Obese Persons Research Articles

BMI, Physical Activity and Diabetes- A Case Control Study in a Rural Area of Kancheepuram district of Tamil Nadu.

AIMS & OBJECTIVES: To assess the association between physical activity, BMI and diabetes mellitus in a study population. METHODS: A community based case control study to associate BMI, physical activity, and diabetes was conducted in the rural area of Chunampet, Cheyyurtaluk of Kancheepuram district in Tamilnadu, which is under PIMS field practicing area, Rural Health Training Centre under Department of Community Medicine, Pondicherry Institute of Medical Sciences, and Chunampet. Study participants: Adult population aged 35 - 50 years of age. Sample size: 150 cases and 150 controls. Definition of cases: Known diabetics and persons with FBS> 126 mg/dl or PPBS>200mg/dl. Definition of controls: Persons who are not a known a case of Diabetes and with FBS<126 and PPBS<200. Exclusion criteria: Critically ill person and Persons with other co morbidities. Questionnaire: A pre-designed and pre-tested questionnaire was used. Details regarding their duration of disease, physical activity are collected by house to house survey. Pulse, blood pressure, height in cms, weight in kgs is recorded. Revised BMI Scale was used to grade overweight and obesity. Intensity of physical activity was graded using British Heart Association grading system. Results: The study was conducted with 150 Diabetics (Cases) and 150 Non-Diabetics (Controls). Among the 150 Diabetics (Cases), 124 were males and 26 females. And, among the 150 Non-Diabetics (Controls), 124 were males and 26 were females. Cases and controls are matched for sex and age (+/- 5 years). No physical activity was positively associated with diabetes (OR= 1.9, CI= 1.3-4.8, p value<0.05). Overweight (OR=1.7, CI=0.8-2.7, p value<0.05) and obese person (OR=2.9, CI= 1.8-4.1) had higher risk for diabetes. Conclusion: The following factors (sedentary life style, obesity) were found to associated with diabetes mellitus and found to be statistically significant (p<0.05)

Latent tuberculosis in migrants travelling through the northeast regions of Mexico

BackgroundLatent tuberculosis infection (LTBI) affects nearly a quarter of the global population. Public health interventions aimed at interrupting tuberculosis transmission do not routinely include systematic screening of migrant populations for LTBI in Mexico, nor other high-income countries. However, early detection and treatment of LTBI in immigrant populations from high-burden countries are recommended by the World Health Organization. ObjectiveThe objective of this study was to determine the proportion of migrants with LTBI in shelters in northeastern Mexico. MethodsIn this cross-sectional study, blood samples were obtained from 455 migrants living in shelters in northeastern Mexico during January 2017 to October 2019. LTBI was diagnosed using the QuantiFERON®-TB Gold Plus test. ResultsMost of the migrants evaluated in this study were from Honduras; ∼86% were male; the average age was 29 ± 10 years. LTBI was identified in 18.4% of those from Central America. Migrants from El Salvador and Nicaragua were more likely to have LTBI than those from Honduras or Guatemala. Overweight or obese persons and older persons had a higher prevalence of LTBI. We detected no significant differences with respect to LTBI when the results were compared based on gender, education, or marital status. ConclusionThe LTBI rates amongst migrants from Central America recently screened in shelters in northeastern Mexico appears to be relatively low given recent estimates of LTBI prevalence in Mexico.

Revisión sobre obesidad como factor de riesgo para mortalidad por COVID-19

Esta revisión presenta la evidencia disponible hasta el mes de junio del 2020 y trata sobre el efecto que tiene la obesidad como posible factor que aumenta la mortalidad en pacientes con diagnóstico por infección por COVID-19. La calidad de la mayoría de los estudios fue buena según la escala de Newcastle Ottawa (mayor o igual a 7/9). Los estudios reportaron seguimientos entre el 6 de febrero hasta el 17 de mayo del 2020. En pacientes con COVID-19, la obesidad fue un factor de riesgo para progresar a mortalidad. Las personas con obesidad deberían ser tratadas como una población de alto riesgo y se deben intensificar las medidas de prevención de contagio antes de la infección y proveer asistencia especializada en casos de confirmados de COVID-19.

