Reduction In Body Mass Index Research Articles

Evaluate the Effects of Different Types of Preoperative Restricted Calorie Diets on Weight, Body Mass Index, Operation Time and Hospital Stay in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta Analysis Study.

Previous studies investigated low-calorie diets (LCD), very-low-calorie diets (VLCD), and very-low-calorie ketogenic diets (VLCKD) in relation to weight loss and outcomes for bariatric surgery patients. However, the overall effects of these diets on various outcomes remain unclear. This study aimed to assess the impact of preoperative restricted calorie diets on weight, body mass index (BMI), operation time (OT), and hospital stay (HS) in bariatric surgery patients. Seventeen articles were analyzed, revealing the highest weight loss (-8.62) and BMI reduction (-5.75) with VLCKD. Due to insufficient data, the impact of these diets on OT and HS could not be determined. Further interventional studies are required to determine the ideal preoperative diet that achieves optimal weight loss, patient compliance, tolerance, acceptance, and surgical outcomes.

Rhythmic gymnastics intervention to reduce body mass index of school-age children with obesity and low physical activity

Obesity is a widespread health concern, prevalent in both developed and developing countries. Among school-age children, obesity can lead to health problems and increase the risk of disability in adulthood. A sedentary lifestyle is a significant contributor to poor health and fitness, and consequently, it may elevate the risk of obesity. To address this issue, rhythmic gymnastics has emerged as a potential method for managing weight and reducing body mass index. The purpose of this study was to investigate the efficacy of rhythmic gymnastics intervention in reducing body mass index among school-age children with low physical activity levels. The intervention was carried out three times a week, and results after four weeks revealed that managed patients lost 1.7 kg of weight with a decrease in body mass index (BMI) of 0.60 SD, while resumed patients lost 2 kg with a decrease in BMI of 0.59. These findings indicate that rhythmic gymnastics intervention can be effective in reducing body mass index in school-age children.

IBC-Oxford University2023_BJSOral_14Onco-metabolic Surgery: The Metabolic Effects and Effectiveness of the Different Reconstruction Methods used in Gastric Cancer Surgery. A Systematic Review and Meta-analysis

Abstract Introduction Gastric Cancer (GC) is the fifth most common cancer worldwide. With the development of screening programmes, early stages of GC began being detected, giving rise to a new concern: Quality of Life. Traditional surgical techniques for GC can be tailored and adjusted based on the principles of metabolic and bariatric surgery to optimise therapeutic benefits without sacrificing oncological safety. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HT), and body mass index (BMI) reduction rate and to provide an overview of recent research on Onco-metabolic Surgery (OS). Methods We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a metaanalysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y (RY) reconstruction, and residual stomach on T2DM, HT and BMI reduction rate. Heterogeneity was assessed using the I2 statistics. Results We included 31 studies in the qualitative synthesis and 18 in the quantitative synthesis. At the end of the follow-up, the duodenal bypass group compared to Billroth I had a significantly higher postoperative partial and complete remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95%CI) [1.27; 1.62]) and 1.3 (95%CI [1.00; 1.69]), respectively. Compared with the Billroth II group, RY reconstruction had significantly greater T2DM remission after gastrectomy (RR=1.19; 95%CI [1.08; 1.31]), while HBP showed no statistically significant differences. Regarding improvement in HT, total gastrectomy was significantly superior to subtotal gastrectomy (95%CI [1.01; 2.64]). Although there were no significant differences in the extent of gastrectomy, a trend towards RY oesophagojejunostomy as the best option for T2DM remission was observed (95%CI [0.98; 2.77]; p=0.06). Conclusion Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Gastrectomy with long-limb Roux-en-Y reconstruction should be considered for patients with early-stage GC, concomitant metabolic diseases, and no surgery contraindications. Further research is needed to assess the impact of OS on metabolic diseases.

Application of telenursing as a nursing care delivery model in improving treatment adherence and glycemic control: A scoping review

Background: Diabetes mellitus is one of the chronic diseases that cause the highest mortality and high medical costs;, therefore medication adherence and glycemic control are important in disease management, one of which is through telenursing. Purpose: To determine the telenursing model to improve medication adherence and glycemic control in patients with type 2 diabetes mellitus. Methods: This study was designed a scoping review. The databases used are CINAHL, PubMed, ScienceDirect and Google Scholar. Articles published from 2016-2022 with appropriate inclusion and exclusion criteria. Thematic analysis was used based on study design, telenursing communication model, telenursing process, duration of telenursing and results. Results: There were 12 relevant articles out of 2112 articles. We found a telephone call follow up is the most common method used for delivery of telenursing intervention. Telenursing intervention is implemented from at least 3 months until 12 months, and includes the assessment of current disease conditions, assessment of adherence to the prescribed treatment plan, treatment plan information, and solutions or follow-up to current issue. Conclusion: Telenursing can be used as a nursing care delivery model in the diabetes mellitus type 2 patients because it is proven to reduce glycemic control, improve treatment adherence, reduce body mass index (BMI), glycosylated hemoglobin (HbA1c), and cholesterol, and improve diet adherence, physical exercise and self-management.

