Improvements In Cholesterol Levels Research Articles

Effectiveness of Resmetirom in Reducing Cholesterol Levels in Patients With Nonalcoholic Steatohepatitis: A Systematic Review and Meta-Analysis.

Nonalcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease (NAFLD) associated with metabolic syndrome and increased cardiovascular risk. Resmetirom, a novel liver-directed selective thyroid hormone receptor-β (THR-β) agonist, has shown promise in addressing both hepatic and systemic lipid metabolism. This systematic review and meta-analysis aimed to evaluate the efficacy of resmetirom in improving cholesterol levels in NASH patients. A systematic literature search was conducted across multiple databases including PubMed, Embase, Cochrane Library, andClinicalTrials.gov, identifying three randomized controlled trials for inclusion. The meta-analysis revealed that resmetirom significantly reduced low-density lipoprotein cholesterol (LDL-C) levels compared to placebo (MD: -23.62; 95% CI: -37.32 to -9.93; p < 0.001). Similarly, triglyceride (TG) levels showed a significant reduction in the resmetirom group (MD: -33.86; 95% CI: -47.79 to -19.92; p < 0.001). Importantly, there was no significant difference in the risk of serious adverse events between resmetirom and placebo groups (RR: 1.09; 95% CI: 0.73 to 1.63; p = 0.67). These findings suggest that resmetirom effectively improves lipid profiles in NASH patients without compromising safety. However, the analysis was limited by the small number of studies, all from the same research group, and high heterogeneity in results. Future research should include more diverse studies, longer follow-up periods, and cost-effectiveness evaluations. Despite these limitations, resmetirom shows promise as a potential treatment for managing dyslipidemia and cardiovascular risk in NASH patients, potentially influencing future treatment guidelines for both liver and cardiovascular health in this population.

Effect Of Combination Decafeinated Green Tea and Green Coffee In Reducing Cholesterol Levels In Patients With Metabolic Syndrome

Background: Green tea and green coffee are natural ingredients that improve cholesterol levels. Combining the two in experimental animal studies provides more significant benefits when compared to single administration in reducing cholesterol levels. Objective: This study aimed to determine the effect of decaffeinated green tea and green coffee as adjuvant treatments in reducing blood cholesterol levels. Methods: This randomized controlled trial included 90 metabolic syndrome patients determined according to the IDF criteria for Asian people aged 50–70. All subjects received atorvastatin 20 mg and were divided into three groups. Participants in Group 1 received decaffeinated green tea and green coffee 2.5 grams twice daily, Group 2 received 5 grams daily, and Group 3 received a placebo. The total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride levels were measured at the beginning and the end of the study. Results: At 90 days, after administration of the extract of decaffeinated green tea and green coffee, we found that the concentration of total cholesterol in Group 1 and Group 2 was significantly reduced compared to the placebo (-50 ± 6.1 vs. -62.8 ± 5.9 vs. -22.5 ± 5.8 mg/dL; p= &lt;0.05). But there was no significant difference in reduction of total cholesterol levels between the first and second groups. The other parameters also decreased, but not significantly compared to the placebo group. Conclusion: Administration of a combination of decaffeinated green tea extract and green coffee as an adjunctive therapy can reduce the average total cholesterol, LDL, HDL, and triglyceride levels more than placebo, but only total cholesterol has a significant difference compared to other cholesterol components.

Lacto-Fermented and Unfermented Soybean Differently Modulate Serum Lipids, Blood Pressure and Gut Microbiota during Hypertension

Soy consumption may reduce hypertension but the impact of food processing on the antihypertensive effect is unclear. Hence, we ascertained the effects of lacto-fermented (FSB) and unfermented soybean (USB) consumption on serum atherogenic lipids, hypertension and gut microbiota of spontaneous hypertensive rats (SHR). FSB displayed a strong in vitro angiotensin converting enzyme (ACE) inhibitory ability of 70 ± 5% while USB inhibited 5 ± 3% of the enzyme activity. Consumption of USB reduced serum ACE activity by 19.8 ± 12.85 U while FSB reduced the enzyme activity by 47.6 ± 11.35 U, respectively. FSB significantly improved cholesterol levels and reduced systolic and diastolic blood pressures by 14 ± 3 mmHg and 10 ± 3 mmHg, respectively, while USB only had a marginal impact on blood pressure. Analysis of FSB showed the abundance of ACE inhibitory peptides EGEQPRPFPFP and AIPVNKP (which were absent in USB) and 30 phenolic compounds (only 12 were abundant in USB). Feeding SHR with FSB promoted the growth of Akkermansia, Bacteroides, Intestinimonas, Phocaeicola, Lactobacillus and Prevotella (short chain fatty acid producers) while USB promoted only Prevotellamassilia, Prevotella and Intestimonas levels signifying the prebiotic ability of FSB. Our results show that, relative to USB, FSB are richer in bioactive compounds that reduce hypertension by inhibiting ACE, improving cholesterol levels and mitigating gut dysbiosis.

