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Epigenetic programming of obesity in early life through modulation of the kynurenine pathway 通过调节犬尿氨酸途径对生命早期的肥胖进行表观遗传编程。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-18 DOI: 10.1038/s41366-024-01647-8
Mojgan Gharipour, Jeffrey M. Craig, Garth Stephenson
Childhood obesity is a global health concern that has its origins before birth. Although genetics plays a crucial role, increasing evidence suggests that epigenetic modifications during fetal life could also influence its incidence. In this model, during the fetal period, interactions between genetic makeup, intrauterine factors, and environmental conditions, increase the risk of childhood obesity. This is in accordance with the Developmental Origins of Health and Disease (DOHaD) hypothesis, in which specific intrauterine environments can have long-lasting effects on the immune system’s essential functions during crucial stages of fetal growth, resulting in permanent changes to the immune function of the offspring. Consequently, dysfunction can consequently make the offspring more prone to inflammatory and immune-related disorders later in life. In this review, we examine how maternal inflammation could influence the risk of childhood obesity. We propose that during pregnancy, modification of the expression of critical genes in metabolic and signaling pathways, such as the kynurenine (Kyn) pathway, occurs due to increased levels of maternal inflammation. We also propose that such expression differences are mediated by epigenetic changes. Furthermore, we also hypothesize that the Kyn pathway produces metabolites that have immunoregulatory effects and may play a crucial role in regulating inflammation during pregnancy. As a result, interventions aimed at improving maternal inflammation may be able to help alleviate the risk of childhood obesity.
儿童肥胖症是一个全球性的健康问题,其根源在出生前。虽然遗传起着至关重要的作用,但越来越多的证据表明,胎儿时期的表观遗传修饰也会影响肥胖症的发病率。在这个模型中,在胎儿时期,遗传构成、宫内因素和环境条件之间的相互作用会增加儿童肥胖的风险。这与 "健康与疾病的发展起源(DOHaD)假说 "相吻合,即在胎儿成长的关键阶段,特定的宫内环境会对免疫系统的基本功能产生长期影响,导致后代的免疫功能发生永久性变化。因此,功能失调会使后代日后更容易患上炎症和免疫相关疾病。在这篇综述中,我们将探讨母体炎症如何影响儿童肥胖的风险。我们认为,在怀孕期间,由于母体炎症水平的增加,代谢和信号通路(如犬尿氨酸(Kyn)通路)中的关键基因的表达会发生改变。我们还提出,这种表达差异是由表观遗传变化介导的。此外,我们还假设,Kyn 通路产生的代谢产物具有免疫调节作用,可能在妊娠期调节炎症方面发挥着至关重要的作用。因此,旨在改善母体炎症的干预措施可能有助于减轻儿童肥胖的风险。
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引用次数: 0
Effects of various exercise types on inflammatory response in individuals with overweight and obesity: a systematic review and network meta-analysis of randomized controlled trials 各种运动类型对超重和肥胖症患者炎症反应的影响:随机对照试验的系统回顾和网络荟萃分析。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-17 DOI: 10.1038/s41366-024-01649-6
Chaofan Chen, Dong Zhang, Mingyi Ye, Yanwei You, Yiling Song, Xiaoke Chen
To explore effective exercise types for reducing chronic inflammation in individuals with overweight and obesity (IOO) while accounting for confounders. A systematic search for RCTs in English between January 2000 and August 2023 was conducted to evaluating exercise effects on inflammatory biomarkers in IOO. A network meta-analysis conducted. A total of 123 RCTs were analyzed. Different exercise type yielded distinct effects on various inflammatory biomarkers. Specifically, aerobic exercise combined with resistance training (COM) and aerobic exercise (AE) were the most effective for improving leptin levels. AE exhibited the greatest effectiveness in reducing CRP and increasing adiponectin. High-intensity interval training (HIIT) was identified as the most effective exercise modality for ameliorating IL-6, TNF-α, and IL-10. Resistance training (RT) had the least effect compared to other exercise types. Meta regression and subgroup analyses revealed that high-intensity AE demonstrated a greater effect size compared to moderate-intensity AE. The impact of AE on IL-10 was positively associated with both the training period and the age of participants. Positive correlations were observed between reductions in body fat and the effect sizes of CRP, TNF-α, and IL-10. Gender influenced AE effects on IL-6 and TNF-α, with females responding better. This study highlights the potential of exercise in alleviating the inflammatory status in IOO, with different exercise types showing various effects on specific inflammatory biomarkers. The intensity and duration of exercise had a dose-response relationship with intervention effectiveness. Changes in body composition correlated with the effectiveness of the intervention. COM, AE, and HIIT are recommended exercise approaches.