Impact of Pharmacist-Led Health Initiatives in Rural Alabama

Perry County is a predominantly African American community in rural Alabama. The prevalence of cardiovascular risk factors such as obesity, diabetes, and hypertension is higher than average in the Perry County population. The Cardiovascular Risk Reduction Clinic, a collaboration between Samford University McWhorter School of Pharmacy, Sowing Seeds of Hope, and the Perry County Health Department, partnered with the Perry County Department of Transportation (DOT) to offer DOT employees, mostly African American men, health screenings and education delivered at times and locations convenient to their work schedules. The objective of the present study was to evaluate the impact of a community partnership with pharmacist-led health interventions on modifiable cardiovascular risk factors in participants lacking access to other community health initiatives due to work obligations. This study was a retrospective chart review evaluating changes in blood pressure and body mass index (BMI). Participants included DOT employees 18 years of age and older who participated in at least two health screenings 12 weeks apart. Over the course of the intervention, the average systolic blood pressure decreased by 6 mmHg, and the average diastolic blood pressure decreased by 4 mmHg. The baseline BMI average of 35.1 kg/m2 had dropped to 34.5 kg/m2 at 12 weeks. Although modest, the reductions in blood pressure and BMI indicate a potential for cardiovascular disease risk reduction. Lessons learned from this pilot project can inform the initiation of similar programs intended to decrease cardiovascular risk. Pharmacist-led interventions combined with community support can lead to positive cardiovascular results among rural communities.

1984. Effects of Semaglutide on Adipose Tissue in HIV-Associated Lipohypertrophy

Abstract Background Lipohypertrophy (central adipose tissue (AT) accumulation) is a common and significant problem in people with HIV (PWH). Pathogenesis remains elusive; yet, AT abnormalities are key drivers of cardiometabolic co-morbidities in HIV. We aimed to assess effects of semaglutide, a glucagon-like peptide-1 receptor agonist, on AT in PWH with lipohypertrophy. Methods We conducted a randomized, double-blinded, placebo-controlled trial of virologically-suppressed, non-diabetic PWH ≥ 18 years of age on stable antiretroviral therapy (ART) with body mass index (BMI) ≥ 25 kg/m2, increased waist circumference/waist-to-hip ratio, and subjective increased abdominal girth after ART initiation. Participants were randomized 1:1 to 32 weeks semaglutide (8-week titration + 24 weeks 1.0 mg weekly subcutaneous injection) or matching placebo. Computed tomography and whole-body dual-energy X-ray absorptiometry were used to measure area/density in abdominal AT [total (TAT), visceral (TAT), and subcutaneous (SAT)] and body composition [lean body mass (LBM), limb/trunk/total body fat (TBF)], resp. Semaglutide effects were estimated using generalized estimating equations or simultaneous quantile regressions on outcome variables. Results 108 participants were enrolled (N = 54 semaglutide: median age = 52 years, 70% male, 61% Black, 83% integrase inhibitor). Groups were well-matched at baseline. In unadjusted models, semaglutide group had greater reductions (P < 0.05) in BMI, homeostatic model of insulin resistance (HOMA-IR), trunk fat, TBF (at quantile ≥ 75th), TAT, and SAT with trends (P < 0.1) for limb fat and VAT (Fig 1/Table 1). Semaglutide effects remained significant for BMI, HOMA-IR, trunk fat, TAT, and VAT after adjusting for age, sex, CD4, and ART duration (Table 2); caloric intake was also significant at ≤ 50th quantile. No differences were seen in LBM, AT density, or VAT/TAT ratio. Semaglutide was well-tolerated; serious adverse events were rare. Conclusion Semaglutide significantly decreased central fat in PWH with lipohypertrophy, primarily driven by reductions in VAT. Semaglutide may offer an effective treatment to decrease visceral adiposity and reduce co-morbidity risk. Further investigation is needed to determine mechanisms by which reductions in visceral adiposity occur. Disclosures Grace A. McComsey, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support

Gender Comparisons of Surgical Outcomes in Patients Undergoing One Anastomosis Gastric Bypass (OAGB): a Historical Cohort Study.

