Percentage Of Body Weight Loss Research Articles

Telehealth-Based Health Coaching Produces Significant Weight Loss over 12 Months in a Usual Care Setting

Background: Telehealth-based health coaching in a usual care setting has yet to be examined. The purpose of this study was to incorporate the inHealth Lifestyle Therapeutics, Inc.’s Telehealth Enabled Approach to Multidisciplinary Care (TEAM) method within a real-world routine clinical care setting to reduce body weight in obese participants. Materials and Methods: n = 70 participants were recruited for this intervention (Age: 58.1 ± 14.6yrs, BMI: 35.5 ± 7.8 kg/m2, 32 males and 38 females). All participants self-selected participation in either the virtual health coaching (VHC) group or usual care (UC) group. VHC participants met with a medical doctor monthly and a certified health coach weekly for the first 12 weeks of the study, bi-weekly for the following 12 weeks, and monthly for the remaining 6 months. Data were analyzed using a two-sample student’s t-test to assess any changes from baseline for both VHC and UC groups. Results: A significant difference for weight-loss between VHC and UC groups (8.24 ± 9.8 vs. 0.16 ± 10.6 kg, respectively, p < 0.05) was observed. In addition, there was a significant change in the mean percentage of body weight loss (6.5 ± 0.1% vs. 0.53 ± 1.45%, respectively, p < 0.05) between groups. Conclusions: Incorporating innovative deliveries that are scalable, such as telehealth-based interventions, may help stem the tide of patient obesity related care. Furthermore, using a TEAM method in a usual care setting may be effective for inducing sustained weight loss at 12 months.

Transcriptomic Differences Between Monozygotic Adolescent Twins Discordant For Metabolic Syndrome Following Weight Loss: A Case Study.

This case reports peripheral blood mononuclear cell (PBMC) transcriptomic changes in a pair of male monozygotic pediatric twins with metabolic syndrome (MetS) undertaking assisted weight loss. These 14-year-old boys presented with similar baseline biochemistry and body composition. After a 16-week weight-loss intervention, percent body weight loss was similar (Twin A 12%, and Twin B 13%). MetS resolved in Twin A but Twin B maintained elevated triglycerides after weight loss. Analysis of the PBMC transcriptome before and after weight loss revealed very different changes in gene expression including differences in the direction of expression of genes related to immune cell activation. 48.7% of genes that were downregulated in Twin A were upregulated in Twin B. This case highlights a novel approach to report the influence of chronic low-grade inflammation and metabolic dysfunction on the PBMC transcriptome. It explores whether expression of genes related to immune functions may underlie the differences in response to weight loss or whether transcriptomic alterations in immune cells may precede more traditional biomarkers of chronic pro-inflammation. These monozygotic twins present an example of divergence of phenotypic outcomes despite identical genetic background and similar treatment response.

Effect of Patient-Participation Continuous Nutritional Counseling in Gastric Cancer Patients who Underwent Gastrectomy.

Body weight loss (BWL) and skeletal muscle loss (SML) are inevitable after gastrectomy for gastric cancer (GC) and can decrease patients' quality of life (QOL) and survival. The aim of this retrospective study was to evaluate the effect of perioperative and post-discharge patient participation in continuous nutritional counseling (CNC) on post-gastrectomy BWL and SML. Ninety-three patients with GC who underwent curative gastrectomy between March 2018 and July 2019 were analyzed. Patients received either pre-discharge nutritional counseling alone (control group, n = 49) or patient-participation CNC (CNC group, n = 44) after gastrectomy. Differences between percentage BWL (%BWL), percentage SML (%SML), and nutrition-related blood parameters between the preoperative values and those at 12 months after surgery were compared between the groups. Compared with the control group, %BWL was significantly lower in the CNC group at 1 month (-6.2 ± 2.5% vs. -7.9 ± 3.3%, p = 0.005), 6 months (-7.8 ± 6.6% vs. -12.3 ± 6.4%, p = 0.001) and 12 months (-7.9 ± 7.6% vs. -13.2 ± 8.2%, p = 0.002), and %SML was significantly lower in the CNC group at 12 months (-5.3 ± 10.3% vs. -12.8 ± 12%, p = 0.002). Regarding nutrition-related blood parameters, change in total cholesterol was significantly lower in the CNC group than the control group at 12 months after surgery (p = 0.02). Multivariate analysis identified no CNC as an independent risk factor for severe BWL (p = 0.001) and SML (p = 0.006) at 12 months after surgery. Following gastrectomy, patient-participation CNC prevented postoperative BWL and SML after surgery. These results support the induction of such a CNC program in these patients.

