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1.
Trials ; 22(1): 522, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362409

RESUMO

BACKGROUND: Community-based diabetes prevention programs varied widely in effectiveness, and the intervention strategy consisting of lifestyle interventions, stepwise addition of metformin, and financial incentives has not been studied in real-world clinical practice settings. The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) trial is a pragmatic trial that aims to compare the effectiveness of a community-based stepwise diabetes prevention program with added financial incentives (intervention) versus the standard of care (control) in reducing the risk of type 2 diabetes over 3 years among overweight or obese individuals with pre-diabetes. METHODS: This is an open-label, 1:1 randomized controlled trial which aims to recruit 846 adult individuals with isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), or both IFG and IGT from Singapore. Intervention arm participants attend 12 group-based sessions (2 nutrition workshops, 9 exercise sessions, and a goal-setting workshop) delivered at community sites (weeks 1 to 6), receive weekly physical activity and nutrition recommendations delivered by printed worksheets (weeks 7 to 12), and receive monthly health tips delivered by text messages (months 4 to 36). From month 6 onwards, intervention arm participants who remain at the highest risk of conversion to diabetes are prescribed metformin. Intervention arm participants are also eligible for a payment/rewards program with incentives tied to attendance at the group sessions and achievement of the weight loss target (5% of baseline weight). All participants are assessed at baseline, month 3, month 6, and every 6 months subsequently till month 36. The primary endpoint is the proportion of participants with diabetes at 3 years. Secondary endpoints include the mean change from baseline at 3 years in fasting plasma glucose, 2-hour plasma glucose, HbA1c, body weight, body mass index, physical activity, and dietary intake. DISCUSSION: The Pre-DICTED trial will provide evidence of the effectiveness and feasibility of a community-based stepwise diabetes prevention program with added financial incentives for individuals with pre-diabetes in Singapore. The study will provide data for a future cost-effectiveness analysis, which will be used to inform policymakers of the value of a nationwide implementation of the diabetes prevention program. TRIAL REGISTRATION: ClinicalTrials.gov NCT03503942 . Retrospectively registered on April 20, 2018. Protocol version: 5.0 Date: 1 March 2019.


Assuntos
Diabetes Mellitus Tipo 2 , Estado Pré-Diabético , Adulto , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevenção & controle , Humanos , Estilo de Vida , Obesidade/diagnóstico , Obesidade/prevenção & controle , Sobrepeso , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
BMC Musculoskelet Disord ; 22(1): 714, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419023

RESUMO

BACKGROUND: Comorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. There are no data on RCT repair outcome from developing regions. We determined the impact of obesity and smoking following RCT repair in a low-income population. METHODS: This is a retrospective case series. Forty-seven shoulders of 42 patients subjected to open or arthroscopic repair of a RCT with a minimum of 2 years follow-up were cross-sectionally evaluated. Patients were seen in the Orthopaedic Service of the Hospital Geral de Fortaleza-CE, Brazil between March and September 2018. RCT were classified as partial or full-thickness lesions. Fatty infiltration (Goutallier) and tendon retraction (Patte) were recorded as well as obesity (BMI > 30), literacy [>/≤ 8 school years (SY)] and smoking status 6 months prior to surgery (present/absent). Outcomes included pain (visual analogue scale; VAS, 0-10 cm), range of motion [active forward flexion and external rotation (ER)], UCLA and ASES scoring. RESULTS: Patients were 59.9 ± 7.4 years-old, 35(74.4%) female with 19 (17.1-30.2 IQR) median of months from diagnosis to surgery and 25 median months of follow-up (26.9-34.0 IQR); over 90% declared < 900.00 US$ monthly family income and two-thirds had ≤8 SY. Forty patients (85.1%) had full-thickness tears, 7 (14.9%) had Goutallier ≥3 and over 80% had < Patte III stage. Outcomes were similar regardless of fatty infiltration or tendon retraction staging. There were 17 (36.1%) smokers and 13 (27.6%) obese patients. Outcome was similar when comparing obese vs non-obese patients. Smokers had more pain (P = 0.043) and less ER (P = 0.029) with a trend towards worse UCLA and ASES scores as compared to non-smokers though differences did not achieve minimal clinically important difference (MCID) proposed for surgical RCT treatment. After adjusting for obesity, VAS and ER values in smokers were no longer significant (P = 0.2474 and 0.4872, respectively). CONCLUSIONS: Our data document outcomes following RCT repair in a low-income population. Smoking status but not obesity impacted RCT repair outcome though not reaching MCID for surgical treatment.