Patterns of Regional Cerebral Blood Flow as a Function of Obesity in Adults.

Background:While obesity has been shown to be a risk factor for Alzheimer’s disease, the potential mechanisms underlying this risk may be clarified with better understanding of underlying physiology in obese persons.Objective:To identify patterns of cerebral perfusion abnormality in adults as a function of body mass index (BMI) defined weight categories, including overweight or obese status.Methods:A large psychiatric cohort of 35,442 brain scans across 17,721 adults (mean age 40.8±16.2 years, range 18–94 years) were imaged with SPECT during baseline and concentration scans, the latter done after each participant completed the Connors Continuous Performance Test II. ANOVA was done to identify patterns of perfusion abnormality in this cohort across BMI designations of underweight (BMI < 18.5), normal weight (BMI = 18.5 to 24.9), overweight (BMI 24.9 to 29.9), obesity (BMI≥30), and morbid obesity (BMI≥40). This analysis was done for 128 brain regions quantifying SPECT perfusion using the automated anatomical labeling (AAL) atlas.Results:Across adulthood, higher BMI correlated with decreased perfusion on both resting and concentration brain SPECT scans. These are seen in virtually all brain regions, including those influenced by AD pathology such as the hippocampus.Conclusion:Greater BMI is associated with cerebral perfusion decreases in both resting and concentration SPECT scans across adulthood.

The prevalence of symptoms and risk factors associated with obstructive sleep apnea among patients attending primary health centers in Erbil, Iraq

Background and objective: Although snoring and day time tiredness and are a common finding in persons with obstructed sleep apnea; however, most of them are unaware of their diseases. This study aimed to find the prevalence of sleep apnea and symptoms at the primary care level. Methods: A cross-sectional study was conducted among randomly selected 500 patients aged ≥ 18 years attending two primary care centers in Erbil city, from the 1st of April 2018 to the end of February 2019. A Berlin modified questionnaire was used to address an individual's characteristics, risk factors, and clinical symptoms. Results: The mean age + SD of 500 individuals was 41.06 + 14.79 years. Nearly all (97.2%) of the participants were living in urban areas. Around three quarters (72.2%) of the sample were married, 27.8% were smokers, 45.8% were overweight, and 18.6% were obese. The overall prevalence of obstructed sleep apnea was 23.2%, the prevalence of low-risk OSA was 22.4%, and the prevalence increased with age. Obstructed sleep apnea was more among females (26%) than males (20.8%), although the difference was not significant. A high percentage was observed among those with raised blood pressure and obese persons (87.9% and 86%, respectively). No significant association was detected between obstructed sleep apnea and smoking. Conclusion: High risk of obstructive sleep apnea was common among patients attending primary care. Awareness and education of physicians and patients about the disease is essential. Those at high risk should be referred to sleep centers for further evaluation.

Human Muscle Mass Measurement through passive Flexible UWB-Myogram Antenna sensor to diagnose Sarcopenia

Sarcopenia disease is due to low muscle mass in humans. Sarcopenia leads to osteoporosis, metabolic syndrome and difficulty in performing day-to-day activities. At present, Dual-energy X-ray Absorptiometry (DXA) measures muscle mass with few limitations. They are variations in measurements according to region under investigation, irregularities in hydration status, and low precision in tall and obese persons. These limitations are due to low dosage level of X-ray radiations in certain muscle regions of human body such as heart, head, lower and upper extremities. This paper presents a non-invasive passive flexible Ultra Wide Band (UWB) Myogram antenna sensor for the prediction of Sarcopenia through human muscle mass measurement. This antenna is adhesively fixed on ventral surface of forearm and biceps for the measurement of skeletal and lean mass respectively. The proposed antenna sensor performs electromagnetic energy absorption from muscle tissues under radiating near-field condition. The muscle tissue signal from antenna is applied to blind source filtering-Non-negative Matrix Factorization (NMF), then subjected to Multi-Synchro Squeezing Transform (MSST), and finally correlated using linear regression machine learning algorithm to diagnose Sarcopenia. Furthermore, the proposed methodology is developed as a product through the MATLAB Mobile App compatible with Android devices. The proposed method of diagnosing Sarcopenia achieves an accuracy of 85% in fifty samples.

