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Qin W, Yang J, Ni Y, Deng C, Ruan Q, Ruan J, Zhou P, Duan K. Efficacy and safety of once-weekly tirzepatide for weight management compared to placebo: An updated systematic review and meta-analysis including the latest SURMOUNT-2 trial. Endocrine 2024:10.1007/s12020-024-03896-z. [PMID: 38850440 DOI: 10.1007/s12020-024-03896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
AIM Tirzepatide, a newly developed dual glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has received approval for treating type 2 diabetes (T2D) and is currently being studied for its potential in long-term weight control. We aim to explore the safety and efficacy of once-weekly subcutaneous tirzepatide for weight loss in T2D or obese patients. METHODS A comprehensive search was performed on various databases including PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception up to April 29, 2024, to identify randomized controlled trials (RCTs) that assessed the efficacy of once-weekly tirzepatide compared to a placebo in adults with or without T2D. The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. The risk of bias was evaluated using the RoB-2 tool (Cochrane), while the statistical analysis was conducted utilizing RevMan 5.4.1 software. RESULTS Seven RCTs comprising 4795 individuals ranging from 12 to 72 weeks were identified. Compared to the placebo group, tirzepatide at doses of 5, 10, and 15 mg demonstrated significant dose-dependent weight loss. The mean difference (MD) in the percentage change in body weight (BW) was -8.07% (95% CI -11.01, -5.13; p < 0.00001), -10.79% (95% CI -13.86, -7.71; p < 0.00001), and -11.83% (95% CI -14.52, -9.14; p < 0.00001), respectively. Additionally, the MD in the absolute change in BW was -7.5 kg (95% CI -10.9, -4.1; p < 0.0001), -11.0 kg (95% CI -16.9, -5.2; p = 0.0002), and -11.5 kg (95% CI -16.2, -6.7; p < 0.00001), for the 5, 10, and 15 mg doses, respectively. All three doses of tirzepatide also significantly reduced body mass index and waist circumference. Furthermore, it led to a greater percentage of patients experiencing weight loss exceeding 5, 10, 15, 20, and 25%. Moreover, tirzepatide showed great success in reducing blood pressure, blood sugar levels, and lipid profiles. In terms of safety, gastrointestinal side effects were the most frequently reported adverse events in all three doses of tirzepatide groups, which were generally mild-to-moderate and transient. CONCLUSION Tirzepatide treatment could lead to remarkable and sustained weight loss that is well-tolerated and safe, representing a novel and valuable therapeutic strategy for long-term weight management.
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Affiliation(s)
- Wenhui Qin
- Department of Endocrinology and Metabolism, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China
| | - Jun Yang
- Department of Endocrinology and Metabolism, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China
| | - Ying Ni
- Department of Endocrinology and Metabolism, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China
| | - Chao Deng
- Department of Pharmacy, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China
| | - Qinjuan Ruan
- Department of Pharmacy, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China
| | - Jun Ruan
- Department of Propaganda, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China
| | - Peng Zhou
- Department of Vascular Surgery, Wuhan Union Hospital, Huazhong university of science and technology, Wuhan, China.
| | - Kai Duan
- Department of Nephrology, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China.
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Chan AML, Ng AMH, Yunus MHM, Idrus RH, Law JX, Yazid MD, Chin KY, Yusof MRM, Ng SN, Koh B, Lokanathan Y. Single high-dose intravenous injection of Wharton's jelly-derived mesenchymal stem cell exerts protective effects in a rat model of metabolic syndrome. Stem Cell Res Ther 2024; 15:160. [PMID: 38835014 DOI: 10.1186/s13287-024-03769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/26/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a significant epidemiological problem worldwide. It is a pre-morbid, chronic and low-grade inflammatory disorder that precedes many chronic diseases. Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) could be used to treat MetS because they express high regenerative capacity, strong immunomodulatory properties and allogeneic biocompatibility. This study aims to investigate WJ-MSCs as a therapy against MetS in a rat model. METHODS Twenty-four animals were fed with high-fat high-fructose (HFHF) diet ad libitum. After 16 weeks, the animals were randomised into treatment groups (n = 8/group) and received a single intravenous administration of vehicle, that is, 3 × 106 cells/kg or 10 × 106 cells/kg of WJ-MSCs. A healthy animal group (n = 6) fed with a normal diet received the same vehicle as the control (CTRL). All animals were periodically assessed (every 4 weeks) for physical measurements, serum biochemistry, glucose tolerance test, cardiovascular function test and whole-body composition. Post-euthanasia, organs were weighed and processed for histopathology. Serum was collected for C-reactive protein and inflammatory cytokine assay. RESULTS The results between HFHF-treated groups and healthy or HFHF-CTRL did not achieve statistical significance (α = 0.05). The effects of WJ-MSCs were masked by the manifestation of different disease subclusters and continuous supplementation of HFHF diet. Based on secondary analysis, WJ-MSCs had major implications in improving cardiopulmonary morbidities. The lungs, liver and heart show significantly better histopathology in the WJ-MSC-treated groups than in the untreated CTRL group. The cells produced a dose-dependent effect (high dose lasted until week 8) in preventing further metabolic decay in MetS animals. CONCLUSIONS The establishment of safety and therapeutic proof-of-concept encourages further studies by improving the current therapeutic model.
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Affiliation(s)
- Alvin Man Lung Chan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
- Ming Medical Sdn Bhd, D3-3 (2nd Floor), Block D3 Dana 1 Commercial Centre, Jalan PJU 1a/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Angela Min Hwei Ng
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Heikal Mohd Yunus
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Ruszymah Hj Idrus
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Jia Xian Law
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Muhammad Dain Yazid
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Mohd Rafizul Mohd Yusof
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - See Nguan Ng
- Ming Medical Sdn Bhd, D3-3 (2nd Floor), Block D3 Dana 1 Commercial Centre, Jalan PJU 1a/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Benson Koh
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia.
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Acosta A, Cifuentes L, Anazco D, O'Connor T, Hurtado M, Ghusn W, Campos A, Fansa S, McRae A, Madhusudhan S, Kolkin E, Ryks M, Harmsen W, Abu Dayyeh B, Hensrud D, Camilleri M. Unraveling the Variability of Human Satiation: Implications for Precision Obesity Management. RESEARCH SQUARE 2024:rs.3.rs-4402499. [PMID: 38826309 PMCID: PMC11142367 DOI: 10.21203/rs.3.rs-4402499/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Satiation is the physiologic process that regulates meal size and termination, and it is quantified by the calories consumed to reach satiation. Given its role in energy intake, changes in satiation contribute to obesity's pathogenesis. Our study employed a protocolized approach to study the components of food intake regulation including a standardized breakfast, a gastric emptying study, appetite sensation testing, and a satiation measurement by an ad libitummeal test. These studies revealed that satiation is highly variable among individuals, and while baseline characteristics, anthropometrics, body composition and hormones, contribute to this variability, these factors do not fully account for it. To address this gap, we explored the role of a germline polygenic risk score, which demonstrated a robust association with satiation. Furthermore, we developed a machine-learning-assisted gene risk score to predict satiation and leveraged this prediction to anticipate responses to anti-obesity medications. Our findings underscore the significance of satiation, its inherent variability, and the potential of a genetic risk score to forecast it, ultimately allowing us to predict responses to different anti-obesity interventions.
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Pandey V, Adhikrao PA, Motiram GM, Yadav N, Jagtap U, Kumar G, Paul A. Biaryl carboxamide-based peptidomimetics analogs as potential pancreatic lipase inhibitors for treating obesity. Arch Pharm (Weinheim) 2024; 357:e2300503. [PMID: 38251950 DOI: 10.1002/ardp.202300503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
A series of 1,1'-biphenyl-3-carboxamide and furan-phenyl-carboxamide analogs were synthesized using an optimized scheme and confirmed by 1H and 13C nuclear magnetic resonance and high-resolution mass spectrometry techniques. The synthesized peptidomimetics analogs were screened in vitro to understand the inhibitory potential of pancreatic lipase (PL). Analogs were assessed for the PL inhibitory activity based on interactions, geometric complementarity, and docking score. Among the synthesized analogs, 9, 29, and 24 were found to have the most potent PL inhibitory activity with IC50 values of 3.87, 4.95, and 5.34 µM, respectively, compared to that of the standard drug, that is, orlistat, which inhibits PL with an IC50 value of 0.99 µM. The most potent analog, 9, exhibited a competitive-type inhibition with an inhibition constant (Ki) of 2.72 µM. In silico molecular docking of analog 9 with the PL (PDB ID:1LPB) showed a docking score of -11.00 kcal/mol. Analog 9 formed crucial hydrogen bond interaction with Ser152, His263, π-cation interaction with Asp79, Arg256, and π-π stacking with Phe77, Tyr114 at the protein's active site. The molecular dynamic simulation confirmed that analog 9 forms stable interactions with PL at the end of 200 ns with root mean square deviation values of 2.5 and 6 Å. No toxicity was observed for analog 9 (concentration range of 1-20 µM) when tested by MTT assay in RAW 264.7 cells.
