Function In Obese Patients Research Articles

Comparative Analysis of Liver Enzyme Changes Before and After Korean Medicine Treatment in People with Obesity: A Retrospective, Multicenter, Observational Study

This retrospective, multicenter, observational study aimed to evaluate the effects of herbal medicine treatment on liver function in obese patients exhibiting elevated liver enzymes. Conducted from May 2023 to April 2024 at various Korean medicine clinics, the study included 84 patients who underwent herbal treatments for obesity. All participants had at least one liver function test (LFT) showing elevated levels of aspartic amino transferase (AST), alanine amino transferase (ALT), or gamma glutamyl transferase (GGT), and a subsequent LFT performed after a minimum of 90 days. The study excluded patients with potential confounding factors such as hepatitis, antibiotic usage, or recent surgeries.</br>The study showed significant reductions in AST, ALT, and GGT levels, with AST and ALT improving to within the normal range and GGT approaching normal levels. Patients also experienced statistically significant reductions in weight and BMI, meeting the minimum clinically important difference threshold.</br>These findings suggest that herbal treatments for obesity are not only safe for patients with obesity-related liver enzyme abnormalities but also effective in improving liver function. This study shows that herbal treatment is effective in the management of obesity-related liver disease and confirms the safety and efficacy of an obesity treatment herbal formula containing ephedra. Larger prospective studies are needed to confirm these findings.

Effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery

ObjectiveThis research aimed to ascertain the effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery.MethodsObese patients undergoing laparoscopic surgery under general anesthesia were separated into the control group (group C) and the dexmedetomidine group (group D) (n = 30). Patients in group D were infused with dexmedetomidine (1 μg/kg) intravenously for 10 min and then at a rate of 0.5 mg/kg h until 30 min before the end of the surgery, and those in group C were infused with an equal volume of saline. The surgery time points were divided into: before anesthesia induction (T0), 5 min after intubation (T1), 30 min after pneumoperitoneum (T2), 10 min after pneumoperitoneum release (T3), at the time of extubation (T4), 3 min after extubation (T5), and 24 h after surgery (T6). Arterial blood was collected for blood gas analysis to record arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). Dynamic lung compliance (Cdyn), oxygenation index (OI), alveolar-arterial oxygen partial pressure difference (A-aDO2), and respiratory index (RI) were calculated. The time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation were recorded. Plasma IL-8 and IL-10 levels were measured from T0 to T6.ResultsThe time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation in group D were not statistically significant when compared with those in group C. Versus at the T1 time point, A-aDO2 and RI were higher and Cdyn and OI were lower in both groups at T2 and T3 time points. Versus group C, group D had higher Cdyn and OI and lower A-aDO2 and RI at T2 and T3 time points. Versus at the T0 time point, at each time point from T1 to T6, IL-8 and IL-10 levels were higher in both groups. Versus group C, group D had lower IL-8 and higher IL-10 levels at each time point from T1 to T6.ConclusionIn obese patients undergoing laparoscopic surgery under general anesthesia, the use of dexmedetomidine can improve the lung compliance and OI of the patients, inhibit the inflammatory response of the lungs of the patients and thus have a certain protective effect on the lung function.

Type 2 diabetes mellitus remission in sleeve gastrectomy patients: Role of enteroendocrine response and serum citrulline and I-FABP levels

IntroductionThis prospective cohort study examines the relationship between post-sleeve gastrectomy (SG) weight loss and serum citrulline, I-FABP levels, and the I-FABP/citrulline ratio in obese patients, alongside the correlation with type 2 diabetes mellitus (T2DM) remission. Methods88 participants were enrolled, including 48 undergoing SG and 21 with T2DM. 40 healthy individuals served as controls. Preoperative and 1-year postoperative assessments included citrulline, I-FABP, glucose, insulin, HbA1c, and C peptide levels. ResultsSignificant weight loss and T2DM remission (11/21) were observed post-SG. Preoperatively, patients had low citrulline and high I-FABP levels, which normalized postoperatively. A positive correlation was found between the I-FABP/citrulline ratio and weight, BMI, glucose, insulin, and C peptide levels. ConclusionSG not only induces enterocyte dysfunction and mass recovery but also may facilitate T2DM remission and alleviate obesity-related effects on the enteroendocrine system. These findings highlight the potential beneficial effects of SG on enteroendocrine function in obese patients.