Correlation between adipocytokine profile and heart rate variability in patients with obesity

Objective. The high prevalence of obesity in employable population dictates the necessity for preclinical diagnosis of diseases associated with it, including the study of the autonomic regulation of heart rhythm. The objective was to study the correlations between the adipocytokine profile and heart rate variability in patients with obesity.&#x0D; Materials and methods. 300 persons were examined, the average age was 46.2 6.4 years; Group 1 was metabolically unhealthy obesity phenotype (MUHOP) 90 patients; group 2 was obesity without metabolic disorders [Ob(+)MD(-)] (MHOP) 50 persons; the control group consisted of 100 healthy respondents. We studied the following indices: blood serum adipocytokines: leptin, insulin, resistin, adiponectin. Heart rate variability was studied using Poly-Spectrum Rhythm 2012 computer electrocardiograph.&#x0D; Results. In the course of the study, decrease in the total heart rate variability and reactivity of the parasympathetic part of the autonomic nervous system in patients from MUHOP group was found, while there were no differences with the control in the MHOP group. It was established that a decrease in the parasympathetic effect on the regulation of heart rhythm is associated with the presence of abdominal obesity, insulin resistance, and an increase in the level of TG, glucose, resistin, and uric acid.&#x0D; Conclusions. The received relationships between indicators of carbohydrate and lipid metabolism, the level of uric acid and adipocytokines with temporal and spectral characteristics of the autonomic nervous system confirm their contribution to the development of autonomic dysfunction in obese persons.

Can reduction in infection and mortality rates from coronavirus be explained by an obesity survival paradox? An analysis at the US statewide level.

Coronavirus disease 2019 (COVID-19) is a declared global pandemic with multiple risk factors. Based on recent empirical studies, obesity is considered by several researchers as one of the serious risk factors for coronavirus-related complications. Yet, other scholars argue in favor of the existence of an obesity survival paradox. The objective of the current study is to analyze the potential relationships between different corona indicators and obesity on a statewide level. Since the United States is ranked as one of the OECD countries with a high level of overweight and obesity among its citizens—the majority of US states exceed the 30% benchmark of obese population—it is an especially interesting case study to explore this issue. In an attempt to estimate projected probabilities for infection by coronavirus and mortality rates as a function of obesity prevalence, the fractional logit regression is employed. Findings may support the counter-intuitive possibility of an obesity survival paradox. Consequently, ethical guidelines referring to priority in intubation and intensive care treatments should account for these complex relationships between obesity and corona. Both projected rates of infection and mortality drop with elevated prevalence of obesity. The reasons for these findings might be explained by several conditions such as elevated social distancing from more obese persons, increased metabolic reserves, more aggressive treatment, and unidentified factors that should be examined in future research.

Risk groups for multiple vitamin and mineral deficiencies in the population

Lack of several vitamins, calcium, magnesium, zinc, iodine and other minerals in the diet now is typical for the majority of the adult and childrens population of Russia, regardless of where they live, throughout the year. In addition, population groups that are additionally at risk of developing micronutrient deficiencies exist. Children 23 years old when switching to food from a common table, early puberty, pregnant and lactating women, persons with food intolerances and allergies, persons on elimination diets (vegetarians, vegans, etc.), or enriching the diet with dietary fiber, obese persons (reduced by caloric content of the diet), persons with gastrointestinal diseases (sparing diets, persons receiving drug therapy, persons with increased physical and psycho-emotional stress, the elderly, persons observing long-term religious fasts, athletes controlling body weight are among them. The role of each micronutrient depends on the sufficiency of the body with other micronutrients involved in the metabolism or necessary for the realization of the final function in the body. A recognized and scientifically grounded way to improve micronutrient status is the enrichment of the diet with vitamins and minerals. In the absence of mandatory fortification of mass-market foods the use of vitamin and mineral supplements is a great idea. The selection criterion is a complete set of vitamins and microelements, the deficiency of which is characteristic for a particular group of the population, and in doses close to the physiological needs of the body.