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Affiliation(s)
- Vikash Pandey
- Department of Natural Products, Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Patil A Adhikrao
- Department of Natural Products, Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Gudle M Motiram
- Department of Natural Products, Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Nisha Yadav
- Laboratory of Natural Product Chemistry, Department of Pharmacy, Birla Institute of Technology and Science, Pilani (Pilani Campus), Pilani, Rajasthan, India
| | - Utkarsh Jagtap
- Laboratory of Natural Product Chemistry, Department of Pharmacy, Birla Institute of Technology and Science, Pilani (Pilani Campus), Pilani, Rajasthan, India
| | - Gautam Kumar
- Department of Natural Products, Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Atish Paul
- Laboratory of Natural Product Chemistry, Department of Pharmacy, Birla Institute of Technology and Science, Pilani (Pilani Campus), Pilani, Rajasthan, India
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Qin W, Yang J, Deng C, Ruan Q, Duan K. Efficacy and safety of semaglutide 2.4 mg for weight loss in overweight or obese adults without diabetes: An updated systematic review and meta-analysis including the 2-year STEP 5 trial. Diabetes Obes Metab 2024; 26:911-923. [PMID: 38016699 DOI: 10.1111/dom.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/23/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
AIM To explore the safety and efficacy of subcutaneous semaglutide 2.4 mg, administered once a week in non-diabetic overweight or obese individuals. METHODS A thorough search was performed of various databases including PubMed, Embase, the Cochrane Library, Web of Science, clinicaltrials.gov, CNKI and Wanfang from their inception up to April 11, 2023. Our aim was to identify randomized controlled trials (RCTs) that compared the efficacy of semaglutide administered once weekly with placebo in overweight or obese adults. Through a review of the literature, data were extracted from relevant studies and assessed for quality, and a meta-analysis was conducted using RevMan 5.4.1 software. RESULTS Six RCTs comprising 3962 overweight or obese individuals were identified. The findings indicated that, in comparison to the placebo group, semaglutide caused a significant and sustainable reduction in the percentage of body weight (BW; mean difference [MD]: -11.80% [95% confidence interval {CI} -12.93, -10.68]; P < 0.00001) as well as a decrease in absolute BW (MD: -12.2 kg [95% CI -13.3, -11.1]; P < 0.00001), body mass index (MD: -4.5 kg/m2 [95% CI -4.9, -4.1]; P < 0.00001) and waist circumference (MD:-9.4 cm [95% CI -10.1, -8.8]; P < 0.00001). Moreover, it achieved a higher proportion of patients who experienced weight loss exceeding 5%, 10%, 15% and 20%. Furthermore, semaglutide showed significant efficacy in controlling blood pressure, blood sugar levels, C-reactive protein levels, and lipid profiles. In terms of safety, the most common adverse effects following semaglutide treatment were gastrointestinal adverse reactions (risk ratio: 1.49 [95% CI 1.38, 1.60]; P < 0.00001), which were generally mild to moderate in severity and temporary. CONCLUSION In overweight or obese non-diabetic individuals, semaglutide had a remarkable and sustained weight loss effect that was well tolerated and safe.
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Affiliation(s)
- Wenhui Qin
- Department of Endocrinology and Metabolism, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingmen, China
| | - Jun Yang
- Department of Endocrinology and Metabolism, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingmen, China
| | - Chao Deng
- Department of Pharmacy, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingmen, China
| | - Qinjuan Ruan
- Department of Pharmacy, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingmen, China
| | - Kai Duan
- Department of Nephrology, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingmen, China
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Hurtado MD, Tama E, D'Andre S, Shufelt CL. The relation between excess adiposity and breast cancer in women: Clinical implications and management. Crit Rev Oncol Hematol 2024; 193:104213. [PMID: 38008197 PMCID: PMC10843740 DOI: 10.1016/j.critrevonc.2023.104213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in women. While the combination of improved screening, earlier detection, and advances in therapeutics has resulted in lower BC mortality, BC survivors are now increasingly dying of cardiovascular disease. Cardiovascular disease in the leading cause of non-cancer related mortality among BC survivors. This situation underscores the critical need to research the role of modifiable cardiometabolic risk factors, such as excess adiposity, that will affect BC remission, long-term survivorship, and overall health and quality of life. PURPOSE First, this review summarizes the evidence on the connection between adipose tissue and BC. Then we review the data on weight trends after BC diagnosis with a focus on the effect of weight gain on BC recurrence and BC- and non-BC-related death. Finally, we provide a guide for weight management in BC survivors, considering the available data on the effect of weight loss interventions on BC.
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Affiliation(s)
- Maria D Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Jacksonville, FL, USA; Precision Medicine for Obesity Program, Mayo Clinic, Rochester, MN, USA.
| | - Elif Tama
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Jacksonville, FL, USA; Precision Medicine for Obesity Program, Mayo Clinic, Rochester, MN, USA
| | - Stacey D'Andre
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Chrisandra L Shufelt
- Center for Women's Health, Division of General Internal Medicine, Jacksonville, FL, USA
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Pakhare M, Anjankar A. Critical Correlation Between Obesity and Cardiovascular Diseases and Recent Advancements in Obesity. Cureus 2024; 16:e51681. [PMID: 38314003 PMCID: PMC10838385 DOI: 10.7759/cureus.51681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Scientific literature has investigated and well-documented the complex relationship between obesity and cardiovascular diseases. Obese people are much more likely to have atrial fibrillation, dyslipidemia, diabetes, and coronary artery disease, among other cardiovascular conditions. Additionally, obesity poses a severe risk for diseases like hypertension, heart failure, and atherosclerotic heart diseases, affecting various aspects relating to their underlying mechanisms, diagnosis, and clinical effects. This article summarizes recent developments in our understanding of and response to obesity. Pharmacotherapy, gut microbiome research, bariatric surgery, digital health solutions, behavioral interventions, and precision medicine are just a few of the fields in which these developments have been made. While liposuction offers a less invasive option for redistributing volume and getting positive results, bariatric surgery remains the most effective treatment for severe obesity. Emphasis is placed on the pathophysiological mechanisms that underlie the complex interactions between obesity and a number of diseases, such as atrial fibrillation, diabetes, hypertension, dyslipidemia, and coronary artery disease. The significance of lifestyle changes in reducing the cardiovascular risks associated with obesity, such as atrial fibrillation and heart disease, is emphasized. To improve overall cardiovascular health and achieve better clinical outcomes, obesity must be promptly identified and actively managed. Investigations into how the gut microbiome affects obesity, the creation of novel pharmacological treatments for appetite suppression and metabolic enhancement, improvements in bariatric surgery methods that emphasize patient success and safety, as well as creative digital health solutions and behavioral treatments, are some examples of emerging research fields. In addition, precision medicine approaches, including the modulation of the gut microbiome through dietary changes and supplements, hold great promise in combating obesity and its associated comorbidities and have the potential to revolutionize the management of obesity by tailoring treatments to the specific needs of individual patients.
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Affiliation(s)
- Mahesh Pakhare
- Medical Education, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Anjankar
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wadden TA, Chao AM, Moore M, Tronieri JS, Gilden A, Amaro A, Leonard S, Jakicic JM. The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities. Curr Obes Rep 2023; 12:453-473. [PMID: 38041774 DOI: 10.1007/s13679-023-00534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW This review examines lifestyle modification for obesity management with the goal of identifying treatment components that could support the use of a new generation of anti-obesity medications (AOMs). RECENT FINDINGS Semaglutide reliably reduces baseline body weight by approximately 15% at 68 weeks, in contrast to 5-10% for lifestyle modification. Tirzepatide induces mean losses as great as 20.9%. Both medications reduce energy intake by markedly enhancing satiation and decreasing hunger, and they appear to lessen the need for traditional cognitive and behavioral strategies (e.g., monitoring food intake) to achieve calorie restriction. Little, however, is known about whether patients who lose weight with these AOMs adopt healthy diet and activity patterns needed to optimize body composition, cardiometabolic health, and quality of life. When used with the new AOMs, the focus of lifestyle modification is likely to change from inducing weight loss (through calorie restriction) to facilitating patients' adoption of dietary and activity patterns that will promote optimal changes in body composition and overall health.