Cholesterol, Exercise and Diet: A Cross-sectional Survey of Middle-aged Maltese Adults

Researchers have shown that poor lifestyle habits like unhealthy dietary intake, physical inactivity, smoking, and alcohol consumption exert negative effects on the cholesterol levels and risk of adverse health outcomes in most segments of the population. For middle-aged adults, specifically, high cholesterol, or hypercholesterolemia, represents a key risk factor in the onset of non-communicable diseases (NCDs). NCDs are considered to be the leading cause of death in this age cohort and result in substantial public health care costs at both a European and local level. Maltese researchers have meanwhile posited that poor awareness exists in the local population about the harmful effects of unhealthy lifestyle factors on cholesterol levels. Given the generally high obesity rates in Malta and the prevalence of lifestyle-related risk factors, like smoking and physical inactivity in particular, a cross-sectional survey was designed to explore risk factors for hypercholesterolemia in a sample of 37 middle-aged adults having undergone a cholesterol test in the previous 12 months. Multiple regression analysis was carried out to ascertain the effects of exercise, diet, smoking, and alcohol consumption on the total cholesterol ratio (TCR). The findings suggest that exercise constitutes a particularly vital component of any intervention aimed at improving cholesterol levels due to its significant influence on TCR. Furthermore, the effect of exercise on lowered TCR values was not dependent on diet. The findings also do not support the idea that popular unhealthy foods unique to the Maltese context have any significant effects on cholesterol levels while controlling for overall dietary habits.

Antidiabetic and antihyperglycemic effect of citrus

The tangerine fruit peels of Citrus reticulata contain significant amounts of three flavanones: hesperidin, naringin, and narirutin. Citrus is a rue group species of blooming trees and shrubs. In contrast to flavonol and quercetinRutaceae, citrus peel complex compounds quantities of flavonol and quercetinRutaceae. DM is one of most chronic diseases in the world. Citrus reticulata is a kind of citrus fruit with a various degrees of Hesperidin, a glycosylated flavanone of hesperetin, suppresses gluconeogenic pathways and diminishes intestinal glucose absorption in diabetes patients, leading in anti-hyperglycemic properties. Recent research looks into the efficacy of naringin to improve cholesterol levels by reducing HMGCoA reductase. Citrus sinensis, Citrus paradisi, and their combination have antihyperlipidemic and antiatherosclerosis properties. Hyperlipidemia is a collection of disorders characterized by elevated blood levels of lipids and lipoproteins, such as cholesterol, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL), which can lead to atherosclerosis. Atherosclerosis and coronary heart disease (CHD) are the leading causes of death and sickness around the world.

A brief review on different plant parts used as immunity boosting agent

A strong immune system is essential to keep a person healthy. Every person should incorporate specific food items into their diet that can strengthen their immune system. Mother Nature has a bag full of plants and trees whose different parts contain different ingredients that can act as immune boosters. Tulsi is a small herb, found in many parts of India and can be grown in our homes too. The leaves of Tulsi have different properties like antimicrobial, antipyretic, anti-inflammatory, and many more. 5-6 leaves of Tulsi daily help to build our immune system. Giloy is an herbaceous vine found in the tropical regions of different Indian subcontinents. The heart-shaped leaves and reddish fruit of Giloy have many active ingredients like alkaloids, glycosides, phytosterols, etc. which help to attain anti-inflammatory, antipyretic, antioxidant properties. 2-3 tablespoons of Giloy juice daily helps to boost our immune system and increase the ability of our body to fight various infectious diseases. Garlic is used in a variety of dishes we cook garlic bulb is a great supplement known to boost the immune system functioning. Active compound present in garlic helps to reduce blood pressure improve cholesterol levels and can also lower the risk of heart diseases. Garlic bulbs can also reduce cold and flu symptoms. The various vitamins present in garlic also add more effect to its immunity-boosting property. Citrus lemon is found primarily in the north-eastern part of India, China or Myanmar, Italy, Spain. It has various phytochemicals such as terpenes, tannins, polyphenols, etc. is considered a rich of all essential vitamins to enrich our immune system and also provide therapeutic benefits