目的在考虑混杂因素的情况下,探索减少超重和肥胖症(IOO)患者慢性炎症的有效运动类型:方法:系统检索2000年1月至2023年8月期间的英文RCT,评估运动对超重和肥胖症患者炎症生物标志物的影响。结果:共收集到 123 项研究数据:结果:共分析了 123 项研究。不同的运动类型对各种炎症生物标志物产生了不同的影响。具体而言,有氧运动结合阻力训练(COM)和有氧运动(AE)对改善瘦素水平最有效。有氧运动在降低 CRP 和增加脂肪连通素方面的效果最好。高强度间歇训练(HIIT)被认为是改善 IL-6、TNF-α 和 IL-10 最有效的运动方式。与其他运动方式相比,阻力训练(RT)的效果最小。元回归和亚组分析显示,与中等强度的AE相比,高强度AE的效果更大。AE对IL-10的影响与训练时间和参与者的年龄呈正相关。体脂减少与CRP、TNF-α和IL-10的效应大小呈正相关。性别影响了 AE 对 IL-6 和 TNF-α 的影响,女性的反应更好:本研究强调了运动在缓解 IOO 炎症状态方面的潜力,不同类型的运动对特定炎症生物标志物有不同的影响。运动强度和持续时间与干预效果呈剂量反应关系。身体成分的变化与干预效果相关。建议采用COM、AE和HIIT等运动方式。
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引用次数: 0
Role of Planetary Health Diet in the association between genetic susceptibility to obesity and anthropometric measures in adults 行星健康饮食在成人肥胖遗传易感性与人体测量之间的关联中的作用。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-17 DOI: 10.1038/s41366-024-01656-7
Tiina Suikki, Mirkka Maukonen, Heidi Marjonen-Lindblad, Niina Erika Kaartinen, Tommi Härkänen, Pekka Jousilahti, Anne-Maria Pajari, Satu Männistö
The roles of overall diet quality in linking genetic background with anthropometric measures are unclear, particularly regarding the recently developed Planetary Health Diet (PHD). This study aims to determine if the PHD mediates or moderates the relationship between genetic susceptibility to obesity and anthropometric measures. The study involved 2942 individuals from a Finnish population-based cohort (54% women, mean age 53 (SD ± 13) years). Habitual diet was assessed using a validated 130-item food frequency questionnaire, and the PHD Score (total score range 0–13 points) was adapted for Finnish food culture to evaluate diet quality. Genetic susceptibility to obesity was evaluated with a polygenic risk score (PRS) based on one million single nucleotide polymorphisms associated with body mass index (BMI). Baseline anthropometrics included weight, height, waist circumference (WC), and body fat percentage, with changes in these measures tracked over 7 years. A five-step multiple linear regression model and multivariable logistic regression with interaction terms were used to assess the mediating and moderating effects of the PHD. These analyses were also replicated in another Finnish cohort study (2 834 participants). PRS for BMI was positively associated with baseline BMI and changes in anthropometric measures, except waist circumference (p = 0.12). Significant associations were observed for baseline BMI and WC (p < 0.001), changes in BMI and WC (p = 0.01), and body fat percentage change (p = 0.05). However, the PHD (average score 3.8 points) did not mediate or moderate these relationships. These findings were consistent in the replication cohort. Diet quality assessed with the PHD did not mediate or moderate the associations between genetic susceptibility to obesity and anthropometric measures. This lack of effect may be partly due to low adherence to the PHD and the older age of participants ( > 50 years) at baseline.