Clinical trials in the field of bariatrics have frequently been gender imbalanced, with males representing only 20% of examinees. Long-term gender-oriented results in one anastomosis gastric bypass (OAGB), and specifically quality of life (QOL) parameters, have not been addressed sufficiently. A better understanding of gender's effect on OAGB outcomes can play an important role in selecting the appropriate bariatric surgery for patients. Our study was aimed at examining mid-term gender-associated outcome of OAGB, including the effect on QOL. A retrospective cohort study of patients who underwent OAGB at surgical ward A, SUMC, Israel, between 2015 and 2020. Demographics, body mass index (BMI), and comorbidities were extracted from the national medical records system. Follow-up quality of life (QOL) and weight parameters were supplemented via telephone questionnaires, using the Bariatric Analysis and Reporting Outcome System (BAROS). A total of 152 patients were included; of these, 51 (33.6%) were males, with an average follow-up period of 4.1 (± 1.3) years post-surgery. Basic demographics showed no significant pre- or post-surgery differences between males and females, except for pre-op weight (which as expected was higher for males). Males had a higher overall BAROS score than females (3.8 ± 2.1 vs. 2.6 ± 2.1, p < 0.001). OAGB surgery results in better outcomes for male than for female patients as measured by the BAROS, despite a similar BMI reduction, and with no difference in complications. Gender-specific outcomes are one of the variables that one should be aware of in optimizing patient selection and pre-operative patient counseling.

Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis.

In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel, as an occupational group, are often exposed to stressful and harmful environments that represent a risk factor for disordered eating, with major repercussions on both physical and mental health. This study aims to explore the effectiveness of weight loss interventions and assess the significance of current obesity treatments for these populations. Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment groups from pre-to-post intervention and cross-sectionally comparing the treatment group to controls at the end of the intervention. A total of 21 studies were included: 16 cross-sectional (BW: n = 15; BMI: n = 12) and 16 longitudinal (BW: n = 15; BMI: n = 12) studies were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = -0.10; p = 0.015; BMI: g = -0.32; p < 0.001), together with a decreased BMI (g = -0.16; p = 0.001) and nominally lower BW (g = -0.08; p = 0.178) in the intervention group compared to controls at the post-intervention time-point. Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in terms of BW and BMI reductions in military populations and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.

The impact of exercise modalities on blood glucose, blood pressure and body composition in patients with type 2 diabetes mellitus

BackgroundPhysical activity has been recommended as an important non-pharmacological therapeutic strategy for the management of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the effects of 12 weeks of strength, aerobic, and a combination of aerobic and resistance training on blood glucose level, blood pressure, and body composition in patients with T2DM.MethodsFrom Debremarkos referral hospital, 40 subjects with T2DM (mean age 42.45 years, 29 men, 11 women) were randomly assigned to one of three intervention groups or the control group. The following variables were measured: body mass index (BMI), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body fat percentage (BFP). Paired sample T-test and one-way ANCOVA were applied whilst controlling for diet, gender, and age.ResultsAll intervention groups showed improvement in a mean difference of FBG − 13.03 (t =-5.55, df = 39, p < 0.001), SBP − 21.63 mmHg − 17.6 mmHg (t =-6.51, df = 39, p < 0.001), DBP − 11.86 mmHg (t = -5.47, df = 39, p < 0.001) and BFP − 9.14 (t = -7.49, df = 39, p < 0.001). There was a significant difference in mean BMI reduction when diet, gender, and age were controlled in a one-way ANCOVA (F (3, 33) = 11.79, p < 0.001), SBP (F (3, 33) = 13.383, p < 0.001), DBP (F (3, 33) = 7.830, p < 0.001), FBG (F (3, 33) = 6.337, p < 0.001), BFP (F (3, 33) = 24.29, p < 0.001) between the exercise intervention groups and control group. Additionally, the estimated marginal means indicate that the combined strength and aerobic exercise intervention group experienced the greatest improvements.ConclusionBody composition, blood pressure, and fasting blood glucose were significantly lower in the combined (aerobic plus strength) treatment than in the individual treatment, indicating that the combined exercise intervention was more successful in altering these parameters.