Polymer‐Functionalized Mitochondrial Transplantation to Plaque Macrophages as a Therapeutic Strategy Targeting Atherosclerosis

AbstractThe pro‐inflammatory microenvironment that contributes to atherosclerotic plaque progression is sustained by M1 macrophages. Metabolic reprogramming toward heightened glycolysis accompanies M1 macrophage polarization, with approaches aimed at lessening glycolytic metabolism in macrophages standing to impact disease progression. The objective is to decrease the inflammatory response in atherosclerotic lesions by inducing favorable metabolic phenotypes in macrophages using an innovative mitochondrial transplantation strategy. The hypothesis is that delivery of mitochondria, functionalized with a dextran and triphenylphosphonium (Dextran‐TPP) polymer conjugate for enhanced cellular transplantation, to atherosclerotic plaques properly regulates M1 macrophage bioenergetics, attenuating inflammatory processes and preventing plaque progression. Dextran‐TPP mitochondria transplantation to M1 macrophages has profound effects on cell bioenergetics, resulting in increased oxygen consumption rate and reduced glycolytic flux that coincides with a decreased inflammatory response. Upon intravenous delivery to ApoE−/− mice fed a high fat diet, Dextran‐TPP mitochondria accumulate in aortic plaques and co‐localize with macrophages. Importantly, Dextran‐TPP mitochondria treatment reduces the plaque burden in ApoE−/− mice, improving cholesterol levels, and ameliorating hepatic steatosis and inflammation. Findings highlight Dextran‐TPP mitochondria as a novel biological particle for the treatment of atherosclerosis, underlining the potential for macrophage metabolic regulation as a therapy in other diseases.

Apple cider vinegar: The “mother” of cures?

Apple cider vinegar (ACV) is one of the most popular natural health products available. Commonly used in salad dressings, sauces, and food preservation, ACV has recently gained acceptance as a dietary supplement. It has been touted as an appetite suppressant, digestive health aid, and immune system boost and studied in treatment of obesity, diabetes, and problems related to hair and skin, among many other conditions. But are these health claims backed by science? ACV is made from the fermented juice of crushed apples and its cloudy appearance is from “the mother” of vinegar, which is the combination of yeast and bacteria. ACV contains probiotics, various minerals (e.g., potassium, magnesium, and calcium), vitamins (e.g., B vitamins and vitamin C), and dietary fiber. Fruit vinegars in general can increase antioxidant and antimicrobial capacities because the fermentation process produces organic and acetic acids. ACV is high in acetic acids which, in concert with phenolic compounds, may be responsible for lowering blood glucose levels, regulating lipid abnormalities, and changing how foods are absorbed from the gut. There are multiple studies suggesting that ACV might positively affect blood glucose levels and insulin response among people with diabetes and improve cholesterol levels and weight loss among obese individuals. Studies involving people with and without diabetes suggest that adding two teaspoons of vinegar to water or a meal may improve blood glucose control, decreasing fasting glucose concentrations after a meal containing starches. A 2019 randomized controlled clinical trial in Clinical Nutrition ESPEN assessed the efficacy of ACV on fasting blood glucose, insulin, and blood pressure. Patients with type 2 diabetes and hyperlipidemia were randomly assigned to an intervention or control group to assess the effect of 20 mL ACV per day over the course of the 8-week study. Researchers found significant improvement in fasting blood glucose but no significant effect on blood pressure was observed. ACV may promote weight loss due to acetic acid's impact on appetite, insulin function, and metabolism. Acetic acids in vinegar are thought to inhibit lipogenesis and stimulate fatty acid oxidation. A highly cited parallel-group, randomized, double-blind, placebo-controlled 2009 trial published in Bioscience, Biotechnology, and Biochemistry evaluated the effects of vinegar intake on the reduction of body fat mass in 175 obese patients, ranging in age from 25 to 60. During the 12-week treatment period, patients ingested 500 mL daily of a beverage containing either 15 mL of vinegar, 30 mL of vinegar, or 0 mL of vinegar (placebo). The researchers confirmed that body weight, BMI, visceral fat area, waist circumference, and serum triglyceride levels were significantly lower in both vinegar intake groups compared to placebo and reductions in body weight and BMI were found to be dose dependent. No adverse effects were reported. This finding was confirmed in a 2020 systematic review published in European Journal of Nutrition that assessed the effect of ACV on metabolic parameters and body weight. Investigators identified 487 studies and confirmed there may be beneficial health effects from the consumption of ACV while the risk of adverse effects in recommended quantities was unremarkable. ACV is available in your local grocery store. ACV dietary supplements are usually sold as capsules, tablets, gummies, or powders, often paired with ginger and cayenne. In general, 1-2 tablespoons (15-30 mL) of ACV daily, with a meal or diluted in liquid, significantly reduces blood glucose levels after eating and aids in weight loss. Overall, fruit vinegars are natural sources of dietary antioxidant polyphenols and organic acids and ACV is generally considered safe. Large amounts over the long term might lead to low levels of potassium and ACV may interact with certain supplements or drugs, including diuretics and insulin. Take care to monitor blood glucose closely if combining ACV with diabetes medications. Caution patients not to consume ACV straight as it can irritate or even burn the esophagus. ACV may be unsafe when applied to skin and has been associated with skin irritation and chemical burns. Advise patients to compare labels as the range of contents and acidity levels may vary per product.

