Function In Overweight Patients Research Articles

The Role of Intestinal Barrier Function in Overweight Patients with IBS with Diarrhea Undergoing a Long-Term Low Fermentable Oligo-, Di-, and Monosaccharide and Polyol Diet

Overweight and obesity have been suggested as significant factors in irritable bowel syndrome (IBS) development. However, the relationship between overweight/obesity and IBS is unclear. It is known that a modified intestinal barrier, especially the permeability of the small intestine (s-IP), can play a significant role in the pathogenesis of both obesity and IBS. Moreover, dietary interventions are essential for treating both pathologies. We evaluated the gastrointestinal (GI) symptoms and the urinary and circulating markers of GI barrier function and integrity, the markers of intestinal dysbiosis and bacterial translocation, in 40 IBS patients with predominant diarrhea (IBS-D) (32 females and 8 males; mean age = 43.5 ± 1.4 years), categorized using their Body Mass Index levels as normal (NW) and overweight (OW). Evaluations were performed before and after 12 weeks of a Low FODMAP Diet (LFD). At the baseline, OW patients showed a significantly higher s-IP than NW. After an LFD, a significant improvement of s-IP in OW patients occurred, along with a significant decrease in markers of epithelial integrity and bacterial translocation. Our findings highlight the close relationship between overweight and the intestinal barrier and support their involvement in IBS-D pathophysiology. Furthermore, the positive role of an LFD in managing overweight IBS-D was highlighted.

The effect of COVID-19 on vascular elasticity and liver function in overweight patients

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить степень изменения сосудистой стенки, сосудистого возраста и метаболических параметров у полиморбидных пациентов, перенесших COVID-19. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включены 62 пациента с артериальной гипертензией, достигших целевых цифр уровня артериального давления (АД) на фоне двойной антигипертензивной терапии (АГТ) после перенесенного COVID-19 с тяжелым и крайне тяжелым течением, которым проводили лабораторное исследование метаболических параметров, оценку изменений показателей, характеризующих эластичность сосудов различного калибра (скорость пульсовой волны (СПВ), индекс аугментации (ИА), центрального систолического АД (ЦСАД), суточное мониторирование уровня АД (СМАД), а также исследовали неинвазивные маркеры фиброза печени. <h3>РЕЗУЛЬТАТЫ И ОБСУЖДЕНИЕ</h3> По данным офисных измерений уровня АД, после перенесенной коронавирусной инфекции на фоне стабильной АГТ отмечено повышение уровня систолического АД (САД) на 29,6% и диастолического АД (ДАД) на 23,6%, а также частоты сердечных сокращений (ЧСС) на 11,8% (<i>p</i>&lt;0,05). Данные СМАД говорят о повышении среднесуточных уровней САД, ДАД и ЧСС. На фоне перенесенной коронавирусной инфекции отмечено увеличение СПВ на 35,4% (<i>p</i>&lt;0,05), ИА на 24,4% (<i>p</i>&lt;0,05), ЦСАД на 22,1%. Ухудшились показатели углеводного и липидного обмена. Отмечено выраженное негативное влияние коронавирусной инфекции на функцию печени. Значение сосудистого возраста (по модифицированной шкале SCORE) увеличилось на 6 лет (<i>p</i>&lt;0,05). <h3>ВЫВОДЫ</h3> В проведенном нами исследовании обнаружено, что пациенты после перенесенного COVID-19 с тяжелым и крайне тяжелым течением имеют высокий риск развития фиброза печени, ухудшения контроля артериальной гипертензии и липидного обмена, ускорения процессов сосудистого старения.

Comparing the effects of twice-daily exenatide and insulin on renal function in patients with type 2 diabetes mellitus: secondary analysis of a randomized controlled trial

This is a secondary analysis of a randomized controlled trial (RCT) on the effects of the glucagon-like peptide-1 receptor agonists exenatide and insulin aspartate 30 injection on carotid intima-media thickness....

