Improvements In Body Mass Index Research Articles

Cognitive and quality-of-life related factors of body mass index (BMI) improvement after deep brain stimulation in the subcallosal cingulate and nucleus accumbens in treatment-refractory chronic anorexia nervosa.

Up to 20% of the cases of anorexia nervosa (AN) are chronic and treatment-resistant. Recently, the efficacy of deep brain stimulation (DBS) for severe cases of AN has been explored, with studies showing an improvement in body mass index and other psychiatric outcomes. While the effects of DBS on cognitive domains have been studied in patients with other neurological and psychiatric conditions so far, no evidence has been gathered in AN. Eight patients with severe, chronic, treatment-resistant AN received DBS either to the nucleus accumbens (NAcc) or subcallosal cingulate (SCC; four subjects on each target). A comprehensive battery of neuropsychological and clinical outcomes was used before and 6-month after surgery. Although Body Mass Index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6months of DBS. Changes in BMI were related to a decrease in depressive symptoms and an improvement in memory functioning. These findings, although preliminary, support the use of DBS in AN, pointing to its safety, even for cognitive functioning; improvements of cognitive flexibility are reported. DBS seems to exert changes on cognition and mood that accompany BMI increments. Further studies are needed better to determine the impact of DBS on cognitive functions.

Examining cognitive-behavioral therapy change mechanisms for decreasing depression, weight, and insulin resistance in adolescent girls at risk for type 2 diabetes

ObjectiveDepression in adolescence is linked to risk for type 2 diabetes (T2D). In this secondary data analysis of a randomized controlled trial comparing cognitive-behavioral therapy (CBT) to a control program to ameliorate insulin resistance via reducing depression symptoms, we examine which CBT change mechanisms (e.g., behavioral activation, cognitive restructuring) contributed to decreased depression and subsequent improvements in body mass index (BMI), percent body fat, and insulin resistance. MethodsGirls 12-17y with overweight/obesity and family history of T2D were randomized to six-week group CBT (n = 61) or health education (HealthEd; n = 58). At baseline and post-treatment, adolescents completed questionnaires assessing activities, thoughts, and depression symptoms. At baseline, post-treatment, and one-year, BMI was calculated and insulin outcomes were derived from two-hour oral glucose tolerance testing. At baseline and one-year, percent body fat was assessed with dual-energy x-ray absorptiometry. Indirect effects of CBT components were tested on one-year changes in BMI, percent body fat, and insulin indices through decreases in depression symptoms during treatment. Intervention was tested as a moderator. ResultsIn CBT, but not HealthEd, there was an indirect effect of increased physical activity during treatment on decreased one-year BMI via reductions in depression symptoms during treatment. Also, there were conditional indirect effects in CBT of increased pleasantness of physical and social activity during treatment on decreased one-year BMI via decreased depression symptoms during treatment. ConclusionBehavioral activation may be a useful intervention to decrease depression and reduce excess weight gain in the targeted prevention of T2D in at-risk adolescent girls. NCT01425905, clinicaltrials.gov

Feasibility of guided internet-based cognitive behavioral therapy for patients with anorexia nervosa

ObjectiveThe objective of the present study was to investigate the feasibility of guided internet cognitive behavioral therapy (ICBT) for anorexia nervosa. MethodsWe conducted a prospective single-arm study between January 2020 and March 2021. The intervention was built using videos, web programs, and chat tools. The intervention program was largely based on metacognitive training. Participants performed the self-help program once a week for 12 consecutive weeks. The primary outcome was the global Eating Disorder Examination Questionnaire (EDE-Q) score. Secondary outcomes included clinical symptoms of eating disorders, metacognitive function, body mass index, depression, and generalized anxiety. The main statistical analysis examined whether the EDE-Q score and other outcomes at the end of the intervention differed from the baseline. ResultsFourteen participants underwent the trial treatment, and 13 completed the intervention. There was a significant reduction in the global EDE-Q score from 3.48 (SD = 1.4) to 2.54 (SD = 1.5, p = 0.02, Cohen's d = 0.75) from baseline to post-intervention. Some EDE-Q subscales and body checking questionnaire scale demonstrated statistically significant improvements, with moderate to large effect sizes. Although there was no significant improvement in body mass index, metacognitive function, or depressive symptoms, there was a significant improvement in the severity of generalized anxiety (M = −4.0, p = 0.01, Cohen's d = 0.95). No adverse events were observed. DiscussionOur findings suggest that guided ICBT for anorexia nervosa is well accepted by female patients and practical as a telemedicine approach that improves symptoms. In the future, tightly controlled randomized controlled trials should be conducted for efficacy verification.