Nutrition in Menopausal Women: A Narrative Review

Among the various aspects of health promotion and lifestyle adaptation to the postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life. In this narrative review, we discuss the current evidence on the association between dietary patterns and clinical endpoints in postmenopausal women, such as body composition, bone mass, and risk markers for cardiovascular disease. Current evidence suggests that low-fat, plant-based diets are associated with beneficial effects on body composition, but further studies are needed to confirm these results in postmenopausal women. The Mediterranean diet pattern along with other healthy habits may help the primary prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period. It consists on the use of healthy foods that have anti-inflammatory and antioxidant properties, and is associated with a small but significant decrease in blood pressure, reduction of fat mass, and improvement in cholesterol levels. These effects remain to be evaluated over a longer period of time, with the assessment of hard outcomes such as bone fractures, diabetes, and coronary ischemia.

Possible Short-Term Biological Effects of Kefir: ⅡⅠ: Efficacy of Kefir Beverage on The Cell Biological, Histochemical, Histopathological and Biochemical Changes in Kidney of High-Fat Fed STZ- Induced Diabetic Male Wistar Rat.

This study was designed to investigate the possible protective role of kefir beverage on kidney structure biologically, histochemical and some biochemical parameters such as cholesterol level, MCP-1, and resistin in high-fat diet-fed streptozotocin-diabetic rats. 60 rats were divided into two experiments by six groups: experiment Ⅰ included 3 non-diabetic ones and experiment ⅠⅠ included three STZ- induced diabetes groups. The groups were fed as follows: group 1 received a standard diet and served as control. Group 2 was fed on a standard diet and kefir (0.7 ml/animal/day by gavage). Group 3 received a high-fat diet and kefir (0.7 ml/animal/day by gavage). The diabetic males of groups A, B, and C were fed on the high-fat diet. Group B received besides kefir (0.7 ml/animal/day by gavage), while group C was injected additionally with insulin (0.76 UI/200 mg BW/day). After 5 weeks, animals of all groups were sacrificed. From the cell biological, histochemical, and histopathological conceptions, both kefir and insulin have various effects on cellular activities and different chemical materials contents, such as DNA, RNA, total protein, collagen, polysaccharides, and lipoproteins, in the examined normal and diabetic renal tubule cells of the male rats. Overall, it seems like kefir beverage may, to some extent, completely repair the diabetic pathological side effects such as kidney dysfunction regarding keeping the kidney tissue structurally almost normal with some changes in the histochemical components investigated, also there was an improvement in cholesterol level with a beneficial effect on lowering inflammatory markers. Finally, kefir highly reduces the collagen formation in the renal cells that prevent renal nephron from its function and we propose probably kefir treats kidney failure as a side effect of diabetes, by a mechanism that is opposite to the proposed mechanism, for the formation of this kidney failure induced by diabetes, via us in the present work.