Predicting Hydration Status Using Machine Learning Models From Physiological and Sweat Biomarkers During Endurance Exercise: A Single Case Study.

Improper hydration routines can reduce athletic performance. Recent studies show that data from noninvasive biomarker recordings can help to evaluate the hydration status of subjects during endurance exercise. These studies are usually carried out on multiple subjects. In this work, we present the first study on predicting hydration status using machine learning models from single-subject experiments, which involve 32 exercise sessions of constant moderate intensity performed with and without fluid intake. During exercise, we measured four noninvasive physiological and sweat biomarkers including heart rate, core temperature, sweat sodium concentration, and whole-body sweat rate. Sweat sodium concentration was measured from six body regions using absorbent patches. We used three machine learning models to determine the percentage of body weight loss as an indicator of dehydration with these biomarkers and compared the prediction accuracy. The results on this single subject show that these models gave similar mean absolute errors, while in general the nonlinear models slightly outperformed the linear model in most of the experiments. The prediction accuracy of using the whole-body sweat rate or heart rate was higher than using core temperature or sweat sodium concentration. In addition, the model trained on the sweat sodium concentration collected from the arms gave slightly better accuracy than from the other five body regions. This exploratory work paves the way for the use of these machine learning models to develop personalized health monitoring together with emerging, noninvasive wearable sensor devices.

P1312: FORODESINE AMPLIFIES HOST INNATE IMMUNE RESPONSE THROUGH TOLL-LIKE RECEPTOR 7 ACTIVATION WHILE PREVENTING EXPERIMENTAL GRAFT-VERSUS-HOST DISEASE

Background: Forodesine, a novel inhibitor of purine nucleoside phosphorylase (PNP), causes nucleotide pool imbalances by accumulating intracellular deoxyguanosine, thereby resulting in selective apoptosis of T-cells. Recent evidence indicates that specific types of nuclear acids including guanosine and its derivatives act as natural ligands for toll-like receptor 7 (TLR7). So far, it is unclear whether and how forodesine can modulate host innate immunity, including antigen-presenting cells (APCs) such as macrophages and dendritic cells (DCs), which express TLR7 abundantly. Aims: The aim of this study is to investigate the role of forodesine in host APC function as well as donor T-cell activation both in vivo graft-versus-host disease (GVHD) models and in vitro cell assays. Methods: NOG mice were subjected to 250 cGy total body irradiation followed by intravenous injection of human isolated T-cells. Mice were treated with forodesine (20 mg/kg) or vehicle daily after transplantation. Results: Despite the mice without treatment developing severe GVHD after transplantation, guanosine and deoxyguanosine were hardly detected in the plasma, suggesting that purine nucleosides released from damaged tissues were rapidly degraded by PNP. In fact, inhibition of PNP activity by forodesine markedly increased plasma guanosine levels, whereas deoxyguanosine was still undetectable. This was also the case in GVHD target organs, including liver and lungs. At the same level of guanosine in the liver, forodesine promoted TNF-a production from in vitro alveolar macrophage cultures. Preincubation with a TLR7 antagonist, ODN20958, attenuated the TNF-a production from macrophages stimulated by guanosine and forodesine. Nuclease treatment did not reduce macrophage TNF-a production, suggesting that single-strand RNA, a well-known TLR7 ligand, is not involved in this response. Similar results were observed in Flt3-ligand-induced plasmacytoid DCs. Not only TNF-a but also IL-12 production was induced by the combination of guanosine and forodesine, and was comparable to that in pDCs pulsed with R848, a potent agonist of TLR7/8. These observations suggest that a sustained high level of guanosine caused by forodesine treatment lead to continuous activation of TLR7 signaling, resulting in cytokine production from APCs. Meanwhile, as reported previously, forodesine inhibited the proliferation of human T-cells activated with CD3 and CD28 antibodies in the presence of deoxyguanosine. Of note, however, this combination did not impair but rather stimulated IFN-g production from activated T-cells cocultured with pDCs. This suggests that T-cell priming capacity mediated by the interaction with pDCs is conserved through TLR7 activation. Finally, we investigated the in vivo effects of forodesine on survival, body weight change, and disease severity of GVHD mice. Forodesine treatment significantly prolonged survival of the mice compared with control mice, with a median survival of 17.5 days vs 14 days, respectively (p = 0.029). The mean body weight loss percentage at day 9 was 11.5% vs 19.0% in the forodesine group and control, respectively (p = 0.003). Furthermore, the clinical GVHD scores were also lower in the forodesine group vs control (4.9 vs 0.6 points, p = 0.001). Image:Summary/Conclusion: This study demonstrates that forodesine amplifies host innate immune response through TLR7 signaling, while ameliorating T-cell GVH reaction. Further studies are needed to investigate whether forodesine can provide host protection against infections in a transplant setting.