High-resistant starch and low-glutelin content 1 rice benefits gut function in obese patients

The intestinal microbiota plays a crucial role in human health, yet the impact of high-resistant starch and low-glutelin rice in the gut of obese individuals remains unexplored. In this study, different types of rice, namely japonica rice (control), low-glutelin content 1 rice (Lgc1), high-resistant starch and low-glutelin content 1 rice (HR + Lgc1), and commercially available low-glycemic index rice (LowGI), were utilized as samples to examine their in vitro digestion and fermentation, as well as the impact of HR + Lgc1 on the intestinal microbiota in obese individuals. The findings revealed that HR + Lgc1 rice exhibited lower in vitro digestion rates for starch and protein compared to the other three types. Following 24 h of in vitro fermentation, the total short-chain fatty acid content in HR + Lgc1 was 108.67 mmol/L, which was 60.33, 51.26, and 17.29% that in control, Lgc1, and LowGI, respectively. Moreover, HR + Lgc1 rice displayed an inhibitory effect on the production of harmful branched-chain fatty acid metabolites. Analysis through 16S rDNA sequencing indicated that, after fermentation, HR + Lgc1 significantly enhanced the abundance of beneficial bacteria such as Bifidobacterium, Parabacteroides, and Faecalibacterium in the gut, whereas it reduced the abundance of harmful bacteria such as Escherichia-shigella. Our findings may contribute to the development of new foods rich in dietary fiber to improve the digestive function of patients with multiple comorbidities.

The effect of inverse ratio ventilation on cardiopulmonary function in obese laparoscopic surgery patients: A systematic review and meta-analysis.

This study aimed to evaluate the effect of inverse ratio ventilation (IRV) strategy on cardiopulmonary function in obese patients under general anesthesia. Databases such as China National Knowledge Infrastructure (CNKI), Wangfang, WeiP, Web of Science, the Cochrane Library, and PubMed were systematically searched. All randomized controlled trials' literature on IRV during laparoscopic surgery in obese patients under general anesthesia was collected. After data were extracted and cross-checked, Rev Man 5.3 software was used for meta-analysis. Finally, five randomized controlled clinical trials (RCTs) were included in the meta-analysis, with a total of 312 patients. Compared with the conventional ventilation group, the inspiratory peak pressure was lower at pneumoperitoneum 30 min and pneumoperitoneum 60 min; the PaO2 and oxygenation index were higher at pneumoperitoneum 60 min, and mean airway pressure was higher at pneumoperitoneum 30 min and pneumoperitoneum 60 min; the dynamic lung compliance was superior at pneumoperitoneum 30 min and pneumoperitoneum 60 min. IRV applied to laparoscopic surgery in obese patients under general anesthesia not only reduces peak airway pressure and improves intraoperative oxygenation index and PaO2 but also enhances mean airway pressure and dynamic lung compliance, which has a specific lung protective effect. It can be used as an option for the mechanical ventilation model in obese patients in clinical practice.

Abstract 14876: Characterizing Regional and Global Effects of Epicardial Adipose Tissue on Left Atrial Function