1177-P: Mediterranean Diet Is Associated with a Better Estimated Renal Function in Overweight, but Not in Obese, Adults with Impaired Fasting Glucose

Background: Impaired fasting glucose (IFG) is a risk factor for renal function, whereas adherence to the Mediterranean diet may be protective. Methods: Cross-sectional study on 1016 overweight (OW) and 1297 obese (OB) adults (52 ± 12 yrs, 55% women) with IFG (s-glucose: 100-125 mg/dl) . Anthropometry, fat-free mass by BIA, s-creatinine, blood pressure, marital status, education, familiarity for diabetes and CVD, smoking and physical activity were evaluated. The 14-item MEDiterranean Diet Adherence Screener (MEDAS, score: 0-14 points) was used to assess Mediterranean diet. Glomerular filtration rate (eGFR) was estimated by CKD-EPI formula. Normal renal function was defined as eGFR ranged 90-140 ml/min/1.73m2, so that both cases of loss of renal function and cases of glomerular hyperfiltration were considered at risk of renal damage. Logistic regression stratified for BMI class and adjusted for above confounders was fitted to assess association of Mediterranean diet with normal renal function. Results: The prevalence of normal renal function was 55% (60% in OW, 52% in OB) . Compared to the first tertile, the highest tertile of MEDAS score was associated to higher odds being normal renal function in OW (OR 1.48, 95%CI 1.07, 2.04, Ptrend=0.014) but not in OB patients. Conclusion: Mediterranean diet is associated with a better renal function in OW patients with IFG. Disclosure A.Leone: None. R.De amicis: None. A.Foppiani: None. S.Bertoli: None. A.Battezzati: None.

A study on the effect of intraoperative continuous positive airway pressure (CPAP) on the postoperative pulmonary function in overweight patients undergoing lower limb, lower abdominal or vaginal surgeries under spinal anesthesia.

Spinal anaesthesia, supine position and higher BMI are risk factors for pulmonary atelectasis. NIV, PEEP and CPAP are employed in ICU's to treat atelectasis postoperatively. However, we wanted to investigate whether CPAP was protective against atelectasis when used intraoperatively, in high risk patients. This study was a randomized controlled trial. Overweight patients, who were to undergo surgeries under spinal anesthesia were included in the study. After informed consent, 126 patients underwent preoperative pulmonary function tests (PFT: FEV1, FVC, PEFR). Following the onset of spinal anaesthesia patients were randomised into group E (n = 63, received CPAP) and control group, group C ( n =63, received nil intervention). Postoperative PFT was done at 20 minutes, 1 hour, 2 hours and 3 hours after surgery. Patients were followed up till discharge for pulmonary complications. We observed significant reduction in pulmonary function (FEV1, FVC and PEFR) postoperatively compared to base-line. CPAP group had better pulmonary function when compared to control group, the difference being significant 20 minu-tes after the surgery(p < 0.05). No postoperative pulmonary complication was reported among the 126 patients studied. Intraoperative use of CPAP in overweight patients undergoing surgeries under spinal anaesthesia could be beneficial in improving pulmonary function in the immediate post-operative period.

The Effects of Exenatide and Metformin on Endothelial Function in Newly Diagnosed Type 2 Diabetes Mellitus Patients: A Case-Control Study.

IntroductionExenatide is a new antidiabetic glucagon-like peptide-1 receptor agonist. In addition to its hypoglycemic effect, exenatide may have a potential protective benefit on vascular endothelial function. This study attempted to compare the effects of exenatide and traditional antidiabetic drug metformin treatment on endothelial function in overweight patients with type 2 diabetes.MethodsNinety overweight patients with newly diagnosed type 2 diabetes were recruited; 45 patients received exenatide (Exe) treatment and 45 patients received metformin (Met) treatment for 12 weeks. The control groups included 37 overweight and 24 non-overweight individuals. The parameters of glucose and lipid metabolism and endothelial function were measured before and after treatment. Vascular endothelial dysfunction was measured by reactive hyperemia index.ResultsNewly diagnosed patients with type 2 diabetes had more serious vascular endothelial dysfunction than both overweight and normal-weight control groups. The levels of body mass index, glucose, HbA1c, homeostasis model assessment insulin resistance, and homeostasis model assessment β-cell function were improved significantly by both exenatide and metformin treatment. Both exenatide and metformin treatment can improve vascular endothelial function (Exe group: 1.67 ± 0.52 vs 1.98 ± 0.67, P < 0.05; Met group: 1.68 ± 0.29 vs 1.82 ± 0.24, P < 0.05). Exenatide treatment was no less effective than metformin in improving endothelial function (0.31 ± 0.70 vs 0.13 ± 0.24, P > 0.05).ConclusionsNewly diagnosed patients with type 2 diabetes may have vascular endothelial dysfunction. Both exenatide and metformin treatment can improve vascular endothelial dysfunction, and exenatide was no less effective than metformin treatment.

Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes.

