into categories based on overweight and degree of obesity. The main findings were: the overweight/obesity status correlated negatively with the degree of serum 25(OH)D deficiency (ρ = -0.27) with a trend towards statistical significance (p = 0.069); the homeostasis model assessment of insulin resistance (HOMA-IR) was significantly different (p = 0.024) in patients with 25(OH)D deficiency, as was total oxidant status (TOS) and oxidative stress index (OSI) in patients with severe serum 25(OH)D deficiency as compared to those with 25(OH)D over 20 ng/mL (TOS: p = 0.007, OSI: p = 0.008); and 25(OH)D had a negative indirect effect on TOS by body mass index (BMI), but BMI was not a significant mediator of the studied relationship. In a setting of overweight and increasing degree of obesity, patients with T2DM did not display decreasing values of 25(OH)D. Subjects with the lowest values of 25(OH)D presented the highest values of BMI. Patients with 25(OH)D deficiency were more insulin resistant and showed increased OS but no elevated systemic inflammation. The negative effect of 25(OH)D on TOS did not seem to involve BMI as a mediator.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Estado Nutricional/fisiologia , Obesidade/sangue , Sobrepeso/sangue , Vitamina D/análogos & derivados , Adulto , Idoso , Antropometria , Biomarcadores/sangue , Glicemia/metabolismo , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Inflamação , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Sobrepeso/complicações , Estresse Oxidativo , Prevalência , Estudos Prospectivos , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia
17.
Am J Physiol Endocrinol Metab ; 321(3): E367-E375, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34338040

RESUMO

Obesity is frequently associated with cerebrovascular dysfunction; however, the underlying mechanism remains less well understood. In this study, by using pharmacological approaches, we show that neuroinflammation involving microglia plays an important role in obesity-related cerebrovascular dysfunction. PLX3397 treatment, which leads to depletion of microglia, reduced the wall thickness and collagen deposition in the basilar artery of diet-induced obesity (DIO) mice. Besides, the phosphorylation of endothelial nitric oxide synthase (eNOS) at Ser1177 was enhanced, suggesting improved endothelial function of the basilar artery. The wire myography data show that acetylcholine-elicited relaxation of basilar artery isolated from DIO mice was improved after the treatment with PLX3397. Moreover, our data demonstrate that brain administration of IL-18 impaired cerebrovascular function in mice with normal body weight. Together, these data suggest that neuroinflammation involving microglia is important in obesity-related vascular dysfunction in the brain.NEW & NOTEWORTHY We reported that microglia, the resident immune cells in the brain, contribute to obesity-related cerebrovascular dysfunction in mice. Moreover, we showed that excessive IL-18 can lead to vascular dysfunction in mouse brain.


Assuntos
Transtornos Cerebrovasculares/patologia , Encefalite/patologia , Microglia/patologia , Obesidade/patologia , Aminopiridinas/administração & dosagem , Animais , Artéria Basilar/patologia , Transtornos Cerebrovasculares/complicações , Encefalite/complicações , Masculino , Camundongos Endogâmicos C57BL , Microglia/efeitos dos fármacos , Obesidade/complicações , Pirróis/administração & dosagem
18.
Int J Clin Pract ; 75(10): e14696, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338415

RESUMO

BACKGROUND: Effects of abdominal obesity on outcomes of atrial fibrillation (AF) ablation remains ill-defined. Here, we evaluated the impact of abdominal obesity on the long-term efficacy and safety of catheter AF ablation among Korean patients. METHODS: We utilised the Korean National Health Insurance Service database to identify patients who underwent AF ablation. Abdominal obesity was defined as waist circumference ≥90 cm (males) and ≥85 cm (females). The primary endpoint was AF recurrence and secondary endpoints were ischaemic stroke, intracranial haemorrhage and death. Additionally, safety endpoints of peri-procedural complications were studied. RESULTS: Among 5397 patients (median age 58 [IQR 51-65] years; 23.6% females), abdominal obesity was present in 1759 (32.6%). The rate of AF recurrence was not statistically different between the groups at 1-year (10.3 vs 8.7 events/100-PYs, P = .078), though abdominal obesity was associated with significantly higher rates of AF recurrence at 3-year (7.6 vs 6.3 events/100-PYs, P = .008) and 6-year (6.3 vs 5.2 events/100-PYs, P = .004) follow-ups. Kaplan-Meier survival analysis found significantly higher rates of AF recurrence in patients with obesity based on body mass index (BMI) and waist circumference (log-rank for trend P = .006). Using multivariable regression analysis, obesity by both BMI and waist circumference was an independent predictor for AF recurrence (HR 1.21 [95% CI, 1.05-1.40]), after accounting for other risk factors. There was a trend for increased rates of ischaemic stroke at 3-year and 6-year follow-ups in patients with abdominal obesity. Furthermore, this group of patients had a greater rate of intracranial haemorrhage. All-cause death was comparable between both groups. Total peri-procedural complications were not associated with abdominal obesity. CONCLUSION: Abdominal obesity as indicated by waist circumference was associated with a greater burden of concomitant diseases and an independent risk factor for long-term redo AF intervention following catheter ablation but had no effects on total peri-procedural complications.


