1
|
Chávez Fernández JA, Ramírez Mendoza M, Kassck Ipinaa H, Sánchez Ángeles LA, González Chávez A, Escobedo G, Méndez-García LA. The cardiovascular polypill as baseline treatment improves lipid profile and blood pressure regardless of body mass index in patients with cardiovascular disease. The Bacus study. PLoS One 2023; 18:e0290544. [PMID: 37624820 PMCID: PMC10456133 DOI: 10.1371/journal.pone.0290544] [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: 02/18/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Pharmacological treatment with lipid-lowering and antihypertensive drugs has been proposed as a strategy to improve excess cardiovascular (CV) risk among obese individuals. The present study aimed to assess whether the CV polypill (Sincronium®) could be an effective strategy to help improve CV risk factor control in obese/overweight individuals requiring secondary prevention. METHODS This was an observational, retrospective study reviewing the hospital medical records of 479 patients with established CV disease who initiated treatment with the CV polypill between 2013 and 2019 at a general hospital in Mexico. Patients were grouped as normal weight, overweight or obese according to their initial body mass index (BMI). We collected blood pressure (BP), lipid profile, and vascular age at the last visit recorded during the period following treatment. RESULTS At the end of the study, all assessed lipid parameters improved compared to baseline regardless of the initial BMI category (all p<0.001). There was an increase from baseline regarding the proportion of patients with at target low-density lipoprotein cholesterol after treatment (2.3% vs. 30.1%; p<0.001), more than 80% of patients achieved triglyceride levels <200 mg/dL (p<0.001), and more than 80% achieved target BP levels in all BMI subgroups (p<0.001). The subanalyses in the elderly population yielded similar results, with a significant overall improvement in lipid and BP control after initiating the CV polypill strategy. CONCLUSIONS The use of the CV polypill as baseline therapy for secondary prevention seems to be a reasonable strategy that enhances CV risk factor control regardless of the patient's BMI.
Collapse
Affiliation(s)
- José Alejandro Chávez Fernández
- Clínica de Enfermedad Coronaria e Insuficiencia Cardiaca, Servicio de Cardiología, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Marcelo Ramírez Mendoza
- Servicio de Cardiología, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | | | - Antonio González Chávez
- Servicio de Medicina Interna, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Galileo Escobedo
- Departamento de Proteómica y Metabolismo, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico
| | | |
Collapse
|
2
|
Vázquez-Velázquez V, García García E. Feasibility and Effectiveness of a Comprehensive Care Program for People Living with Obesity: A Real-World Experience in a Public Hospital in Mexico. Obes Facts 2022; 15:774-786. [PMID: 36122569 PMCID: PMC9801369 DOI: 10.1159/000527024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Existing evidence indicates that the best treatment model for obesity leading to successful weight loss consists of a so-called comprehensive lifestyle intervention program, but the offer, implementation, and coverage of these kinds of programs for the diagnosis, management, and follow-up of people living with obesity are limited. So, the aim of this study was an evaluation of the feasibility and effectiveness of a comprehensive care program for obesity in a public tertiary hospital in Mexico. METHODS An observational, longitudinal, and retrospective study evaluated a six-month long medium-intensity comprehensive care program (seven visits focused on medical, nutritional, psychological, and psychiatric diagnosis and treatment). A total of 1,017 people living with obesity were recruited for the program. Logistic regression models were used to predict the factors associated with attendance and weight loss. RESULTS Of the 1,017 participants, 661 completed the program (65% retention rate) and attended 4.9 ± 1.9 visits each, with 40.1% losing ≥5% of their starting weight (X = 4.3 ± 4.4%). From visit 1 to visit 7, the participants that completed the program had weight decreases of Δ = -4.8 kg and body mass index (BMI) -2.3 kg/m2; p < 0.01. Each additional visit increased the likelihood of a 5% weight loss [OR 1.90, 95% CI: 1.51-2.38, p < 0.001] and 10% [OR 2.45, 95% CI: 1.49-4.02, p < 0.001], becoming statistically significant after attending more than four visits. Each additional year of age increased the likelihood of losing ≥5% body weight [OR 1.01, 95% CI: 1.00-1.03, p < 0.05] and increased the likelihood of completing the program [OR 1.02, 95% CI: 1.00-1.03, p < 0.01] after controlling for sex, weight, BMI, and psychiatric and weight loss medications. DISCUSSION/CONCLUSION This study demonstrates the feasibility and effectiveness of a six-month comprehensive program for obesity in a public hospital in Mexico.