Assuntos
Lesões do Manguito Rotador , Idoso , Artroscopia , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Pobreza , Lesões do Manguito Rotador/epidemiologia , Lesões do Manguito Rotador/cirurgia , Fumar , Resultado do Tratamento
3.
Nutr Metab Cardiovasc Dis ; 31(9): 2605-2611, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34348875

RESUMO

BACKGROUND AND AIMS: To analyze lifestyle habits and weight evolution during the COVID-19 pandemic-associated lockdown, in diabetes and overweight/obesity patients (body mass index (BMI) [25-29.9] and ≥30 kg/m2, respectively). METHODS AND RESULTS: We collected information on participants' characteristics and behavior regarding lifestyle before and during the lockdown, through the CoviDIAB web application, which is available freely for people with diabetes in France. We stratified the cohort according to BMI (≥25 kg/m2vs < 25 kg/m2) and examined the determinants of weight loss (WL), WL > 1 kg vs no-WL) in participants with a BMI ≥25 kg/m2, in both univariate and multivariate analyses. Of the 5280 participants (mean age, 52.5 years; men, 49%; diabetes, 100% by design), 69.5% were overweight or obese (mean BMI, 28.6 kg/m2 (6.1)). During the lockdown, patients often quit or decreased smoking; overweight/obese participants increased alcohol consumption less frequently as compared with normal BMI patients. In addition, overweight/obese patients were more likely to improve other healthy behaviors on a larger scale than patients with normal BMI: increased intake of fruits and vegetables, reduction of snacks intake, and reduction of total dietary intake. WL was observed in 18.9% of people with a BMI ≥25 kg/m2, whereas 28.6% of them gained weight. Lifestyle favorable changes characterized patients with WL. CONCLUSIONS: A significant proportion of overweight/obese patients with diabetes seized the opportunity of lockdown to improve their lifestyle and to lose weight. Identifying those people may help clinicians to personalize practical advice in the case of a recurrent lockdown.


Assuntos
COVID-19/prevenção & controle , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Estilo de Vida Saudável , Obesidade/terapia , Comportamento de Redução do Risco , Perda de Peso , Adulto , Idoso , Índice de Massa Corporal , COVID-19/epidemiologia , COVID-19/transmissão , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Dieta Saudável , Exercício Físico , Feminino , França/epidemiologia , Hábitos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Obesidade/diagnóstico , Obesidade/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Abandono do Hábito de Fumar , Fatores de Tempo , Ganho de Peso
4.
Cardiovasc Diabetol ; 20(1): 162, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348706

RESUMO

In a cohort study performed using primary care databases in a General Practitioners Network, Groenewegen et al. report a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably heart failure (Groenewegen et al. in Cardiovasc Diabetol 20:123, 2021). However, no mention is made of body mass index and hypertension in the methods or in the results. Obesity is linked to hypertension and hypertension is a major risk factor for all cardiovascular diseases, and prospective studies have shown that obesity and hypertension contribute significantly to atrial fibrillation in persons with diabetes. The data would be improved by assessing the role of obesity and of hypertension in the incidence of heart diseases in these patients. This would also lead to a better and personalized treatment of patients with diabetes, for instance through weight loss and intensification of treatment of hypertension, to modify the incidence of atrial fibrillation, ischaemic heart disease and heart failure.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Hipertensão , Isquemia Miocárdica , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Estudos Prospectivos , Fatores de Risco
5.
Medicine (Baltimore) ; 100(32): e26872, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397903