Background: Obesity is associated with left atrial (LA) dysfunction. Excess epicardial adipose tissue (EAT) deposition is one potential mechanism for this dysfunction. However, it is unknown if the effects of EAT on LA function are mediated via adjacency to LA tissue or rather, represent effects of generalized cardiometabolic dysfunction, also common in obesity. We hypothesized EAT located around the LA would be associated with LA function compared to EAT located distally on the left ventricle (LV). Methods: ardiac MRI was performed in 54 middle-aged obese adults (n = 80, age 40-55 yrs) enriched for increased heart failure risk (N-terminal pro-B-type natriuretic peptide >40 pg/mL or high-sensitivity cardiac troponin T >0.6 pg/mL; visceral fat >2kg). EAT was quantified by tracing the area of LV EAT depots on short axis and LA EAT depots on long axis. LA strain was assessed by MRI feature tracking as reservoir strain during LV systole, conduit strain during early LV diastole, and contractile strain during late LV diastole. Linear regression was performed between EAT area and LA strain components. LA function was quantified by LA reservoir, conduit, and contractile strain. Results: LV EAT amount was 12 times higher than LA EAT (66.7 vs 5.3 cm 2 ). LA EAT was associated with decreased LA conduit strain (r = 0.37, 95% CI = 0.12 to 0.58, p = 0.006) and a trend towards lower reservoir strain (r = -0.26, 95% CI = -0.49 to 0.01, p = 0.058). There was no association with contractile strain. There were no relationships between LV EAT and LA function. Conclusion: Increased LA EAT was associated with worse LA strain. In contrast, LV EAT had no demonstrable effect on LA strain. Our results suggest LA EAT may have direct mechanical or paracrine effects on atrial tissue function and may be a therapeutic target for improving LA function in obese patients.

The relationship between serum superoxide dismutase and thyroid function in obese patients after Laparoscopic sleeve gastrectomy

To investigate the cross-sectional and longitudinal correlation between serum superoxide dismutase (SOD) levels and thyroid function with obesity before and after laparoscopic sleeve gastrectomy (LSG). Patients with morbid obesity (n = 219, 112 males and 107 females) who underwent LSG were selected and they were subdivided into normal levels of SOD (NSOD, n = 112) and high levels of SOD (HSOD, n = 107) according to the median value of SOD levels (183 U/mL). SOD and thyroid hormones were measured and compared at baseline, 3, 6, and 12 months after LSG. The HSOD group had lower body mass index (BMI), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) than the NSOD group (p < 0.001, p = 0.031, p < 0.001, respectively). However, they had higher free triiodothyronine (FT3) and free thyroxine (FT4) (p = 0.019 and p = 0.017, respectively). SOD was significantly negatively associated with TSH and positively associated with FT4. Of all the patients, 22.31% (NSOD: 66.67%; HSOD: 33.33%) had subclinical hypothyroidism (SH), and there were lower SOD levels in the SH group. Preoperative SOD was a protective factor for SH. After LSG, SOD and FT4 levels were increased at 12 months after LSG, however, TSH, FT3, total triiodothyronine (TT3) and TT4 levels decreased compared to the preoperative levels at 3, 6, and 12 months in the SH group. Postoperative changes in FT4 and TT4 levels correlated with changes in SOD levels. SOD, which is correlated with thyroid hormones, protects against SH in patients with obesity. The improvement in thyroid function with SH after LSG may be related to increased SOD levels.

OR25-02 Hunting The Magic Bullet In Treating Male Secondary Hypogonadism Associated With Metabolic Syndrome: Results Of a Prospective Study Comparing Liraglutide Vs. Gonadotropins