To explore the factors mediating the relationship between body mass index (BMI) and diabetic retinopathy (DR) in Chinese type 2 diabetes patients. This is a cross-sectional study. Data of 2,533 patients with type 2 diabetes were studied from the Shanghai Diabetes Registry Database. DR was assessed using non-mydriatic fundus photography and graded as non-DR, mild-moderate (DR I-II), and sight-threatening (DR III-IV). BMI (kg/m(2)) was classified as normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). β cell function was evaluated by fasting C-peptide (FCP). DR was present in 701 (27.7 %) patients. Patients with DR had lower BMI (24.3 vs. 24.9 kg/m(2), P = 0.001) and fasting C-peptide (1.46 vs. 1.86 ng/ml, P < 0.001) than those without DR. The association between BMI (2 kg/m(2) interval) and DR was U-shaped; patients with BMI 28-29.9 kg/m(2) had the lowest DR rate. Compared with normal weight, overweight was associated with reduced risk of any DR [odds ratio (OR) 0.73], DR I-II (OR 0.76), and DR III-IV (OR 0.64) after adjustment for sex, age at diabetes diagnosis, and duration of diabetes. This negative association attenuated after adjustment for other confounders and became nonsignificant after further adjustment for FCP. Patients with different BMI categories had similar DR risk when stratified by FCP tertiles. Overweight patients have lower DR prevalence than normal weight individuals, which may be attributable to better β cell function in overweight patients.

Leptin is associated with vascular endothelial function in overweight patients with type 2 diabetes.

BackgroundThe adipocyte-derived hormone leptin plays a key role in the regulation of appetite and body weight. Recent studies have suggested that leptin is also involved in the pathogenesis of obesity-related atherosclerosis and cardiovascular disease. In this study, we investigated the association of plasma leptin levels with vascular endothelial function in lean and overweight patients with type 2 diabetes.MethodsOne hundred seventy-one type 2 diabetic patients, of which 85 were overweight (body mass index (BMI) ≥ 25 kg/m2), were enrolled in this cross-sectional study. Plasma leptin concentrations were measured by enzyme-linked immunosorbent assay. Flow-mediated dilatation (FMD) of the brachial artery was measured to evaluate vascular endothelial function using ultrasound.ResultsNo significant difference in FMD was found between the lean and overweight groups (7.0 ± 3.8% and 6.5 ± 3.6%, respectively; p = 0.354). FMD was negatively correlated with age (r = −0.371, p < 0.001) and serum creatinine levels (r = −0.236, p = 0.030), but positively correlated with BMI (r = 0.330, p = 0.002) and plasma leptin levels (r = 0.290, p = 0.007) in the overweight group. FMD was not associated with any parameters in the lean group. Multiple regression analysis including possible atherosclerotic risk factors revealed that the plasma leptin level (β = 0.427, p = 0.013) was independently associated with FMD in the overweight group (R2 = 0.310, p = 0.025), but not the lean group.ConclusionPlasma leptin levels are associated with vascular endothelial function in overweight patients with type 2 diabetes.

Simple Cystatin C Formula for Estimation of Glomerular Filtration Rate in Overweight Patients with Diabetes Mellitus Type 2 and Chronic Kidney Disease

In clinical practice the glomerular filtration rate (GFR) is estimated from serum creatinine-based equations like the Cockcroft-Gault formula (C&G) and Modification of Diet in Renal Disease formula (MDRD). Recently, serum cystatin C-based equations, the newer creatinine formula (The Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI)), and equation that use both serum creatinine and cystatin C (CKD-EPI creatinine & cystatin formula) were proposed as new GFR markers. Present study compares serum creatinine-based equations, combined (including both serum creatinine and cystatin C) equation, and serum simple cystatin C formula (100/serum cystatin C) against 51CrEDTA clearance in 113 adult overweight Caucasians with diabetes mellitus type 2 (DM2) and chronic kidney disease (CKD). The results of present study demonstrated that the simple cystatin C formula could be a useful tool for the evaluation of renal function in overweight patients with DM2 and impaired kidney function in daily clinical practice in hospital and especially in outpatients. Despite the advantages of the simple cystatin C formula, cystatin C-based equations cannot completely replace the “gold standard” for estimation of the GFR in a population of DM2 patients with CKD, but may contribute to a more accurate selection of patients requiring such invasive and costly procedures.