MHealth Intervention to Improve Cardiometabolic Health in Rural Hispanic Adults: A Pilot Study.

Hispanic/Latino adults have high rates of hypertension, obesity, and type II diabetes. Mobile health technologies (mHealth) are effective in supporting self-management of lifestyle behaviors; however, the effectiveness in rural Hispanic/Latino adults is unclear. A pilot 12-week self-management mHealth intervention in rural Hispanic/Latino adults with cardiometabolic risk was conducted. A randomized, 2-group (intervention and enhanced usual care) design was used to test the use of the MyFitnessPal app, a smart scale, and text messages to support daily self-monitoring of weight, food intake, and steps. Seventy participants enrolled. The intervention group had greater improvement in body mass index ( P = .052) and waist circumference ( P = .043) at 12 weeks and a trend toward greater fitness at 12 and 24 weeks. Both groups improved hemoglobin A 1c level at 12 and 24 weeks. mHealth using MyFitnessPal, smart scale, and text messages may be effective for improving aspects of cardiometabolic health in rural Hispanic/Latino adults.

Real-world study of an online platform for the prescription of physical exercise to obese patients - Effect on anthropometric, biochemical parameters and quality of life

Introduction: one of the risk factors related to obesity is a sedentary lifestyle. Physical exercise produces metabolic benefits. Its prescription through online tools has been poorly evaluated, though. Objective: the objective of our study was to assess the effect of the prescription of physical exercise through an online platform on anthropometric parameters, cardiovascular risk factors, and quality of life in sedentary obese patients. Material and methods: in a total of 35 obese patients, anthropometric data, muscle mass by ultrasound at the quadriceps level, laboratory parameters, blood pressure, and quality of life using the SF36 tool were collected at baseline and at 12 weeks. For 12 weeks, a structured physical exercise program was prescribed through an online platform - www.vibraup.com. Results: after the physical exercise program with the online platform, there was a significant improvement in body mass index (-1.51 ± 0.1 kg/m2; p = 0.01), weight (-3.7 ± 0.6 kg; p = 0.01), waist circumference (-6.9 ± 0.3 cm; p = 0.01), fat mass (-3.9 ± 0.2 kg ; p = 0.01), muscle mass (5.5 ± 1.6 kg; p = 0.01), diastolic blood pressure (-4.5 ± 0.4 mm Hg; p = 0.01), insulin (-2.8 ± 0.1 IU/L; p = 0.04), and insulin resistance (HOMA-IR) (-0.9 ± 0.1 units; p = 0.03). The ultrasound parameters of the anterior rectus muscle also improved significantly. The prevalence of metabolic syndrome decreased from 27.3 % to 12.1 % (p = 0.03). The SF36 quality of life test showed a significant improvement in general health (20.9 ± 4.1 points; p = 0.001), physical role (6.9 ± 0.9 points; p = 0 .01), and mental health (14.0 ± 1.3 points; p = 0.01). Conclusion: the prescription of physical exercise with an online platform to obese patients improves weight, decreases body fat mass and increases muscle mass, with a decrease in insulin resistance and an improvement in quality of life.

Long-term follow-up of a randomized clinical trial comparing glycemic excursion minimization (GEM) to weight loss (WL) in the management of type 2 diabetes

IntroductionWe previously reported the physical, psychological and behavioral 3-month post-treatment results of a randomized controlled trial comparing glycemic excursion minimization (GEM) versus conventional weight loss (WL) therapy in the management...

S2551 Endoscopic Re-sleeve Is an Effective and Repeatable Treatment for Weight Regain Following Surgical Sleeve Gastrectomy: A Case Presentation