Abstract Disclosure: S. La Vignera: None. R.A. Condorelli: None. A.E. Calogero: None. R. Cannarella: None. E. Greco: None. A. Aversa: None. Background: Previously, we hypothesized a role for glucagon-like peptide-1 (GLP1) analogs in the treatment of male infertility (DOI: 10.1111/andr.13015), although no studies have so far investigated this issue. Purpose: To prospectively investigate the effects of treatment with liraglutide, a GLP1 analog, on reproductive and sexual function in men with functional hypogonadism of childbearing age. Patients and Methods: 110 obese men of childbearing age (18-35 years) with functional hypogonadism were enrolled and divided into three groups based on their desire to have children. Group A consisted of men actively seeking paternity, Group B of men who did not seek paternity, and Group C of men who had already fathered a child. Group A was treated with gonadotropins [urofollitropin 150 IU three times a week and human chorionic gonadotropin (hCG) 2000 IU twice a week], Group B with liraglutide (3 mg daily), and Group C with transdermal testosterone (60 mg daily). The following endpoints were measured at enrolment and after 4 months: anthropometric and metabolic parameters, gonadotropins, total testosterone, conventional sperm parameters (Group A and B only), the score of the International Index of Erectile Function 5 Items (IIEF5), and frequency of phosphodiesterase type 5 inhibitors (PDE5i) use. Results: The groups did not differ on any of the baseline endpoints. Weight, body mass index, and waist circumference significantly decreased after treatment in Group B, but not in the other Groups. Liraglutide significantly increased LH (3.2±0.2 IU/L vs. 2.0±0.3 IU/L; p&amp;lt;0.01), FSH (2.6±0.2 IU/L vs. 1.6±0.3 IU/L; p&amp;lt;0.01), total testosterone (4.1±0.5 ng/mL vs. 1.4±0.6 ng/mL; p&amp;lt;0.05), and sex hormone-binding globulin (36.0±4.0 nmol/L vs. 14.0±3.0 nmol/L) levels from baseline, while no improvement was observed in the other Groups. Liraglutide increased sperm concentration (16±4 mil/ml vs. 6±2 mil/ml; p&amp;lt;0.05), progressive motility (34±4 % vs. 14±2 %; p&amp;lt;0.01), and morphology (10±2 % vs. 4±2 %; p&amp;lt;0.05), while treatment with gonadotropins only increased sperm progressive motility (19±2 % vs. 12±3 %; p&amp;lt;0.05) compared to baseline. The IIEF-5 score improved after liraglutide treatment (4±2 vs. 21±4; p&amp;lt;0.05), while no significant changes were observed in the other Groups. Similarly, PDE5i use decreased significantly in Group B (31%), compared with Groups A (48%) and C (45%). Conclusions: Liraglutide is an effective weight loss drug, which also improves serum gonadotropin and total testosterone levels, sperm conventional parameters, and sexual function in obese patients with functional hypogonadism seeking parenthood. This is the first study documenting the efficacy of liraglutide on the testicular function of these patients. Presentation Date: Saturday, June 17, 2023

Evaluation of left ventricular dysfunction by three-dimensional speckle-tracking echocardiography and bioinformatics analysis of circulating exosomal miRNA in obese patients

BackgroundObesity is an independent risk factor for cardiovascular disease and affects the human population. This study aimed to evaluate left ventricular (LV) dysfunction in obese patients with three-dimensional speckle-tracking echocardiography (3D-STE) and investigate the possible related mechanisms at the exosomal miRNA level.MethodsIn total, 43 participants (16 obese patients and 27 healthy volunteers) were enrolled. All subjects underwent full conventional echocardiography as well as 3D-STE. Characterization and high-throughput sequencing for the isolated circulating exosomes and the differentially expressed miRNAs (DEMs) were screened for target gene prediction and enrichment analysis.ResultsObese patients had significantly lower global longitudinal strain (GLS) (-20.80%±3.10% vs. -14.77%±2.05%, P < 0.001), global circumferential strain (GCS) (-31.63%±3.89% vs. -25.35%±5.66%, P = 0.001), global radial strain (GRS) (43.21%±4.89% vs. 33.38%±3.47%, P < 0.001), and indexed LV end-diastolic volume (LVEDV) [38.07mL/m2 (27.82mL/m2–9.57mL/m2) vs. 24.79mL/m2 (21.97mL/m2–30.73mL/m2), P = 0.002] than healthy controls. GLS (ρ = 0.610, P < 0.001), GCS (ρ = 0.424, P = 0.005), and GRS (ρ = -0.656, P < 0.001) indicated a moderate relationship with body mass index (BMI). In obese patients, 33 exosomal miRNAs were up-regulated and 26 exosomal miRNAs were down-regulated when compared to healthy controls (P < 0.05). These DEMs possibly contribute to obesity-associated LV dysfunction through the PI3K-Akt signaling pathway. Important miRNAs, including miR-101-3p, miR-140-3p, and miR-99a-5p, have clinical utility in predicting early obesity-related myocardial injury.ConclusionsThe global strain obtained from 3D-STE can sensitively detect the decrease in LV myocardial function in obese patients. Key miRNAs and pathways provide a new theoretical basis and targets of action for studying obesity-induced LV dysfunction.Trial registrationIn accordance with the World Health Organization (WHO) definition of a clinical trial, this study does not include human health-related interventions. This study was carried out at the General Hospital of Ningxia Medical University after obtaining institutional ethical approval (KYLL-2022-0556) and written informed consent from all participants.