Decrease of dipeptidyl peptidase 4 activity is associated with weight loss after bariatric surgery

PurposeDipeptidyl peptidase 4 (DPP4) is expressed and secreted by adipocytes. DPP4 induces insulin resistance independently of its effect on glucagon-like peptide 1, thus it is conceivable that DPP4 directly contributes to metabolic dysfunction in patients with morbid obesity. The aim of this study was to investigate the impact of weight loss induced by bariatric surgery on DPP4 activity, and whether these changes are associated with improvements in markers of metabolic dysfunction and fatty liver disease.Materials and MethodsWe included 68 non-diabetic patients who underwent bariatric surgery. Serum DPP4 activity was measured using a fluorogenic substrate before and after surgery.ResultsResults: After a median follow-up period of 12 (IQR 11-17) months, median serum DPP4 activity decreased from 230 (IQR: 194-273) to 193 (164-252) pmol/min (p=0.012). The decrease in DPP4 activity was significantly correlated with decreases in BMI, improved cholesterol levels, reduced hepatic injury markers as well as improved post-prandial insulin sensitivity. After multivariable adjustment, ΔDPP4 activity remained significantly associated with Δcholesterol (beta=0.341, p=0.025), ΔLDL cholesterol (beta=0.350, p=0.019), Δgamma-glutamyltransferase (beta=0.323, p=0.040) and ΔMatsuda index (beta=-0.386, p=0.045).ConclusionWe demonstrated that weight loss induced by bariatric surgery results in decreased circulating DPP4 activity beyond the initial phase of weight loss. The associations between decreased DPP4 activity and improved cholesterol levels as well as hepatic injury markers point towards pleiotropic effects of DPP4 beyond glucose metabolism which warrant further investigation.

Estimating Atherosclerosis Cardiovascular Disease Risk of 10-year with the Systemic Coronary Risk Estimation Method and Statin Use Recommendation

Stroke and heart disease belong to atherosclerotic cardiovascular diseases (ASCVD), which is one of the death causes in Indonesia. This study aimed to estimate the risk of atherosclerosis cardiovascular disease in the next 10 years using the Systemic Coronary Risk Estimation (SCORE) method. This research was an observational study with descriptive cross-sectional study design. Respondent data collection was taken prospectively which means directs data was collected through interviews, blood pressure measurement, and peripheral blood sampling. The results showed that respondents who were involved in this study were those with an average age of 49.70 ± 7.1 years. Respondents were more dominated by women (76.1%); BMI of respondents showed in the non-obese group 27.14 ± 4.6 kg/m2; total cholesterol, LDL, TG, and HDL levels respectively had an average of 152.17 ± 39.5 mg/dL; 91.28 ± 40.9 mg/dL; 117.24 ± 96.9 mg/dL; and 30.87 ± 8.8. The number of respondents who smoke was 17.39% and that of those who have undergone physical activity in the form of sports was 60.87%. Based on the results of risk estimation using the SCORE method, it was found that the number of people who were in the low-risk category was 54.35% and the moderate risk category was 45.65%. This study concludes that the risk of ASCVD for the next 10 years in the community is at low and moderate levels. Non-pharmacological treatment is more recommended at this level and statins can be given to individuals if there is no improvement in cholesterol levels.

Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis.

IntroductionPeople living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV‐negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost‐effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid‐lowering therapy.MethodsWe developed a discrete‐state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75 years, receiving antiretroviral therapy in Thailand, and not using lipid‐lowering therapy. The model simulated each individual’s probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/year) and (3) treating everyone with pitavastatin 2 mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality‐adjusted life‐years (QALYs) were assigned in annual cycles over a 20‐year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective.ResultsPravastatin was estimated to be less effective and less cost‐effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost‐effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness‐to‐pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost‐effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost‐effective at an annual cost of 600 Baht ($US19.30)/year.ConclusionsNeither pravastatin nor pitavastatin were projected to be cost‐effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid‐lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.