Introduction: Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric surgery in the United States. Weight regain is common with up to 70% of patients reporting weight regain at 6 years follow-up. Endoscopic revision (re-sleeve) has emerged as an effective, safe and less-invasive alternative to surgical revision. We describe the case of a patient who had weight regain five years following LSG and after a first endoscopic revision, treated with repeat re-sleeve with excellent outcomes. Case Description/Methods: A 47-year-old female with a history of obesity and related complications presented for further evaluation. She previously had LSG with significant initial weight loss; but experience weight regain. She then underwent endoscopic sleeve revision 2 years later resulting in 50 lb. weight loss. Five years later, the patient experienced constant acid reflux and gradual weight regain of approximately 40 lb. We proceeded with a second endoscopic re-sleeve for the treatment of weight regain. The endoscopic exam showed evidence of prior sleeve gastrectomy with a markedly enlarged gastric body, intact staple line, and loose endoscopic sutures (Fig 1a). Two parallel anterior and posterior suture placement sites were mapped using coagulation. A tissue screw was used to capture the muscularis propria and an endoscopic suturing device was used to allow for full-thickness bites. A running stich was used to oppose the anterior and posterior placement sites with 2-0 polypropylene sutures (Fig 1b). A cinching device was used to cinch and cut the threaded suture. A total of five sutures were placed in an interrupted sequential pattern with an average of 7 bites per suture to reduce the gastric body volume. No immediate or late complication (Fig 1c). The total procedure duration was 51minutes. The patient tolerated the procedure well and was discharged the same day. The patient lost 20 lb. and 32 lb. at 1 month, and 3-months respectively, corresponding to improvement in body mass index from 35 kg/m 2 pre-procedure to 29 kg/m2 on follow up (Fig 1d). Discussion: LSG and endoscopic sleeve gastroplasty are commonly performed weight loss procedures; however, weight regain remains a limitation. This case emphasizes that endoscopic re-sleeve is a repeatable and feasible option for patients with recurrent weight regain following a revision. Future studies are needed to improve techniques to achieve more durable effects.Figure 1.: (a) Sleeve gastrectomy with prior revision; (b) Endoscopic revision with running stich with overstitch device; (c) Completed endoscopic sleeve revision; (d) Weight loss trend following procedures: A - LSG, B - First endoscopic revision, C- Second endoscopic revision. Laparoscopic sleeve gastrectomy (LSG), Total body weight loss (TBWL).

The effects of glucagon-like peptide (GLP)-1 receptor agonists on weight and glycaemic control in Prader-Willi syndrome: A systematic review.

The mainstay management of hyperphagia and obesity in Prader-Willi syndrome (PWS) relies on dietary restrictions, strict supervision and behavioural modifications, which can be stressful for the patient and caregiver. There is no established pharmacological strategy to manage this aspect of PWS. Theoretically, glucagon-like peptide-1 (GLP-1) receptor agonists (GLP1-RA) used in patients with obesity and type 2 diabetes mellitus (T2DM) may be efficacious in weight and glycaemic control of PWS patients. We conducted a systematic review of the literature to summarize the evidence on the use of GLP1-RA in PWS patients. Primary studies were searched in major databases using key concepts 'Prader-Willi syndrome' and 'GLP1 receptor agonist' and outcomes, 'weight control OR glycaemic control OR appetite regulation'. Ten studies included, summarizing GLP1-RA use in 23 PWS patients (age, 13-37 years), who had used either exenatide (n = 14) or liraglutide (n = 9) over a duration of 14 weeks to 4 years. Sixteen (70%) of these patients had T2DM. Ten patients experienced improvement in body mass index, ranging from 1.5 to 16.0 kg/m2 , while improvement in HbA1c was seen in 19 of 23 cases, ranging between 0.3% and 7.5%. All five studies reporting appetite or satiety showed improvement in satiety levels. There were no reported serious side effects. GLP1-RA appears safe in PWS patients and may have potential benefits for weight, glycaemic and appetite control. Nonetheless, we also highlight a significant gap in the literature on the lack of well-designed studies in this area, which limits the recommendation of GLP1-RA use in PWS patients at present.

Effect of Megestrol Acetate Combined With Oral Nutrition Supplement in Malnourished Lung Cancer Patients: A Single-Center Prospective Cohort Study.