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Affiliation(s)
- Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA.
| | - Ariana M Chao
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Molly Moore
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA
| | - Jena S Tronieri
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA
| | - Adam Gilden
- Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Anastassia Amaro
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon Leonard
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3027, Philadelphia, PA, 19104, USA
| | - John M Jakicic
- Department of Medicine, Medical Center, Kansas University, Kansas City, KS, USA
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9
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Elmaleh-Sachs A, Schwartz JL, Bramante CT, Nicklas JM, Gudzune KA, Jay M. Obesity Management in Adults: A Review. JAMA 2023; 330:2000-2015. [PMID: 38015216 DOI: 10.1001/jama.2023.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Importance Obesity affects approximately 42% of US adults and is associated with increased rates of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and premature death. Observations A body mass index (BMI) of 25 or greater is commonly used to define overweight, and a BMI of 30 or greater to define obesity, with lower thresholds for Asian populations (BMI ≥25-27.5), although use of BMI alone is not recommended to determine individual risk. Individuals with obesity have higher rates of incident cardiovascular disease. In men with a BMI of 30 to 39, cardiovascular event rates are 20.21 per 1000 person-years compared with 13.72 per 1000 person-years in men with a normal BMI. In women with a BMI of 30 to 39.9, cardiovascular event rates are 9.97 per 1000 person-years compared with 6.37 per 1000 person-years in women with a normal BMI. Among people with obesity, 5% to 10% weight loss improves systolic blood pressure by about 3 mm Hg for those with hypertension, and may decrease hemoglobin A1c by 0.6% to 1% for those with type 2 diabetes. Evidence-based obesity treatment includes interventions addressing 5 major categories: behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures. Comprehensive obesity care plans combine appropriate interventions for individual patients. Multicomponent behavioral interventions, ideally consisting of at least 14 sessions in 6 months to promote lifestyle changes, including components such as weight self-monitoring, dietary and physical activity counseling, and problem solving, often produce 5% to 10% weight loss, although weight regain occurs in 25% or more of participants at 2-year follow-up. Effective nutritional approaches focus on reducing total caloric intake and dietary strategies based on patient preferences. Physical activity without calorie reduction typically causes less weight loss (2-3 kg) but is important for weight-loss maintenance. Commonly prescribed medications such as antidepressants (eg, mirtazapine, amitriptyline) and antihyperglycemics such as glyburide or insulin cause weight gain, and clinicians should review and consider alternatives. Antiobesity medications are recommended for nonpregnant patients with obesity or overweight and weight-related comorbidities in conjunction with lifestyle modifications. Six medications are currently approved by the US Food and Drug Administration for long-term use: glucagon-like peptide receptor 1 (GLP-1) agonists (semaglutide and liraglutide only), tirzepatide (a glucose-dependent insulinotropic polypeptide/GLP-1 agonist), phentermine-topiramate, naltrexone-bupropion, and orlistat. Of these, tirzepatide has the greatest effect, with mean weight loss of 21% at 72 weeks. Endoscopic procedures (ie, intragastric balloon and endoscopic sleeve gastroplasty) can attain 10% to 13% weight loss at 6 months. Weight loss from metabolic and bariatric surgeries (ie, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass) ranges from 25% to 30% at 12 months. Maintaining long-term weight loss is difficult, and clinical guidelines support the use of long-term antiobesity medications when weight maintenance is inadequate with lifestyle interventions alone. Conclusion and Relevance Obesity affects approximately 42% of adults in the US. Behavioral interventions can attain approximately 5% to 10% weight loss, GLP-1 agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists can attain approximately 8% to 21% weight loss, and bariatric surgery can attain approximately 25% to 30% weight loss. Comprehensive, evidence-based obesity treatment combines behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures as appropriate for individual patients.
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Affiliation(s)
- Arielle Elmaleh-Sachs
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Family Health Centers at NYU Langone, New York, New York
| | - Jessica L Schwartz
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Carolyn T Bramante
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis
| | - Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Melanie Jay
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- New York Harbor Veteran Affairs, New York, New York
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Ostrominski JW, Arnold SV, Butler J, Fonarow GC, Hirsch JS, Palli SR, Donato BMK, Parrinello CM, O’Connell T, Collins EB, Woolley JJ, Kosiborod MN, Vaduganathan M. Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020. JAMA Cardiol 2023; 8:1050-1060. [PMID: 37755728 PMCID: PMC10535010 DOI: 10.1001/jamacardio.2023.3241] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/04/2023] [Indexed: 09/28/2023]
Abstract
Importance Individually, cardiac, renal, and metabolic (CRM) conditions are common and leading causes of death, disability, and health care-associated costs. However, the frequency with which CRM conditions coexist has not been comprehensively characterized to date. Objective To examine the prevalence and overlap of CRM conditions among US adults currently and over time. Design, Setting, and Participants To establish prevalence of CRM conditions, nationally representative, serial cross-sectional data included in the January 2015 through March 2020 National Health and Nutrition Examination Survey (NHANES) were evaluated in this cohort study. To assess temporal trends in CRM overlap, NHANES data between 1999-2002 and 2015-2020 were compared. Data on 11 607 nonpregnant US adults (≥20 years) were included. Data analysis occurred between November 10, 2020, and November 23, 2022. Main Outcomes and Measures Proportion of participants with CRM conditions, overall and stratified by age, defined as cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes (T2D), or all 3. Results From 2015 through March 2020, of 11 607 US adults included in the analysis (mean [SE] age, 48.5 [0.4] years; 51.0% women), 26.3% had at least 1 CRM condition, 8.0% had at least 2 CRM conditions, and 1.5% had 3 CRM conditions. Overall, CKD plus T2D was the most common CRM dyad (3.2%), followed by CVD plus T2D (1.7%) and CVD plus CKD (1.6%). Participants with higher CRM comorbidity burden were more likely to be older and male. Among participants aged 65 years or older, 33.6% had 1 CRM condition, 17.1% had 2 CRM conditions, and 5.0% had 3 CRM conditions. Within this subset, CKD plus T2D (7.3%) was most common, followed by CVD plus CKD (6.0%) and CVD plus T2D (3.8%). The CRM comorbidity burden was disproportionately high among participants reporting non-Hispanic Black race or ethnicity, unemployment, low socioeconomic status, and no high school degree. Among participants with 3 CRM conditions, nearly one-third (30.5%) did not report statin use, and only 4.8% and 3.0% used glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, respectively. Between 1999 and 2020, the proportion of US adults with multiple CRM conditions increased significantly (from 5.3% to 8.0%; P < .001 for trend), as did the proportion having all 3 CRM conditions (0.7% to 1.5%; P < .001 for trend). Conclusions and Relevance This cohort study found that CRM multimorbidity is increasingly common and undertreated among US adults, highlighting the importance of collaborative and comprehensive management strategies.
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Affiliation(s)
- John W. Ostrominski
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Suzanne V. Arnold
- Saint Luke’s Mid America Heart Institute and University of Missouri–Kansas City, Kansas City
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas
- Department of Medicine, University of Mississippi, Jackson
| | - Gregg C. Fonarow
- Division of Cardiology, University of California, Los Angeles Medical Center, David Geffen School of Medicine, Los Angeles
| | - Jamie S. Hirsch
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Swetha R. Palli
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
| | | | | | | | | | | | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute and University of Missouri–Kansas City, Kansas City
| | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
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11
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Ferraz Barbosa B, Aquino de Moraes FC, Bordignon Barbosa C, Palavicini Santos PTK, Pereira da Silva I, Araujo Alves da Silva B, Cristine Marques Barros J, Rodríguez Burbano RM, Pereira Carneiro dos Santos N, Rodrigues Fernandes M. Efficacy and Safety of Setmelanotide, a Melanocortin-4 Receptor Agonist, for Obese Patients: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:1460. [PMID: 37888071 PMCID: PMC10608339 DOI: 10.3390/jpm13101460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND A malfunction in the melanocortin-4 receptor (MC4R) is associated with obesity in rare genetic syndromes; setmelanotide is a new drug that activates this receptor and is being used to treat severe obesity. This meta-analysis evaluated the efficacy and safety of setmelanotide for weight loss in severe obesity linked to human MC4R deficiency. METHODS We searched PubMed, Embase, and Cochrane for randomized and nonrandomized clinical trials using setmelanotide. We considered a p-value ≤ 0.05 statistically significant. RESULTS We included 376 patients, of whom 328 (87.2%) received setmelanotide for a mean follow-up of 52 weeks. The mean age was 32.8 (14.67) years. Weight loss was significant (MD -3.52; 95% CI -3.98, -3.05; p = 0.01; I2 = 92%), with an average proportion of -6.91% weight loss during treatment. Changes in BMI showed an MD of -10.55 kg/m2 in patients > 18 years and -0.61 kg/m2 in patients < 18 years (BMI score). However, the drug was associated with a higher risk of skin hyperpigmentation (OR 0.69; 95% CI 0.55, 0.80; p = 0.08). CONCLUSIONS Our results support the use of setmelanotide in treating severe obesity.