Do caregivers’ involvement in Type 2 diabetes education affect patients’ health outcomes?: A systematic review and meta-analysis

Introduction: The prevalence of Type 2 diabetes mellitus (T2DM) is rising worldwide. Patients frequently struggle with controlling their diabetes and need the assistance of caregivers for effective self-management because managing diabetes requires a variety of strategies, including diet, glucose monitoring, and exercise. This study aimed to examine the effect of caregiver involvement in T2DM education within a community on patients’ diabetes care outcomes. Methods: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all published studies from the earliest record to May 2022 that reported adult caregivers of T2DM patients who participated in educational interventions concerning diabetes management and that reported one or more outcomes of the interventions were conducted. Four databases were used, including PubMed, Cochrane Library, EMBASE, and CINAHL. The meta-analysis focused on glycated hemoglobin (HbA1c) levels among randomized controlled trials (RCTs), with additional attention to lipid levels. Review Manager 5.4 was used to perform this meta-analysis. Results: A total of 17 out of 683 studies were synthesized. Involvement of caregivers in T2DM education is shown to reduce body mass index and HbA1c. This involvement also improves patients’ knowledge, physical activity, and self-efficacy, but the effect on medication adherence varies. A meta-analysis of six RCT studies shows that caregiver involvement in T2DM education reduced pooled HbA1c levels by 0.83 (95% Confidence interval: −1.27–−0.38) compared to involvement (p = 0.0003). Meta-analysis of three types of lipids (low-density lipoprotein, total cholesterol, and high-density lipoprotein) showed no strong evidence that caregiver participation in diabetes education improved lipid levels. Conclusions: Caregivers play key roles in diabetes management and can contribute to improving patient HbA1c levels. Future research should focus on enhancing caregiver participation in T2DM education.

The effect of subcutaneous dulaglutide on weight loss in patients with Type 2 diabetes mellitus: Systematic review and meta-analysis of randomized controlled trials.

Dulaglutide, a subcutaneously administered glucagon-like peptide 1 receptor agonist, has been hypothesized to lead to weight loss in patients with Type 2 diabetes mellitus (T2DM). However, the consequences of its prescription on body weight (BW) and other anthropometric indices, for example, body mass index (BMI) or waist circumference (WC), have not been completely clarified. Therefore, we aimed to assess the effects of subcutaneous dulaglutide administration on BW, BMI and WC values in T2DM subjects by means of a systematic review and meta-analysis of RCTs. We computed a literature search in five databases (PubMed/Medline, Web of Science, EMBASE, Scopus and Google Scholar) from their inception to February 2023 to identify RCTs that examined the influence of subcutaneous dulaglutide on obesity indices. We calculated effect sizes using the random-effects model (using DerSimonian-Laird method). Results were derived across weighted mean differences (WMD) and 95% confidence intervals (CI). Subgroup analyses were applied to explore possible sources of heterogeneity among the RCTs. The current systematic review and meta-analysis was conducted in compliance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In total, 18 studies with 33 RCT arms (BW = 33 RCT arms, 14,612 participants, 7869 cases and 6743 controls; BMI = 10 RCT arms, 14,612 subjects, 7869 cases and 6743 controls; WC = 10 RCT arms, 1632 participants, 945 cases and 687 cases) were included in the meta-analysis. BW (WMD: -0.86 kg, 95% CI: -1.22, -0.49, p < 0.001), BMI (WMD: -0.68 kg/m2 , 95% CI: -0.88, -0.49, p < 0.001) and WC (WMD: -1.23 cm, 95% CI: -1.82, -0.63, p < 0.001) values decreased notably following subcutaneous dulaglutide administration versus placebo. BW notably decreased in RCTs lasting >18 weeks (WMD: -1.42 kg, 95% CI: -1.90, -0.94, p < 0.001), whereas notable reductions in WC were seen in RCTs lasting ≤18 weeks (WMD: -1.78 cm, 95% CI: -2.59, -0.98, p < 0.001). Dulaglutide dosages >1 mg/day significantly decreased BW (WMD: -1.94 kg, 95% CI: -2.54, -1.34, p < 0.001), BMI (WMD: -0.80 kg/m2 , 95% CI: -1.07, -0.54, p < 0.001) and WC (WMD: -1.47 cm, 95% CI: -1.80, -1.13, p < 0.001). BW decreased particularly following dulaglutide prescription in individuals with obesity (WMD: -1.05 kg, 95% CI: -1.28, -0.82, p < 0.001) versus overweight. The dose-response meta-analysis revealed that BW decreased significantly when dulaglutide was prescribed in doses ≤3 mg/day versus >3 mg/day. Subcutaneous dulaglutide administration in T2DM reduces BW, BMI and WC. The decrease in BW and WC was influenced by the dose and the duration of dulaglutide administration. The reduction in BMI was only influenced by the dosage of dulaglutide. Moreover, T2DM patients who suffered from obesity experienced a notable decrease in BW versus T2DM subjects without obesity.