RESUMO

ABSTRACT: Overweight/obesity can influence bone mineral accretion, but the conclusions are not consistent. We aimed to examine the association between bone mineral density (BMD) levels and body mass index (BMI) in 12 to 15 years old adolescents.We performed a cross-sectional study including 8365 adolescents. BMD was evaluated using a quantitative ultrasound device. Z scores for BMI were evaluated using World Health Organization references. Logistic regression models were performed to evaluate the association between BMD levels and BMI.Totally 1866 (22.3%) adolescents had low /reduced BMD, and boys had a higher rate than girls (72.6% vs 27.4%, P < .001). The rates of thinness, normal weight, overweight, and obesity were 2.8%, 57.1%, 22.3%, and 17.8%, respectively. The multivariable-adjusted (age, sex, systolic blood pressure, and height Z score) ORs (95% CIs) of low/reduced BMD associated with BMI groups (thinness, normal [reference], overweight, and obesity) were 0.59 (0.39-0.89), 1.00, 1.61 (1.41-1.84), and 1.98 (1.69-2.30), respectively (Ptrend < .001). This positive association existed in boys and girls though the differences were not significant between normal weight and thin girls. The multivariable-adjusted ORs for each 1-unit increase in BMI Z score were 1.36 (1.24-1.49) for girls, and 1.23 (1.16-1.30) for boys, and 1.26 (1.20-1.32) for all participants.We observed a positive association between BMI and low/reduced BMD in 12 to 15 years old adolescents. More attention should be paid on overweight and obese adolescents to reduce the risk of low BMD. Further studies are needed to explore the mechanisms of this association.


Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas , Obesidade , Sobrepeso , Magreza , Adolescente , Índice de Massa Corporal , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Causalidade , China/epidemiologia , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/metabolismo , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/metabolismo , Medição de Risco , Magreza/diagnóstico , Magreza/metabolismo , Ultrassonografia/métodos
6.
Medicine (Baltimore) ; 100(32): e26882, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397906

RESUMO

BACKGROUND: Papillary thyroid carcinoma (PTC) incidence has been increasing worldwide. Obesity, that is, having a high body mass index, is associated with the incidence of several cancers including colon, breast, esophageal, and kidney cancer. However, the association between obesity and the clinical features of PTC is still unknown. This study aimed to determine the impact of obesity on the clinical features of PTC. METHOD: A database search was conducted for articles published up to 2020 on obesity and clinical features of PTC. Data were extracted from articles that met the meta-analysis inclusion criteria. RESULTS: A total of 11 retrospective cohorts and 11,729 patients were included. Obesity was associated with the following variables in PTC patients: older age (difference in means = 1.95, 95% confidence interval [CI] 0.16-3.74, P = .03), male sex (odds ratio [OR] = 3.13, 95%CI 2.24-4.38, P < .00001), tumor size ≥1 cm (OR = 1.34, 95%CI 1.11-1.61, P < .002), multifocality (OR = 1.54, 95%CI 1.27-1.88, P < .0001), extrathyroidal extension (OR = 1.78, 95%CI 1.22-2.59, P = .003) and advanced tumor, node, metastasis stage (OR = 1.68, 95%CI 1.44-1.96, P < .00001). Preoperative serum thyroid-stimulating hormone level (difference in means  = 0.09, 95%CI 0.35-0.52, P = .70), Vascular invasion (OR = 0.84, 95%CI 0.56-1.26, P = .41), lymph node metastasis (OR = 1.07, 95%CI 0.87-1.32, P = .50), distant metastasis (OR = 1.14, 95%CI 0.64-2.04, P = .66), and recurrence (OR = 1.45, 95%CI 0.97-2.15, P = .07) were not associated with obesity. CONCLUSION: Obesity was associated with several poor clinicopathologic prognostic features: older age, male gender, tumor size ≥1 cm, extrathyroidal extension, multifocality, and advanced tumor/node/metastasis stage. However, thyroid-stimulating hormone level, vascular invasion, lymph node metastasis, distant metastasis, and recurrence were not associated with obesity in PTC.