Effect of 7-Hydroxy-2-(4- Hydroxy -3-Methoxyphenyl)-Chroman-4-one On Level of Mangan-Superoxide Dismutase (Mn-Sod) and Superoxide Dismutase 2 (Sod2) Gene Expression in Hyperlipidemia Rats

Hyperlipidemia is a lipid metabolism disorder characterized by an increase in serum lipid levels. Hyperlipidemia is a major risk factor for many metabolic syndrome diseases because it triggers oxidative stress. Oxidative stress can be reduced by endogenous antioxidant enzymes triggered by exogenous antioxidant compounds, such as 7-OH-2- (4-OH-3-methoxyphenyl)-chroman-4-one isolated from the seeds of Swietenia macrophylla King. The aims of this study were to investigate the effects of 7-OH-2-(4-OH-3-methoxyphenyl)-chroman-4-one compounds on cholesterol level, LDL level, Mn-SOD levels and SOD2 gene expression of hyperlipidemic rats. Thirty rats ( Rattus norvegicus ) were divided into 6 groups, normal group (N), hyperlipidemia group (HL), hyperlipidemia group with simvastatin (P), hyperlipidemic group with 7-OH-2-(4-OH-3-methoxyphenyl)-chroman-4-one with dose 10 (F10), 30 (F30) and 90 (F90) mg/200g body weight (BW). Cholesterol and LDL were analyzed with CHOD-PAP method, Mn-SOD level was analyzed by ELISA method and SOD2 gene expression was analyzed by qPCR method. The decrease in cholesterol and LDL levels were most prevalent in group F90 with dose 90 mg/200g BW of 7-OH-2-(4-OH-3-methoxyphenyl)-chroman-4-one, with average difference each of them was 172.43 mg/dL and 36.12 mg/dL. The rats fed on high-cholesterol diet exhibited a significant elevation in Mn-SOD levels (p 0.05). 7-OH-2-(4-OH-3-methoxyphenyl)-chroman-4-one with dose of 90 mg/200g BW improved cholesterol levels, LDL levels, Mn-SOD levels and SOD2 gene expression in hyperlipidemic rats.

Longer-term liraglutide administration at the highest dose approved for obesity increases reward-related orbitofrontal cortex activation in response to food cues: Implications for plateauing weight loss in response to anti-obesity therapies.

GLP-1 analogs have recently risen to the forefront as effective medications for lowering weight through actions in the central nervous system (CNS). However, their actions in the CNS have not yet been studied in the human brain after longer-term administration at the highest dose approved for obesity (liraglutide 3.0 mg). A total of 20 participants with obesity were treated with placebo and liraglutide (3.0 mg) in the context of a randomized, placebo-controlled, double-blind, cross-over trial after 5 weeks of dose escalation. Neurocognitive and neuroimaging (fMRI) responses to food cues were examined at the clinical research center of Beth Israel Deaconess Medical Center. While using liraglutide, patients lost more weight (placebo-subtracted -2.7%; P < .001), had decreased fasting glucose (P < .001) and showed improved cholesterol levels. In an uncontrolled analysis, brain activation in response to food images was not altered by liraglutide vs placebo. When controlled for BMI/weight, liraglutide increased activation of the right orbitofrontal cortex (OFC) in response to food cues (P < .016, corrected for multiple comparisons). In contrast to prior studies, we demonstrate for the first time that liraglutide treatment, administered over a longer period at the highest doses approved for obesity, does not alter brain activation in response to food cues. A counter-regulatory increase in reward-related OFC activation in response to food cues can be observed when neuroimaging data are controlled for BMI changes, indicating changes in CNS that could lead to later plateaus of weight loss. These data point to a promising focus for additional interventions which, by contributing to the CNS reward system, could provide tangible benefits in reversing the plateauing phenomenon and promoting further weight loss.

Abstract P088: Assessing the Use of a Preventive Cardiology Lifestyle Screening (PCLS) Tool in a Pediatric Sub-Specialty Lipid Clinic