Thyroid Function in Obese Patients without Thyroid Disorders

Thyroid Function in Obese Patients without Thyroid Disorders

Comparative Analysis of Knee Replacement Surgery who follow up by Physical Therapy and Intra-articular Steroid Injections for Obese Patients.

Knee osteoarthritis (KOA) is the most common chronic articular disease, and its prevalence has doubled since the mid-20th century. It affects 16% of the adult population over 50 years of age in the post-industrial era [1].&#x0D; Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA).[2]&#x0D; Although OA was previously regarded as a disease of the elderly, its development starts much earlier than originally thought, and OA is ranked among the top 20 diseases in the 40–45 years age group [3].&#x0D; This review aims to provide a comprehensive analysis of the outcomes of knee replacement surgery following up physical therapy, versus intra-articular steroid injections for obese patients (BMI &gt;30)&#x0D; The study design employed in this review is narrative, and articles published after 2010 from PubMed were considered for inclusion. The review examines the impact of each intervention on the complete regain of knee function in this specific population.&#x0D; Through the analysis of relevant studies, this review seeks to inform clinical decision-making and guide the management of obese patients with knee osteoarthritis.&#x0D; Conclusion. &#x0D; Based on the reviewed literature, knee replacement surgery appears to offer a better chance of achieving complete regain of knee function in obese patients (BMI &gt;30) undergoing physical therapy compared to intra-articular steroid injections. However, the findings are limited by the availability of studies and the heterogeneity in the research methodologies.&#x0D;

Inflammasome activation and metabolic remodelling in p16-positive aging cells aggravates high-fat diet-induced lung fibrosis by inhibiting NEDD4L-mediated K48-polyubiquitin-dependent degradation of SGK1.

Chronic changes caused by a high-fat diet (HFD) may be associated with weakened lung function in obese patients. However, few studies have focused on the role of senescent cells in HFD-induced pulmonary fibrosis. This study aimed to determine whether (i) obesity causes the accumulation of aging cells in the lungs, (ii) p16 accumulation in aging epithelial cells or fibroblasts exacerbates long-term HFD-induced senescence-associated pulmonary fibrosis (SAPF) and (iii) p16 deletion or clearance of aging cells ameliorates HFD-induced SAPF through inactivation of the inflammasome and metabolic remodelling. Twelve-month old male mice of p16INK4a (hereafter p16) knockout (p16-- ) and wild-type (WT), ApoE knockout (ApoE-- ) and ApoE-- p16-- were fed a HFD to induce obesity, and the effects of treatment with the senolytic drug ABT263 or the SGK1 specific inhibitor EMD638683 on fibrosis, inflammaging, gene expression, integrin-inflammasome signalling and metabolism were examined. A549 and IMR-90 cells were transduced with p16-overexpressing adenovirus, and treated with palmitic and oleic acids (P&O) to induce steatosis in vitro. We found that long-term HFD promoted the expression of p16 and the increase of senescent cells in the lung. P16 knockout or ABT263 treatment alleviated pulmonary fibrosis, the increase of senescent cells and senescence-associated secretory phenotype (SASP) in HFD-fed mice, as well as in P&O-treated A549 and IMR-90 cells. RNA sequencing and bioinformatics analyses revealed that p16 knockout inhibited activation of the integrin-inflammasome pathway and cellular glycolysis. Mass spectrometry, co-immunoprecipitation and GST pull-down assays demonstrated that p16 bound to the N-terminal of SGK1, thereby interfering with the interaction between the E3 ubiquitin ligase NEDD4L and SGK1, and subsequently inhibiting K48-polyubiquitin-dependent degradation of SGK1 mediated by the NEDD4L-Ubch5 complex. EMD638683 was found to alleviate HFD-induced pulmonary fibrosis and activation of the integrin-inflammasome pathway. P16 accumulation promoted activation of integrin- inflammasome pathway and cell glycolysis by binding to the N- terminal of SGK1, intefering with the interaction between the E3 ubiquitin ligase NEDD4L and SGK1, thereby inhibiting K48- polyubiquitin- dependent degradation of SGK1 mediated by the NEDD4L-Ubch5 complex. ABT263 or EMD638683 could be used as potential drugs to treat pulmonary fibrosis in obese patients.

