Efficacy and safety of once-weekly subcutaneous semaglutide in adults with overweight or obesity: systematic review with meta-analysis

BACKGROUND

To evaluate the efficacy and safety of once-weekly subcutaneous semaglutide treatment in overweight or obese patients without type 2 diabetes.

METHODS

Randomized clinical trials that accessed the impact of once-weekly semaglutide on body weight and safety outcomes in overweight or obese patients were retrieved from Pubmed, EMBASE, and Lilacs up to November 2023. Risk of bias was assessed with RoB 2.0, and certainty of evidence (CoE) with GRADE. We conducted a random-effects meta-analysis.

RESULTS

We included ten publications with 22.155 patients. Semaglutide decreased relative body weight (MD: -11.80; 95%CI: -13.53 to -10.07; CoE: High), absolute body weight (MD: -11.58; 95%CI: -13.25 to -9.90; CoE: High) and BMI (MD: -4.15; 95%CI: -4.85 to -3.45; CoE: High). Semaglutide also increased the proportion of patients who achieved 5%, 10% and 15% of weight loss ([weight loss ≥5%: RR 2.29, 95% CI: 1.88 to 2.80; CoE: High]; [weight loss ≥10%: RR 4.54, 95% CI: 3.45 to 5.98; CoE: High]; [weight loss ≥15%: RR 8.29, 95%CI: 5.54 to 12.39; CoE: High]). Semaglutide leads to small risk to adverse events (RR: 1.03; 95%CI: 1 to 1.06; CoE: High), no difference in the serious adverse events (RR: 1.07; 95%CI: 0.70 - 1.62; CoE: Low), but increases in the risk to discontinued treatment (RR: 2.03; 95%CI: 1.87 - 2.20; CoE: High) and gastrointestinal adverse events (RR: 3.26; 95%CI: 1.99 - 5.34; CoE: Moderate).

CONCLUSION

This up-to-date systematic review highlights that once-weekly semaglutide treatment resulted in clinically important weight loss, becoming a promising adjuvant therapy to treat obesity.

Diet as an epigenetic factor in inflammatory bowel disease

Inflammatory bowel disease (IBD) has as a main characteristic the exacerbation of the immune system against enterocytes, compromising the individual's intestinal microbiota. This inflammatory cascade causes several nutritional deficiencies, which further compromise immunological functioning and, as a result, worsen the prognosis. This vicious cycle can be interrupted as the patient's dietary pattern meets their needs according to their clinical condition, acting directly on the inflammatory process of IBD through the interaction of food, intestinal microbiota, and epigenome. Specific nutritional intervention for IBD has a crucial role in preventing and managing disease activity. This review addresses epigenetic modifications through dietary compounds as a mechanism for modulating the intestinal microbiota of patients with IBD.

Exergame and/or conventional training-induced neuroplasticity and cognitive improvement by engaging epigenetic and inflammatory modulation in elderly women: A randomized clinical trial

OBJECTIVE

To evaluate the acute and long-term impact of exergaming (EXE) and conventional therapy (CON) in the peripheral levels of brain-derived neurotrophic factor (BDNF), inflammatory markers (interleukin [IL]-1b, IL-6, IL-8, and tumor necrosis factor-alpha [TNF-α]) and epigenetic mechanisms (global histone H3 and H4 acetylation levels in mononuclear cells) of healthy elderly women. We also evaluated the effect of intervention on cognitive performance in these individuals.

METHODS

Twenty-two elderly women were randomly assigned into two groups: EXE (n = 12) and CON (n = 10). Both interventions were performed twice a week for 6 weeks (12 sessions). Blood samples were obtained before intervention, after the first session, and 1 hour after the last session. Cognitive performance was evaluated before and after intervention.

RESULTS

Both EXE and CON interventions ameliorated cognitive performance, improved inflammatory profile, enhanced BDNF levels, and induced histone H4 and H3 hyperacetylation status in elderly women.

CONCLUSION

Our study demonstrated that the proposed interventions can be considered important strategies capable of promoting cognitive improvement in healthy elderly women. The acetylation status of histones and inflammatory cytokines are possible molecular mechanisms that mediate this beneficial response, being distinctly modulated by acute and long-term exposure.