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Affiliation(s)
- Bárbara Ferraz Barbosa
- Department of Medicine, University of Aquino Bolivia, Santa Cruz de la Sierra 0701, Bolivia; (B.F.B.); (C.B.B.)
| | | | - Camila Bordignon Barbosa
- Department of Medicine, University of Aquino Bolivia, Santa Cruz de la Sierra 0701, Bolivia; (B.F.B.); (C.B.B.)
| | | | | | | | | | | | | | - Marianne Rodrigues Fernandes
- Oncology Research Center, Federal University of Pará, Belém 66073-005, PA, Brazil; (J.C.M.B.); (N.P.C.d.S.); (M.R.F.)
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12
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de Mesquita YLL, Pera Calvi I, Reis Marques I, Almeida Cruz S, Padrao EMH, Carvalho PEDP, da Silva CHA, Cardoso R, Moura FA, Rafalskiy VV. Efficacy and safety of the dual GIP and GLP-1 receptor agonist tirzepatide for weight loss: a meta-analysis of randomized controlled trials. Int J Obes (Lond) 2023; 47:883-892. [PMID: 37460681 DOI: 10.1038/s41366-023-01337-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/05/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for type 2 diabetes. We performed a meta-analysis to assess tirzepatide's weight reduction efficacy and safety. METHODS We searched PubMed, Embase, and Cochrane for randomized controlled trials published from inception to July 2022, comparing tirzepatide with placebo for the co-primary endpoints of absolute and percent change in weight. Mean difference (MD) and odds ratio (OR) were calculated for continuous and binary outcomes, respectively. Review Manager 5.4.1 and RStudio were used for the statistical analysis, and RoB-2 (Cochrane) to assess the risk of bias. RESULTS Of 397 search results, 6 studies (4036 participants) ranging from 12 to 72 weeks were included. Pooled analysis showed that tirzepatide 5 mg, 10 mg, and 15 mg were more effective than placebo, with MD in body weight of -7.7 kg (95% CI -11.0, -4.4; p < 0.001), -11.6 kg (95% CI -18.8, -4.3; p = 0.002), and -11.8 kg (95% CI -17.4, -6.2; p < 0.001), respectively, and MD in percent change in weight of -8.1% (95% CI -11.0, -5.2; p < 0.001), -11.9% (95% CI -18.1, -5.6; p < 0.001), and -12.4% (95% CI -17.2, -7.5; p < 0.001), respectively. Tirzepatide also reduced BMI and waist circumference. Adverse events were more common with tirzepatide with respect to nausea (OR 4.2; 95% CI 2.4, 7.5; p < 0.001), vomiting (OR 7.0; 95% CI 4.3, 11.4; p < 0.001), and diarrhea (OR 2.8; 95% CI 1.6, 4.9; p < 0.001) (15 mg dose), when compared with placebo. CONCLUSIONS The results support that tirzepatide leads to substantial weight reduction and constitutes a valuable therapeutic option for weight management, despite an increase in gastrointestinal symptoms. PROTOCOL REGISTRATION CRD42022348576.
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Affiliation(s)
| | - Izabela Pera Calvi
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad Oblast, Russia
| | - Isabela Reis Marques
- Division of Medicine, Universitat Internacional de Catalunya, Barcelona, Catalunya, Spain
| | - Sara Almeida Cruz
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad Oblast, Russia
| | | | | | | | - Rhanderson Cardoso
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Filipe Azevedo Moura
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- TIMI study group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
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13
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Hti Lar Seng NS, Lohana P, Chandra S, Jim B. The Fatty Kidney and Beyond: A Silent Epidemic. Am J Med 2023; 136:965-974. [PMID: 37451390 DOI: 10.1016/j.amjmed.2023.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
As the prevalence of obesity rises in the United States, so does the incidence of obesity-related kidney disease. Obesity itself is an independent risk factor for chronic kidney disease where the pathophysiology is complex, involving altered hemodynamics, renin-angiotensin-aldosterone system overactivation, and adipokines leading to inflammation and fibrosis. Obesity-related kidney disease comprises both obesity-related glomerulopathy and fatty kidney disease. Obesity-related glomerulopathy is a consequence of glomerular hyperfiltration and often presents clinically with subnephrotic proteinuria and pathologically with glomerulomegaly with or without focal glomerulosclerosis. Fatty kidney disease is the effect of renal ectopic fat contributing to chronic kidney disease. Whether the renal ectopic fat is a distinct clinical entity or a pathologic mechanism contributing to obesity-related glomerulopathy, the treatment paradigm of weight and proteinuria reduction remains the same. We present the pathophysiology behind obesity-related kidney disease, clinical outcomes, and treatment strategies, which include lifestyle interventions, use of renin-angiotensin-aldosterone system inhibitors, glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter-2 inhibitors, and bariatric surgery. With old and novel therapeutics, we are attempting to stave off the silent epidemic that obesity-related kidney disease is becoming.
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Affiliation(s)
- Nang San Hti Lar Seng
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY
| | - Petras Lohana
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY
| | - Shruti Chandra
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY
| | - Belinda Jim
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY.
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14
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Herouvi D, Paltoglou G, Soldatou A, Kalpia C, Karanasios S, Karavanaki K. Lifestyle and Pharmacological Interventions and Treatment Indications for the Management of Obesity in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1230. [PMID: 37508727 PMCID: PMC10378563 DOI: 10.3390/children10071230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Obesity is a multifactorial chronic impairment that further decreases quality of life and life expectancy. Worldwide, childhood obesity has become a pandemic health issue causing several comorbidities that frequently present already in childhood, including cardiovascular (hypertension, dyslipidemia), metabolic (Type 2 diabetes mellitus, fatty liver disease, metabolic syndrome), respiratory, gastrointestinal and musculoskeletal disorders. In addition, obese children frequently experience stress and psychosocial symptoms, including mood disorders, anxiety, prejudice and low self-esteem. Given that cardiovascular risk factors and pediatric obesity have the tendency to pertain into adulthood, obesity management, including weight control and physical activity, should start before the late teens and certainly before the first signs of atherosclerosis can be detected. This review aims to concisely present options for childhood obesity management, including lifestyle modification strategies and pharmacological treatment, as well as the respective treatment indications for the general practitioner.
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Affiliation(s)
- Despina Herouvi
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - George Paltoglou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Christina Kalpia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
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15
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Playdon MC, Hardikar S, Karra P, Hoobler R, Ibele AR, Cook KL, Kumar A, Ippolito JE, Brown JC. Metabolic and bariatric surgery and obesity pharmacotherapy for cancer prevention: current status and future possibilities. J Natl Cancer Inst Monogr 2023; 2023:68-76. [PMID: 37139980 PMCID: PMC10157771 DOI: 10.1093/jncimonographs/lgad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/19/2022] [Accepted: 01/19/2023] [Indexed: 05/05/2023] Open
Abstract
Obesity is a chronic, relapsing, progressive disease of excess adiposity that increases the risk of developing at least 13 types of cancer. This report provides a concise review of the current state of the science regarding metabolic and bariatric surgery and obesity pharmacotherapy related to cancer risk. Meta-analyses of cohort studies report that metabolic and bariatric surgery is independently associated with a lower risk of incident cancer than nonsurgical obesity care. Less is known regarding the cancer-preventive effects of obesity pharmacotherapy. The recent approval and promising pipeline of obesity drugs will provide the opportunity to understand the potential for obesity therapy to emerge as an evidence-based cancer prevention strategy. There are myriad research opportunities to advance our understanding of how metabolic and bariatric surgery and obesity pharmacotherapy may be used for cancer prevention.