背景/目的:整体饮食质量在将遗传背景与人体测量指标联系起来方面的作用尚不明确,尤其是最近开发的 "行星健康饮食"(PHD)。本研究旨在确定 PHD 是否会介导或调节肥胖遗传易感性与人体测量指标之间的关系:研究对象/方法:2942 人来自芬兰人口队列(54% 为女性,平均年龄为 53(SD ± 13)岁)。使用经过验证的130项食物频率问卷对习惯饮食进行评估,并根据芬兰饮食文化改编了PHD评分(总分范围为0-13分),以评估饮食质量。根据与体重指数(BMI)相关的一百万个单核苷酸多态性,采用多基因风险评分(PRS)对肥胖遗传易感性进行了评估。基线人体测量指标包括体重、身高、腰围(WC)和体脂率,并对这些指标在 7 年中的变化进行跟踪。采用五步多元线性回归模型和带有交互项的多变量逻辑回归来评估 PHD 的中介和调节作用。这些分析也在另一项芬兰队列研究(2 834 名参与者)中得到了验证:结果:BMI 的 PRS 与基线 BMI 和人体测量指标的变化呈正相关,但腰围除外(p = 0.12)。基线体重指数(BMI)和腰围(WC)之间存在显著相关性(P=0.12):PHD 评估的饮食质量并不能调节或缓和肥胖遗传易感性与人体测量指标之间的关联。缺乏影响的部分原因可能是对 PHD 的依从性较低,以及基线参与者的年龄较大(大于 50 岁)。
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引用次数: 0
The relationship between leptin-to-adiponectin ratio and HOMA-IR and metabolic syndrome in five African-origin populations 五个非洲原住民的瘦素-脂联素比率和 HOMA-IR 与代谢综合征之间的关系。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-17 DOI: 10.1038/s41366-024-01655-8
Nadia Sweis, Julianne Jorgensen, Julia Zeng, Candice Choo-Kang, Joseph Zapater, Kweku Bedu-Addo, Terrence Forrester, Pascal Bovet, Estelle V. Lambert, Walter Riesen, Wolfgang Korte, Yang Dai, Lara R. Dugas, Brian T. Layden, Amy Luke
This cross-sectional study aims to assess the associations between serum leptin, adiponectin, leptin-to-adiponectin ratio (L/A ratio), and metabolic syndrome (MS) and HOMA-IR in five African-origin populations: Ghana, South Africa, Jamaica, Seychelles, and US. Clinical measures included serum glucose, insulin, adipokines, blood pressure and anthropometric measures. MS was determined using the Harmonized criteria. The final sample included 2087 adults. After adjusting for age, sex, and fat mass, L/A ratio, unlike HOMA-IR, was significantly associated with MS across all sites (p < 0.001). Within sites, L/A ratio was only associated with MS and HOMA-IR in the US (p < 0.001) and South Africa (p < 0.01), respectively. Leptin was associated with MS in South Africa only (p < 0.05) but was significantly associated with HOMA-IR across all five sites and within the US (p < 0.05). Similarly, adiponectin was associated with HOMA-IR in South Africa (p < 0.05) and with MS across all five sites (p < 0.001) and within each site separately, except Ghana. Our study suggests that individuals of the African diaspora in different geographical locations may differ in the determinants of MS. Future studies should investigate the determinants for the disparate relationships between MS, IS and adipokines across different African-origin populations.