Serum Ketone Levels May Correspond with Preoperative Body Weight Loss in Patients Undergoing Elective Surgery: A Single-Center, Prospective, Observational Feasibility Study.

Although nutritional-risk scoring systems allow the determination of the patient’s malnutrition at admission, additional tools might be useful in some clinical scenarios. Previous medical history could be unavailable in unconscious or demented patients. This study aimed to assess the ketone bodies serum levels in patients undergoing elective surgeries and to determine the possible correlation between ketone bodies serum levels and preoperative body weight loss. The study included 21 patients who underwent elective surgery. Hyperketonemia, defined as ketone bodies over 1 mmol/L, was observed in seven (33.3%) patients. Patients with hyperketonemia had significantly higher preoperative percentage body weight loss (p = 0.04) and higher nutritional risk scores prior to surgery (p = 0.04). Serum glucose and the percentage of body weight loss were associated with increased ketone bodies serum levels (Odds Ratios: 0.978 (0.961–0.996, p = 0.019) and 1.222 (1.0–1.492, p = 0.05), respectively). A significant linear correlation was found between the percentage of body weight loss and both ketones bodies (r2 = 0.25, p = 0.02) and albumin serum levels (r2 = 0.19, p = 0.04). Our study’s results might suggest a positive association between preoperative body weight loss and ketone bodies serum levels. The observation between increased ketone bodies serum levels in patients and preoperative body mass loss merits further research.

Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial

OBJECTIVETo determine whether silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) or laparoscopic sleeve gastrectomy (LSG) produces superior diabetes remission at 5 years.RESEARCH DESIGN AND METHODSIn a single-center, double-blind trial, 114 adults with type 2 diabetes and BMI 35–65 kg/m2 were randomly assigned to SR-LRYGB or LSG (1:1; stratified by age-group, BMI group, ethnicity, diabetes duration, and insulin therapy) using a web-based service. Diabetes and other metabolic medications were adjusted according to a prespecified protocol. The primary outcome was diabetes remission assessed at 5 years, defined by HbA1c <6% (42 mmol/mol) without glucose-lowering medications. Secondary outcomes included changes in weight, cardiometabolic risk factors, quality of life, and adverse events.RESULTSDiabetes remission after SR-LRYGB versus LSG occurred in 25 (47%) of 53 vs. 18 (33%) of 55 patients (adjusted odds ratios 4.5 [95% CI 1.6, 15.5; P = 0.009] and 4.2 [1.3, 13.4; P = 0.015] in the intention-to-treat analysis). Percent body weight loss was greater after SR-LRYGB than after LSG (absolute difference 10.7%; 95% CI 7.3, 14.0; P < 0.001). Improvements in cardiometabolic risk factors were similar, but HDL cholesterol increased more after SR-LRYGB. Early and late complications were similar in both groups. General health and physical functioning improved after both types of surgery, with greater improvement in physical functioning after SR-LRYGB. People of Māori or Pacific ethnicity (26%) had lower incidence of diabetes remission than those of New Zealand European or other ethnicities (2 of 25 vs. 41 of 83; P < 0.001).CONCLUSIONSSR-LRYGB provided superior diabetes remission and weight loss compared with LSG at 5 years, with similar low risks of complications.

Abstract TP233: Activation Of Alpha 7 Nicotinic Acetylcholine Receptor Protects The Ischemic Brain Via Reductions In Jak2/stat3 Signaling In Mice.