β-Cell Function and Insulin Dynamics in Obese Patients With and Without Diabetes After Sleeve Gastrectomy.

Improved β-cell function seems to be essential for better glucose homeostasis after Roux-en-Y gastric bypass but is less studied after sleeve gastrectomy (SG). We evaluated the effects of SG on β- cell function in obese patients with diabetes (DM group) and without (Control group) in response to both oral and intravenous glucose stimulation. The DM group demonstrated impaired insulin sensitivity and insulin response to glucose before surgery. The insulin sensitivity index of both groups significantly improved after SG. In addition, the insulin response to glucose (early insulinogenic index in OGTT and AIRglu in IVGTT) increased in the DM group but decreased in the Control group. As a result, β-cell function improved significantly in both groups after SG since the disposition index (DI) increased in both. However, the DI of DM group still can't restore to the level of Control group up to 1 year after SG. Our results support that both obese patients with and without diabetes could benefit from SG in β-cell function. For obese patients at risk of or have been diagnosed with diabetes, interventions should be recommended early to preserve or restore β-cell function, and SG could be an effective choice. Further studies are needed for long-term effects.

The Effects of a Very-Low-Calorie Ketogenic Diet on the Intestinal Barrier Integrity and Function in Patients with Obesity: A Pilot Study.

The very-low-calorie ketogenic diet (VLCKD) is effective and safe for obese individuals, but limited information exists on its impact on the intestinal barrier. This study analyzed the effects of 8 weeks of VLCKD on 24 obese patients (11M/13F). Carbohydrate intake was fixed at 20-50 g/day, while protein and lipid intake varied from 1-1.4 g/kg of ideal body weight and 15-30 g per day, respectively. Daily calorie intake was below 800 kcal. The lactulose-mannitol absorption test assessed small intestinal permeability. Multiple markers, such as serum and fecal zonulin, fatty acid-binding protein, diamine oxidase concentrations, urinary dysbiosis markers (indican and skatole), and circulating lipopolysaccharide levels, were analyzed. Inflammation markers (serum interleukin 6, 8, 10, and tumor necrosis factor-α concentrations) were also evaluated. The results showed significant reductions in weight, BMI, and waist circumference post-diet. However, the lactulose-mannitol ratio increased by 76.5%, and a significant increase in dysbiosis markers at the end of the diet occurred. This trend was particularly evident in a subgroup of patients. Despite initial benefits, the VLCKD might negatively affect the intestinal barrier function in obese patients, potentially worsening their compromised intestinal balance.

Thyroid Function in Obese Patients without Thyroid Disorders

Background: Thyroid status influences weight and thyroid function is altered in obese individuals. Objective: This study aimed to see the levels of free thyroxine (FT4) and thyroid-stimulating hormone (TSH) and their relationship with the parameters of obesity in obese children and adults with primary exogenous obesity without thyroid disorders. Materials and Methods: This retrospective cross-sectional study was done in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, from May 2019 to March 2020 in 238 children and adults with primary exogenous obesity. Individuals with thyroid disorders were excluded from the study. Data were taken from hospital records to assess the thyroid function (FT4 and TSH) in obesity. Results: Two hundred and thirty-eight individuals with a mean age of 16.42 ± 9.72 years (range 3–62 years) and mean body mass index of 31.09 ± 7.64 kg/m2 were included in the study. The distribution of FT4 was normal and that of TSH was skewed to the right. Ninety-five percent confidence interval (CI) of FT4 and TSH was within the normal reference range. Ninety-five percent CI of FT4 was in the upper end of normal (1.176–1.251 mIU/L in ≤20 years and 1.094–1.306 mIU/L in &gt;20 years) and that of TSH was in the lower end of normal (2.619–3.207 mIU/L in ≤20 years and 2.616–4.141 mIU/L in &gt;20 years). About 13.4% had low FT4 and 15.4% had raised TSH. Waist circumference (WC) had a negative linear association with FT4 (r = −0.229, P = 0.003, R 2 = 5.24%), which was not present in the multivariate analysis. WC was significantly higher in the first versus third quartile of FT4 (103.974 ± 17.211 vs. 94.818 ± 14.544 cm). Conclusion: FT4 and TSH levels were in the lower and upper end of normal, respectively, in obese patients without thyroid disorders. Central obesity was negatively associated with FT4 in obese individuals.