Objective: Lifestyle modification is recommended to improve cholesterol levels in the pediatric population with the goal of reducing CVD risk. Existing tools assessing pediatric lifestyle habits are cumbersome and lack specificity. We developed the Preventive Cardiology Lifestyle Screen (PCLS) to assess behaviors relevant to CVD risk, and evaluated its use in a subspecialty lipid clinic at a large pediatric teaching hospital. Methods: Eligible participants were 2-21 years old, English speaking and presenting for care in a pediatric lipid clinic. We evaluated test-retest agreement using weighted kappa statistics, and validity of PCLS compared to longer research questionnaires [Block Food and Activity Questionnaires and Rapid Eating Assessment for Patients (REAP)] using Spearman correlation coefficients. Results: Participants (n = 138) had a mean age of 13 years; 50% were female, 22% reported a household income &lt;$50,000. Median non-HDL cholesterol was 149.2 mg/dL and HDL cholesterol was 48 mg/dL. Of participants 2-17 years old (n=122), 15% were overweight and 46% were obese. Test re-test agreement for those ≥10 years (n=24) was good (weighted kappa &gt;.75) for fruits and vegetables (0.83, 0.82 respectively), chicken no skin (0.89), processed meats (0.78) and sports drinks (.75). Test-retest agreement was poor (weighted kappa &lt;.50) for regular soda intake (0.40), regular fat dairy (0.47), and eating lunch (0.45). Activity (sports 0.94 gym class 0.77) and inactivity (weekend video games 0.88 hours of sleep 0.78) overall had high test-retest agreement for most questions. Examining across dietary domains, the PCLS performed well at baseline compared to the BLOCK and REAP surveys in the domains of saturated fat, glycemic index, sodium and fiber (Table 1). Conclusion: The PCLS performed well on test re-test agreement, and responses correlated with previously validated research tools in most domains. This tool shows promise for use in the care of children with CVD lipid disorders.

Effectiveness of dietetic consultation for lowering blood lipid levels in the management of cardiovascular disease risk: A systematic review and meta-analysis of randomised controlled trials.

AimEvidence of the effectiveness of dietetic consultation for the management of cardiovascular disease (CVD) risk factors has not been previously synthesised. A systematic review and four meta‐analyses evaluated the effectiveness of dietetic consultation for lowering blood lipid levels in high‐risk individuals in primary health‐care settings.MethodsOf the 4860 records identified, 10 eligible randomised controlled trials (RCTs, n = 1530) were evaluated for reporting blood lipid outcomes following dietetic consultation (DN)—defined as at least one exclusive individual face‐to‐face consultation with a dietitian and comparators (C)—defined as no nutrition intervention or usual or minimal care provided by physicians and/or nurses.ResultsDN groups were effective for lowering blood lipid levels across nine studies reporting total cholesterol (TC) and LDL; and across five of six studies reporting triglycerides (TG). Between‐group differences were not consistently assessed, with significance levels reported in four studies all in favour of DN, P < 0.05. Meta‐analyses for TC and LDL (seven studies) confirmed DN and C groups were equally effective, P > 0.05; and for TG (six studies) DN groups were significantly more effective than C groups, P < 0.05).ConclusionsThis review provides RCT evidence that dietetic counselling is effective for lowering TG levels and at least as effective as usual and minimal care for improving cholesterol levels in high‐risk individuals in primary health care. However, more adequate reporting of methods and greater consistency in timing interventions and data collection will enhance the quality of the evidence and increase confidence in the health benefits of dietetic counselling for the management of CVD risk.

Contribution of TLR4 signaling in intermittent hypoxia-mediated atherosclerosis progression

BackgroundIntermittent hypoxia (IH), a typical character of obstructive sleep apnea (OSA), is related to atherogenesis. However, the role of IH on atherosclerosis (AS) progression and the mechanisms involved remains poorly understood.MethodsIn the present study, high-fat fed ApoE−/− mice were treated with recombinant shRNA-TLR4 lentivirus and exposed to IH. Atherosclerotic lesions on the en face aorta and cross-sections of aortic root were examined by Oil-Red O staining. The content of lipids and collagen of aortic root plaques were detected by Oil-Red O staining and Sirius red staining, respectively. The TLR4, NF-κB p65, α-SMA and MOMA-2 expression in aorta and IL-6 and TNF-α expression in the mice serum were also detected.ResultsCompared with the Sham group, the IH treated group further increased atherosclerotic plaque loads and plaque vulnerability in the aortic sinus. Along with increased TLR4 expression, enhanced NF-κB activation, inflammatory activity and aggravated dyslipidemia were observed in the IH treated group. TLR4 interference partly inhibited IH-mediated AS progression with decreased inflammation and improved cholesterol levels. Similarly, in endothelial cells, hypoxia/reoxygenation exposure has been shown to promote TLR4 expression and activation of proinflammatory TLR4/NF-κB signaling, while TLR4 interference inhibited these effects.ConclusionsWe found that the IH accelerated growth and vulnerability of atherosclerotic plaque, which probably acted by triggering the activation of proinflammatory TLR4/NF-κB signaling. These findings may suggest that IH is a risk factor for vulnerable plaque and provide a new insight into the treatment of OSA-induced AS progression.