Collapse
Affiliation(s)
- Verónica Vázquez-Velázquez
- Department of Endocrinology and Metabolism, Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
- *Verónica Vázquez-Velázquez,
| | - Eduardo García García
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
| |
Collapse
|
3
|
Lei S, Inojosa JRM, Kumar S, Lee AT, Scott CG, Lerman A, Lerman LO, Senecal CG, Lin W, Zhang X, Cohen P, Lopez-Jimenez F. Effectiveness of a Weight Loss Program Using Digital Health in Adolescents and Preadolescents. Child Obes 2021; 17:311-321. [PMID: 33826417 PMCID: PMC8236388 DOI: 10.1089/chi.2020.0317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To identify an efficacious intervention on treating adolescents with overweight and obesity, this might result in health benefits. Methods: Adolescents with overweight or obesity aged 10-17 years with BMI percentile ≥85th were included in this historical observational analysis. Subjects used an entirely remote weight loss program combining mobile applications, frequent self-weighing, and calorie restriction with meal replacement. Body weight changes were evaluated at 42, 60, 90, and 120 days using different metrics including absolute body weight, BMI, and BMI z-score. Chi-square or Fisher exact tests (categorical variables) and Student's t-test (continuous variables) were used to compare subjects. Results: In total, 2,825 participants, mean age 14.4 ± 2.2 years, (54.8% girls), were included from October 27, 2016, to December 31, 2017, in mainland China; 1355 (48.0%) had a baseline BMI percentile ≥97th. Mean BMI and BMI z-score were 29.20 ± 4.44 kg/m2 and 1.89 ± 0.42, respectively. At day 120, mean reduction in body weight, BMI, and BMI z-score was 8.6 ± 0.63 kg, 3.13 ± 0.21 kg/m2, and 0.42 ± 0.03; 71.4% had lost ≥5% body weight, 69.4% of boys and 73.2% of girls, respectively. Compared with boys, girls achieved greater reduction on BMI z-score at all intervals (p < 0.004 for all comparisons). Higher BMI percentile at baseline and increased frequency of use of the mobile application were directly associated with more significant weight loss. Conclusions: An entirely remote digital weight loss program is effective in facilitating weight loss in adolescents with overweight or obesity in the short term and mid term.
Collapse
Affiliation(s)
- Sha Lei
- Department of Cardiovascular Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Cardiology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Jose R. Medina Inojosa
- Department of Cardiovascular Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexander T. Lee
- Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Conor G. Senecal
- Department of Cardiovascular Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Weihua Lin
- Hangzhou MetaWell Technology Co., Hangzhou, China
| | | | - Pinchas Cohen
- USC Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Address correspondence to: Francisco Lopez-Jimenez, MD, MSc, Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| |
Collapse
|
4
|
Vera-Zertuche JM, Mancilla-Galindo J, Tlalpa-Prisco M, Aguilar-Alonso P, Aguirre-García MM, Segura-Badilla O, Lazcano-Hernández M, Rocha-González HI, Navarro-Cruz AR, Kammar-García A, Vidal-Mayo JDJ. Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study. Epidemiol Infect 2021; 149:e109. [PMID: 33913410 PMCID: PMC8134888 DOI: 10.1017/s0950268821001023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/03/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04-2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04-3.80; immunosuppression: HR = 5.06, 95% CI 2.26-11.41; hypertension: HR = 2.30, 95% CI 1.77-3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.