Background: The optimal treatment of cancer-related malnutrition remains unknown. A single-center prospective cohort study was performed to compare the efficacy of megestrol acetate (MA) combined with oral nutrition supplement (ONS) and MA alone for the treatment of lung cancer-related malnutrition.Methods: 76 eligible patients were prospectively enrolled in two arms, Arm 1 patients (n = 40, 52.6%) received MA 160 mg/d, and Arm 2 patients (n = 36, 47.4%) received MA 160 mg/d combined with ONS 55.8 g/t.i.d, all orally. All patients received anticancer therapy. Treatment duration was 3 months. The primary endpoints were improvements in body mass index (BMI) and Eastern Cooperative Oncology Group (ECOG) score. Secondary endpoints were assessed by appetite, mid-upper arm circumference (MAC), serum pre-albumin levels, and serum albumin levels.Results: Baseline levels were comparable between Arm 1 and Arm 2 patients. Compared with Arm 1, primary endpoints (BMI, P = 0.018; ECOG, P = 0.022) and secondary endpoints (MAC, P = 0.025; serum pre-albumin, P = 0.043; and serum albumin, P = 0.034) were improved significantly after treatment in Arm 2. While toxicity was negligible and comparable between Arm 1 and Arm 2.Conclusion: MA combined with ONS may be an effective and safe treatment option for lung cancer-related malnutrition patients.Clinical Trial Registration:www.clinicaltrials.gov, identifier ChiCTR2100049007.

The effectiveness of self-management programmes for people with type 2 diabetes receiving insulin injection: A systematic review and meta-analysis.

People with type 2 diabetes (T2D) receiving insulin injection are reported to encounter challenges to achieve optimal glycaemic control. The evidence on effectiveness of self-management programmes for T2D people receiving insulin injection is far from conclusive. To examine the effectiveness of self-management programmes for people with T2D receiving insulin injection. Twelve databases were searched from dates of inception to June 2021. All randomised controlled trials (RCTs) and controlled clinical trials examining the effectiveness of self-management programmes were included. The methodological quality was appraised using the Joanna Briggs Institute critical appraisal tools by two independent researchers. Data were summarised narratively or pooled statistically where appropriate. Nine RCTs involving 2613 participants were included. At post-intervention, meta-analysis results showed that self-management programmes significantly improved glycated haemoglobin A1c (HbA1c) (mean difference [MD]: -0.21, 95% confidence interval [CI] -0.29 to -0.12, P<.001), self-management behaviours (standardised MD [SMD]: 0.23, 95% CI: 0.12 to 0.33, P<.001) and self-efficacy (SMD: 0.20, 95% CI: 0.09 to 0.31, P=.0002). Only one intensive lifestyle intervention reported significant improvements in body weight and waist circumference. Three RCTs demonstrated significant improvements in body mass index compared with the control group. Only one study demonstrated significant improvements in total cholesterol and triglycerides in favour of the intervention group. At six months post-intervention, pooled results of two studies revealed decreased diabetes-related distress (MD: -2.98, 95% CI: -5.15 to -0.82, P=.007). No significant changes in blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, depression and anxiety were found. Self-management programmes have the potential to improve glycaemic control, weight management, blood lipids, self-management behaviours, self-efficacy and diabetes-related distress of people with T2D receiving insulin injection. More rigorous experimental trials are warranted to examine the effectiveness of self-management programme and its maintenance.

Etat nutritionnel de patients atteints de maladie cœliaque au niveau d’une clinique pédiatrique d’Oran

Introduction Celiac disease (CD) is an enteropathy that requires a gluten-free diet (GFD), a restriction often generating nutritional imbalances Objective. to assess the nutritional status of a pediatric CD population. Population and methods. Among 84 CD patients recruited, 64 were retained (37 F/27M) and aged 1-&lt;17 years old (1-&lt;5 y (n=24), 5-&lt;10 y (n=17), and 10-&lt;17 y (n=23)). The anthropometric measurements, parents education level and profession were collected. Eating habits, GFD quality, daily energy expenditure (DEE) were evaluated. Food consumption was estimated by a 24 hour recall, followed by a 3 day record. Results were compared to the recommended intakes (RI). Results. Nine % of 1-&lt;5 y CD were thin, and 19% were overweight/obese. Significant improvement of body mass index (BMI) z-score was noted in CD girls (p&lt;0.0001), and boys (p&lt;0.01), after GFD. Non-existent breakfast was noted in 23% of children and 22% of adolescents. Sugary drinks consumption was observed in 38% of 1-&lt;5 y infants, and snacking was found in 79% of them, as well as, in half of 5-&lt;10 y, and 10-&lt;17 y population. Twenty six % of adolescents had GFD voluntary deviations. Energy balance (total energy intake (TEI) - DEE) was positive in 5-&lt;10 y, and negative in 10-&lt;17 y. In all CD population, breakfast energy intake was lower than RI, but was important for snack time, also during morning snack in 1-&lt;5 y and 5-&lt;10 y infants. Simple carbohydrates and saturated fatty acids intakes were higher than RI, and iron and vitamin (Vit.) D deficiency was noted in CD population. Adolescents had low calcium and zinc intakes. Conclusion. The studied CD pediatric population presents some nutritional imbalances, requiring a dietary monitoring.

Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention.

Objectives: To examine the association of perceived discrimination with participant retention and diabetes risk among American Indians and Alaska Natives. Methods: Data were drawn from the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project (N = 2553). Results: Perceived discrimination was significantly and negatively associated with short-term and long-term retention and diabetes risk without adjusting. After controlling for socioeconomic characteristics and clinical outcomes, perceived discrimination was not associated with retention but was significantly associated with less improvement in body mass index (BMI) and high-density lipoprotein (HDL) cholesterol. Every unit increase in the perceived discrimination score was associated with 0.14kg/m2 less BMI reduction (95% CI: [0.02, 0.26], p = 0.0183) and 1.06mg/dl lower HDL at baseline (95% CI: [0.36, 1.76], p = 0.0028). Discussion: Among racialized groups, improving retention and health in lifestyle interventions may require investigating perceived discrimination and the broader context of structural racism and colonialism.

PLASMA BIOCHEMISTRY PROFILES OF WILD WESTERN TIGER SNAKES (NOTECHIS SCUTATUS OCCIDENTALIS) BEFORE AND AFTER SIX MONTHS OF CAPTIVITY.

Urban wildlife often suffer poorer health than their counterparts living in more pristine environments due to exposure to anthropogenic stressors such as habitat degradation and environmental contamination. As a result, the health of urban versus nonurban snakes might be assessed by differences in their plasma biochemistries. We compared the plasma profiles of western tiger snakes (Notechis scutatus occidentalis) from a heavily urbanized wetland and a natural, nonurbanized wetland. Despite the urbanized snakes having lower body mass index, we found no significant difference between the plasma profiles of the two populations. We collected snakes from each population and kept them in captivity for 6 mo, providing them with stable conditions, uncontaminated (exempt from heavy metals and pesticides) food and water, and lowered parasite intensity in an attempt to promote better health through depuration. After captivity, snakes experienced a significant improvement in body mass index and significant changes in their plasma profiles. Snakes from the natural wetland initially had more variation of DNA damage; mean concentration of DNA damage in all snakes slightly decreased, but not significantly, after captivity. We present the plasma biochemistry profiles from western tiger snakes both before and after captivity and suggest a period of removal from natural stressors via captivity may offer a more reliable result of how plasma profiles of healthy animals might appear.

Results of a prospective cardiovascular disease prevention program.

The Cardiovascular Health Program (CHP) Registry is a 12-month, prospective study of therapeutic lifestyle change (TLC). Adult participants received comprehensive assessment of health behaviors and cardiovascular disease (CVD) risk factors. Personalized TLC action plans addressed modifiable health behaviors for diet, exercise, stress management, and sleep. Participants attended a half-day interactive workshop and met face-to-face with certified health coaches four times over 6 months. Monthly telephonic coaching for 6 more months completed the intervention. Measured outcomes included adherence to behavioral prescriptions, anthropometrics, CVD-relevant laboratory tests, and for a subset of participants, carotid intima-media thickness (CIMT). Of 965 participants, 648 (67%) completed the program and were included in the analysis. Participants were of mean age 55.4 ± 12.5 years, 57% women, and racially diverse. Adherence to prescribed TLC was substantial: dietary behaviors at goal rose from 53% to 86%, exercise 44% to 66%, perceived stress 65% to 79%, and sleep quality 28% to 49%. For participants with abnormal anthropometrics at baseline, there were improvements in body mass index in 63%, waist circumference (men 71%, women 74%), systolic BP 69%, and diastolic BP 71%. For participants with abnormal laboratory values at baseline, there were improvements in total cholesterol in 74%, LDL-cholesterol 65%, triglycerides 86%, fasting glucose 72%, and insulin resistance 71%. Improvements were not driven by prescribed medications. CIMT improved or showed no change in 70% of those measured, associated with significant improvements in sleep quality and longer total sleep time. Longer trials incorporating controls and major adverse CVD events are warranted.

Weight loss, hypertension and mental well-being improvements during COVID-19 with a multicomponent health promotion programme on Zoom: a service evaluation in primary care

BackgroundObesity is a risk factor for complications from SARS-CoV-2 infection, increasing the need for effective weight management measures in primary care. However, in the UK, COVID-19 restrictions have hampered primary...