Effect of Ramadan intermittent fasting on renal and liver function markers among healthy overweight and obese males: A prospective cohort study

Intermittent fasting (IF) has garnered attention for its potential to promote health and combat chronic diseases. This study focused on the effects of Ramadan fasting, a form of IF observed by Muslims, on renal and liver function markers, anthropometric measurements, and dietary intake in healthy overweight and obese men. The study involved 60 participants from Hargeisa, Somaliland, with an average age of 40.01 ± 7.99 years. Results revealed significant reductions in body weight (P ≤ 0.001), waist circumference (P ≤ 0.001), and body mass index (P ≤ 0.001) after Ramadan fasting. Urea levels decreased significantly (P = 0.003), and though creatinine levels showed a non-significant decrease, uric acid levels increased significantly within the normal range (P ≤ 0.001). Serum glutamate oxaloacetate transaminase (GOT) levels decreased significantly (P ≤ 0.001), while glutamate pyruvate transaminase (GPT) and alkaline phosphatase (ALP) levels remained stable. Dietary analysis indicated a significant decrease in total carbohydrates (P = 0.023), proteins (P = 0.006), and dietary cholesterol intake (P ≤ 0.001). These findings suggest that Ramadan fasting positively impacts anthropometric and renal-liver function markers in healthy overweight and obese men. The study contributes to the expanding understanding of intermittent fasting's potential health benefits, emphasizing the importance of considering Ramadan fasting as a preventive approach for metabolic disorders. Further research should explore long-term effects, mechanistic insights, and personalized clinical applications, while public health initiatives could educate individuals about safe and informed fasting practices.

Diet, gym, supplements, or maybe it is all in your mind? A systematic review and meta-analysis of studies on placebo and nocebo effects in weight loss in adults.

There is evidence that placebo and nocebo effects are significant for many conditions, but their impact on weight loss has not yet been well described. A systematic review of studies indexed on PubMed, Cochrane, PsycINFO, PsycARTICLES, TripDatabase, and Embase was carried out. Studies (1) with at least two study groups - placebo and a corresponding control group; (2) published in English; and (3) focusing on adults participating in weight loss programs or on placebo/nocebo effects in weight loss were included. Synthesis and meta-analysis of the results of studies with comparable research plans were performed. Some preliminary trends suggesting placebo and nocebo effects in weight loss were found. Placebo effects manifested in trends towards a slightly greater reduction of Body Mass Index (BMI) and body fat ratio in the placebo compared with the control groups. On the other hand, in one study, it was found that the expectancy effects of taking oral weight-loss agents might be disadvantageous (i.e., because they elicit a nocebo effect on weight loss). The findings suggest a possibility that the nocebo effect may occur when an intervention has a medical context. In contrast, the placebo effect can be observed in cases where the intervention is of a different nature. However, considering the low number of studies analyzing the use of placebos in weight loss, new primary research is needed.

Health outcomes of an ambulatory exercise-based cardiac rehabilitation program across patient risk categories