Assuntos
Fibrilação Atrial , Isquemia Encefálica , Ablação por Cateter , Obesidade Abdominal , Acidente Vascular Cerebral , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Recidiva , República da Coreia/epidemiologia , Fatores de Risco , Resultado do Tratamento
19.
Am J Physiol Endocrinol Metab ; 321(3): E433-E442, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34370596

RESUMO

Sepsis is a dysregulated systemic response to infection and can lead to organ damage and death. Obesity is a significant problem worldwide and affects outcomes from sepsis. Our laboratory demonstrated that white adipose tissue (WAT) undergoes browning during sepsis, a process whereby WAT adopts a brown adipose tissue phenotype. However, this browning process was not observed in obese mice during sepsis. White adipose tissue browning is detrimental in patients with burn injury and cancer. We hypothesize that norepinephrine (NE) induces WAT browning in nonobese mice but not in obese mice similarly to sepsis-induced WAT browning. Six-week-old C57BL/6 male mice were randomized to a high-fat diet or normal diet. After 6-7 wk of feeding, polymicrobial sepsis was induced by cecal ligation and puncture (CLP). Norepinephrine was administered intraperitoneally via osmotic minipumps for 18 h or 72 h (no CLP) at which time tissue and plasma were harvested. Controls were mice that underwent CLP (no NE) with 18-h harvest. A separate group of mice underwent pretreatment with NE or vehicle infusion for 72 h, CLP was performed, and at 18 h had tissue and plasma harvested. Sepsis resulted in significant weight loss in both nonobese and obese mice. NE treatment alone caused weight loss in obese mice. Septic nonobese mice had higher uncoupling protein-1 (UCP1) expression compared with control and obese septic mice. NE treatment increased UCP1 expression in nonobese, but not obese mice. NE-treated obese septic mice had lower lung myeloperoxidase (MPO) activity, alanine aminotransferase (ALT), aspartate aminotransferase (AST), TNFα, and IL-6 levels compared with NE-treated nonobese septic mice. Obesity protects mice from septic-induced and NE-induced WAT browning.NEW & NOTEWORTHY White adipose tissue browning is detrimental in patients with burn injury and cancer. WAT browning occurs in nonobese mice and can be induced by ß receptor norepinephrine infusion, but obese mice are resistant to sepsis-induced and norepinephrine-induced WAT browning. We propose that the lack of WAT browning and unchanged inflammatory cytokine response may contribute to the protection of obese mice from sepsis.


Assuntos
Tecido Adiposo Marrom/metabolismo , Tecido Adiposo Branco/metabolismo , Norepinefrina/administração & dosagem , Obesidade/metabolismo , Sepse/metabolismo , Tecido Adiposo Marrom/efeitos dos fármacos , Tecido Adiposo Branco/diagnóstico por imagem , Animais , Dieta Hiperlipídica , Masculino , Camundongos Endogâmicos C57BL , Obesidade/complicações , Sepse/complicações
20.
Wiad Lek ; 74(7): 1617-1621, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34459761

RESUMO

OBJECTIVE: The aim: To study the association between the effectiveness of treatment with pioglitazone non-alcoholic fatty liver disease (NAFLD) in patients with obesity and PPARG rs1801282 (Pro12Ala)-polymorphism in Ukrainians. PATIENTS AND METHODS: Materials and methods: 123 patients with NAFLD in combination with obesity 1, 2, 3 classes were included in comprehensive weight loss program (5 visits, 12-weeks). The case group was treated with pioglitazone 15 mg / day, while the control group received only program. Ultrasound (US) steatometry and genetic testing rs1801282 polymorphism in PPARG gene were performed. RESULTS: Results: Pioglitazone, PPARG rs1801282 genotype, CAP before treatment, previous weight loss attempts, and duration of obesity were associated with the change in controlled attenuation parameter (CAP) during treatment. There was a significant association between the target CAP reduction achievement and pioglitazone treatment (adjusted odds ratio 0.23, 95% CI 0.07-0.73; p = 0.01) with the CC genotype of PPARG gene (adjusted odds ratio 92.9, 95% CI 7.4-1159; p < 0.001) compared to patients with the CG genotype. CONCLUSION: Conclusions: Pioglitazone and PPARG rs1801282 polymorphism could influence on dynamics of CAP reduction during treatment.


Assuntos
Hepatopatia Gordurosa não Alcoólica , PPAR gama , Predisposição Genética para Doença , Genótipo , Humanos , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/genética , Obesidade/complicações , Obesidade/genética , PPAR gama/genética , Pioglitazona/uso terapêutico , Polimorfismo de Nucleotídeo Único
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