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Affiliation(s)
- Mary C Playdon
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Sheetal Hardikar
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Prasoona Karra
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Rachel Hoobler
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Anna R Ibele
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Katherine L Cook
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanika Kumar
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin C Brown
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Louisiana State University Health Sciences Center New Orleans School of Medicine, New Orleans, LA, USA
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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16
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Li Z, Zhang B, Wang N, Zuo Z, Wei H, Zhao F. A novel peptide protects against diet-induced obesity by suppressing appetite and modulating the gut microbiota. Gut 2023; 72:686-698. [PMID: 35803703 PMCID: PMC10086289 DOI: 10.1136/gutjnl-2022-328035] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE The obesity epidemic and its metabolic complications continue to be a major global public health threat with limited effective treatments, especially drugs that can be taken orally. Peptides are a promising class of molecules that have gained increased interest for their applications in medicine and biotechnology. In this study, we focused on looking for peptides that can be administrated orally to treat obesity and exploring its mechanisms. DESIGN Here, a 9-amino-acid peptide named D3 was designed and administered orally to germ-free (GF) mice and wild-type (WT) mice, rats and macaques. The effects of D3 on body weight and other basal metabolic parameters were evaluated. The effects of D3 on gut microbiota were evaluated using 16S rRNA amplicon sequencing. To identify and confirm the mechanisms of D3, transcriptome analysis of ileum and molecular approaches on three animal models were performed. RESULTS A significant body weight reduction was observed both in WT (12%) and GF (9%) mice treated with D3. D3 ameliorated leptin resistance and upregulated the expression of uroguanylin (UGN), which suppresses appetite via the UGN-GUCY2C endocrine axis. Similar effects were also found in diet-induced obese rat and macaque models. Furthermore, the abundance of intestinal Akkermansia muciniphila increased about 100 times through the IFNγ-Irgm1 axis after D3 treatment, which may further inhibit fat absorption by downregulating Cd36. CONCLUSION Our results indicated that D3 is a novel drug candidate for counteracting diet-induced obesity as a non-toxic and bioactive peptide. Targeting the UGN-GUCY2C endocrine axis may represent a therapeutic strategy for the treatment of obesity.
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Affiliation(s)
- Zhanzhan Li
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Bing Zhang
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Ning Wang
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhenqiang Zuo
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
| | - Hong Wei
- Laboratory Animal Department, College of Basic Medicine Army Medical University, Chongqing, China
| | - Fangqing Zhao
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China .,University of Chinese Academy of Sciences, Beijing, China.,Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming, China.,Key Laboratory of Systems Biology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, China
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17
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Abstract
Diabetes is a heterogeneous disease that affects 9% of the world's population (11% in the United States). The consequences of diabetes for the brain are severe; it nearly doubles a person's risk of stroke and is a major contributor to risk for cerebral small vessel disease and dementia. These effects on the brain are in addition to peripheral neuropathy, retinopathy, nephropathy, and coronary heart disease. In this article, we explain the treatments that can prevent or mitigate its harmful effects and propose a role for neurologists and other neurology clinicians in managing patients during routine care.
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18
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Herbozo S, Brown KL, Burke NL, LaRose JG. A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions. Curr Obes Rep 2023; 12:24-35. [PMID: 36729299 PMCID: PMC9894524 DOI: 10.1007/s13679-023-00493-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions. RECENT FINDINGS Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.
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Affiliation(s)
- Sylvia Herbozo
- Department of Surgery, Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Illinois at Chicago, Chicago, USA.
- Department of Psychiatry and Behavioral Sciences and Department of Surgery, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL, 60612, USA.
| | - Kristal Lyn Brown
- Division of General Internal Medicine, School of Medicine, The Johns Hopkins University, Baltimore, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, The Bronx, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, USA
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19
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Garvey WT, Cheng M, Ramasamy A, Smolarz BG, Park S, Kumar N, Kim N, DerSarkissian M, Bhak RH, Duh MS, Wu M, Hansen S, Young-Xu Y. Clinical and Cost Benefits of Anti-Obesity Medication for US Veterans Participating in the MOVE! Weight Management Program. Popul Health Manag 2023; 26:72-82. [PMID: 36735596 DOI: 10.1089/pop.2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010-2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort (N = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort (N = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%-10%, 10%-15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.
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Affiliation(s)
- W Timothy Garvey
- UAB Diabetes Research Center, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mu Cheng
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | | | - Suna Park
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Neela Kumar
- Novo Nordisk, Inc., Plainsboro, New Jersey, USA
| | - Nina Kim
- Novo Nordisk, Inc., Plainsboro, New Jersey, USA
| | | | | | | | - Melody Wu
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Yinong Young-Xu
- Clinical Epidemiology Program, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
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20
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Pathophysiology of obesity and its associated diseases. Acta Pharm Sin B 2023. [DOI: 10.1016/j.apsb.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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21
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Le Jemtel TH, Samson R, Oparil S. Integrated Care Model of Adiposity-Related Chronic Diseases. Curr Hypertens Rep 2022; 24:563-570. [PMID: 36083439 DOI: 10.1007/s11906-022-01223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Although obesity is a disease, most patients with obesity do not undergo effective treatment nor adhere to long-term care. We examine the barriers that patients with obesity confront when searching for effective treatment and propose an integrated care model of adiposity-related chronic diseases in a cardio-renal metabolic unit. RECENT FINDINGS The current care of obesity is fragmented between primary care providers, medical specialists and metabolic bariatric surgeons with little or no coordination of care between these providers. The current care of obesity heavily focuses on weight loss as the primary aim of treatment thereby reenforcing the weight stigma and turning patients away from effective therapy like metabolic bariatric surgery. An interdisciplinary cardio-renal metabolic unit that, besides weight loss, emphasizes prevention/remission of adiposity-related chronic diseases may deliver thorough and rewarding care to most patients with obesity.
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Affiliation(s)
- Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Samson R, Ennezat PV, Le Jemtel TH, Oparil S. Cardiovascular Disease Risk Reduction and Body Mass Index. Curr Hypertens Rep 2022; 24:535-546. [PMID: 35788967 DOI: 10.1007/s11906-022-01213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Anti-hypertensive and lipid lowering therapy addresses only half of the cardiovascular disease risk in patients with body mass index > 30 kg/m2, i.e., obesity. We examine newer aspects of obesity pathobiology that underlie the partial effectiveness of anti-hypertensive lipid lowering therapy for the reduction of cardiovascular disease risk in obesity. RECENT FINDINGS Obesity-related insulin resistance, vascular endothelium dysfunction, increased sympathetic nervous system/renin-angiotensin-aldosterone system activity, and glomerulopathy lead to type 2 diabetes, coronary atherosclerosis, and chronic disease kidney disease that besides hypertension and dyslipidemia increase cardiovascular disease risk. Obesity increases cardiovascular disease risk through multiple pathways. Optimal reduction of cardiovascular disease risk in patients with obesity is likely to require therapy targeted at both obesity and obesity-associated conditions.
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Affiliation(s)
- Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | | | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Lin Q, Xue Y, Zou H, Ruan Z, Ung COL, Hu H. Efficacy and safety of liraglutide for obesity and people who are overweight: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Clin Pharmacol 2022; 15:1461-1469. [PMID: 36180402 DOI: 10.1080/17512433.2022.2130760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND As the pandemic of obesity presents an increasing serious health challenge worldwide, additional medical interventions, especially pharmacotherapy, should be addressed for the affected people. Liraglutide 3.0 mg, is one of the possible options for long-term anti-obesity treatment. RESEARCH DESIGN AND METHODS We systematically searched the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. A meta-analysis was then performed using random-effect models. RESULTS Meta-analyses of seven phase 3 and 4 RCTs (N = 6,028), which were conducted in adults with obesity or overweight for at least 1 year, demonstrated a significant weight reduction with liraglutide 3.0 mg (mean difference of percentage weight change -4.81%; 95% CI: -5.56% to -4.06%; P < 0.00001), relative to placebo. However, more participants taking liraglutide experienced at least one adverse event. More discontinuations due to adverse events were observed among them. In the subgroup analysis among participants with or without diabetes mellitus (DM), pooled result showed that liraglutide was associated with a greater decrease in the percentage of weight change in participants without DM. CONCLUSIONS This study provided support for the use of liraglutide 3.0 mg for weight management in adults with obesity or who are overweight.