研究目的这项横断面研究旨在评估五个非洲裔人群的血清瘦素、脂肪连素、瘦素与脂肪连素比率(L/A 比率)、代谢综合征(MS)与 HOMA-IR 之间的关联:方法:临床测量包括血清葡萄糖、胰岛素、脂肪因子、血压和人体测量。多发性硬化症是根据统一标准确定的。最终样本包括 2087 名成年人:结果:在对年龄、性别和脂肪量进行调整后,与 HOMA-IR 不同的是,L/A 比值与所有部位的 MS 都有显著相关性(p 结论:我们的研究表明,非洲人的 L/A 比值与 MS 有显著相关性:我们的研究表明,散居在不同地理位置的非洲人在多发性硬化症的决定因素方面可能存在差异。未来的研究应调查不同非洲裔人群中 MS、IS 和脂肪因子之间不同关系的决定因素。
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引用次数: 0
Loss of body weight is dose-dependently associated with reductions in symptoms of hip osteoarthritis 体重的减轻与髋关节骨关节炎症状的减轻呈剂量依赖关系。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-17 DOI: 10.1038/s41366-024-01653-w
Zubeyir Salis, Ryan Gallagher, Luke Lawler, Amanda Sainsbury
While weight loss is recommended for managing hip osteoarthritis (OA), most evidence comes from knee OA studies, limiting its applicability to hip OA. This study addresses this gap by examining the effects of weight loss on hip OA symptoms. A retrospective audit of routinely collected healthcare data from participants enrolled in the Osteoarthritis Healthy Weight for Life (OAHWFL) program, designed for individuals with knee or hip OA. In total, 1714 adults with hip OA were selected from the OAHWFL program; 1408 completed the initial 18-week weight loss phase, while 306 did not complete it. After 18 weeks, participants transitioned to an indefinite weight maintenance phase. Percentage change in body weight from baseline at 18 weeks. Changes in the five subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS) (Pain, Activity Limitations in Daily Living, Stiffness and Range of Motion, Sports and Recreation Function, and Hip-related Quality of Life) from baseline to 18 weeks. Linear regression, adjusted for sex and baseline values of age, weight, and respective HOOS scores, assessed the relationship between percentage weight change (analyzed as both a continuous variable and in categories: ≤2.5%, >2.5–5.0%, >5.0–7.5%, >7.5–10%, and >10% of baseline weight) and changes in all five HOOS subscales. At baseline, participants had a mean age of 65.14 years, 70% were female, and 78% were individuals with obesity (Body Mass Index ≥30 kg/m2). A statistically significant dose-response relationship was observed between weight loss and improvements in all HOOS subscales, with the greatest improvement in the Hip-related Quality of Life subscale (14.42 points, 31.14%) for >10% weight loss. Our findings suggest that weight loss is associated with reduced symptoms of hip OA, supporting weight loss as an effective treatment strategy for hip OA.
背景/目的:虽然减肥被推荐用于控制髋关节骨关节炎(OA),但大多数证据来自膝关节OA研究,限制了其对髋关节OA的适用性。本研究通过考察减肥对髋关节OA症状的影响来弥补这一不足:对参加骨关节炎健康体重终身计划(OAHWFL)的参与者的常规医疗保健数据进行回顾性审计,该计划专为膝关节或髋关节OA患者设计:OAHWFL项目共选取了1714名患有髋关节OA的成年人,其中1408人完成了最初为期18周的减重阶段,306人未完成。18周后,参与者转入无限期体重维持阶段:18周时体重与基线相比的变化百分比:结果:髋关节残疾和骨关节炎结果评分(HOOS)五个分量表(疼痛、日常生活活动受限、僵硬度和活动范围、运动和娱乐功能以及髋关节相关生活质量)从基线到 18 周的变化:线性回归评估了体重变化百分比(作为连续变量和以下类别进行分析:≤2.5%、>2.5-5.0%、>5.0-7.5%、>7.5-10% 和>10%)与所有五个 HOOS 分量表变化之间的关系,并对性别和年龄、体重及各自的 HOOS 评分基线值进行了调整:基线时,参与者的平均年龄为 65.14 岁,70% 为女性,78% 为肥胖者(体重指数≥30 kg/m2)。据统计,体重减轻与所有 HOOS 分量表的改善之间存在明显的剂量反应关系,体重减轻 >10% 时,髋关节相关生活质量分量表的改善幅度最大(14.42 分,31.14%):我们的研究结果表明,减肥与髋关节OA症状的减轻有关,支持减肥作为髋关节OA的有效治疗策略。
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引用次数: 0
Global barriers to decision makers for prioritizing interventions for obesity 决策者在确定肥胖症干预措施的优先次序方面面临的全球性障碍。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-16 DOI: 10.1038/s41366-024-01650-z
Lars Holger Ehlers, Nicoline Weinreich Reinstrup, Renée Hangaard Olesen, Jens-Christian Holm, Phil McEwan, Carel W. Le Roux
The treatment of obesity remains underprioritized. New pharmacologic options for the treatment of obesity have shown effectiveness and safety but are not widely reimbursed. Despite the unmet need and the existence of effective prevention and treatment strategies, substantial barriers exist to effectively address obesity as a disease. The purpose of this scoping review was to investigate the barriers for decision makers in prioritizing interventions for obesity and to seek out interconnection between barriers to prevention and treatment. A scoping review was conducted using a systematic search of both scientific databases and Health Technology Assessment (HTA) databases. Studies that addressed barriers to reimbursement or prioritization of obesity treatment and prevention were included. A total of 26 articles and 14 HTAs were included. Four main barriers for decision makers to prioritize new interventions for obesity were identified: perceptions, knowledge, economics, and politics. There was a high degree of interconnectedness among barriers, as well as large overlaps between barriers in relation to bariatric surgery, pharmacologic treatments, and prevention regulation. Multiple barriers exist that impact decision makers in prioritizing interventions for treating obesity. A strong interconnectedness of the barriers was found, indicating a systems approach to improve global prioritization to address the disease. This study suggests that decision makers should carefully consider all main barriers when addressing the obesity epidemic.