Assuntos
Obesidade , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Índice de Massa Corporal , Causalidade , Progressão da Doença , Humanos , Obesidade/diagnóstico , Obesidade/epidemiologia , Prognóstico , Medição de Risco , Câncer Papilífero da Tireoide/epidemiologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia
10.
Int J Health Geogr ; 20(1): 34, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34320996

RESUMO

BACKGROUND: Obesity remains one of the most challenging public health issues of our modern time. Despite the face validity of claims for influence, studies on the causes of obesity have reported the influence of the food environment to be inconsistent. This inconsistency has been attributed to the variability of measures used by researchers to represent the food environments-Researcher-Defined Food Environments (RDFE) like circular, street-network buffers, and others. This study (i.) determined an individual's Activity Space (AS) (ii.) explored the accuracy of the RDFE in representing the AS, (iii.) investigated the accuracy of the RDFE in representing actual exposure, and (iv.) explored whether exposure to food outlet reflects the use of food outlets. METHODS: Data were collected between June and December 2018. A total of 65 participants collected Global Positioning System (GPS) data, kept receipt of all their food purchases, completed a questionnaire about their personal information and had their weight and height measured. A buffer was created around the GPS points and merged to form an AS (GPS-based AS). RESULTS: Statistical and geospatial analyses found that the AS size of participants working away from home was positively related to the Euclidean distance from home to workplace; the orientation (shape) of AS was also influenced by the direction of workplace from home and individual characteristics were not predictive of the size of AS. Consistent with some previous studies, all types and sizes of RDFE variably misrepresented individual exposure in the food environments. Importantly, the accuracy of the RDFE was significantly improved by including both the home and workplace domains. The study also found no correlation between exposure and use of food outlets. CONCLUSIONS: Home and workplace are key activity nodes in modelling AS or food environments and the relationship between exposure and use is more complex than is currently suggested in both empirical and policy literature.


Assuntos
Abastecimento de Alimentos , Sistemas de Informação Geográfica , Humanos , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/etiologia , Características de Residência , Inquéritos e Questionários , Local de Trabalho
11.
ACS Biomater Sci Eng ; 7(8): 3658-3668, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34260213

RESUMO

This study presents a disposable, novel, and sensitive biosensing system to determine adiponectin, an obesity biomarker, in real human serum. The graphite paper (GP) working electrode is a new material for impedimetric biosensors. In the literature, there is no study in which this electrode is used in impedance-based biosensors for adiponectin detection. Sensitive and useful techniques, such as electrochemical impedance spectroscopy and cyclic voltammetry, were utilized for investigation of the modification of the GP electrode surface and optimization and characterization of the constructed biosensor. The single frequency impedance technique was used to study the interactions between antiadiponectin and adiponectin. The morphology of the electrode surface for each immobilization step was examined with scanning electron microscopy. All experimental parameters were optimized to fabricate a rapid and sensitive biosensing system. The designed biosensor presents excellent performance with a wide detection range (0.05-25 pg mL-1) and a low limit of detection (0.0033 pg mL-1) for adiponectin determination. Also, it has been demonstrated that the biosensor sensitively allows for the detection of adiponectin in human serum. The affinity of the designed immunosensor toward other proteins and components was examined in the presence of the target protein (adiponectin), leptin (100 pg mL-1), creatine kinase (50 pg mL-1), parathyroid hormone (50 pg mL-1), and d-glucose (0.5 M). The selectivity of the adiponectin biosensor resulted in high capacity to neglect the interference effect. The constructed biosensor showed good linearity, long-term storage life (10 weeks), high reusability (18 times regenerability), and high ability to detect adiponectin concentrations at picogram levels.


Assuntos
Técnicas Biossensoriais , Grafite , Adiponectina , Anticorpos Imobilizados , Biomarcadores Tumorais , Técnicas Eletroquímicas , Eletrodos , Humanos , Imunoensaio , Obesidade/diagnóstico
12.
Am J Obstet Gynecol MFM ; 3(5): 100441, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34229125