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Affiliation(s)
- Qiucen Lin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yan Xue
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Huimin Zou
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Zhen Ruan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, China
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Ghusn W, De la Rosa A, Sacoto D, Cifuentes L, Campos A, Feris F, Hurtado MD, Acosta A. Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Netw Open 2022; 5:e2231982. [PMID: 36121652 PMCID: PMC9486455 DOI: 10.1001/jamanetworkopen.2022.31982] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE No retrospective cohort study has assessed the effectiveness of semaglutide at doses used in randomized clinical trials to treat obesity (ie, 1.7 and 2.4 mg). OBJECTIVE To study weight loss outcomes associated with semaglutide treatment at doses used in randomized clinical trials for patients with overweight or obesity. DESIGN, SETTING, AND PARTICIPANTS This cohort study, conducted at a referral center for weight management, retrospectively collected data on the use of semaglutide for adults with overweight or obesity between January 1, 2021, and March 15, 2022, with a follow-up of up to 6 months. A total of 408 patients with a body mass index (BMI) of 27 or more were prescribed weekly semaglutide subcutaneous injections for 3 months or more. Patients with a history of bariatric procedures, taking other antiobesity medications, and with an active malignant neoplasm were excluded. EXPOSURES Weekly 1.7-mg or 2.4-mg semaglutide subcutaneous injections for 3 to 6 months. MAIN OUTCOMES AND MEASURES The primary end point was the percentage of weight loss. Secondary end points were the proportion of patients achieving weight loss of 5% or more, 10% or more, 15% or more, and 20% or more after 3 and 6 months and the percentage of weight loss for patients with or without type 2 diabetes after 3 and 6 months. RESULTS The study included 175 patients (132 women [75.4%]; mean [SD] age, 49.3 [12.5] years; mean [SD] BMI, 41.3 [9.1]) in the analysis at 3 months and 102 patients at 6 months. The mean (SD) weight loss after 3 months was 6.7 (4.4) kg, equivalent to a mean (SD) weight loss of 5.9% (3.7%) (P < .001), and the mean (SD) weight loss after 6 months was 12.3 (6.6) kg, equivalent to a mean (SD) weight loss of 10.9% (5.8%) (P < .001 from baseline). Of the 102 patients who were followed up at 6 months, 89 (87.3%) achieved weight loss of 5% or more, 56 (54.9%) achieved weight loss of 10% or more, 24 (23.5%) achieved weight loss of 15% or more, and 8 (7.8%) achieved weight loss of 20% or more. Patients with type 2 diabetes had a lower mean (SD) percentage weight loss at 3 and 6 months compared with those without type 2 diabetes: 3.9% (3.1%) vs 6.3% (3.7%) at 3 months (P = .001) and 7.2% (6.3%) vs 11.8% (5.3%) at 6 months (P = .005). CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that weekly 1.7-mg and 2.4-mg doses of semaglutide were associated with weight loss similar to that seen in randomized clinical trials. Studies with longer periods of follow-up are needed to evaluate prolonged weight loss outcomes.
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Affiliation(s)
- Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alan De la Rosa
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Sacoto
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alejandro Campos
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Fauzi Feris
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maria Daniela Hurtado
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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25
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Zhao G, Zhang Q, Wu F, Yin S, Xie Y, Liu H. Comparison of weight loss and adverse events of obesity drugs in children and adolescents: a systematic review and meta-analysis. Expert Rev Clin Pharmacol 2022; 15:1119-1125. [PMID: 36039827 DOI: 10.1080/17512433.2022.2117152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The global incidence of childhood obesity is increasing. Currently, there are only few established drugs for treating adolescent obesity. Randomized clinical trials (RCTs) comparing pharmacological interventions in children with obesity are scarce; therefore, we aimed to analyze the relative efficacy and adverse reactions of these drugs and compare the effects of each drug on body mass index (BMI). RESEARCH DESIGN AND METHODS This meta-analysis focused on the slimming effect, safety, and correlation of metformin, orlistat, exenatide, liraglutide, and topiramate in children with obesity. Several international databases were searched and clinical trials on the treatment of obesity in children in which the drug was administered for ≥ 6 months were included. Changes in BMI before and after treatment were analyzed using a Bayes framework, and the surface under the cumulative ranking was calculated. RESULTS Of 2102 relevant articles retrieved, 21 RCTs were included in the study. Compared to other drugs, liraglutide reduced BMI the most in children with obesity. However, it was most associated with drug withdrawal due to adverse events while topiramate was least. CONCLUSIONS Liraglutide had a higher probability of achieving clinically significant weight loss compared with other drugs while topiramate was superior in safety.
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Affiliation(s)
- Guangming Zhao
- Changchun University of Chinese Medicine, Changchun 130117, China
| | - Qi Zhang
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Fan Wu
- Personnel Section, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Shuang Yin
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Yiqi Xie
- Institute of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Hongyan Liu
- Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine, Beijing 101300, China
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Porat D, Dukhno O, Vainer E, Cvijić S, Dahan A. Antiallergic Treatment of Bariatric Patients: Potentially Hampered Solubility/Dissolution and Bioavailability of Loratadine, but Not Desloratadine, Post-Bariatric Surgery. Mol Pharm 2022; 19:2922-2936. [PMID: 35759355 DOI: 10.1021/acs.molpharmaceut.2c00292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Gastrointestinal anatomical/physiological changes after bariatric surgery influence variables affecting the fate of drugs after ingestion, and medication management of these patients requires a thorough and complex mechanistic analysis. The aim of this research was to study whether loratadine/desloratadine antiallergic treatment of bariatric patients is at risk of being ineffective due to impaired solubility/dissolution. The pH-dependent solubility of loratadine/desloratadine was studied in vitro, as well as ex vivo, in gastric content aspirated from patients before versus after bariatric surgery. Then, a biorelevant dissolution method was developed to simulate the gastric conditions after sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB), accounting for key variables (intragastric volume, pH, and contractility), and the dissolution of loratadine/desloratadine was studied pre- versus post-surgery. Dissolution was also studied after tablet crushing or syrup ingestion, as these actions are recommended after bariatric surgery. Finally, these experimental data were implemented in a newly developed physiologically based pharmacokinetic (PBPK) model to simulate loratadine/desloratadine PK profiles pre- versus post-surgery. For both drugs, pH-dependent solubility was demonstrated, with decreased solubility at higher pH; over the pH range 1-7, loratadine solubility decreased ∼2000-fold, and desloratadine decreased ∼120-fold. Ex vivo solubility in aspirated human gastric fluid pre- versus post-surgery was in good agreement with these in vitro results and revealed that while desloratadine solubility still allows complete dissolution post-surgery, loratadine solubility post-surgery is much lower than the threshold required for the complete dissolution of the drug dose. Indeed, severely hampered loratadine dissolution was revealed, dropping from 100% pre-surgery to only 3 and 1% post-SG and post-OAGB, respectively. Tablet crushing did not increase loratadine dissolution in any post-bariatric condition, nor did loratadine syrup in post-OAGB (pH 7) media, while in post-laparoscopic SG conditions (pH 5), the syrup provided partial improvement of up to 40% dissolution. Desloratadine exhibited quick and complete dissolution across all pre-/post-surgery conditions. PBPK simulations revealed pronounced impaired absorption of loratadine post-surgery, with 84-88% decreased Cmax, 28-36% decreased Fa, and 24-31% decreased overall bioavailability, depending on the type of bariatric procedure. Desloratadine absorption remained unchanged post-surgery. We propose that desloratadine should be preferred over loratadine in bariatric patients, and as loratadine is an over-the-counter medication, antiallergic therapy after bariatric surgery requires special attention by patients and clinicians alike. This mechanistic approach that reveals potential post-surgery complexity, and at the same time provides adequate substitutions, may contribute to better pharmacotherapy and overall patient care after bariatric surgery.
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Affiliation(s)
- Daniel Porat
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Oleg Dukhno
- Department of Surgery B, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Ella Vainer
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Sandra Cvijić
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Arik Dahan
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
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Anti-obesity weight loss medications: Short-term and long-term use. Life Sci 2022; 306:120825. [PMID: 35870619 DOI: 10.1016/j.lfs.2022.120825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/21/2022]
Abstract
As obesity prevalence increases, more and more drugs that assist with weight loss have been developed. Numerous weight loss drugs had been approved, but many have also been withdrawn based on their lack of efficacy as well as safety concerns. Initial approaches in developing weight loss drugs was by increasing physiological energy expenditure and suppressing the appetite. Subsequently, as more physiological mechanisms for weight gain has been unearthed, drugs targeting newly discovered receptors and/or enzymes have been introduced with improved safety profiles and fewer psychological adverse events. Additionally, drugs targeting hunger or satiety signaling have been actively studied, and have shown increased adoption by physicians. Studies have also evaluated drugs that target metabolic tissues-such as adipose tissue or muscle-to promote weight loss, however to-date nothing has carried on into clinical practice. Starting with a brief history of early obesity treatments, this review evaluates current weight loss pharmaceutical options based on their duration of therapy status.
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28
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Oo WM, Mobasheri A, Hunter DJ. A narrative review of anti-obesity medications for obese patients with osteoarthritis. Expert Opin Pharmacother 2022; 23:1381-1395. [PMID: 35855642 DOI: 10.1080/14656566.2022.2104636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : The prevalence of both obesity and osteoarthritis (OA) are increasing worldwide (twindemic), and the association between the two chronic diseases is also well-established. AREAS COVERED : In this narrative review, we will briefly describe the double burdens of both diseases, the impact of weight loss or gain on OA incidence and structural progression and discuss the biomechanical and anti-inflammatory mechanisms mediating these effects. FDA-approved anti-obesity drugs are summarized in terms of their clinical efficacy and safety profile, and the completed or ongoing phase 2/3 clinical trials of such drugs in OA patients with obesity are examined. EXPERT OPINION : We will discuss the perspectives related to principles of prescription of anti-obesity drugs, the potential role of phenotype-guided approach, time to drug effects in clinical trials, sustainability of weight loss based on the real-world studies, the importance of concomitant therapies such as dieting and exercises, and the role of weight loss on non-weight bearing OA joints. Although obesity is the major risk factor for OA pathogenesis and progression, and there are a variety of anti-obesity medications on the market, research on the use of these disease-modifying drugs in OA (DMOAD) is still sparse..