Expression of inflammatory genes, WBC-derived inflammatory biomarkers and liver function indices: Effects of myo-inositol supplementation in obese patients with NAFLD

Myo-inositol (MI) has known to exert anti-diabetic, anti-oxidative and anti-inflammatory properties. The present study examined the effects of MI supplementation on the expression of some inflammatory genes, serum high-sensitivity C-reactive protein (hs-CRP), WBC-derived inflammatory biomarkers, body composition and liver function in obese patients with non-alcoholic fatty liver disease (NAFLD). Forty-eight obese patients with NAFLD were randomly allocated into either MI (4 g/day) or placebo (maltodextrin 4 g/day) group along with dietary recommendations for 8 weeks. At the end of the study, reduction in fat mass and an increase in fat free mass were statistically greater in the MI group compared with placebo group. Moreover, MI supplementation resulted in a significant reduction in TNF-α mRNA expression, compared with placebo. Despite the decrease in systemic inflammation response index (SIRI) and monocytes to lymphocyte ratio (MLR) in the MI group, no differences were observed in other WBC-derived inflammatory markers as well as serum hs-CRP.

Clinical effectiveness of α-lipoic acid, myo-inositol and propolis supplementation on metabolic profiles and liver function in obese patients with NAFLD: A randomized controlled clinical trial

To compare the effects of α-lipoic acid (ALA), myo-inositol (MI) and propolis supplementation on metabolic parameters and liver function in obese patients with non-alcoholic fatty liver disease (NAFLD) METHODS: Ninety-two obese patients with NAFLD were randomly allocated into one of the four groups (ALA, MI, propolis, and control groups) for 8 weeks. At pre-and post-intervention, anthropometric measures, metabolic parameters and liver function were assessed. Clinical effectiveness was assessed using Absolute Risk Reduction (ARR) and Number Needed to Treat (NNT). After 8 weeks, apart from waist-to-hip ratio, all studied anthropometric measures decreased significantly in each of the groups over the trial. Although the greatest improvements in glycemic indices were observed in MI group (p<0.05), the differences among the groups were not significant. Control group showed the greatest reduction in serum triglyceride level (p=0.026) while the greatest improvements in serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were observed in MI group (p=0.043, p=0.019 and p=0.041, respectively). Alanine aminotransferase (ALT) levels reduced significantly in all groups, particularly in propolis group (p=0.012). The greatest reduction in serum aspartate transaminase (AST) level was observed in control group (p<0.001), however, the difference among the groups was statistically marginal (p=0.058). The estimated NNTs for one grade reduction in liver steatosis for MI, ALA and propolis supplementation compared with control group were 1.5, 2.2 and 3, respectively. Dietary recommendation for weight loss accompanied by MI and then ALA supplementation improved metabolic parameters and liver steatosis. "Registered under ClinicalTrials.gov Identifier no: IRCT20100209003320N22".

Comprehensive guidance for antibiotic dosing in obese adults: 2022 update.

Drug dosing in obese patients continues to be challenging due to a lack of high-quality evidence to guide dosing recommendations. We first published guidance for antibiotic dosing in obese adults in 2017, in which we critically reviewed articles identified from a broad search strategy to develop dosing recommendations for 35 antimicrobials. In this updated narrative review, we searched Pubmed, Web of Science, and the Cochrane Library using Medical Subject Headings including anti-infectives, specific generic antimicrobial names, obese, pharmacokinetics, and others. We reviewed 393 articles, cross-referenced select cited references, and when applicable, referenced drug databases, package inserts, and clinical trial data to update dosing recommendations for 41 antimicrobials. Most included articles were pharmacokinetic studies, other less frequently included articles were clinical studies (mostly small, retrospective), case reports, and very rarely, guidelines. Pharmacokinetic changes are frequently reported, can be variable, and sometimes conflicting in this population, and do not always translate to a documented difference in clinical outcomes, yet are used to inform dosing strategies. Extended infusions, high doses, and therapeutic drug monitoring remain important strategies to optimize dosing in this population. Additional studies are needed to clinically validate proposed dosing strategies, clarify optimal body size descriptors, dosing weight scalars, and estimation method of renal function in obese patients.