Erickson Solution-Focused Health Coaching: an Innovative Approach for Sustainable Nutrition

Abstract Background Overweight and obesity have become an epidemic and a significant public health challenge. Apart from genetics, every obesogenic factor is modifiable and therefore, it is personal behaviors that play a dominant role in obesity prevention and management. Also, in a current climate emergency, each individual's behavior including food preferences and nutrition needs to be viewed from the global perspective. Previously, we examined Erickson solution-focused health coaching as a behavioral intervention supporting the adherence to healthy nutrition and exercise. Currently, we incorporated the 'ecology' aspect to our model. By applying Erickson ecology health coaching worldwide, we aim to support sustainable nutrition resulting in obesity prevention and management. To that effect, we established the Erickson Coaching for Health World Game (ECOHEALTH WG) project. Methods The ECOHEALTH WG involves research activities, health coach training, health education including ecological nutrition, and individual or group health coaching. Results Our research investigation assessed the impact of Erickson health coaching on the adherence to sustainable nutrition, anthropometry and body composition in overweight and obese persons with sleep apnea. The mean weight loss was 5.2±1.0% and 77% of participants achieved a target reduction of &amp;gt; 3%, in association with the sustained shift to plant-based food preferences. Moreover, health coach training was conducted in Austria, China, Slovakia, and Turkey. In the coming months, we project conducting health coach training in multiple countries around the Globe. Conclusions The ECOHEALTH WG project represents a unique opportunity to assist people to adhere to sustainable nutrition worldwide, with beneficial effects on the environment. A partnership between health coaches and healthcare providers has major potential to support healthy food choices and sustainable nutrition worldwide.

The Association of Sleep Disorders, Obesity and Sleep-Related Hypoxia with Cancer.

BackgroundSleep disorders have emerged as potential cancer risk factors.Objective This review discusses the relationships between sleep, obesity, and breathing disorders with concomitant risks of developing cancer.ResultsSleep disorders result in abnormal expression of clock genes, decreased immunity, and melatonin release disruption. Therefore, these disorders may contribute to cancer development. Moreover, in sleep breathing disorder, which is frequently experienced by obese persons, the sufferer experiences intermittent hypoxia that may stimulate cancer cell proliferation.DiscussionDuring short- or long- duration sleep, sleep-wake rhythm disruption may occur. Insomnia and obstructive sleep apnea increase cancer risks. In short sleepers, an increased risk of stomach cancer, esophageal squamous cell cancer, and breast cancer was observed. Among long sleepers (>9 hours), the risk of some hematologic malignancies is elevated.ConclusionSeveral factors including insomnia, circadian disruption, obesity, and intermittent hypoxia in obstructive sleep apnea are contributing risk factors for increased risk of several types of cancers. However, further studies are needed to determine the more significant of these risk factors and their interactions.

Effect of Fasting Therapy and Low-Calorie Diet on Anthropometric and Serum Lipids in Obese Females

Background: Preclinical and clinical studies have shown the importance of calorie restriction diet in weight reduction and cardiovascular risk factors. In this study, our objective is to compare the naturopathic-based short-term fasting therapy with low-calorie diet (LCD) on anthropometric and lipid profile among obese and overweight persons. A total number of subjects (n = 100) with body mass index (BMI) ≥25 were randomly allocated into either fasting therapy intervention (n = 48) or a LCD (n = 52). Materials and Methods: Participants underwent very LCD (288–904 kcal) in fasting therapy and a LCD (1234 kcal) in the other group respectively for 10 days. Individuals in both the groups were assessed with anthropometric parameters such as BMI, weight, waist circumference, hip circumference and waist-hip ratio, serum lipid profile, and serum leptin levels at the baseline and after 10 days. Results: The anthropometric measurements were decreased significantly in the fasting group when compared with the LCD group (P &lt; 0.05). The decrease in mean serum total cholesterol (TC) (−27.43%), triglycerides (TGs) (−13.05%), and low-density lipoprotein (LDL) (−20.9%) in the treated group were statistically significant (P &lt; 0.001), whereas serum high density lipoprotein (2.32%) was increased but insignificantly (P &gt; 0.001) when compared with the nontreated group. Conclusions: Our findings support that short-term fasting therapy is beneficial in anthropometric measures and reducing leptin level among obese or overweight person compared to LCD. However, long-term adherence of weight loss with these interventions should be tested in future studies with bigger sample size.