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.,Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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29
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Kajikawa M, Higashi Y. Obesity and Endothelial Function. Biomedicines 2022; 10:biomedicines10071745. [PMID: 35885049 PMCID: PMC9313026 DOI: 10.3390/biomedicines10071745] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 02/08/2023] Open
Abstract
Obesity is a major public health problem and is related to increasing rates of cardiovascular morbidity and mortality. Over 1.9 billion adults are overweight or obese worldwide and the prevalence of obesity is increasing. Obesity influences endothelial function through obesity-related complications such as hypertension, dyslipidemia, diabetes, metabolic syndrome, and obstructive sleep apnea syndrome. The excess fat accumulation in obesity causes adipocyte dysfunction and induces oxidative stress, insulin resistance, and inflammation leading to endothelial dysfunction. Several anthropometric indices and imaging modalities that are used to evaluate obesity have demonstrated an association between obesity and endothelial function. In the past few decades, there has been great focus on the mechanisms underlying endothelial dysfunction caused by obesity for the prevention and treatment of cardiovascular events. This review focuses on pathophysiological mechanisms of obesity-induced endothelial dysfunction and therapeutic targets of obesity.
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Affiliation(s)
- Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan;
| | - Yukihito Higashi
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan;
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Correspondence: ; Tel.: +81-82-257-5831
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30
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Setmelanotide in obesity: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Campos A, Cifuentes L, Hashem A, Busebee B, Hurtado-Andrade MD, Ricardo-Silgado ML, McRae A, De la Rosa A, Feris F, Bublitz JT, Hensrud D, Camilleri M, Kellogg TA, Eckel-Passow JE, Olson J, Acosta A. Effects of Heterozygous Variants in the Leptin-Melanocortin Pathway on Roux-en-Y Gastric Bypass Outcomes: a 15-Year Case-Control Study. Obes Surg 2022; 32:2632-2640. [PMID: 35654930 PMCID: PMC9721531 DOI: 10.1007/s11695-022-06122-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Heterozygous variants in the leptin-melanocortin pathway are associated with obesity. However, their effect on the long-term outcomes after Roux-en-Y gastric bypass (RYGB) is still unknown. METHODS In this matched case-control study, 701 participants from the Mayo Clinic Biobank with a history of RYGB were genotyped. Sixty-three patients had a heterozygous variant in the leptin-melanocortin pathway. After excluding patients with potential confounders, carriers were randomly matched (on sex, age, body mass index [BMI], and years since surgery) with two non-carrier controls. The electronic medical record of carriers and matched non-carriers was reviewed for up to 15 years after RYGB. RESULTS A total of 50 carriers and 100 matched non-carriers with a history of RYGB were included in the study. Seven different genes (LEPR, PCSK1, POMC, SH2B1, SRC1, MC4R, and SIM1) in the leptin-melanocortin pathway were identified. At the time of surgery, the mean age was 50.8 ± 10.6 years, BMI 45.6 ± 7.3 kg/m2, and 79% women. There were no differences in postoperative years of follow-up, Roux limb length, or gastric pouch size between groups. Fifteen years after RYGB, the percentage of total body weight loss (%TBWL) in carriers was - 16.6 ± 10.7 compared with - 28.7 ± 12.9 in non-carriers (diff = 12.1%; 95% CI, 4.8 to 19.3) and the percentage of weight regain after maximum weight loss was 52.7 ± 29.7 in carriers compared with 29.8 ± 20.7 in non-carriers (diff = 22.9%; 95% CI, 5.3 to 40.5). The nadir %TBWL was lower - 32.1 ± 8.1 in carriers compared with - 36.8 ± 10.4 in non-carriers (diff = 4.8%; 95% CI 1.8 to 7.8). CONCLUSIONS Carriers of a heterozygous variant in the leptin-melanocortin pathway have a progressive and significant weight regain in the mid- and long-term after RYGB. Genotyping patients experiencing significant weight regain after RYGB could help implement multidisciplinary and individualized weight loss interventions to improve weight maintenance after surgery.
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Affiliation(s)
- Alejandro Campos
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Anas Hashem
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Bradley Busebee
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Maria D Hurtado-Andrade
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Maria L Ricardo-Silgado
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Alison McRae
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Alan De la Rosa
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Fauzi Feris
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Joshua T Bublitz
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Donald Hensrud
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael Camilleri
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA
| | - Todd A Kellogg
- Division of Endocrine & Metabolic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeanette E Eckel-Passow
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Janet Olson
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Charlton 8-142, 200 First St. S.W, Rochester, MN, 55902, USA.
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Barrett LA, Xing A, Sheffler J, Steidley E, Adam TJ, Zhang R, He Z. Assessing the use of prescription drugs and dietary supplements in obese respondents in the National Health and Nutrition Examination Survey. PLoS One 2022; 17:e0269241. [PMID: 35657782 PMCID: PMC9165812 DOI: 10.1371/journal.pone.0269241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Obesity is a common disease and a known risk factor for many other conditions such as hypertension, type 2 diabetes, and cancer. Treatment options for obesity include lifestyle changes, pharmacotherapy, and surgical interventions such as bariatric surgery. In this study, we examine the use of prescription drugs and dietary supplements by the individuals with obesity. Methods We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2003–2018. We used multivariate logistic regression to analyze the correlations of demographics and obesity status with the use of prescription drugs and dietary supplement use. We also built machine learning models to classify prescription drug and dietary supplement use using demographic data and obesity status. Results Individuals with obesity are more likely to take cardiovascular agents (OR = 2.095, 95% CI 1.989–2.207) and metabolic agents (OR = 1.658, 95% CI 1.573–1.748) than individuals without obesity. Gender, age, race, poverty income ratio, and insurance status are significantly correlated with dietary supplement use. The best performing model for classifying prescription drug use had the accuracy of 74.3% and the AUROC of 0.82. The best performing model for classifying dietary supplement use had the accuracy of 65.3% and the AUROC of 0.71. Conclusions This study can inform clinical practice and patient education of the use of prescription drugs and dietary supplements and their correlation with obesity.
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Affiliation(s)
- Laura A. Barrett
- School of Information, Florida State University, Tallahassee, Florida, United States of America
| | - Aiwen Xing
- Department of Statistics, Florida State University, Tallahassee, Florida, United States of America
| | - Julia Sheffler
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, United States of America
| | - Elizabeth Steidley
- School of Information, Florida State University, Tallahassee, Florida, United States of America
| | - Terrence J. Adam
- Institute for Health Informatics and College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rui Zhang
- Institute for Health Informatics and College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Zhe He
- School of Information, Florida State University, Tallahassee, Florida, United States of America
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, United States of America
- * E-mail:
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33
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Dong Y, Zheng Y, Zhu L, Li T, Guan Y, Zhao S, Wang Q, Wang J, Li L. Hua-Tan-Sheng-Jing Decoction Treats Obesity With Oligoasthenozoospermia by Up-Regulating the PI3K-AKT and Down-Regulating the JNK MAPK Signaling Pathways: At the Crossroad of Obesity and Oligoasthenozoospermia. Front Pharmacol 2022; 13:896434. [PMID: 35559247 PMCID: PMC9086321 DOI: 10.3389/fphar.2022.896434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Oligoasthenozoospermia is the leading cause of male infertility, seriously affecting men's health and increasing the societal medical burden. In recent years, obesity-related oligoasthenozoospermia has attracted increased attention from researchers to find a cure. This study aimed to evaluate the efficacy of Hua-Tan-Sheng-Jing decoction (HTSJD) in treating obesity with oligoasthenozoospermia, determine its active ingredients and identify its mechanism of action. Methods: The ingredients of HTSJD were determined by combining the ultra-performance liquid chromatography with mass spectrometry (UPLC-MS/MS) and systems pharmacology approach. The common pathogenesis of obesity and oligoasthenozoospermia and the potential mechanism of HTSJD against obesity with oligoasthenozoospermia were obtained through target fishing, network construction, and enrichment analyses. Further, molecular docking of the key ingredients with the upstream receptors of the key signaling pathways of the potential mechanism was used to predict their affinity. Finally, high-fat-induced obesity with oligoasthenozoospermia rat model was constructed to determine the effects of HTSJD on semen concentration, sperm motility, body weight, and serum lipid metabolism. The key proteins were validated by immunohistochemistry (IHC). Results: A total of 70 effective components and 847 potential targets of HTSJD (H targets) were identified, of which 743 were common targets related to obesity and oligoasthenozoospermia (O-O targets) mainly enriched in the pathways related to inflammation, oxidative stress and hormone regulation. Finally, 143 common targets (H-O-O targets) for HTSJD against obesity with oligoasthenozoospermia were obtained. Combining the hub genes and the results of Gene Ontology (GO) functional and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of H-O-O targets, PI3K-AKT and MAPK signaling pathways were identified as the key pathways. Molecular docking results showed that Diosgenin, Kaempferol, Quercetin, Hederagenin, Isorhamnetin may act on the related pathways by docking EGFR, IGF1R and INSR. The animal-based in vivo experiments confirmed that HTSJD improves the sperm quality of high-fat diet-fed rats by reducing their body weight and blood lipid levels, influencing the PI3K-AKT and MAPK signaling pathways and altering the corresponding protein expressions. Conclusion: HTSJD treats obesity with oligoasthenozoospermia by up-regulating the PI3K-AKT signaling pathway and down-regulating the MAPK signaling pathway, which are at the crossroad of obesity and oligoasthenozoospermia.