The effect of DASH diet on glycemic response, meta-inflammation and serum LPS in obese patients with NAFLD: a double-blind controlled randomized clinical trial

BackgroundAs dietary approaches to stop hypertension (DASH) dietary pattern has been shown to be effective in hypertension and obesity, the present study investigated the effects of following DASH diet on glycemic, meta-inflammation, lipopolysaccharides (LPS) and liver function in obese patients with non-alcoholic fatty liver disease (NAFLD).MethodsIn this double-blind controlled randomized clinical trial, 40 obese patients with NAFLD were randomly allocated into either “DASH diet” (n = 20) or calorie-restricted diet as "Control” (n = 20) group for 8 weeks. Anthropometric measures, blood pressure, glycemic response, liver enzymes, toll-like reseptor-4 (TLR-4) and monocyte chemoattractant protein (MCP-1) and LPS as well as Dixon's DASH diet index were assessed at baseline and after 8 weeks.ResultsAfter 8 weeks, although all obesity indices decreased significantly in both groups, the reduction in all anthropometric measures were significantly greater in DASH vs control group, after adjusting for baseline values and weight change. Fasting glucose level decreased in both group, however, no inter-group significant difference was found at the end of study. Nevertheless, serum levels of hemoglobin A1c (HbA1c), TLR-4, MCP-1 and LPS as well as aspartate aminotransferase (AST) decreased significantly in DASH group, after adjusting for baseline values and weight change (p < 0.001, p = 0.004, p = 0.027, p = 0.011, and p = 0.008, respectively). The estimated number needed to treats (NNTs) for one and two grade reductions in NAFLD severity following DASH diet were 2.5 and 6.67, respectively.ConclusionAdherence to DASH diet could significantly improve weight, glycemia, inflammation and liver function in obese patients with NAFLD.

Myo-inositol supplementation improves cardiometabolic factors, anthropometric measures, and liver function in obese patients with non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) as the hepatic manifestation of metabolic syndrome is closely associated with type 2 diabetes mellitus. Myo-inositol (MI)-a 6-C sugar alcohol-with insulin-mimetic, anti-diabetic, lipid-lowering, and anti-inflammatory properties has exerted favorable effects on insulin resistance-related disorders and metabolic disease, while recent animal studies revealed its positive effects on liver function. This study aimed to investigate the effects of MI supplementation on cardiometabolic factors, anthropometric measures, and liver function in obese patients with NAFLD. This double-blinded placebo-controlled randomized clinical trial was carried out on 48 obese patients with NAFLD who were randomly assigned to either MI (4g/day) or placebo (maltodextrin 4g/day) along with dietary recommendations for 8 weeks. Glycemic indices, lipid profile, liver enzymes anthropometric measures, and blood pressure were evaluated pre- and post-intervention. Dietary intakes were assessed using a 3-day 24 h recall and analyzed by Nutritionist IV software. Insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR), and beta-cell function (HOMA-B) was also estimated. Anthropometric measures decreased significantly in both groups, while the reduction in weight (p = 0.049) and systolic blood pressure (p = 0.006) in the MI group was significantly greater than in the placebo group after adjusting for baseline values and energy intake. Although energy and macronutrient intakes decreased significantly in both groups, between-group differences were not significant after adjusting for the potential confounders. MI supplementation led to a significant reduction in serum fasting insulin (p = 0.008) and HOMA-IR (p = 0.046). There were significant improvements in lipid profile, liver enzymes, and aspartate aminotransferase/alanine aminotransferase ratio as well as serum ferritin level in the MI group, compared to the placebo group at the endpoint. By MI supplementation for eight weeks, 1 in 3 patients reduced one- grade in the severity of NAFLD. MI supplementation could significantly improve IR, lipid profile, and liver function in patients with NAFLD. Further clinical trials with larger sample sizes, longer duration, different MI doses, and other inositol derivatives are recommended.