RESUMO

BACKGROUND: In patients with obesity, the distribution of subcutaneous tissue can make blood pressure measurement on the standard location of the upper arm difficult. In these cases, alternative locations, such as the lower arm or wrist, are commonly used. It is unknown whether there is a discrepancy in these measurements for pregnant patients at extremes of body mass index. OBJECTIVE: We hypothesized that noninvasive blood pressure measurements on the lower arm and wrist will differ from blood pressure measurements on the upper arm and that this difference will be greater with increasing body mass index. STUDY DESIGN: We conducted a prospective observational study of pregnant patients from July 2020 to August 2020. We collected study subjects' biometric measurements and took 3 blood pressure measurements (systolic and diastolic blood pressures) from the upper arm, lower arm, and wrist. Measurements on the lower arm and wrist were considered alternative locations and compared with measurements on the upper arm. We stratified patients by body mass index. Agreement between locations was assessed using the Bland-Altman analysis. We used linear regression to assess the blood pressure discrepancy dependence on body mass index. RESULTS: We included 100 patients with 20 patients from each body mass index class. Blood pressure measurements at each site correlated but were discrepant. For the lower arm, there was an upward bias of 11.5 mm Hg (limit of agreement, +30.7 to -7.8) for systolic blood pressure and 11.2 mm Hg (limit of agreement, +25.9 to -2.9) for diastolic blood pressure compared with the upper arm. For the wrist, there was an upward bias of 7.1 mm Hg (limit of agreement, +35.1 to -20.9) for systolic blood pressure and 7.3 mm Hg (limit of agreement, +26.2 to -11.7) for diastolic blood pressure compared with the upper arm. Overall, there was a greater discrepancy in blood pressure measurements between the lower and upper arms with increasing body mass index. When comparing blood pressure measurements between the lower and upper arms, the discrepancy increased by 0.43 mm Hg (P<.001) for systolic blood pressure and 0.18 mm Hg (P=.02) for diastolic blood pressure with each increasing body mass index unit. There was no statistically significant change in the discrepancy of systolic (P=.45) or diastolic (P=.86) blood pressure in the upper arm vs the wrist based on body mass index. CONCLUSION: This study highlighted that blood pressure measurements are higher when taken at alternative locations, such as the lower arm and wrist, and that lower arm blood pressure measurements are increasingly discrepant from upper arm blood pressure measurements with increasing body mass index.


Assuntos
Determinação da Pressão Arterial , Punho , Braço , Pressão Sanguínea , Feminino , Humanos , Obesidade/diagnóstico , Gravidez
13.
Vasc Health Risk Manag ; 17: 371-377, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34234445

RESUMO

Purpose: The aim of this study was to investigate the associations of high blood pressure (BP) and wide pulse pressure (PP) with obesity among common Korean people. Materials and Methods: This study analyzed data from the Seventh Korean National Health and Nutrition Examination Survey (2017). The associations of BP with body mass index (BMI) and waist-to-height ratio (WHT2R) were investigated using their lump mean values. Results: The BPs of males and females increased with BMI, the PP of females increased with BMI and then decreased, and the PP of males is nearly independent of BMI. The BPs of males and females increased to their maximum values with WHT2R and then decreased. The PPs of males and females increased with WHT2R. Conclusion: BMI can be used as a useful predictor for high BP, and WHT2R can be used as a useful predictor for wide PP.


Assuntos
Pressão Sanguínea , Hipertensão/epidemiologia , Obesidade/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/diagnóstico , Obesidade/fisiopatologia , Valor Preditivo dos Testes , República da Coreia/epidemiologia , Fatores de Risco , Relação Cintura-Quadril , Adulto Jovem
14.
Atherosclerosis ; 330: 14-21, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34218213