肥胖症的治疗仍未得到足够重视。治疗肥胖症的新药物方案已显示出有效性和安全性,但并未广泛报销。尽管需求尚未得到满足,而且存在有效的预防和治疗策略,但在有效解决肥胖症这一疾病方面仍存在巨大障碍。本次范围界定审查的目的是调查决策者在确定肥胖症干预措施的优先次序时遇到的障碍,并找出预防和治疗障碍之间的相互联系。我们通过对科学数据库和卫生技术评估 (HTA) 数据库进行系统检索,对范围进行了界定。涉及肥胖症治疗和预防的报销障碍或优先顺序的研究被纳入其中。共纳入了 26 篇文章和 14 项健康技术评估。确定了决策者优先考虑肥胖症新干预措施的四大障碍:观念、知识、经济和政治。这些障碍之间存在高度的相互关联性,在减肥手术、药物治疗和预防法规方面的障碍之间也存在大量重叠。存在着多种障碍,影响着决策者对治疗肥胖症的干预措施进行优先排序。研究发现,这些障碍之间存在着很强的相互关联性,这表明需要采用系统方法来改善全球治疗肥胖症的优先次序。这项研究表明,决策者在应对肥胖症流行时应仔细考虑所有主要障碍。
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引用次数: 0
Childhood maltreatment, adulthood obesity and incident type 2 diabetes: a retrospective cohort study using UK Biobank 童年虐待、成年肥胖和 2 型糖尿病:利用英国生物数据库进行的回顾性队列研究。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-15 DOI: 10.1038/s41366-024-01652-x
Tamta Nadaraia, Ed Whittaker, Indira Kenyon, Jirapitcha Boonpor, Ziyi Zhou, Shinya Nakada, Ike Dhiah Rochmawati, Carlos Celis-Morales, Joey Ward, Naja Hulvej Rod, Jill P. Pell, Helen Minnis, Thomas Hehlmann, Frederick K. Ho, Daniel Mackay
This study aims to explore the association of childhood maltreatment with obesity and type 2 diabetes (T2D) in adulthood, and whether obesity is a mediator of the latter. In a retrospective cohort study using UK Biobank data, participants recalled childhood maltreatment. Linear regression, logistic regression, and Cox proportional hazard models were used to investigate the associations with body mass index (BMI), obesity, and T2D, adjusted for sociodemographic factors. Decomposition analysis was used to examine the extent to which T2D excess risk was attributed to BMI. Of the 153,601 participants who completed the childhood maltreatment questions, one-third reported some form of maltreatment. Prevalence of adult obesity and incidence of T2D were higher with the number of reported childhood maltreatment types. People who reported ≥3 types of childhood maltreatment were at higher risk of obesity (OR 1.55, 95% CI 1.47–1.63) and incident T2D (HR 1.65, 95% CI 1.52–1.80). Excess T2D risk among those reporting maltreatment could be reduced by 39% if their BMI was comparable to participants who had not been maltreated, assuming causality. People who recalled maltreatment in childhood are at higher risk of T2D in adulthood, partly due to obesity.
