Journal of Obesity & Metabolic Syndrome最新文献

Background: There is a dearth of comparative studies on heart rate (HR) abnormalities at rest, chronotropic responses during submaximal exercise, and such responses during recovery from submaximal exercise between healthy-weight and overweight/obese young adults.

Methods: Eighty healthy young adults (30 men and 50 women) aged 19 to 33 years participated in the present study. A symptom-limited, submaximal, cycle ergometer exercise test of intensity targeted at 60% to 70% of the subject's age-predicted maximum HR was performed. The HR, blood pressure, and minute ventilation were measured at rest and during exercise. Post-exercise, HR was first measured at 1 minute of recovery and then every 2 minutes until the 5th minute.

Results: Our results showed significantly higher resting HR (P<0.001), lower percentage HR reserve during exercise (P<0.001), and slower HR recovery after exercise (P<0.05, P<0.01, or P<0.001) in overweight/obese men and women than in the non-overweight/obese controls. The prevalence of high resting HR, submaximal chronotropic incompetence, and blunted HR recovery were more common in the overweight/obese individuals than in the healthy-weight controls. Peak VO₂ and ventilatory equivalent for oxygen were associated with resting HR, exercise HR parameters, and post-exercise HR recovery indices in both men and women.

Conclusion: High resting HR, submaximal chronotropic incompetence, and blunted HR recovery in overweight/obese individuals in this study may be attributed to poor cardiorespiratory fitness and low respiratory efficiency.

The combination of glucagon-like peptide-1 (GLP-1) with other gut hormones including the glucose-dependent insulinotropic polypeptide (GIP) has been explored to complement and enhance further the GLP-1 effects on glycemia and weight loss. Tirzepatide is the first dual GLP-1/GIP receptor co-agonist which has been approved for treatment of type 2 diabetes mellitus (T2DM) based on the findings from the SURPASS program. The SURPASS trials assessed the safety and efficacy of tirzepatide in people with T2DM, from monotherapy through to insulin add-on in global populations, with another two trials dedicated to Japanese population. Over periods of treatment up to 104 weeks, once weekly tirzepatide 5 to 15 mg reduced glycosylated hemoglobin (1.87% to 3.02%), body weight (5.4 to 12.9 kg) and improved multiple cardiometabolic risk factors (including reduction in liver fat, new-onset macroalbuminuria, blood pressure, and lipids) across the T2DM spectrum. Tirzepatide provided better efficacy than placebo and other commonly used glucose-lowering medications such as semaglutide 1 mg, dulaglutide, insulin degludec, and glargine. All tirzepatide doses were well tolerated with similar side-effect profile to the GLP-1 receptor analogues. In people without diabetes, tirzepatide 5 to 15 mg once weekly for the treatment for obesity (SURMOUNT-1) resulted in substantial reductions in body weight (16.5% to 22.4%) over 72 weeks. Overall, the SURPASS program and SURMOUNT-1 study suggest that tirzepatide is marking a new era in T2DM and/or obesity management through dual agonism of gut hormones.

Metabolic/bariatric surgery is currently the most effective measure to treat morbid obesity and obesity-related comorbidities such as type 2 diabetes. It has proven effective not only in terms of short-term weight loss, but also in maintaining the lower body weight for several decades. Such weight loss improves patient quality of life and extends life expectancy. It is crucial for patients to understand the likely results of a given bariatric procedure so that they can make an informed decision about whether to undergo surgery. The amount of weight loss after metabolic/bariatric surgery is usually the most important outcome of interest to patients considering surgical treatment. It is also the most common primary endpoint for healthcare providers. Patients undergoing surgery want tangible and realistic expectations about how much weight they could lose after surgery, and healthcare professionals need to determine at each follow-up visit after surgery whether patients are on track to reach their weight loss target so they can provide timely intervention to patients with insufficient weight loss or weight regain. Weight loss after metabolic/bariatric surgery is influenced by many clinical variables, including initial body mass index, age, gender, ethnicity, and type of surgery. A well-validated chronological weight loss prediction model would enable patient-centered counseling and goal setting. This review summarizes and compares several publicly available prediction models.

Background: Bariatric surgery is the most effective intervention for weight loss possibly through modulating subcutaneous adipose tissue (SAT) molecular programs. The post-operative molecular and biological impacts, including gene expression, deserve in-depth investigation especially given the small sample sizes in the literature.

Methods: Five existing datasets (n=237 SATs) were re-processed and corrected for batch-to-batch variation. Unsupervised approaches and robust linear mixed effect model were used to compare gene expression post- (n=126) to pre-operation (n=111).

Results: Post-operative SATs showed distinct global gene expression. Forty-four and 395 genes were over- and under-expressed post-operation (all Bonferroni P<0.05). The under-expressed genes significantly enriched for 21 biological processes/pathways (all Bonferroni P<0.05), 17 (76.2%) and two (9.5%) directly involved in immunity and amino/proteo-glycan metabolism, respectively.

Conclusion: Post-operative SATs might adopt distinct transcriptomic landscapes and undergo a reduction in immune-related processes and amino/proteo-glycan metabolism.

Background: Due to the aging population worldwide, diseases that frequently attack elderly people, such as sarcopenia and osteoporosis, are major public health issues.