Introduction: The alpha7 nicotinic acetylcholine receptor (α7nAChR) is the principal mediator of the cholinergic anti-inflammatory pathway (CAP). CAP is mediated through several signaling pathways, including the JAK2/ STAT3 pathway. Studies have shown decrease in brain α7nAChR and increase in phosphorylation (p) of JAK2 and STAT3 expression after stroke. Increase JAK2/STAT3 signaling induces expression of high mobility group box 1 (HMGB1) and receptor for advanced glycation end products (RAGE), which promotes release of cytokines. Pharmacological activation of α7nAChR reduced microglial activation and inflammatory cytokines and improved functional outcomes after experimental stroke. However, little is known about how the activation of α7nAChR modulates JAK2/STAT3 signaling after stroke. Hypothesis: We hypothesized α7nAChR activation by PNU120596 (PNU), an allosteric modulator will decrease JAK2/STAT3 signaling and improve neurological deficits (ND) after stroke. Methods: Young (8-12 weeks, n=5-6) male mice underwent 60-minute middle cerebral artery occlusion (MCAo) or sham surgery and euthanized at 24 hours. In second cohort (n=5-6), PNU or vehicle was administered for 3 consecutive days. One hour after the last injection, MCAo or sham surgery was done. Twenty-four hours after MCAo, body weight, ND scores were recorded and brains harvested for western blotting. Brain α7nAChR, pSTAT3, HMGB1 and RAGE expression was determined. Results: At 24 hours after MCAo, the brain expression of α7nAChR decreased (p=0.006) while pSTAT3 expression increased (p=0.001) as compared to sham. PNU treatment prevented a decrease in α7nAChR expression in the brain (p=0.017) and decreased pSTAT3 expression (p=0.005) compared to the vehicle group after MCAo. No difference in the HMGB1 expression was seen between groups. An increase in RAGE expression was observed in vehicle MCAo (p=0.006) compared to sham. A decline (p=0.08) in RAGE expression in PNU MCAo compared to vehicle MCAo was observed. NDS and percent body weight loss were lower in the PNU MCAo compared to vehicle MCAo. Conclusions: Activation of α7nAChR downregulated inflammatory JAK2/STAT3-HMGB1/RAGE signaling and may be a druggable target to improve recovery after stroke.

Potential serum protein biomarkers of cancer cachexia, muscle atrophy, and survival in pancreatic ductal adenocarcinoma.

545 Background: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of death in the United States. Treatment is difficult and often complicated by the presence of cachexia, a systemic wasting condition affecting most PDAC patients at diagnosis. Skeletal muscle atrophy is a hallmark of cachexia and predicts outcomes after surgery and chemotherapy. In this study, we sought to identify possible serum biomarkers of cachexia, which correlates with changes to lean body mass and survival, using an aptamer-based platform in patients with PDAC. We hypothesize that unique proteins associate with cachexia and survival measures. Methods: Using SomaScan we measured the serum levels of 4,006 proteins in 21 patients with PDAC undergoing curative surgery. Clinical data and anthropometric measurements derived from pre-operative CT imaging were compared to protein levels with Spearman correlational analyses and logistic regression. We then queried DAVID Bioinformatics database to identify enriched functional protein categories. Results: Mean age was 66.9 ± 8.91 years, and mean body-weight loss in the six months preceding diagnosis was 12.6 ± 8.80%. Using consensus guidelines considering percent weight loss and skeletal muscle mass and radiation attenuation, 10 subjects (46.7%) were defined as “cachectic.” We found 241 proteins significantly correlated to Cancer Weight Loss Grade (a composite measure of percent body weight loss and body mass index). High IDUA, CTLA4 and USE1, in particular, predicted the worst weight loss grade with 75% sensitivity and 92% specificity (AUC = 0.8894, odds ratio: 36, p = 0.0068). Four additional proteins significantly correlated with skeletal muscle index (CK-MM, CK-MB, PCOC2 and ADH4) while 13 proteins significantly correlated with muscle radiation attenuation. Lastly, we identified 18 proteins that significantly correlated with survival quartile. Of these, we found that elevated HS6ST2 and DEPP significantly predicted early recurrence and death compared to those with lower levels (medial survival: 177 days v. 850 days, p = 0.0049). Of the correlative proteins, enriched gene ontology terms included signal peptide (28.2), cytokine (6.86), negative regulation of endopeptidase activity (3.39), and immunoglobulin domain (3.24). Conclusions: Cancer cachexia in PDAC and various gastrointestinal malignancies remains a key clinical issue. While there are no definitive biomarkers currently in use to diagnose and manage cachexia preemptively, we present several potential candidates in a small cohort of patients. Ultimately, such assays may better elucidate common cachexia-inducing pathways, a shared spectrum of biomarkers and allow for the development of more specific therapies targeting cachexia.

Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program

BackgroundAlthough there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change.MethodsA retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download.ResultsOf the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997).ConclusionsThis multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.

Egg Production and Biological Activities in Laying Hens are Affected By Different Molting Programs

This study was conducted to compare two molting methods by using aluminum sulfate (2.5 g/kg) and diet withdrawal on productivity, eggs quality, and lipid profile of laying hens. A total of 180 Hy-line Brown hens 80 weeks of age were randomly assigned to three replicates of three treatments of 30 hens/treatment from 70–87 weeks of age; hens were exposed to one of the following two molt groups: T1, aluminum sulfate (2.5 g/kg) and T2, feed withdrawal(14 days). Egg production was recorded daily/hen in each cage and weekly for each treatment. Following the forced molting, feed consumption was recorded and calculated weekly. Feed conversion rate as a feed/g egg mass was calculated weekly for each treatment. Haugh unit was determined by [11]. At the end of the experiment blood samples were collected from nine laying hens/treatment from the extrinsic vein using a 5mL sterilized syringe with heparin for biochemical determination parameters. Blood samples were centrifuged at 4000rpm for ten minutes. Plasma and serum were separated and stored (- 20°C) until the biochemical measurement. Cholesterol, Triglycerides, Total Protein, Albumin, Globulin, ALT, and AST were determined in this study. The data were analyzed using (ANOVA) to analyze the difference between treatments. A significant difference was identified between treatments, by using Duncan’s test for multiple comparisons. The results of this study indicated that hens subject to feed withdrawal treatment showed a significant (p < 0.05) percentage of body weight loss compared to those in the feed with aluminum (2.5g/kg). We did not find significant (p>0.05) differences in hens performance for all treatments in the post molt for 56 days. Our data showed hens had significantly lower (p < 0.05) in hen day egg production when compared with other treatments after molting, also, the egg weight showed no significant differences between treatments. The results showed a significant (p<0.05) difference in albumin and globulin between molt methods. Our experiment indicated that aluminum sulfate (2.5 g/kg) and feed withdrawal represent a viable alternative to the molting method for the successful induction of molting and retention of post molt performance.

A randomized controlled trial of oral nutritional supplementation versus standard diet following McKeown minimally invasive esophagectomy in patients with esophageal malignancy: a pilot study.

BackgroundBody weight loss (BWL) following esophagectomy is a common complication in esophageal cancer (EC) which represents a deterioration in quality of life (QoL) and poor long-term prognosis. A pilot randomized controlled study was initiated to evaluate the feasibility, safety, and efficacy of a short‐term oral nutritional supplementation (ONS) on postoperative BWL and QoL in patients undergoing esophagectomy.MethodsPatients enrolled in this study were randomly divided into two different groups: the intervention group which received oral nutritional intervention (300 mL/day for 4 weeks) and the control group which received standard diet alone. Participants were assessed at discharge and 1, 3, and 6 months following discharge for BWL and QoL. At the same time, the data of clinical baseline characteristics, nutrition-related complications, and feasibility were prospectively collected and analyzed.ResultsA total of 77 patients were enrolled in this study. However, owing to severe postoperative complications and discontinuation of the program, 33 participants in the ONS group and 31 participants in the control group were eligible for final analysis of body weight change and QoL. Significant differences in percentage of BWL (%BWL) between the two groups were discovered at 3 and 6 months follow-up: participants in the ONS group had lower %BWL than those in the control group (P=0.024; P=0.025, respectively). There were significant differences in body mass index (BMI) loss between the two groups. At 1 month, QoL was significantly improved in the ONS group (P=0.031); however, no differences of QoL were noticed at 3 and 6 months. Compared with the control group, ONS improved the physical function and role function and eased the symptom of fatigue (P=0.014, P=0.030, and P=0.008, respectively). It was also noted that ONS increased the nutrition-related complications compared to the standard diet (50% vs. 42.9%), although the difference was not statistically significant (P=0.647).ConclusionsThis pilot study indicated that addition of ONS was feasible, safe, and might prevent the loss of body weight and BMI and have a positive impact on the QoL in esophagectomy patients. The effectiveness of ONS requires further confirmation in an appropriately powered study.Trial RegistrationChinese Clinical Trial Registry ChiCTR2100045303.