Worksite intervention effects on motivation, physical activity, and health: A cluster randomized controlled trial

ObjectivesThe current study tested the hypothesis that a physical activity (PA) intervention in the worksite would lead to increases in autonomous motivation and perceived competence for PA, self-administered regular PA, and cardiorespiratory fitness (CRF), as well as improvements in health (i.e., reduced blood pressure (BP), waist circumference, and improved cholesterol levels). Moreover, the study tested the self-determination theory (SDT) model of health behaviour change. DesignCluster randomized controlled trial. MethodParticipants from a population of employees working within the area of transport and distribution (n = 202) were cluster randomized (n = 6 worksites) to an intervention and a control condition. The 16-week group-based worksite intervention was designed based on the tenets of SDT combined with techniques from motivational interviewing (MI). Participants were assessed at baseline and at post-test five months later. ResultsComplete-case analyses applying multivariate and univariate analysis of variance indicated an overall intervention effect, and moderate to small effect sizes (Cohen's d) in favour of the intervention group on CRF, diastolic BP, and high-density lipoprotein cholesterol (HDL-C), as well as need support for PA, autonomous motivation for PA, and perceived competence for PA. Intention-to-treat analyses demonstrated the same pattern with smaller effect sizes. Path analysis obtained a good fit between the data and the SDT model of health behaviour change. ConclusionsOffering need supportive interventions to enhance autonomous motivation and competence for PA among employees resulted in important improvements in CRF as well as positive changes in health. Trial registration“My Exercise. A Team-based Workplace Intervention for Increased Exercise”, clinicaltrials.gov, NCT02429635, April 14, 2015.

IMPACT OF SUSTAINED VIROLOGICAL RESPONSE OF VIRUS C OUTCOME ON TYPE II DIABETIC PATIENTS INSULIN RESISTANCE AND METABOLIC STATE

Background: Diabetes is one of the most prevalent non-communicable diseases throughout the world, affecting 415 million people in 2015. Hepatitis C virus (HCV) infection is widespread, affecting up to 185 million people worldwide. Interestingly, a systematic review has also shown a significant association between the presence of type 2 diabetes mellitus T2D and the risk of HCV infection. Chronic HCV is associated with hepatic and peripheral insulin resistance (IR) . Objective: Investigating the impact of SVR12 following combination of Sofosbuvir and Daclatasvir on IR and metabolic state in type 2 D.M. Patients and Methods: The study was conducted on100 patients. Patients were divided in two groups; group I, that included 30 patients who have both T2D and HCV and did not receive any anti viral drugs, and they served as a control group. Group II, which included 70 patients as a case group who have type 2 DM and HCV and received treatment for 12 weeks according to the Egyptian guidelines using Sofosbuvir and Daclatasvir, and achieved SVR12. All patients were included in the final analysis investigated by fasting and postprandial blood sugar, full lipid profil, HbA1c and microalbuminuria, HOMA- IR , fibroscan and liver enzymes . Serum HCV-RNA was tested at baseline, after 4 weeks, end of treatment, and 12 weeks after the end of treatment. Results showed that cirrhotic patients showed worse metabolic profile as FBS, PPBS, HbA1c, and Homa - IR, serum cholesterol and serum triglycerides compared to non cirrhotic ones at the start of the therapy. Following the achievement of SVR, Group II patients showed a decrease in its mean fasting blood sugar, postprandial blood sugar, HbA1c, albuminuria , Homa - IR score, cholesterol, triglycerides. Group I showed only improvement of cholesterol level. Normalization of SGOT, SGPT, serum bilirubin and serum albumin was recorded only in group II patients, while INR level showed no change from its pretreatment level in both groups. Additionally, fibroscan result improved in group II , while it increased in group I . So, the achievement of SVR in diabetic patients with CHC have a favorable outcome on IR which was more pronounced in non cirrhotic patients. Conclusion: The achievement of SVR in patients with HCV and diabetes mellitus is associated with improvement in Insulin resistance and metabolic markers. This improvement can lead to stopping of anti-diabetic treatment with additional improvement of albuminuria which reflect improvement of vascular complications of IR.