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Affiliation(s)
- Yang Dong
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yanfei Zheng
- National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Linghui Zhu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Tianxing Li
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanyuan Guan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shipeng Zhao
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qi Wang
- National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ji Wang
- National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lingru Li
- National Institute of TCM Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
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34
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Falardeau J. New Options (or not) for Treatment of Idiopathic Intracranial Hypertension. Curr Neurol Neurosci Rep 2022; 22:257-264. [PMID: 35332515 DOI: 10.1007/s11910-022-01188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Idiopathic intracranial hypertension (IIH) is a disorder primarily affecting obese women of childbearing age and, if left untreated, can lead to irreversible vision loss. No consensus exists on the best management strategy for IIH. Weight loss is advocated and few useful medical options exist. There is an unmet need to discover new treatment options for this increasingly prevalent condition. This article reviews the recent advances and research on the treatment of IIH. RECENT FINDINGS Venous sinus stenting (VSS) is now performed in many experienced centers, and there is growing interest in bariatric surgery as a treatment modality. Newly approved anti-obesity drugs are showing effectiveness in weight loss, and novel targeted disease-modifying IIH therapies are being explored. Further evaluation of these novel therapeutic strategies as well as studies exploring the use of anti-obesity drugs in IIH is needed. While VSS is gaining popularity due to its efficacy and low complication rate, there is insufficient evidence to support any surgical procedure over another. Bariatric surgery is appealing for patients with non-sight-threatening IIH and needs to be further explored.
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Affiliation(s)
- Julie Falardeau
- Department of Ophthalmology, Oregon Health and Science University, 3303 S Bond Avenue, 11th floor, Portland, OR, 97239, USA.
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35
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Hales CM, Gu Q, Ogden CL, Yanovski SZ. Use of prescription medications associated with weight gain among US adults, 1999-2018: A nationally representative survey. Obesity (Silver Spring) 2022; 30:229-239. [PMID: 34907655 PMCID: PMC8842491 DOI: 10.1002/oby.23299] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/20/2021] [Accepted: 08/28/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate trends in the use of obesogenic medications among adults. METHODS Cross-sectional data on adults aged ≥20 years are from the 1999 to 2018 National Health and Nutrition Examination Survey (n = 52,340). Obesogenic medications were defined according to the 2015 Endocrine Society guidelines on the pharmacological management of obesity. Weight status was categorized according to BMI. Trends in prior 30-day use were evaluated. RESULTS In NHANES 2017-2018, 20.3% of US adults used an obesogenic medication. Beta-blockers (9.8%) and antidiabetics (5.7%) were the most common; antipsychotics (1.0%) were the least common. Most common indications were disorders of glucose metabolism, hypertension, neuralgia or neuritis, heart disease, and musculoskeletal pain and/or inflammation. From 1999 to 2018, the proportional use of obesogenic medications increased for anticonvulsants (34.4% to 55.0%) but decreased for antidepressants (32.1% to 18.8%), antidiabetics (82.9% to 52.5%), and beta-blockers (83.9% to 80.7%). The proportional use of obesogenic medications was not associated with weight status, except for antipsychotics. CONCLUSIONS Use of obesogenic medications was common. Differences in the proportional use of obesogenic medication may reflect changing availability of obesogenic versus nonobesogenic medications over time. The decision to prescribe a nonobesogenic alternative, if one exists, is guided by weighing the risks and benefits of available treatments.
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Affiliation(s)
- Craig M Hales
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Qiuping Gu
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Cynthia L Ogden
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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36
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Kyrillos JV, Skolnik NS, Mukhopadhyay B, Pennings N. Integrating semaglutide into obesity management - a primary care perspective. Postgrad Med 2022; 134:37-49. [PMID: 36691306 DOI: 10.1080/00325481.2022.2149964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This final article in the supplement aims to summarize a clinical approach for weight management geared toward primary care practitioners, offering practical advice about how to integrate weight management into day-to-day practice. To achieve long-term successful weight loss, a comprehensive multimodal approach is recommended, focusing on both lifestyle modification and appropriate use of therapy. Once-weekly subcutaneous semaglutide 2.4 mg is a novel treatment that can be used as an adjunct to lifestyle modification for the management of overweight and obesity. Key considerations are presented to support its optimal administration in conjunction with lifestyle modification, with a focus on assessing suitability and the importance of dose escalation and monitoring.
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Affiliation(s)
- Janine V Kyrillos
- Jefferson Comprehensive Weight Management, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neil S Skolnik
- Abington Family Medicine, Abington Jefferson Health, Abington, PA, USA
| | | | - Nicholas Pennings
- Family Medicine, Campbell University School of Osteopathic Medicine, Campbell University, Lillington, NC, USA
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37
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Nugent JL, Singh A, Wirth KM, Oppler SH, Hocum Stone L, Janecek JL, Sheka AC, Kizy S, Moore MEG, Staley C, Hering BJ, Ramachandran S, Ikramuddin S, Graham ML. A nonhuman primate model of vertical sleeve gastrectomy facilitates mechanistic and translational research in human obesity. iScience 2021; 24:103421. [PMID: 34877488 PMCID: PMC8633018 DOI: 10.1016/j.isci.2021.103421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/22/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
The obesity epidemic significantly contributes to overall morbidity and mortality. Bariatric surgery is the gold standard treatment for obesity and metabolic dysfunction, yet the mechanisms by which it exerts metabolic benefit remain unclear. Here, we demonstrate a model of vertical sleeve gastrectomy (VSG) in nonhuman primates (NHP) that mimics the complexity and outcomes in humans. We also show that VSG confers weight loss and durable metabolic benefit, where equivalent caloric intake in shams resulted in significant weight gain following surgery. Furthermore, we show that VSG is associated with early, weight-independent increases in bile acids, short-chain fatty acids, and reduced visceral adipose tissue (VAT) inflammation with a polarization of VAT-resident immunocytes toward highly regulatory myeloid cells and Tregs. These data demonstrate that this strongly translational NHP model can be used to interrogate factors driving successful intervention to unravel the interplay between physiologic systems and improve therapies for obesity and metabolic syndrome.
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Affiliation(s)
- Julia L Nugent
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Amar Singh
- Department of Surgery, University of Minnesota, MN, USA.,Schulze Diabetes Institute, Department of Surgery, University of Minnesota, MN, USA
| | - Keith M Wirth
- Department of Surgery, University of Minnesota, MN, USA
| | - Scott Hunter Oppler
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Laura Hocum Stone
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Jody L Janecek
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Adam C Sheka
- Department of Surgery, University of Minnesota, MN, USA
| | - Scott Kizy
- Department of Surgery, University of Minnesota, MN, USA
| | - Meghan E G Moore
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Christopher Staley
- Department of Surgery, University of Minnesota, MN, USA.,BioTechnology Institute, University of Minnesota, MN, USA
| | - Bernhard J Hering
- Department of Surgery, University of Minnesota, MN, USA.,Schulze Diabetes Institute, Department of Surgery, University of Minnesota, MN, USA
| | - Sabarinathan Ramachandran
- Department of Surgery, University of Minnesota, MN, USA.,Schulze Diabetes Institute, Department of Surgery, University of Minnesota, MN, USA
| | | | - Melanie L Graham
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
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38
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Nutritional Management in Bariatric Surgery Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212049. [PMID: 34831805 PMCID: PMC8618972 DOI: 10.3390/ijerph182212049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023]
Abstract
The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon's work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.
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39
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Lingvay I, Garvey WT, Wadden TA. Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy and Body Weight in Adults With Overweight or Obesity-Reply. JAMA 2021; 326:1214-1215. [PMID: 34581743 DOI: 10.1001/jama.2021.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ildiko Lingvay
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Thomas A Wadden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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