104 New Presentations of Anorexia Nervosa and Atypical Anorexia Nervosa In Adolescents During the COVID-19 Pandemic

Primary Subject areaAdolescent MedicineBackgroundThe coronavirus (COVID-19) pandemic has had profound effects on adolescent mental health. Beginning in mid-March 2020, public health measures were implemented throughout the province of Quebec, including full school closure and confinement. Previous studies have demonstrated the association between stressful events and the exacerbation of anorexia nervosa (AN), however the association of the COVID-19 pandemic on new AN diagnoses remains unknown.ObjectivesTo assess the incidence and severity of newly diagnosed AN or atypical AN (AAN) cases among adolescents during the COVID-19 pandemic compared to the five preceding years.Design/MethodsWe performed a retrospective analysis from Jan 1 2015 to Nov 15 2020 of new eating disorder assessments at an urban tertiary pediatric hospital. Baseline demographic information and clinical assessment variables were collected. The primary outcomes were the incidence of de novo AN or AAN diagnoses and hospitalization within 7 days of diagnosis. Event rate time trends were compared during the period of pandemic public health measures (March 2020 to November 2020) to the proceeding 5-years (January 2015 to February 2020) using an interrupted time series and logistic mixed modeling.ResultsOverall, 353 patients met inclusion criteria during the study period. Median patient age was 15.9 (IQR 13.8-16.9) years, 93% were female, and 65% of patients were diagnosed with atypical AN. For the full cohort at diagnosis, %mBMI was 92% (SD ±15%) and mean weight loss was 11 Kg (SD ±7Kg). In the 5 years preceding the pandemic, there were 4.5 new AN/AAN cases per month with a modest downward trend (ßcoeff=-0.016). During confinement, new diagnoses rose to 8.0/month with a steep upward trend (ßcoeff=1.417, p < 0 .001). Similarly, hospitalizations for new cases increased from 0.8 to 2.6/month with a significant increase in linear tend (ßcoeff -0.012 vs. 0.500, p < 0 .001). Moreover, patients diagnosed during COVID-19 confinement had a shorter duration of symptoms (6 months vs. 10 months, p=0.001), with a higher percentage of body weight loss (19% vs. 16%, p=0.03) at a faster rate (2.3kg/mo vs. 1.5Kg/mo, p=0.001). Bradycardia was more pronounced at diagnosis during the pandemic (55 bpm vs. 62 bpm, p=0.001) with a greater proportion meeting threshold for admission (38% vs. 19%, p=0.001).ConclusionDuring the COVID-19 confinement, new diagnoses of AN and AAN nearly doubled and hospitalizations for these patients more than tripled. Markers for disease severity were more pronounced and evolved more rapidly. Findings highlight the urgent need for increased community resources during the pandemic, as well as prospective research to understand drivers and prognosis for these patients more effectively.

255-OR: Blinded, Randomized Trial of Banded Roux-en-y Gastric Bypass vs. Sleeve Gastrectomy for Type 2 Diabetes after Five Years

Background: Bariatric surgical procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are increasingly being utilized to manage type 2 diabetes in those with morbid obesity. It is unclear which procedure is more effective for diabetes remission. Methods: In a prospective, parallel, two-arm, study conducted in a single centre, eligible patients aged 20-55 years, with BMI 35-65kg/m2 and type 2 diabetes of at least 6 months duration were randomized 1:1 to silastic ring (SR)-LRYGB or LSG using random number codes. Patients and assessors remained blinded to treatment allocation until after primary outcome of type 2 diabetes remission was assessed at 5 years, defined by HbA1c &amp;lt;6% (42mmol/mol) without the use of glucose lowering medications. Results: Of the 114 patients randomized, 5 died during the 5 year follow up. Diabetes remission assessed in 108/109 (99%) patients, was achieved by 26/53 (49%) after SR-LRYGB vs. 18/55 (33%) after LSG (adjusted odds ratio 6.8; 95% confidence interval, 2.1 to 22.1, p=0.002). Percentage body weight loss assessed in 99/109 (91%) patients, was also greater after SR-LRYGB than after LSG, (26.9± 8.5% vs. 16.3±8.2%, p&amp;lt;0.0001). Acute, 30-day complication rates were similar in both groups. Late re-intervention rates were higher after SR-LRYGB (20 vs. 12). General health and physical functioning domains improved after both types of surgery, with greater improvements in physical functioning after SR-LRYGB (p&amp;lt;0.01). Conclusions: Among patients with obesity and type 2 diabetes, SR-LRYGB provides greater diabetes remission and weight loss compared to LSG at 5 years. Disclosure R. Murphy: None. R. G. Cutfield: None. M. W. C. Booth: None.