Time course of epigenetic modulation in response to concurrent exercise training in patients with schizophrenia

This study aimed to investigate the short and long-term effects of concurrent exercise training on anthropometric variables, HDCA2 activity and cortisol levels of individuals with schizophrenia (SZ). Therefore, 10 patients were submitted to the program (endurance and strength exercises in the same session, 60 min of duration, three times a week) and blood samples were collected before, 30 days and 180 days after the intervention started. Exercise training reduced the body mass index and body mass after 180 days of the intervention. A significant decrease on HDAC2 activity was found 180 days after intervention compared to before the intervention. The cortisol levels remained unchanged in any evaluated time-points. The concurrent exercise training was able to modulate HDAC2 activity in mononuclear cells and improve anthropometric variables in a time-dependent manner in patients with SZ.

Type and Intensity as Key Variable of Exercise in Metainflammation diseases: A Review

Monocyte and lymphocyte subpopulations exhibit functions that vary between the anti- and pro-inflammatory spectrum, such as classic CD16- and non-classical CD16+ monocytes, as well as T helper 2 lymphocytes (Th2), the Th1/Th17 lymphocytes ratio, and T regulatory lymphocytes (Treg). Metabolic disease-associated inflammation is accompanied by an imbalance in monocyte and lymphocyte phenotypes and functionality, as well as a stronger proportion of inflammatory subpopulations. These changes appear to be important for the development and progression of diseases like diabetes and cardiovascular disease. On the other hand, the regular practice of physical exercise is an important tool to restore the functionality of monocytes and lymphocytes, and to balance the subtypes ratio. However, key variables regarding exercise prescription, such as the type of exercise, intensity, and volume differentially impact on the acute and chronic immune response in individuals diagnosed with meta inflammation diseases. Here, we discuss the impact of different physical exercise protocols, acutely and chronically, on monocytes and lymphocytes of individuals with metabolic disease-associated inflammation. In this review, we focus on the best effects of different exercise protocols to dose the "exercise pill" in different inflammatory status.

Effects of Qigong practice in quality of life, fatigue, sleep, pain and epigenetic biomarkers in adult women with fibromyalgia

Fibromyalgia is a syndrome mainly diagnosed through patient medical history. These individuals may present symptoms, such as sleeping disorders, migraines, and widespread pain through the musculoskeletal system, resulting in less quality of life. Treatment for fibromyalgia is based on pharmacological and non-pharmacological options. Mind-body practices, such as Baduanjin Qigong, have been described as promising alternatives to better multiple symptoms presented by individuals with the condition. Searching for non-pharmacological alternatives that significantly increase the quality of life of these individuals, this study evaluates the alterations in epigenetic markers in short- and long-term after the practice of Baduanjin Qigong. The participants took part in presential sessions of Baduanjin Qigong twice a week for 8 weeks, as well as being encouraged to practice at home for 4 weeks. The evaluation of the biomarkers was made through the collection of blood samples before the first session, after the sessions in person and after the 4 weeks of practice at home. Fatigue, sleep quality and chronic pain were evaluated before the first sessions and at the end of the process, through the application of self-reported instruments: Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Chronic Illness-Fatigue (FACIT), Pittsburgh Sleep Quality Index (PSQI) and Multidimensional Pain Evaluation Scale (EMADOR). As a result, significant improvements were found in quality of life, and in the symptoms of fatigue, sleep disturbance and in chronic pain in some regions of the body. In spite of the clinical-functional improvements, no significant alterations were found in the activity of histone acetyltransferase (HAT) enzymes after the intervention. The practice of Qigong approved to be a good alternative to improve the main symptoms of fibromyalgia in women, without involving modulation of HAT activity.