Serum B-type natriuretic peptide does not increase with higher systolic blood pressure in obese men despite evidence of blood pressure-related increases in left ventricular mass and filling pressure

B-type natriuretic peptide (BNP) is a cardiac hormone secreted predominantly from the ventricles in response to increased ventricular pressure. Along this line, hypertensive patients with left ventricular hypertrophy typically have high circulating BNP concentrations. BNP has natriuretic and vasodilatory actions. Obese persons have low circulating BNP concentrations, and a relative lack of this natriuretic and vasodilatory factor could contribute to obesity-related hypertension. The relationship between BNP, BP, left ventricular mass (LVM), and left ventricular filling pressure among obese persons is not clear. To address this issue, we studied 98 healthy obese medication-free men with normal left ventricular ejection fraction. We measured BP using 24 -h ambulatory (A) BP recordings, LVM and E/e', an estimate of left ventricular filling pressure, using echocardiography, and fasting BNP in serum. Mean systolic ABP ± SD was 114 ± 4 mm Hg in 1st and 149 ± 8 mm Hg in 4th systolic ABP quartile, P < 0.001. LVM and E/e' increased across systolic ABP quartiles (mean LVM±SD: 81.5±13.7 g/m2 in 1st and 100.1 ± 26.7 g/m2 in 4th quartile, P = 0.018; mean E/e'±SD: 5.3±1.6 in 1st and 7.0 ± 2.0 in 4th quartile, P = 0.002). In contrast, serum BNP did not increase across systolic ABP quartiles (median (IQR): 6.7 (3.1-12.3) pg/ml in 1st and 5.3 (2.8-9.7) pg/ml in 4th quartile, P = 0.75). Unexpectedly, among healthy obese medication-free men, serum BNP does not increase with higher systolic ABP despite evidence of BP-related increases in LVM and E/e'. This further suggests that a relatively low amount of circulating BNP could contribute to obesity-related hypertension in its early stages.

Effect of body weight on static and dynamic posturography

BackgroundPostural balance is important to allow us to maintain the daily life. Poor postural response and reduced motor activity were shown to be most prominent among obese persons than in non-obese. It is found that obese elderly groups show a high prevalence of fall and supposed that adipose tissue distribution may be considered as a major factor to balance problems. In this research, we studied computerized dynamic posturography (CDP) static and dynamic tests among healthy adults according to their BMI classification (underweight/normal weight/overweight/obese).ResultsWe found a significant difference between studied groups among the different scores recorded from sensory organization test and rhythmic weight shift test, which means the presence of an effect of increased body mass index on the different sensory systems required to maintain balance control and the motor strategy used to maintain balance. In obese elderly subjects, there was increased reliance on vestibular system to maintaining balance. With increasing BMI, there was decrease in visual dependence in maintaining balance.ConclusionsIncreased body weight affects the balance function of the normal individual. Computerized dynamic posturography is a good test to study static and dynamic status among obese subjects. So we found a positive relation between aging, BMI, and postural control.

Obesity

Obesity and its associated disorders are leading causes of morbidity and premature mortality around the world. Obese persons are also vulnerable to low self-esteem and depression because of the psychological and social stigmata that often accompany being overweight. Despite conventional wisdom that obesity results from deficient self-control, research has provided insight into the physiology behind unwanted weight gain. Obesity is recognized as a chronic condition resulting from an interaction between environmental influences and an individual’s genetic predisposition. This review contains 3 figures, 13 tables, and 126 references. Keywords: Obesity, Body mass index, Hypertension, impaired glucose tolerance or diabetes, hyperlipidemia, heart disease, pulmonary disease, gastroesophageal reflux, sleep apnea