Abstract Background Exercise-based cardiac rehabilitation is recommended after an ST-segment elevation myocardial infarction (STEMI) to improve prognosis, quality of life and control of cardiovascular risk factors. Ambulatory training has been proposed as an alternative if in-hospital training is unavailable. Purpose To study the health outcomes of an ambulatory exercise-based Cardiac Rehabilitation Program (aCRP) in STEMI patients across different patient risk profiles. Methods A Phase 2 aCRP aimed to STEMI patients was implemented in our hospital in 2022. Conventional or cardiopulmonary exercise testing (C/CPET) was performed, patient risk was stratified as low risk or intermediate/high risk, and a 3-month, individualized aerobic and strength ambulatory training program was provided. C/CPET was repeated at the end of Phase 2 and peak oxygen consumption (peak VO2) was measured. Questionnaires were used to analyse quality of life (SF-36), depression (PHQ-2), anxiety (GAD-2), adherence to Mediterranean diet (PREDIMED) and weekly physical activity (IPAQ). Comparisons were performed between patients at low risk and patients at intermediate/high risk. A p&amp;lt;0.05 was considered statistically significant. Results The cohort comprised 41 patients who completed Phase 2 of aCRP (mean age 60.1±10.2 years, 82.9% male and 53.7% smokers) and were stratified as low risk (n=15, 36.6%) or intermediate/high risk (n=26, 63.4%). Reductions in systolic blood pressure (-7.9±15.7mmHg), LDL cholesterol (-59.5±35mg/dL), weight (-3±6.5kg) and body mass index (BMI, -1±2.2) were attained (all p&amp;lt;0.05). Smoking abstinence was accomplished in 90.9% of smokers and most patients achieved an LDL&amp;lt;55mg/dL target (75.6%). Quality of life improved (+8.4±23.7 points in SF-36, p=0.03) and anxiety symptoms diminished (-0.6±1.8 points in GAD2, p=0.04). A median 4.1±4.7ml/kg/min peak VO2 increase was achieved (+17.9% from baseline, p&amp;lt;0.001) and patients increased their reported weekly physical activity in 2681.1±3385.3 METS/week (+156.2% from baseline, p&amp;lt;0.001). No significant differences were noted between low risk and intermediate/high risk patients, except lower LDL&amp;lt;55mg/dL (65.4% vs. 93.3%, p=0.045) and higher weight loss and BMI reduction (-4.2±7.7 vs. -0.8±3kg, p=0.05 and -0.16±1.1 vs. -1.54±2.5, p=0.02, respectively) in intermediate/high risk patients. No readmissions for cardiovascular causes or complications of ambulatory training were registered. Conclusions In STEMI patients, a Phase 2 ambulatory Cardiac Rehabilitation Program can provide excellent control of cardiovascular risk factors, improve quality of life, and significantly increase functional capacity and reported weekly physical activity. Results are comparable in patients at low risk and intermediate/high risk of cardiac rehabilitation, which could support the inclusion of intermediate/high risk patients in ambulatory exercise-based cardiac rehabilitation programs if in-hospital supervised training is unavailable.Health outcomes of aCRP.

Abstract 16779: Tirzepatide Reduces High-Sensitivity C-reactive Protein in Patients With Type 2 Diabetes and High Cardiovascular Risk: A Post Hoc Analysis of the SURPASS-4 Trial

Background: People with type 2 diabetes (T2D) who have elevated levels of high-sensitivity C-reactive protein (hsCRP) face a greater risk of myocardial infarction and coronary death. Early data for tirzepatide (TZP), a GIP/GLP-1 receptor agonist, suggest a hsCRP lowering effect. Here, we compare the effect of TZP and insulin glargine (iGlar) on hsCRP in patients with T2D and established or high risk for cardiovascular (CV) disease. Methods: hsCRP concentration was quantified by immunoassay (Roche, Indianapolis, IN) with lower limits of detection at concentrations of 0.15 mg/L. Plasma was collected from 1995 fasted participants at baseline (329, 328, 338, and 1000 on 5, 10, 15 mg TZP and on iGlar, respectively) and 52 weeks in SURPASS-4. The % changes of hsCRP from baseline were estimated by mixed model with repeated measures. The shifts in hsCRP risk categories (hsCRP &gt;3 mg/L or 1-3 mg/L versus &lt;1 mg/L) from baseline to 52 weeks are reported. The linear relationship between % change from baseline of hsCRP and change in body mass index (BMI) was analyzed using Pearson correlation coefficient. Results: Baseline hsCRP (mean ± SD, 5.6 ± 12.5 mg/L) was elevated in this study population. Among the participants, 48%, 36%, and 16% were in the &gt;3, 1-3 and &lt;1 mg/L hsCRP categories, respectively. Participants in the elevated hsCRP categories had higher body weight and BMI at baseline. After 52 weeks of treatment, the 5, 10, 15 mg TZP and iGlar groups resulted in -38.0%, -44.2%, -47.8%, and 0.6% changes in the concentration of hsCRP, respectively. More TZP-treated patients improved their hsCRP categories when compared with iGlar-treated participants (Table). The reduction in hsCRP in the pooled TZP groups correlated with the reduction of BMI (r=0.07, p=0.049). Conclusions: Tirzepatide treatment significantly lowers hsCRP in patients with T2D and increased CV risk versus baseline and iGlar. Substantially more participants shift to a lower hsCRP category when compared with insulin glargine.