Значення комплаєнтності пацієнтів у довготривалій модифікації стилю життя в процесі корекції маси тіла

Мета. Визначити значення реабілітаційної комплаєнтності пацієнтів у довготриваліймодифікації стилю життя в процесі корекції маси тіла в рамках програми фізичної терапії.Методи. Обстежено 288 осіб другого зрілого віку з аліментарно-екзогенним ожирінням І–ІІІ ступеня. За результатами визначення реабілітаційного комплаєнсу їх було поділено надві групи. Групу порівняння становили особи з низьким рівнем комплаєнсу, які були інфор-мовані про ризики ожиріння та принципи зменшення маси тіла. Основну групу становилиособи з високим рівнем комплаєнсу, які проходили річну програму корекції із застосуваннямзаходів для підтримки комплаєнсу, модифікації харчування, збільшення фізичної активно-сті, лімфодренажу, психокорекції. Контрольну групу становили 60 осіб з нормальною масоютіла. За допомогою анкетування визначали поширеність модифікованих факторів ризикувиникнення ожиріння у стилі життя. Після впровадження реабілітаційної програми повторновизначали їх поширеність; ефективність програми визначали за динамікою індексу маси тіла.Результати. Початкове анкетування показало значну поширеність модифікованих етіологічнихфакторів ожиріння. У пацієнтів основної групи після річного періоду спостереження за всімазапитаннями анкети визначалось значне зменшення поширеності факторів ризику ожиріння.На фоні застосування програми реабілітації із використанням заходів для утриманнякомплаєнсу на високому рівні досягнуто статистично значущого покращення індексу маситіла. Висновок. Високий рівень комплаєнсу сприяє тривалій модифікації стилю життя хворихожирінням, виконанню ними наданих рекомендацій і, як наслідок, значному зменшеннюмаси тіла. Низький рівень комплаєнсу супроводжується невиконанням рекомендацій щодомодифікації стилю життя та відсутністю зменшення маси тіла.

Corneal Keratocyte Density and Corneal Nerves Are Reduced in Patients With Severe Obesity and Improve After Bariatric Surgery.

PurposeObesity is associated with peripheral neuropathy, which bariatric surgery may ameliorate. The aim of this study was to assess whether corneal confocal microscopy can show a change in corneal nerve morphology and keratocyte density in subjects with severe obesity after bariatric surgery.MethodsTwenty obese patients with diabetes (n = 13) and without diabetes (n = 7) underwent assessment of hemoglobin A1c (HbA1c), lipids, IL-6, highly sensitive C-reactive protein (hsCRP), and corneal confocal microscopy before and 12 months after bariatric surgery. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and keratocyte density (KD) from the anterior, middle, and posterior stroma were quantified. Twenty-two controls underwent assessment at baseline only.ResultsCNFL (P < 0.001), CNBD (P < 0.05), and anterior (P < 0.001), middle (P < 0.001), and posterior (P < 0.001) keratocyte densities were significantly lower in obese patients compared to controls, and anterior keratocyte density (AKD) correlated with CNFL. Twelve months after bariatric surgery, there were significant improvements in body mass index (BMI; P < 0.001), HDL cholesterol (P < 0.05), hsCRP (P < 0.001), and IL-6 (P < 0.01). There were significant increases in CNFD (P < 0.05), CNBD (P < 0.05), CNFL (P < 0.05), and anterior (P < 0.05) and middle (P < 0.001) keratocyte densities. The increase in AKD correlated with a decrease in BMI (r = –0.55, P < 0.05) and triglycerides (r = –0.85, P < 0.001). There were no significant correlations between the change in keratocyte densities and corneal nerve fiber or other neuropathy measures.ConclusionsCorneal confocal microscopy demonstrates early small fiber damage and reduced keratocyte density in obese patients. Bariatric surgery leads to weight reduction and improvement in lipids and inflammation and an improvement in keratocyte density and corneal nerve regeneration.