研究背景本研究旨在探讨童年虐待与成年后肥胖和2型糖尿病(T2D)之间的关系,以及肥胖是否是后者的中介因素:在一项利用英国生物库数据进行的回顾性队列研究中,参与者回忆了童年时期遭受虐待的情况。采用线性回归、逻辑回归和 Cox 比例危险模型来研究与体重指数 (BMI)、肥胖和 T2D 的关系,并对社会人口因素进行调整。采用分解分析法研究了体质指数对终末期糖尿病超额风险的影响程度:在 153,601 名填写了儿童虐待问题的参与者中,有三分之一报告了某种形式的虐待。报告的童年虐待类型越多,成人肥胖率和T2D发病率越高。报告遭受过≥3种童年虐待的人患肥胖症(OR 1.55,95% CI 1.47-1.63)和T2D(HR 1.65,95% CI 1.52-1.80)的风险较高。假设存在因果关系,如果受虐待者的体重指数(BMI)与未受虐待者相当,那么报告受虐待者患T2D的风险可降低39%:结论:忆及童年受虐待的人成年后患 T2D 的风险较高,部分原因是肥胖。
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引用次数: 0
Comparative effectiveness of metabolic and bariatric surgeries: a network meta-analysis 代谢手术和减肥手术的比较效果:网络荟萃分析。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-14 DOI: 10.1038/s41366-024-01648-7
Adnan Malik, Muhammad Imran Malik, Sadia Javaid, Shahbaz Qureshi, Abdul Nadir
Bariatric surgery is recommended for patients with unhealthy weight. Our study aim to compare and rank different bariatric surgical approaches in reducing weight parameters. We searched MEDLINE, Cochrane CENTRAL, Scopus, and Web of Science databases from inception to September 2023. We extracted all outcomes as mean change from the baseline. The mean difference and 95% confidence interval were used as a summary measure. All analysis was conducted with R version 4.2.2 (2022-10-31) and R Studio version 2022.07.2 (2009–2022) (RStudio, Inc.). Included surgeries were: Biliopancreatic diversion (BPD-RYGB), Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Gastric Plication (LGP), Duodenal-Jejunal Bypass Sleeve (DJBS), Single-anastomosis gastric bypass (SAGB), Laparoscopic vertical banded gastroplasty (LVBG), Sleeve Gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Gastric plication, Biliopancreatic diversion (BPD), and Intra-gastric balloon (IGB). Only clinical trials were included, with outcomes focused on weight parameters such as reductions in BMI (kg/m²), weight (kg), waist circumference (cm), fat mass (kg), and excess weight loss (EWL) (%). Our analysis of 67 studies showed that SADI-S was the best surgical technique in decreasing BMI (kg/m2) (MD = −18.06; 95% CI [−25.31; −10.81]) and DS follows in efficacy with a P-score (MD = −18.88; 95% CI [−31.15; −6.62]) however the pooled analysis was heterogeneous (I2 = 98.5%). For weight (kg), waist circumference (cm), and fat mass (kg), BPD-RYGB was the best surgical technique to reduce these parameters (MD = −41.48; 95% CI [−47.80, −35.51], MD = −29.08; 95% CI [−37.16, −21.00], and MD = −31.11; 95% CI [−38.77, −23.46]; respectively). The pooled analysis was heterogeneous except in fat mass (I2 = 0%, p-value = 0.8). Our network meta-analysis showed that the best surgical technique in increasing EWL (%) was RY-DS (MD = −61.27; % CI [−91.72; −30.82]) the next one in efficacy according to P-score was LVBG (MD = −59.03; % CI [−84.47; −33.59]). SADI-S is most effective in reducing BMI followed by RYGB. DS was associated with most estimated weight loss %.