Remission of nonalcoholic steatohepatitis after bariatric surgery: a single referral center cohort study

BackgroundObesity is associated with nonalcoholic steatohepatitis (NASH), which leads to an increased rate of primary liver cancers, cirrhosis, and decreased life expectancy. Metabolic/bariatric surgery (MBS) determines long-term weight loss and the resolution of obesity-related medical problems. ObjectiveThe aim of this study was to evaluate the impact of MBS on liver histologic features in individuals with obesity. SettingTertiary referral university hospital. MethodsWe retrospectively analyzed data on 37 patients undergoing MBS from a prospectively held database. All patients had a liver biopsy at the time of MBS and a second liver biopsy in case of further surgery or for NASH follow-up. Eighteen patients had NASH on the first liver biopsy. The primary endpoint was the resolution of steatohepatitis without worsening of fibrosis on the second liver biopsy. Secondary endpoints were the evolution of liver steatosis, hepatocyte ballooning, nonalcoholic fatty liver disease activity score, and biochemical parameters from the time of the first to the second liver biopsy. ResultsFifteen (83.3%) patients had significant resolution of steatohepatitis (P < .001) without fibrosis worsening. There was a statistically significant improvement of all blood tests except for low-density lipoprotein, alkaline phosphatases, and bilirubinemia. The Homeostatic Model Assessment (HOMA) index was significantly improved after MBS (P < .001), and circulating insulin and leptin concentrations were significantly reduced. Mean weight loss was 47 kg, with a 16.6 kg/m2 body mass index reduction and a % of total weight loss (%TWL) of 40.3 ±14% from the moment of MBS to the last follow-up. ConclusionMBS is effective in determining NASH regression without fibrosis worsening and in reducing HOMA index and leptin and insulin concentrations.

Effect of cannabis and subproducts on anthropometric measures: a systematic review and meta-analysis.

Obesity poses a significant public health challenge. Research has examined the impact of cannabis and subproducts on health but varying results have hindered a consensus. This study aimed to evaluated the effects of cannabis and subproducts on body measurements. For searching randomized controlled trials evaluating cannabis and/or subproducts use and changes in anthropometric measures, a systematic search at MEDLINE, Embase, Cochrane Library and Web of Science was conducted until March 2023. The outcomes included changes in body weight, body mass index (BMI) and waist circumference (WC). Meta-analysis was realized using R software (version 4.2.1). In general, cannabis use reduced weight by 1.87 kg (95% CI: -3.71 to -0.03) and WC (mean difference = -2.19, 95% CI: -4.44 to 0.06). When examining subgroups, longer follow-up periods were associated with a more pronounced BMI reduction (mean difference = -1.10, 95% CI: -2.23 to 0.03). Cannabinoid CB1 exhibited an increase in body fat (mean difference = 1.70, 95% CI: 0.66-2.74). These findings suggest that cannabis and subproducts could be considered adjuncts in obesity treatment by helping to reduce relevant anthropometric measurements.

A Whole Foods Plant-Based Weight Loss Intervention Improves Quality of Life, Metabolic, Microbiome and Immune Profile in MGUS/SMM As Well As Progression Trajectory in a Subset - the Nutrivention Trial