RESUMO

BACKGROUND AND AIMS: We aimed to evaluate the effects of serum testosterone, obesity and their interaction on blood pressure (BP) parameters and hypertension among Chinese rural adults. METHODS: A total of 6199 adults were recruited from the Henan Rural Cohort Study. Serum testosterone was measured by liquid chromatography-tandem mass spectrometry. Logistic regression and linear regression were used to evaluate the association between testosterone, hypertension and BP parameters (including systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP)). A generalized linear model was performed to identify the interactive effects of testosterone and obesity on hypertension. RESULTS: High levels of serum testosterone were associated with a lower prevalence of hypertension in males (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.53, 0.89). After stratification by obesity, observed associations were only found in non-obese males. Each one-unit increase in ln-testosterone was associated with a 1.23 mmHg decrease in SBP, 0.97 mmHg decrease in DBP, and 1.05 mmHg decrease in MAP among males. Moreover, interactive effects between testosterone and obesity on hypertension and BP parameters were found, indicating that protective effects of serum testosterone on hypertension and BP parameters were counteracted and accompanied by increased values of obesity-related indicators in males, and additional testosterone increased BP parameters and prevalence of hypertension at high levels of waist-to-hip ratio and waist-to-height ratio in females. CONCLUSIONS: Elevated levels of serum testosterone were associated with decreased BP parameters and prevalent hypertension in males, and obesity modifying effects of serum testosterone on BP parameters and hypertension.


Assuntos
Hipertensão , Testosterona , Adulto , Pressão Sanguínea , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Fatores de Risco
15.
BMC Cardiovasc Disord ; 21(1): 332, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229605

RESUMO

Recently, we face a surge in the fast-forward Coronavirus Disease 2019 (COVID-19) pandemic with nearly 170 million confirmed cases and almost 3.5 million confirmed deaths at the end of May 2021. Obesity, also known as the pandemic of the 21st century, has been evolving as an adverse prognostic marker. Obesity is associated with a higher risk of being SARS-CoV-2-positive (46%), as well as hospitalization (113%) and death (48%) due to COVID-19. It is especially true for subjects with morbid obesity. Also, observational studies suggest that in the case of COVID-19, no favorable "obesity paradox" is observed. Therefore, it is postulated to introduce a new entity, i.e., coronavirus disease-related cardiometabolic syndrome (CIRCS). In theory, it applies to all stages of COVID-19, i.e., prevention, acute proceedings (from COVID-19 diagnosis to resolution or three months), and long-term outcomes. Consequently, lifestyle changes, glycemic control, and regulation of the renin-angiotensin-aldosterone pathway have crucial implications for preventing and managing subjects with COVID-19. Finally, it is crucial to use cardioprotective drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and statins. Nevertheless, there is the need to conduct prospective studies and registries better to evaluate the issue of obesity in COVID-19 patients.


Assuntos
COVID-19/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , COVID-19/diagnóstico , COVID-19/terapia , Fatores de Risco Cardiometabólico , Dieta/efeitos adversos , Exercício Físico , Hospitalização , Humanos , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/terapia , Obesidade/diagnóstico , Obesidade/terapia , Distanciamento Físico , Serviços Preventivos de Saúde , Prognóstico , Medição de Risco , Comportamento Sedentário
16.
Prev Chronic Dis ; 18: E66, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34197283

RESUMO

INTRODUCTION: Severe COVID-19 illness in adults has been linked to underlying medical conditions. This study identified frequent underlying conditions and their attributable risk of severe COVID-19 illness. METHODS: We used data from more than 800 US hospitals in the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to describe hospitalized patients aged 18 years or older with COVID-19 from March 2020 through March 2021. We used multivariable generalized linear models to estimate adjusted risk of intensive care unit admission, invasive mechanical ventilation, and death associated with frequent conditions and total number of conditions. RESULTS: Among 4,899,447 hospitalized adults in PHD-SR, 540,667 (11.0%) were patients with COVID-19, of whom 94.9% had at least 1 underlying medical condition. Essential hypertension (50.4%), disorders of lipid metabolism (49.4%), and obesity (33.0%) were the most common. The strongest risk factors for death were obesity (adjusted risk ratio [aRR] = 1.30; 95% CI, 1.27-1.33), anxiety and fear-related disorders (aRR = 1.28; 95% CI, 1.25-1.31), and diabetes with complication (aRR = 1.26; 95% CI, 1.24-1.28), as well as the total number of conditions, with aRRs of death ranging from 1.53 (95% CI, 1.41-1.67) for patients with 1 condition to 3.82 (95% CI, 3.45-4.23) for patients with more than 10 conditions (compared with patients with no conditions). CONCLUSION: Certain underlying conditions and the number of conditions were associated with severe COVID-19 illness. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, and anxiety disorders were the strongest risk factors for severe COVID-19 illness. Careful evaluation and management of underlying conditions among patients with COVID-19 can help stratify risk for severe illness.