Collapse
Affiliation(s)
- J. M. Vera-Zertuche
- Endocrinology Department, Obesity Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J. Mancilla-Galindo
- Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - M. Tlalpa-Prisco
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - P. Aguilar-Alonso
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - M. M. Aguirre-García
- Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - O. Segura-Badilla
- Facultad de Ciencias de la Salud y de los Alimentos, Departamento de Nutrición y Salud Pública, Programa UBB Saludable, Universidad del Bío-Bío, Bío-Bío, Chile
| | - M. Lazcano-Hernández
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - H. I. Rocha-González
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - A. R. Navarro-Cruz
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - A. Kammar-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J. de J. Vidal-Mayo
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
5
|
Vázquez‐Velázquez V, Laviada‐Molina H, García‐García E, Sandoval‐Diez E, Mancillas‐Adame L. Perceptions, Attitudes, and Barriers to Obesity Care in Mexico: Data From the ACTION-IO Study. Obesity (Silver Spring) 2021; 29:317-326. [PMID: 33491317 PMCID: PMC7898320 DOI: 10.1002/oby.23077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The Awareness, Care, and Treatment in Obesity Management-International Observation (ACTION-IO) study (ClinicalTrials.gov identifier NCT03584191) aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care in people with obesity (PwO) and health care professionals (HCPs). This study presents the results from Mexico. METHODS An online survey was conducted. In Mexico, eligible PwO were ≥18 years of age with BMI ≥30 kg/m2 based on self-reported height and weight. Eligible HCPs had direct patient care. RESULTS The survey was completed by 2,000 PwO and 400 HCPs in Mexico. Many PwO (71%) and HCPs (94%) categorized obesity as a chronic disease. Sixty-three percent of PwO felt motivated to lose weight, but many HCPs perceived that PwO were not interested in losing weight (76%) or motivated to lose weight (69%). Lack of financial means to support weight-loss efforts was a barrier for PwO (34%) to discussing weight with HCPs. Sixty-five percent of PwO had discussed weight with HCPs in the past 5 years. PwO (80%) and HCPs (89%) considered lack of exercise as the main barrier to weight loss. Few PwO (34%) had successfully lost ≥5% of their body mass over the past 3 years. CONCLUSIONS This ACTION-IO study in Mexico identified discrepancies in the perceptions of PwO and HCPs, highlighting opportunities for further education and patient-centered approaches.
Collapse
Affiliation(s)
- Verónica Vázquez‐Velázquez
- Obesity and Eating Disorder ClinicInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Eduardo García‐García
- Obesity and Eating Disorder ClinicInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Leonardo Mancillas‐Adame
- Endocrinology DivisionUniversity Hospital and Medical SchoolAutonomous University of Nuevo LeónSan Nicolás de los GarzaMexico
| |
Collapse
|
6
|
A 12-week aerobic exercise intervention results in improved metabolic function and lower adipose tissue and ectopic fat in high-fat diet fed rats. Biosci Rep 2021; 41:227560. [PMID: 33432988 PMCID: PMC7846962 DOI: 10.1042/bsr20201707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
Investigations of long-term exercise interventions in humans to reverse obesity is expensive and is hampered by poor compliance and confounders. In the present study, we investigated intrahepatic and muscle fat, visceral and subcutaneous fat pads, plasma metabolic profile and skeletal muscle inflammatory markers in response to 12-week aerobic exercise in an obese rodent model. Six-week-old male Wistar rats (n=20) were randomized to chow-fed control (Control, n=5), sedentary high-fat diet (HFD, n=5), chow-fed exercise (Exercise, n=5) and HFD-fed exercise (HFD+Exercise, n=5) groups. The exercise groups were subjected to 12 weeks of motorized treadmill running at a speed of 18 m/min for 30 min/day. Differences in post-intervention measures were assessed by analysis of covariance (ANCOVA), adjusted for baseline bodyweight and pre-intervention measures, where available. Post-hoc analyses were performed with Bonferroni correction. Plasma metabolic profile was worsened and fat pads, ectopic fat in muscle and liver and inflammatory markers in skeletal muscle were elevated in sedentary HFD-fed animals relative to chow-fed controls. HFD+Exercise animals had significantly lower leptin (P=0.0004), triglycerides (P=0.007), homeostatic model assessment of insulin resistance (HOMA-IR; P=0.065), intramyocellular lipids (IMCLs; P=0.003), intrahepatic lipids (IHLs; P<0.0001), body fat% (P=0.001), subcutaneous adipose tissue (SAT; P<0.0001), visceral adipose (P<0.0001) and total fat mass (P<0.0001), relative to sedentary HFD-fed animals, despite only modestly lower bodyweight. Messenger RNA (mRNA) expression of inflammatory markers Interleukin 6 (IL6) and Tumor necrosis factor α (TNFα) were also reduced with aerobic exercise in skeletal muscle. Our results suggest that 12 weeks of aerobic exercise training is effective in improving metabolic health, fat depots, ectopic fat and inflammation even against a high-fat dietary background.
Collapse
|