Introduction Obesity, low adiponectin, high leptin, high insulin, and diets lacking plant-based foods are risk factors for plasma cell disorders (PCDs). Patients (pts) with monoclonal gammopathy (MGUS) and smoldering myeloma (SMM) and an elevated body mass index (BMI) are twice as likely to progress to myeloma (MM). There is evidence of microbiome dysbiosis in pts with PCDs and dietary changes can induce large microbial shifts. Therefore, there is a rationale to study a whole food plant-based dietary (WFPBD) intervention to improve modifiable biomarkers and disease trajectory. Methods This was a pilot, single-arm trial of WFPBD (self-selected prepared frozen lunch/dinner provided by Plantable with breakfast/snack guidance and no calorie restriction) for 12-weeks (w) and health coaching for 24w (by Plantable coach and a research dietitian) in pts with MGUS/SMM and BMI ≥25 (NCT04920084). The primary endpoint was feasibility (mean BMI reduction ≥5% and mean dietary adherence [kcal % unprocessed plant food intake] ≥70%) at 12w; secondary endpoints included quality of life (QoL) (EORTC QLQ C30 survey using a linear-mixed effect model), metabolic markers (plasma insulin, adiponectin leptin (AL) ratio via ELISA), gut microbiome (inverse Simpson index α-diversity and relative abundance of butyrate producers (RABP) via stool 16S sequencing), peripheral blood immune profile (leukocyte subsets via 36 color flow cytometry), secreted biomarkers (plasma via Olink inflammation panel) and change in monoclonal (M)-spike concentrations. Rate of change of M-spike/year (y) measured by slope with 95% CI was calculated for up to 20 months (m) pre-intervention and 20m post intervention start (baseline (BL)). A p-value for difference in M-spike rates was calculated. Results The study enrolled 23 pts of which 20 completed the 12w intervention and 16 completed 1y. The median age was 62y with 43% male, 43% non-White, 52% MGUS, 74% obese, and 26% prediabetic/diabetic. The study met feasibility endpoints with 90% mean and 92% median adherence during 12w intervention and 77% median at 24w. There was an 8.3% mean and 6.6% median BMI reduction at 12w and 8.6% median at 24w. There was an improvement in global health status/QoL (median increase 16.7 points, p=0.03), a reduction in dyspnea (median decrease -33.3 points, p=0.001), fatigue (median decrease -11.1 points, p=0.06), and insulin (median decrease 0.791 mU/L; p=0.01), and an increase in AL ratio (median increase 0.09; p=0.0002), α-diversity (median increase 6.18 to 8.42; p= 0.03) and RABP (median increase 0.03 to 0.08; p=0.042) at 12w. Prelim results at 12w suggest a measurable, albeit not significant change in immune subsets such as an increase in monocytes, regulatory T cells, and a decrease in dendritic cells, trends previously associated with anti-inflammatory diets, as well as increase in butyrate. A decrease in proinflammatory cytokines IL8 (p=0.065), IL12B (p=0.068), and TNFB (p=0.082) and an increase in FGF21 (p=0.043) (promoter of insulin sensitivity) was also observed. Butyrate is known to reduces pro-inflammatory cytokines and increase anti-inflammatory proteins, including FGF21. Further immune and microbiome analysis is ongoing. Of 16 pts followed for 1y, 2 with significant BMI reduction had significant improvement in M-spike trajectory: Case 1: Mayo Int Risk IgGκ/IgGλ MGUS achieved a 1y BMI reduction of 19%. Pre-intervention M-spike changed +0.28g/dL/y (6 M-spike values), and during intervention M-spike changed +0.03g/dL/y (11 M-spike values); p=0.008. BL M-spike 1.2g/dL and bone marrow plasma cells (BM PC) &amp;lt;5%; 1.5y BM PC 5-9%. Case 2: IMWG Int Risk IgGκ SMM achieved a 1y BMI reduction of 13%. Pre-intervention M-spike changed +0.11g/dL/y (8 M-spike values), and during intervention M-spike changed -0.05g/dL/y (8 M-spike values); p=0.04. BL M-spike 1.2g/dL and BM PC 20-30%; 1y BM PC 10-15%. Two pts without significant BMI reduction (-4% and -1% at 1y) had rising M-spikes. The remaining 12 pts had median 7.5% BMI reduction at 1y with stable M-spike. Conclusions This is the first dietary intervention trial in PCDs with insights into the mechanisms by which a WFPBD may delay progression. The intervention improves QoL, metabolic (BMI, insulin resistance), microbiome (α-diversity and butyrate producers) as well as immune (reduced inflammation) profile with potentially slowing progression trajectory in a subset. A larger trial is underway (NCT05640843).

Efficacy of bariatric intervention as a bridge to cardiac transplant.

Many patients with heart failure (HF) are denied cardiac transplants due to inability to meet transplantation body mass index (BMI) criteria. Bariatric intervention, including surgery, medication, and weight loss guidance, may help patients lose weight and become eligible for transplantation. We aim to contribute to the literature on the safety and efficacy of bariatric intervention on patients with obesity and HF who are awaiting cardiac transplantation. University hospital, United States. This was a mixed retrospective/prospective study. Eighteen patients with HF and BMI >35 kg/m2 were reviewed. Patients were divided based on whether they underwent bariatric surgery or nonsurgical intervention and whether they had left ventricular assist devices or other advanced heart failure therapy including inotropic support, guideline-directed medical therapy, and/or temporary mechanical circulatory support. Weight, BMI, and left ventricular ejection fraction (LVEF) were collected before bariatric intervention and 6 months after bariatric intervention. No patients were lost to follow-up. Bariatric surgery led to statistically significant decreases in weight and BMI when compared with nonsurgical patients. At 6 months after intervention, surgical patients lost an average of 18.6 kg and decreased their BMI by 6.4 kg/m2 while nonsurgical patients lost 1.9 kg and decreased their BMI by .7 kg/m2. After bariatric intervention, surgical patients had an average LVEF increase of 5.9% and nonsurgical patients had an average decrease of 5.9%, although these findings lacked statistical significance. Our study suggests that bariatric intervention among patients with HF and obesity is a safe and effective method of weight and BMI reduction.

Diet in the management of type 2 diabetes: umbrella review of systematic reviews with meta-analyses of randomised controlled trials

ObjectiveTo systematically summarise and evaluate the existing evidence on the effect of diet on the management of type 2 diabetes and prevention of complications.DesignUmbrella review of systematic reviews with meta-analyses...