Pharmacotherapies for Post-Bariatric Weight Regain: Real-World Comparative Outcomes.

This study aimed to compare outcomes of treatment strategies for weight regain after bariatric surgery. This is a retrospective analysis of 207 individuals treated for post-bariatric weight regain at an academic center from January 1, 2014, through November 25, 2019. Percentage body weight loss was compared after 3, 6, 9, and 12 months of treatment among an intensive lifestyle modification (ILM) group, a non-glucagon-like-1 receptor agonist (GLP-1-RA)-based weight-loss pharmacotherapy (WLP) group, and a GLP-1-RA-based WLP group (the latter two groups in conjunction with ILM). The percentage body weight loss was significantly different between groups after 3 months (1.4% vs. 2.2% vs. 4.5% [P < 0.001] for ILM, non-GLP-1-RA-based WLP, and GLP-1-RA-based WLP groups, respectively), 6 months (0.8% vs. 2.9% vs. 6.7% [P < 0.001]), and 9 months (-1.6% vs. 5.6% vs. 6.9% [P = 0.007]). There was a significant difference in the percentage of individuals achieving ≥5% weight loss after 3, 6, and 9 months, with most occurring in the GLP-1-RA-based WLP group. In a multiple regression analysis including bariatric surgery type, treatment group was the only significant predictor of percentage weight change. GLP-1-RA-based WLP therapies were found to be more effective for treating post-bariatric weight regain than non-GLP-1-RA-based WLP or ILM, regardless of surgery type.

Impact of Body Weight Loss on Survival in Patients with Advanced Gastric Cancer Receiving Second-Line Treatment

Limited information is available regarding the impact of body weight loss (BWL) in patients with advanced gastric cancer (AGC) who receive second-line chemotherapy. We retrospectively reviewed data for consecutive AGC patients who received second-line treatment with taxane-based chemotherapy at our institution between January 2014 and September 2018. We calculated variables, including percent BWL per month during chemotherapy (%BWL/m), and analyzed the correlations between BWL and other clinicopathological parameters with survival. Forty-four AGC patients were registered (median age, 67.5 years; females, n = 16 [36.3%]; severe ascites, n = 12 [27.3%]). The median overall survival was significantly shorter among patients with a %BWL/m of 1% or more, compared with patients with less weight loss (6.3 mo, vs. 12.3 mo, P = 0.038). The %BWL/m (≥1% vs. <1%) was significantly correlated with survival in a univariate analysis (HR = 2.11, P = 0.04), and the survival period was shorter for patients with severe ascites (HR = 1.92; 95% CI, 0.90–3.90) and if their %BWL/m was 1% or more (HR = 2.01; 95% CI, 0.98–4.10) in a multivariate analysis. In conclusion, BWL during second-line chemotherapy was associated with a poor prognosis among patients with AGC.

Liraglutide for overweight and obesity

Liraglutide for overweight and obesity

The effect of the distance from the pyloric sphincter and size of the calibration tube on ­postoperative outcomes of the laparoscopic sleeve gastrectomy