Acute and chronic non-invasive radiofrequency intervention modulates inflammatory but non epigenetic makers in physically active women

The non-invasive radiofrequency (RF) intervention has been demonstrating to improve anthropometric variables in women. However, the molecular mechanisms involved in this response were not elucidated. This study aimed verify the effect of RF on anthropometric measurements, inflammatory cytokines (interleukin (IL)-1β, IL-1ra, monocyte chemoattractant protein type 1 (MCP-1)) and global histone H4 acetylation levels in the peripheral blood of healthy women. The volunteers were divided in sedentary (SED) and physically active (PA) groups and submitted to the intervention (4 sessions, 1 time per week). Blood samples were collected before (T1), after the first session (T2) and after the last session (T3). The anthropometric measures were checked before and after the intervention. A significant reduction in body mass and adipose mass was observed in the PA group at T3 when compared to T1; while reductions in supra-iliac and abdominal skinfolds and abdominal circumference were found in SED and PA groups after intervention. The PA group presented greater reductions in supra-iliac skinfold and abdominal circumference at T3 when compared to the SED group. The intervention did not alter IL-1β and IL-1ra and global histone H4 acetylation levels in both groups. A significant increase in MCP-1 levels was found at T3 compared to T1 in the SED group. In the PA group, a reduction in MCP-1 levels was observed at T2 compared to T1. However, there was an increase in this marker at T3 compared to T1. Non-invasive RF improved anthropometric measurements with more pronounced effects in the PA and this response might involve the modulation of MCP-1.

Plantar stimulation in parkinsonians: From biomarkers to mobility - randomized-controlled trial

BACKGROUND

The decrease of Brain-Derived Neurotrophic Factor (BDNF) serum levels has been related to the pathophysiology of several neurodegenerative diseases as well as to neural plasticity and rehabilitation. Automated Mechanical Peripheral Stimulation (AMPS) has been investigated as a complementary therapy for Parkinson Disease (PD).

OBJECTIVES

(1) to investigate the effects of AMPS on BDNF and Cortisol serum levels of subjects with PD; (2) to evidence the interplay between BDNF and Cortisol serum levels and the functional mobility improvement after AMPS treatment.

METHODS

Thirty-three subjects with PD were randomized into two groups: effective stimulation (AMPS, n = 16) or placebo stimulation (AMPS SHAM, n = 17). Fourteen healthy aged-matched subjects were included as a reference group. Each AMPS group received eight sessions of treatment using a commercial medical device (Gondola™). BDNF and Cortisol serum levels, spatiotemporal gait parameters and TUG test were assessed at baseline and after eight sessions of treatment.

RESULTS

After the treatment, AMPS group showed significantly higher levels of BDNF and lower levels of Cortisol compared to AMPS SHAM. AMPS group also showed a positive effect on gait pattern as a higher improvement on gait velocity, stride length, and TUG performance was shown.

CONCLUSION

Effective AMPS treatment increased BDNF and decreased Cortisol serum levels and produced improvements in functional mobility.

Exercise-induced modulation of histone H4 acetylation status and cytokines levels in patients with schizophrenia

The present study aimed to investigate the short and long-term effects of a concurrent exercise protocol on global histone H4 acetylation levels and inflammatory markers (interleukin-4 (IL-4), interleukin-6 (IL-6), interferon gamma (IFN-γ) and cortisol) in phytohemagglutinin-stimulated peripheral blood mononuclear cells (PBMC) and in peripheral blood of patients with schizophrenia (SZ), as well the intervention impact on anthropometric characteristics. Seventeen individuals were submitted to the intervention three times a week and blood samples were collected pre, 30, 60 and 90days after the intervention started. A remarkable reduction on body mass index and body mass were observed following intervention. The protocol also induced a histone H4 hypoacetylation status in PBMC all times evaluated when compared to the pre intervention period. Although the IL-4 and cortisol levels were not altered in response to the intervention, a reduction in IL-6 production during the 60 and 90days compared to the pre intervention period was observed. Finally, diminished IFN-γ production was found in the 90days period compared to the pre intervention and 30days after periods. In addition, systemic IL-6 levels were lower at 60 and 90days compared to the pre intervention. The concurrent exercise protocol was able to improve anthropometric characteristics in patients with SZ, engaging the modulation of cytokine and histone H4 acetylation levels.