Assuntos
COVID-19 , Complicações do Diabetes , Hospitalização/estatística & dados numéricos , Multimorbidade , Doenças não Transmissíveis/epidemiologia , Obesidade , Transtornos Fóbicos , Fatores Etários , Idoso , COVID-19/mortalidade , COVID-19/terapia , Comorbidade , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Masculino , Mortalidade , Obesidade/diagnóstico , Obesidade/epidemiologia , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/epidemiologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
17.
Int J Mol Sci ; 22(12)2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34208585

RESUMO

Leptin is a principal adipose-derived hormone mostly implicated in the regulation of energy balance through the activation of anorexigenic neuronal pathways. Comprehensive studies have established that the maintenance of certain concentrations of circulating leptin is essential to avoid an imbalance in nutrient intake. Indeed, genetic modifications of the leptin/leptin receptor axis and the obesogenic environment may induce changes in leptin levels or action in a manner that accelerates metabolic dysfunctions, resulting in a hyperphagic status and adipose tissue expansion. As a result, a vicious cycle begins wherein hyperleptinaemia and leptin resistance occur, in turn leading to increased food intake and fat enlargement, which is followed by leptin overproduction. In addition, in the context of obesity, a defective thermoregulatory response is associated with impaired leptin signalling overall within the ventromedial nucleus of the hypothalamus. These recent findings highlight the role of leptin in the regulation of adaptive thermogenesis, thus suggesting leptin to be potentially considered as a new thermolipokine. This review provides new insight into the link between obesity, hyperleptinaemia, leptin resistance and leptin deficiency, focusing on the ability to restore leptin sensitiveness by way of enhanced thermogenic responses and highlighting novel anti-obesity therapeutic strategies.


Assuntos
Leptina/metabolismo , Obesidade/metabolismo , Transdução de Sinais , Animais , Biomarcadores , Regulação da Temperatura Corporal , Gerenciamento Clínico , Suscetibilidade a Doenças , Metabolismo Energético , Humanos , Hipotálamo/metabolismo , Leptina/sangue , Leptina/deficiência , Obesidade/diagnóstico , Obesidade/etiologia , Obesidade/terapia , Termogênese , Resultado do Tratamento
18.
Trials ; 22(1): 454, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266458

RESUMO

BACKGROUND: Polycystic ovary syndrome is a common cause of infertility and shows a high incidence in women of reproductive age. Acupuncture is an appropriate adjunctive treatment for PCOS. However, the add-on effect of acupuncture as an adjunctive treatment for obese women with PCOS has not been studied, and previous studies indicate that there are individual differences in the curative effect of acupuncture, while deeper research on the mechanism of differences in the individual curative effect of acupuncture for obese women with PCOS is still lacking. This trial aims to assess the add-on treatment efficacy of acupuncture for obese women with PCOS and to explore the role of the gut microbiome on the differences in the individual curative effect of acupuncture based on metagenomic analysis. METHODS/DESIGN: This is an open-label, randomized, controlled trial. A total of 86 obese women with PCOS will be recruited. Subjects will be randomly assigned to a study group and a control group in a 1:1 ratio, with 43 subjects in each group (10 patients from each group who meet the study criteria will participate in the metagenomic analysis). An additional 10 subjects who meet the study criteria will be recruited to a healthy control group. The study group will receive acupuncture and clomiphene citrate treatment; the control group will only receive clomiphene citrate. Acupuncture treatment will be conducted three times a week from the fifth day of menstruation or withdrawal bleeding until the start of the next menstruation, for up to three menstrual cycles. The primary outcome will be LH/FSH. The secondary outcomes will comprise biometric features, hormone biomarkers, metabolic biomarkers, inflammatory biomarkers, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and metagenomic analysis. The outcomes will be measured at baseline and post-intervention. Data will be analyzed using SPSS 19.0, and the gut microbiome will be analyzed using metagenomic analysis. DISCUSSION: In this study, we are evaluating the add-on effects of acupuncture and exploring the mechanism of the differences in the individual curative effect of acupuncture based on the gut microbiome, which may provide evidence to explain the different outcomes of different trials on acupuncture for PCOS and hopefully to provide a new aspect to study the mechanism of acupuncture's treatment effect. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000029882 . Registered on 16 February 2020.