建议体重不健康的患者接受减肥手术。我们的研究旨在对不同减肥手术方法在减轻体重方面的参数进行比较和排序。我们检索了从开始到 2023 年 9 月的 MEDLINE、Cochrane CENTRAL、Scopus 和 Web of Science 数据库。我们将所有结果提取为与基线相比的平均变化。平均差异和 95% 的置信区间被用作总结性指标。所有分析均使用 R version 4.2.2 (2022-10-31) 和 R Studio version 2022.07.2 (2009-2022) (RStudio, Inc.) 进行。纳入的手术包括胆胰转流术(BPD-RYGB)、Roux-en-Y 胃旁路术(RYGB)、腹腔镜胃折叠术(LGP)、十二指肠空肠旁路袖带术(DJBS)、单吻合胃旁路术(SAGB)、腹腔镜垂直胃束带成形术(LVBG)、袖状胃切除术(SG)、腹腔镜可调节胃束带术(LAGB)、胃成形术、胆胰转流术(BPD)和胃内气球(IGB)。这些研究只包括临床试验,其结果主要集中在体重参数上,如体重指数(BMI)(千克/平方米)、体重(千克)、腰围(厘米)、脂肪量(千克)和超重(EWL)(%)的减少。我们对 67 项研究进行的分析表明,SADI-S 是降低 BMI(kg/m2)的最佳手术技术(MD = -18.06;95% CI [-25.31;-10.81]),DS 的疗效以 P 值(MD = -18.88;95% CI [-31.15;-6.62])紧随其后,但汇总分析结果存在差异(I2 = 98.5%)。就体重(千克)、腰围(厘米)和脂肪量(千克)而言,BPD-RYGB 是降低这些参数的最佳手术技术(MD = -41.48; 95% CI [-47.80, -35.51],MD = -29.08; 95% CI [-37.16, -21.00],MD = -31.11; 95% CI [-38.77, -23.46])。除脂肪量(I2 = 0%,P 值 = 0.8)外,汇总分析存在异质性。我们的网络荟萃分析表明,RY-DS(MD = -61.27;% CI [-91.72;-30.82])是增加 EWL(%)的最佳手术技术,而根据 P 值,疗效次之的是 LVBG(MD = -59.03;% CI [-84.47;-33.59])。SADI-S 在降低体重指数方面最为有效,其次是 RYGB。DS与估计体重减轻率最高有关。
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引用次数: 0
Semaglutide effects on safety and cardiovascular outcomes in patients with overweight or obesity: a systematic review and meta-analysis 塞马鲁肽对超重或肥胖患者的安全性和心血管后果的影响:系统综述和荟萃分析。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-12 DOI: 10.1038/s41366-024-01646-9
André Saad Cleto, João Matheus Schirlo, Mayara Beltrame, Victor Hugo Oliveira Gomes, Isabela Hellmann Acras, Guinter Sponholz Neiverth, Breno Bach Silva, Beatriz Moreira Salles Juliatto, Janete Machozeki, Camila Marinelli Martins
Semaglutide is a GLP-1 receptor agonist that provides a reduction in glycated hemoglobin and weight. The objective was to evaluate whether the use of semaglutide, in individuals with overweight or obesity, reduces cardiovascular outcomes and adverse effects (AE). The data bases Pubmed, Lilacs, Scielo, Scopus, Web of Science and Cochrane Library were surveyed. Initially, 3333 articles were found, of which 19 articles were included. An additional search included 19 studies, totaling 38 articles. Relative risk (RR) values were significant for hospitalization due to heart failure (HF) 0.24 95% CI 0.12–0.57 (n = 2; 1045 participants; I² = 0.18), death due to cardiovascular causes 0.83 95% CI 0.71–0.98 (n = 3; 24 084 participants; I² = 0.21), death from any cause 0.79 95% CI 0.70–0.89 (n = 3; 24 084 participants; I² = 0.07), coronary revascularization 0.76 95% CI 0.69–0.85 (n = 2;20 951 participants; I² = 0.41), and non-fatal myocardial infarction 0.76 95%CI 0.66–0.88 (n = 3; 24 084 participants; I² = 0.21), with a difference between the subgroups (p = 0.05), favoring the subcutaneous administration route. The RR of stroke was 0.65 95% CI 0.44–0.97 for patients with diabetes (n = 2; 6480 participants; I² = 0.66). There was no difference between the frequency of constipation and routes of administration, as well as between doses of oral semaglutide. The RR of adverse effects was only not significant for discontinuation of treatment for oral semaglutide. The use of semaglutide reduced 76% in hospitalization due to HF, 17% deaths due to cardiovascular causes, 21% deaths due to any cause, 24% non-fatal myocardial infarction, 24% coronary revascularization and 35% stroke (in patients with diabetes). The use of semaglutide was associated with a higher relative risk and frequency of most adverse effects evaluated.