Methods: This study used a systematic review and meta-analysis to examine the associations among body mass index (BMI), sarcopenia, and bone mineral density (BMD) in a group of adults older than 60 years. Eight studies with a total of 18,783 subjects were examined using a random effect model.

Results: In sarcopenia patients, total hip BMD (d=0.560; 95% confidence interval [CI], 0.438 to 0.681; P<0.01; I²=53.755%), femoral neck BMD (d=0.522; 95% CI, 0.423 to 0.621; P<0.01; I²=77.736%) and lumbar spine BMD (d=0.295; 95% CI, 0.111 to 0.478; P<0.01; I²=66.174%) were lower than in control subjects. Additionally, BMI (d=0.711; 95% CI, 0.456 to 0.996; P<0.01; I²=97.609%) correlated with the BMD of the total hip, femoral neck, and lumbar spine. That is, sarcopenia patients with low BMD levels in the total hip, femoral neck, and lumbar spine also had low fat levels. Thus, sarcopenia patients with low BMD in the total hip, femoral neck and lumbar spine and low BMI could have a higher than average risk of osteosarcopenia. No sex effects were significant (P>0.05) for any variable.

Conclusion: BMI could be a key point in osteosarcopenia, suggesting that a low body weight could be facilitate the transition from sarcopenia to osteosarcopenia.

The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.

Background: Growth differentiation factor-15 (GDF-15) is involved in insulin resistance and diabetes. In this study, we determine the associations of GDF-15 with miR-181b-5p, miR-330-3p, mothers against decapentaplegic homolog 7 (SMAD7), and insulin resistance in visceral adipose tissue (VAT) and peripheral blood mononuclear cells (PBMCs) in type 2 diabetes mellitus (T2DM) patients.

Methods: Sixty patients, equally divided into those with T2DM and non-diabetic controls, were recruited for gene expression analysis. Protein-protein interaction (STRING), target prediction (miRNet), and functional enrichment were conducted accordingly.

Results: Our study showed that VAT and PBMCs had similar expression profiles, where GDF-15 and miR-181b-5p were upregulated, whereas SMAD7 and miR-330-3p were downregulated. Serum GDF-15 could differentiate between T2DM and non-diabetic patients (P<0.001). Target prediction revealed a microRNA (miRNA)-messenger RNA regulatory network, transcription factors, and functional enrichment for the miRNA that suggested involvement in T2DM pathogenesis.

Conclusion: VAT GDF-15 is associated with insulin resistance and is possibly regulated by miR-181b-5p, miR-330-3p, and SMAD7 in T2DM.

Background: Kidney transplant (KT) candidates and recipients with obesity experience more frequent complications such as infection, poorer allograft outcomes, diabetes, and mortality, limiting their eligibility for transplantation. Bariatric surgery (BS) is not commonly performed among KT patients given concerns about immunosuppression absorption, wound healing, infections, and graft outcomes. Its role has not been described before in an Asian KT patient setting.

Methods: A retrospective review of patients who underwent BS at the largest KT center in Singapore from 2008 to 2020 was conducted. Metabolic outcomes, immunosuppression doses, graft outcomes, and mortality were studied.

Results: Seven patients underwent BS and KT (4 underwent BS before KT, 3 underwent BS after KT; 4 underwent sleeve gastrectomy, 3 underwent gastric bypass). Mean total weight losses of 23.8% at 1 year and 18.6% at 5 years post-BS were achieved. Among the five patients with diabetes, glycemic control improved after BS. There were no deaths in the first 90 days or graft loss in the first year after KT and BS. Patients who underwent BS after KT had no significant changes in immunosuppression dose.

Conclusion: BS can be safely performed in KT recipients and candidates and results in sustainable weight losses and improvements in metabolic comorbidities. Although no major complications were observed in our study, close monitoring of this complex group of patients is imperative.

Obesity and obesity-associated morbidity continues to be a major public health issue worldwide. Dementia is also a major health concern in aging societies and its prevalence has increased rapidly. Many epidemiologic studies have shown an association between obesity and cognitive impairment, but this relationship is not as well established as other comorbidities. Conflicting results related to the age and sex of participants, and the methodology used to define obesity and dementia may account for the uncertainty in whether obesity is a modifiable risk factor for dementia. More recently, sarcopenia and sarcopenic obesity have been reported to be associated with cognitive impairment. In addition, new mediators such as the muscle-myokine-brain axis and gut-microbiota-brain axis have been suggested and are attracting interest. In this review, we summarize recent evidence on the link between obesity and cognitive impairment, especially dementia. In particular, we focus on various metrics of obesity, from body mass index to sarcopenia and sarcopenic obesity.

Although the rate of childhood obesity seems to have plateaued in recent years, the prevalence of obesity among children and adolescents remains high. Childhood obesity is a major public health concern as overweight and obese youth suffer from many co-morbid conditions once considered exclusive to adults. It is now well demonstrated that abdominal obesity as measured by waist circumference (WC) is an independent risk factor for cardiovascular disease and metabolic dysfunction in youth. Despite the strong associations between WC and cardiometabolic risk factors, there is no consensus regarding the optimal WC measurement sites to assess abdominal obesity and obesity-related health risk in children and adolescents. Currently, the WC measurement site that provides the best reflections of visceral fat and the best correlations with cardiometabolic risk factors is unclear. The purpose of this review is to explore whether WC measurement sites influence the relationships between WC, visceral fat, and cardiometabolic risk factors in children and adolescents.