Assuntos
Terapia por Acupuntura , Síndrome do Ovário Policístico , Clomifeno , Feminino , Humanos , Menstruação , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/terapia , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Trials ; 22(1): 464, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281590

RESUMO

BACKGROUND: Preclinical studies demonstrated that glucagon-like peptide 1 (GLP-1) is locally synthesized in taste bud cells and that GLP-1 receptor exists on the gustatory nerves in close proximity to GLP-1-containing taste bud cells. This local paracrine GLP-1 signalling seems to be specifically involved in the perception of sweets. However, the role of GLP-1 in taste perception remains largely unaddressed in clinical studies. Whether any weight-reducing effects of GLP-1 receptor agonists are mediated through the modulation of taste perception is currently unknown. METHODS AND ANALYSIS: This is an investigator-initiated, randomized single-blind, placebo-controlled clinical trial. We will enrol 30 women with obesity and polycystic ovary syndrome (PCOS). Participants will be randomized in a 1:1 ratio to either semaglutide 1.0 mg or placebo for 16 weeks. The primary endpoints are alteration of transcriptomic profile of tongue tissue as changes in expression level from baseline to follow-up after 16 weeks of treatment, measured by RNA sequencing, and change in taste sensitivity as detected by chemical gustometry. Secondary endpoints include change in neural response to visual food cues and to sweet-tasting substances as assessed by functional MRI, change in body weight, change in fat mass and change in eating behaviour and food intake. DISCUSSION: This is the first study to investigate the role of semaglutide on taste perception, along with a neural response to visual food cues in reward processing regions. The study may identify the tongue and the taste perception as a novel target for GLP-1 receptor agonists. ETHICS AND DISSEMINATIONS: The study has been approved by the Slovene National Medical Ethics Committee and will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Results will be submitted for publication in an international peer-reviewed scientific journal. TRIAL REGISTRATION: ClinicalTrials.gov NCT04263415 . Retrospectively registered on 10 February 2020.


Assuntos
Diabetes Mellitus Tipo 2 , Receptor do Peptídeo Semelhante ao Glucagon 1 , Método Duplo-Cego , Feminino , Peptídeos Semelhantes ao Glucagon , Humanos , Hipoglicemiantes/efeitos adversos , Obesidade/diagnóstico , Obesidade/tratamento farmacológico , Percepção , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Paladar
20.
Nutrients ; 13(7)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34201490

RESUMO

The aim of this study was to assess the impact of the nationwide total lockdown (LD) in France on weight loss and body composition modifications in subjects participating in a weight loss program and to evaluate the impact of remote consultations on participants' adherence to the weight loss program. The CO-RNPC study was a prospective multicentre cohort study including participants undergoing a two to six months program. The rate of weight loss in kg/week was computed before (15 days), during (99 days) and after LD (15 days). In the 1550 completing participants, body weight decreased from 87.1 kg [IQR 77.0; 100.2] to 82.3 kg [72.1; 94.3] resulting in a difference of -4.79 kg [-4.48; -5.10] (p < 0.01), with a corresponding reduction in waist circumference by 4 cm ([0; 9], p < 0.01). The median weight loss was 4.4 kg [0.5; 9.4] in those who used remote consultations, and 1.4 kg [0.8; 5.7] in the no remote consultation group (p < 0.01). In this large prospective cohort, we observed that the rate of weight loss was reduced during LD. This reduction was counterbalanced in participants involved in a remote consultation follow-up with a dose-effect response based on the number of remote consultations.


Assuntos
Composição Corporal , COVID-19/prevenção & controle , Obesidade/terapia , Distanciamento Físico , Consulta Remota , Perda de Peso , Programas de Redução de Peso , COVID-19/transmissão , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/fisiopatologia , Cooperação do Paciente , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
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