A CLINICAL STUDY ON THE MANAGEMENT OF STHAULYA BY TRIKATU CHURNA

Sthaulya / Atisthaulya in Ayurveda comes under the heading of Medoroga which results due to dysfunc-tion of Meda Dhatvagni (factor responsible for nourishment / metabolism of Meda dhatu) and in modern parlance it is equated with Obesity due to its close similarities. It is the main cause for so many complica-tions like Hypertension, Diabetes mellitus, Osteoarthritis, Infertility, Impotency etc. as well as psychologi-cal disturbances like anxiety, depression etc. Thus, the mortality and morbidity rate were high in obese per-sons compared to others. This shows the importance of the need for further researches of effective measures in the management of Sthaulya. Hence in the present study a clinical trial was carried out with Trikatu Churna in the management of Sthaulya (obesity) for 30 days. 30 patients were selected with diag-nosis of Sthaulya out of which 24 completed the treatment. The study concluded with the positive results of Trikatu churna in reducing the signs and symptoms of Sthaulya.

Commentary: COVID-19 and Obesity: Exploring Biologic Vulnerabilities, Structural Disparities, and Weight Stigma

commentary: COVID-19 and Obesity: Exploring Biologic Vulnerabilities, Structural Disparities, and Weight Stigma

Nonalcoholic Fatty Liver Disease Risk Factors Affect Liver-Related Outcomes After Direct-Acting Antiviral Treatment for Hepatitis C.

In hepatitis C (HCV) patients, obesity and/or diabetes may increase the risk of liver-related outcomes. We aimed to determine whether diabetes and/or obesity are associated with adverse outcomes in direct-acting antiviral (DAA)-treated HCV patients. We conducted a retrospective study of 33,003 HCV-infected, DAA-treated Veterans between 2013 and 2015. Body mass index was used to categorize patients into underweight (< 18.5kg/m2), normal weight (18.5 to < 25kg/m2), overweight (25 to < 30kg/m2), obesity I (30 to < 35kg/m2), and obesity II-III (> 35kg/m2). Diabetes was defined by ICD-9/10 codes in association with hemoglobin A1c > 6.5% or medication prescriptions. Patients were followed from 180days post-DAA initiation until 2/14/2019 to assess for development of cirrhosis, decompensations, hepatocellular carcinoma (HCC), and death. Multivariable Cox proportional hazards regression models were used to determine the association between diabetes and/or obesity and outcomes. During a mean follow-up of 3years, 10.1% patients died, 5.0% were newly diagnosed with cirrhosis, 4.7% had a decompensation and 4.0% developed HCC. Diabetes was associated with an increased risk of mortality (AHR = 1.25, 95% CI 1.10-1.42), cirrhosis (AHR = 1.31, 95% CI 1.16-1.48), decompensation (AHR = 1.74, 95% CI 1.31-2.31), and HCC (AHR = 1.32, 95% CI 1.01-1.72) among patients without baseline cirrhosis. Compared to normal-weight persons, obese persons had a higher risk of cirrhosis, but overweight and obese persons had lower risk of mortality and HCC. In this large DAA-treated Veterans cohort, pre-DAA diabetes increases mortality and liver-related events independent of SVR. Continued vigilance is warranted in patients with diabetes despite SVR. Elevated BMI categories appear to have improved outcomes, although further studies are needed to understand those associations.

Gravicentric approach to Type 2 Diabetes therapy. &#x0D; The success prediction. A proof-of-concept