背景塞马鲁肽是一种GLP-1受体激动剂,可降低糖化血红蛋白和体重。研究目的是评估超重或肥胖症患者使用塞马鲁肽是否会减少心血管后果和不良反应(AE):方法:调查了 Pubmed、Lilacs、Scielo、Scopus、Web of Science 和 Cochrane Library 等数据库:结果:初步检索到 3333 篇文章,其中 19 篇被收录。额外的搜索包括 19 项研究,共计 38 篇文章。相对风险(RR)值显著的有:心力衰竭(HF)导致的住院治疗 0.24 95% CI 0.12-0.57 (n = 2; 1045 名参与者;I² = 0.18)、心血管原因导致的死亡 0.83 95% CI 0.71-0.98 (n = 3; 24 084 名参与者;I² = 0.21)、任何原因导致的死亡 0.79 95% CI 0.70-0.89 (n = 3; 24 084 名参与者;I² = 0.亚组间存在差异(P = 0.05),皮下注射途径更优。糖尿病患者中风的 RR 为 0.65 95% CI 0.44-0.97(n = 2;6480 名参与者;I² = 0.66)。便秘频率与给药途径以及口服塞马鲁肽的剂量之间没有差异。只有口服塞马鲁肽中断治疗的不良反应发生率不显著:结论:在糖尿病患者中,使用塞马鲁肽可减少76%因高血压住院治疗、17%因心血管原因死亡、21%因任何原因死亡、24%非致命性心肌梗死、24%冠状动脉血运重建和35%中风。使用semaglutide与大多数不良反应的相对风险和频率较高有关。
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引用次数: 0
Feasibility and efficacy of adding high-intensity interval training to a multidisciplinary lifestyle intervention in children with obesity—a randomized controlled trial 在针对肥胖儿童的多学科生活方式干预中加入高强度间歇训练的可行性和有效性--随机对照试验。
IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-10 DOI: 10.1038/s41366-024-01645-w
Charlotte Nørkjær Eggertsen, Ryan Godsk Larsen, Kirsten Duch, Morten Bilde Simonsen, Cecilie Brøns Christensen, Tine Caroc Warner, Jens Brøndum Frøkjær, Aase Handberg, Theresa Stjernholm, Esben Thyssen Vestergaard, Søren Hagstrøm
Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL). This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention (N = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program (N = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities >85% of maximal heart rate. Attendance rate for the 3-months HIIT intervention was 68.0 ± 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% vs. 20.5%) and 12 months (26.5% vs 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD): 0.01, 95% confidence interval (CI): −0.09; 0.12, P = 0.82) or 12 months (MD: 0.06, CI: −0.07;0.19, P = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI: 0.17; 0.06, P < 0.01) at 3 months and 0.20 (CI: 0.26;0.14, P < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI: 0.01;5.44, P = 0.05) in PedsQL Child total-score and 3.85 (CI: 0.96; 6.74, P < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI: 10.97; 2.83, P < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure. Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.
背景:在丹麦,针对肥胖儿童的多学科生活方式干预通常包括有关体育锻炼的建议,但没有结构化的锻炼计划。我们假设,在多学科生活方式干预中加入高强度间歇训练(HIIT)将改善体重指数 z 值(主要结果)、腰围、血压和健康相关生活质量(HRQOL):这项随机对照试验包括 173 名肥胖儿童和青少年。参与者被分配接受为期 12 个月的生活方式干预(83 人),或接受为期 12 个月的生活方式干预,同时进行为期 12 周的 HIIT 训练(90 人)。HIIT每周进行三次,包括强度大于最大心率85%的活动:为期 3 个月的 HIIT 干预的参加率为 68.0 ± 23.2%。在三个月(7.8% 对 20.5%)和 12 个月(26.5% 对 48.2%)时,HIIT 的辍学率低于对照组。HIIT 和对照组在 3 个月和 12 个月时的 BMI z-score 变化没有差异(平均差 (MD): 0.01,95% 置信区间 (CI): -0.09; 0.12,P = 0.82)(MD: 0.06,CI: -0.07; 0.19,P = 0.34)。在整个随机过程中,BMI z-score降低了0.11(CI:0.17;0.06,P 结论:BMI z-score降低了0.11(CI:0.17;0.06):增加为期 12 周的 HIIT 训练并不能进一步增强为期 12 个月的生活方式干预对 BMI z 分数的积极影响。增加 HIIT 可改善 3 个月后的 HRQOL,但会降低 12 个月后的 HRQOL。在社区环境中实施 HIIT 是可行的,而且对坚持生活方式干预有积极作用。
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引用次数: 0
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International Journal of Obesity
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