Increased apparatus dead space and tidal volume increase blood concentrations of oxygen and sevoflurane in overweight patients: a randomised controlled clinical study

General anaesthesia impairs respiratory function in overweight patients. We wanted to determine whether increased tidal volume (V(T)), with unchanged end-tidal carbon dioxide partial pressure (P(ET)CO₂), affects blood concentrations of oxygen and sevoflurane in overweight patients. The present study is a prospective, randomised, clinical study. American Society of Anesthesiologists physical status I and II patients with BMI over 25 scheduled for elective surgery of the lower abdomen were randomly assigned to one of two groups with 10 patients in each. One group was ventilated with normal V(T) (NV(T)) and one group with increased V(T) (IV(T)) achieved by increasing inspired plateau pressure 0.04 cmH₂O kg⁻¹ above initial plateau pressure. Extra apparatus dead space was added to maintain P(ET)CO₂ at 4.5 kPa. Respiratory rate was set at 15 min⁻¹, and sevoflurane was delivered to the fresh gas by a vaporiser set at 3%. Arterial oxygenation, sevoflurane tensions (P(a)sevo, F(i)sevo, P(ET)sevo), paCO₂, P(ET)CO₂, V(t) and airway pressure were measured. The two groups of patients were similar with regard to sex, age, weight, height and BMI. Arterial oxygen tension (mean ± SD) was significantly higher in the IV(T) group (15 ± 4.3 vs. 10 ± 2.7 kPa after 60 min of anaesthesia, P < 0.05). Mean PETsevo did not differ between the groups, whereas arterial sevoflurane tension (mean ± SD) was significantly higher in the IVT group (1.74 ± 0.18 vs. 1.43 ± 0.19 kPa after 60 min of anaesthesia, P < 0.05). Ventilation with larger tidal volumes with isocapnia maintained with added apparatus dead space increases the tension of oxygen and sevoflurane in arterial blood in overweight patients.

Relationship Between Bilirubin Concentration, Coronary Endothelial Function, and Inflammatory Stress in Overweight Patients

Bilirubin has antioxidant properties and may protect against atherosclerosis and coronary heart disease (CHD). Further, in patients with metabolic syndrome, hyperbilirubinemia is associated with attenuation of insulin resistance. The aim of the present study was to determine the relationship between serum bilirubin concentration and coronary endothelial function in overweight patients. The study population consisted of 107 patients without CHD who underwent coronary flow studies. Vascular reactivity was examined by intra-coronary administration of papaverine and nitroglycerin. Coronary endothelial function was evaluated by assessing the change in coronary artery diameter to papaverine [percent change in flow-mediated dilatation (%FMD)] and nitroglycerin (%NTG). Serum total bilirubin, high-sensitivity C-reactive protein (hs-CRP), high density lipoprotein-cholesterol (HDL-C), fasting plasma glucose and immunoreactive insulin levels were also measured, and the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated. Patients were divided into two groups according to body mass index (BMI): an overweight group (BMI ≥ 25; n = 36) and a normal weight group (BMI < 25; n = 71). In the overweight group, univariate analysis revealed that log-transformed total bilirubin was positively correlated with %FMD and HDL-C (r = 0.38, p< 0.05; r = 0.30, p < 0.05, respectively) and was inversely correlated with log-transformed hs-CRP and HOMA-IR (r = -0.45, p < 0.01; r = -0.45, p< 0.05, respectively). Multivariate analysis revealed that log-transformed hs-CRP was the only independent predictor of log-transformed total bilirubin (p< 0.05). These results suggest that a high bilirubin level was associated with favorable coronary endothelial function in overweight patients. Further, the anti-inflammatory effects of bilirubin may mediate this effect.

Improvements in myocardial function in overweight people with and without type 2 diabetes

Background: There is great debate as to the relative contributions and importance of losing weight or increasing cardiorespiratory fitness and improving cardiovascular health and mortality. Myocardial function has been strongly linked to cardiovascular disease mortality. We sought to compare the predictors of improvements in myocardial function in overweight patients with and without type 2 diabetes (T2DM).

Effect of High-Dose Vitamin E on Insulin Resistance and Associated Parameters in Overweight Subjects

In the report of Manning et al. (1), patient’s plasma peroxides were decreased by 29% at 6 months with a transient reduction in insulin resistance. Consequently, they postulate that vitamin E improves oxidative stress and hepatocellular function in overweight patients and suggest that “vitamin E could have a role to play in delaying the onset of diabetes in at-risk individuals (1).” The rationale for …