This study is the proof-of-concept of our "Gravicentric" theory. This concept is based on several fundamental points: obesity as the main foe; rapid reversibility of the disease; as well as a new perspective on the roles different pharmacological classes play in general, and the role of insulin and GLP-1 analogs, in particular. The paper presents and discusses our experience of the implementation of insulin and GLP-1 analogs. The possibility of "insulin weaning"; the therapeutic approach for over-treated patients; and physiological dosing of insulin is also discussed therein.&#x0D; Objectives&#x0D; Primary: To evaluate the long-term efficacy of GLP-1 analogs in insulin-treated Type 2 Diabetes Mellitus (T2DM) patients.&#x0D; Secondary: To analyze which patient would most likely benefit from this combined treatment.&#x0D; Methods&#x0D; In 54 T2DM patients with a mean disease duration of 17.5 years and a mean extent of insulin therapy of 4.5 years, additional GLP-1 analogs therapy was prescribed. Mean duration of GLP-1 treatment was 25.8 months (2.15 years).&#x0D; During the intervention, clinical, biochemical, and anthropometric parameters were analyzed. Compliance, Hypoglycemia and Metabolic Index (MI) assessments were implemented.&#x0D; Results&#x0D; Mean Glycated hemoglobin (HbA1C) decreased from 9.28 1.43 to 8.54 1.4% on GLP-1 analogs, p 0.01. Total Daily dose of Insulin (TDI) showed considerable reduction: 80.6 42.7 U/day before starting GLP-1 vs.41.0 30.7 U/day on GLP-1, p 0.01. These changes were directly linked to weight loss: BMI has dropped from 35.1 4.8 kg/cm2 before, to 32.8 5.0 kg/cm2 on GLP-1 analogs, with patients losing 6.7 kg on average. Moreover, 13 (24%) participants discontinued at least one kind of insulin, while 7 (13%) stopped taking insulin completely, with simultaneous improvement in diabetes control. No clinically significant hypoglycemia was observed.&#x0D; Post-hoc, the participants were categorized according to each patients ability to reduce TDI by more than 20 U/day, and then split into two groups. Group A 34 patients (64.2%) who successfully reduced TDI; Group B 19 patients (35.8%) who failed to do so. The comparison of the two groups showed the following:&#x0D; &#x0D; Significantly larger virtually twice as large baseline TDI in Group A (97.440.4 U/day vs. 52.231.0 U/day), p 0.001.&#x0D; Very effective BMI reduction (BMI 3.3 2.4 kg/cm2 0.9 1.2 kg/cm2, p 0.001) and much better compliance (1.4 1.1 vs. 2.2 1.0, p 0.02) in Group A.&#x0D; A considerable decline of insulin requirements in group A, on GLP-1 therapy (TDI on GLP-1 was -62.4 31.9 U/day) with no TDI reduction in Group B (TDI on GLP-1 was +0.03 14.1 U/day, p 0.001).&#x0D; &#x0D; Thus, in spite of the fact that on GLP1 therapy HbA1C has declined to the same levels in both groups, patients from group A became much leaner and metabolically healthier.&#x0D; We suggest overtreatment as the critical factor of obesity in Group A.&#x0D; Conclusions&#x0D; Adding GLP-1 analogs to insulin in poorly controlled, insulin-treated T2DM patients resulted in an impressive weight (BMI) reduction with significant improvements in glucose control. This provided for a further decline in insulin resistance and insulin requirements. We suggest that the best candidate for successful GLP-1 analogs therapy is an obese, overtreated and compliant T2DM person. Changes in Metabolic Index (MI) rather than surrogate glycemic parameters (HbA1C) are better predictors of a successful T2DM therapy. Neither the duration of diabetes nor the length of insulin therapy in the past is likely to have a critical role in predicting success. These findings are proof-of-concept of our Gravicentric theory in T2DM.

Weight Reduction for Obesity-Induced Heart Failure with Preserved Ejection Fraction.

Heart failure with preserved ejection fraction mainly affects the elderly. The obesity phenotype of heart failure with preserved ejection fraction reflects the coexistence of two highly prevalent conditions in the elderly. Obesity may also lead to heart failure with preserved ejection fraction in middle-aged persons, especially in African American women. Obesity is twice as common in middle-aged than in elderly persons with heart failure with preserved ejection fraction. Obese middle-aged persons with heart failure with preserved ejection fraction are less likely to be Caucasian and to have atrial fibrillation or chronic kidney disease as comorbidities than elderly patients with heart failure with preserved ejection fraction. Obesity-associated low-grade systemic inflammation may induce/heighten inflammatory activation of the coronary microvascular endothelium, leading to cardiomyocyte hypertrophy/ stiffness, myocardial fibrosis, and left ventricular diastolic dysfunction. Both substantial weight reduction with bariatric surgery and lesser levels of weight reduction with caloric restriction are promising therapeutic approaches to obesity-induced heart failure with preserved ejection fraction.