Evaluation of nutritional conditions, haemoglobin levels, retention in care and viral suppression in a cohort of HIV-infected Malawian adolescents undergoing a one-year tailored intervention within the Diseases Relief through Excellence and Advanced Means

Background. The United Nations Children’s Fund (UNICEF) reported that ~1 770 000 adolescents were living with HIV infection in 2017, of whom >80% were in sub-Saharan Africa. In Malawi, ~25 000 boys and 46 000 girls are infected with HIV. Objective. The present study aimed to evaluate a specific adolescent-friendly service implemented in a Diseases Relief through Excellence and Advanced Means (DREAM) health centre in Malawi. Methods. All HIV-positive patients aged 10 - 19 years in the care of the DREAM centre in Blantyre on 17 December 2016 were included in the study and followed-up until 1 January 2018. The service was organised for one adult-free day, with some side activities managed by a co-ordinator and youth leaders. Assessments were performed at the end of the period (EOP). Results. On 17 December 2016, 425 patients were enrolled in the study. Follow-up status at EOP was 403 (94.8%) patients in care, 7 (1.6%) lost to follow-up (LTFU), 2 (0.5%) died and 13 (3.1%) were transferred to other facilities. Death and LTFU rates were 0.72/100 and 2.9/100 person-years, respectively. Moreover, 50.6% (n=198/391) of patients had an improvement in body mass index (BMI)-for-age z-scores, and 70.2% ( n =33/47) of patients who were malnourished at baseline improved (higher improvement in older patients). Mean (standard deviation (SD)) haemoglobin levels increased from 12.5 (1.5) mg/dL to 13.1 (1.9) mg/dL (significance level p =0.000). At the EOP, 79.0% ( n =309/391) of patients had viral suppression. Conclusion. Care of adolescent HIV+ patients remains a challenge, but the implementation of specific projects involving adolescents and youth leaders can increase adherence and improve viral suppression.

Care for older adults with dementia: PACE day care or residential dementia care units?

BackgroundPersons with dementia (PwD) are at greater risk for various adverse health outcomes, and the best care model remains to be determined. This study aimed to compare the physical and neurocognitive performance of PwD in the Program of All-inclusive Care for the Elderly (PACE) and residential dementia care units. MethodsThis was a case-control study comparing outcomes between care recipients of PACE services (PC group) and residential dementia care (RC group). Demographic characteristics, underlying diseases, physical function, cognitive function, mood status, and behavioral and psychotic symptoms of dementia (BPSDs) were assessed every 3-6 months in both groups, while frailty status and Timed Up-and-Go Test (TUGT) performance were assessed every 6 months in the PC group only. ResultsOverall, 96 participants (PC group: 25, RC group: 71; mean age: 86.4 ± 6.8 years) were enrolled with the median follow-up period of 43.6 weeks. Lower incidence of hospital admissions was noted in the PC group (0.52 ± 1.12 vs 1.38 ± 2.49 admissions/1,000 person-days, p=0.023), even though the PC group had higher multimorbidity and more severe BPSDs. During the study period, the PC group showed a significant improvement in body mass index, less physical dependence, better cognitive performance and reduced depressive mood. In addition, the PC group showed improvement in frailty, leisure hour activities, and TUGT results. However, participants in the PC group were more likely to experience BPSD deterioration (β coeff.: 0.193, 95% CI: 0.121- 0.265). ConclusionThe PACE services significantly reduced unexpected hospital admissions of PwD, facilitated the maintenance of physical independence, and improved cognitive performance and mood status. Further randomized controlled studies are needed to determine the most appropriate care model for PwD.

Bone response to eccentric versus concentric cycling in adolescents with obesity

ObjectivesBecause adolescents with obesity are susceptible to bone fragility during weight loss (WL), we evaluated the impact of eccentric (ECC) versus classical concentric (CON) training at the same oxygen consumption (V˙O2) on bone density, geometry and strength. MethodsThirty five adolescents were included into 2 training (CON and ECC cycling) and a control (CTR, without training) groups. Anthropometry, dual-energy X-ray absorptiometry, hip structural analysis and quantitative bone ultrasound were assessed before and after the 12-week intervention. ResultsThe trainings promoted significant improvements in body mass index, total fat (FM) and lean mass (LM), with better improvements for FM and LM in the ECC group (p < 0.05). Leg LM percentage increased only in the ECC group (p < 0.05). Total body bone mineral content and density increased in both training groups (p < 0.001) with significant time x group interactions only between ECC and CTR (p < 0.05). Buckling ratio at the intertrochanteric region and femoral shaft increased only in CTR and CON groups (p < 0.05). Speeds of sounds at the calcaneum increased only in ECC group (p < 0.01). ConclusionsBone fragility, from a compromised relationship between density, geometry and strength, might be prevented with the ECC modality.