Aim. To study of the effect of the diameter of the calibration tube and the distance from the pyloric sphincter on the outcomes of the laparoscopic sleeve gastrectomy.&#x0D; Methods. The study included 945 (915 women) patients with a body mass index 51.59 kg/m2. The average age of the patients was 53.58.5 years. The patients were divided into 2 groups by the type of laparoscopic surgery: in the first group (n=463), a 36 Fr calibration tube was used, the distance from the pyloric sphincter was 46 cm; in the second group (n=482), a 32 Fr calibration tube was used, the distance from the pyloric sphincter was 23 cm. The main comparison criteria was the percentage of body weight loss in the first 6 and 12 months, and an additional comparison criteria was the of concomitant diseases progress in postoperative and the existence of complications.&#x0D; Results. A comparative analysis showed that the first group in the first 6 months lost 593% of its initial body weight, while in 12 months 714%; in the second group, 733 and 873% of the initial weight, respectively. Concomitant diseases in the first group decreased by 7080% by the 6th month after surgery and by 8596% by the 12th month. In the 2nd group, similar remission with improvement was between 84 and 94% at the 6th month, and remained the same at the 12th month.&#x0D; Conclusion. The results of the study show that in laparoscopic sleeve gastrectomy with a calibration tube diameter 32 Fr and a distance of 23 cm from the pyloric sphincter, compared to a calibration tube diameter 36 Fr or more and a distance of 46 cm from the pyloric sphincter, a body weight loss faster and more effective with earlier remission of concomitant diseases, while the number of complications is comparable.

Overexpression of UBQLN1 reduces neuropathology in the P497S UBQLN2 mouse model of ALS/FTD

Missense mutations in UBQLN2 cause X-linked dominant inheritance of amyotrophic lateral sclerosis with frontotemporal dementia (ALS/FTD). UBQLN2 belongs to a family of four highly homologous proteins expressed in humans that play diverse roles in maintaining proteostasis, but whether one isoform can substitute for another is not known. Here, we tested whether overexpression of UBQLN1 can alleviate disease in the P497S UBQLN2 mouse model of ALS/FTD by crossing transgenic (Tg) mouse lines expressing the two proteins and characterizing the resulting genotypes using a battery of pathologic and behavioral tests. The pathologic findings revealed UBQLN1 overexpression dramatically reduced the burden of UBQLN2 inclusions, neuronal loss and disturbances in proteostasis in double Tg mice compared to single P497S Tg mice. The beneficial effects of UBQLN1 overexpression were primarily confirmed by behavioral improvements seen in rotarod performance and grip strength in male, but not female mice. Paradoxically, although UBQLN1 overexpression reduced pathologic signatures of disease in P497S Tg mice, female mice had larger percentage of body weight loss than males, and this correlated with a corresponding lack of behavioral improvements in the females. These findings lead us to speculate that methods to upregulate UBQLN1 expression may reduce pathogenicity caused by UBQLN2 mutations, but may also lead to gender-specific outcomes that will have to be carefully weighed with the therapeutic benefits of UBQLN1 upregulation.

Self-selected fluid volume and flavor strength does not alter fluid intake, body mass loss, or physiological strain during moderate-intensity exercise in the heat

The purpose of this study was to determine the effects of ad libitum flavor and fluid intake on changes in body mass (BM) and physiological strain during moderate intensity exercise in the heat. Ten subjects (24±3yrs, 7M/3F) performed 60min of treadmill walking at 1.3m/s and 7% grade in an environmental chamber set to 33°C and 10% relative humidity while carrying a 22.7kg pack on two different occasions. Subjects consumed either plain water or water plus flavor (Infuze), ad libitum, at each visit. Pre and post exercise, fluid consumption (change in fluid reservoir weight) and BM (nude) were measured. During exercise, heart rate (HR), systolic blood pressure (SBP), rate of perceived exertion (RPE), oxygen consumption (VO2), respiratory exchange ratio (RER), core temperature (TC), and physiological strain index (PSI) were recorded every 15min during exercise. No significant differences were observed for fluid consumption between fluid conditions (512±97.2mL water vs. 414.3±62.5mL Infuze). Despite a significant decrease from baseline, there were no significant differences in overall change of BM (Δ -1.18 vs. -0.64Kg) or percent body weight loss for water and Infuze conditions, respectively (1.58±0.6 and 0.79±0.2%). Furthermore, there were no significant differences in HR (144±6 vs. 143±8 bpm), SBP (157±5 vs. 155±5mmHg), RPE, VO2 (27.4±0.9 vs. 28.1±1.2ml/Kg/min), RER, TC (38.1±0.1 vs. 37.0±0.1°C), and peak PSI (5.4±0.4 vs. 5.7±0.8) between conditions. Offering individuals the choice to actively manipulate flavor strength did not significantly influence ad libitum fluid consumption, fluid loss, or physiological strain during 60min of moderate intensity exercise in the heat.