Mean Weight Reduction Research Articles

Type 2 Diabetes Patients Reach Target Glycemic Control Faster Using IDegLira than Either Insulin Degludec or Liraglutide Given Alone.

Background and ObjectivesThe time-course when changes in glycemic control and body weight were first manifest in patients with type 2 diabetes mellitus (T2DM) treated with a combination of insulin degludec and liraglutide (IDegLira) was assessed, comparing IDegLira to its individual components.MethodsData from weeks 0–12 from two studies were analyzed, one comparing IDegLira to each component (DUAL I), and one comparing IDegLira to insulin degludec titrated to a maximum 50 units (DUAL II). Efficacy endpoints included glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) reduction, proportion of patients achieving HbA1c [<7.0 % (<53.0 mmol/mol)] and FPG (≤7.2 mmol/L) targets, and proportion achieving HbA1c target without hypoglycemia and without hypoglycemia and weight gain.ResultsMean HbA1c was lower, and the proportion of patients reaching target HbA1c greater, with IDegLira versus comparators (both studies) at weeks 8 and 12. Proportions of patients reaching target HbA1c without hypoglycemia and without hypoglycemia and weight gain were higher for IDegLira versus insulin degludec, though not versus liraglutide. Mean FPG was lower with IDegLira, and the proportion achieving target FPG higher, versus components (both studies) from weeks 4–12. IDegLira was associated with mean weight reduction from weeks 4–12, although less than with liraglutide alone. Hypoglycemia occurred infrequently in weeks 0–12, with no difference in incidence between IDegLira and insulin degludec in either study.ConclusionsIDegLira reduces plasma glucose to a greater extent than its components, measurable within the first 12 weeks of therapy, and without weight gain or an increased hypoglycemia risk versus insulin degludec.Electronic supplementary materialThe online version of this article (doi:10.1007/s40261-016-0376-0) contains supplementary material, which is available to authorized users.

Effectiveness of Program Modification Strategies of the Diabetes Prevention Program: A Systematic Review.

The purpose of this study is to review the effectiveness of commonly used program modifications classified under cultural adaptation and program translational strategies for the Diabetes Prevention Program (DPP) in terms of risk reduction for type 2 diabetes. Authors extracted data about weight, body mass index (BMI), and 5 areas of program modification strategies from 28 interventions and analyzed them in SPSS software. Bivariate analyses examined the odds of achieving a significant reduction in outcomes by each modification of the DPP and by presence of a maintenance component, as well as the mean reduction of weight and BMI by more versus fewer modifications and by the presence of a maintenance component. There were no statistically significant differences in achieving a significant reduction in weight or BMI by any type of modification or by the presence of a maintenance component. Programs with fewer modifications reported significantly greater reduction in mean weight at 12 months postintervention and the furthest time point extracted. Programs with a maintenance component achieved significantly greater reduction in mean weight measured at the furthest time point extracted. The DPP appears to be programmatically robust to a variety of cultural adaptation and translational strategies. Potentially cost-saving modifications do not seem to reduce effectiveness, which should encourage implementation on a broader scale. Program planners should, however, make efforts to include maintenance components because they appear to significantly reduce risk for acquiring type 2 diabetes.

Beneficial effects of exercise: shifting the focus from body weight to other markers of health*

Background: Exercise is widely promoted as a method of weight management, while the other health benefits are often ignored. The purpose of this study was to examine whether exercise-induced improvements in health are influenced by changes in body weight. Methods: Fifty-eight sedentary overweight/obese men and women (BMI 31.8 (SD 4.5) kg/m2 ) participated in a 12-week supervised aerobic exercise intervention (70% heart rate max, five times a week, 500 kcal per session). Body composition, anthropometric parameters, aerobic capacity, blood pressure and acute psychological response to exercise were measured at weeks 0 and 12. Results: The mean reduction in body weight was -3.3 (3.63) kg (p&lt;0.01). However, 26 of the 58 participants failed to attain the predicted weight loss estimated from individuals’ exercise-induced energy expenditure. Their mean weight loss was only -0.9 (1.8) kg (p&lt;0.01). Despite attaining a lower-than-predicted weight reduction, these individuals experienced significant increases in aerobic capacity (6.3 (6.0) ml/kg/min; p&lt;0.01), and a decreased systolic (-6.00 (11.5) mmHg; p&lt;0.05) and diastolic blood pressure (-3.9 (5.8) mmHg; p&lt;0.01), waist circumference (-3.7 (2.7) cm; p&lt;0.01) and resting heart rate (-4.8 (8.9) bpm, p&lt;0.001). In addition, these individuals experienced an acute exercise-induced increase in positive mood. Conclusions: These data demonstrate that significant and meaningful health benefits can be achieved even in the presence

Three Years After Bariatric Surgery in Obese Adolescents

Research Article| February 01 2016 Three Years After Bariatric Surgery in Obese Adolescents AAP Grand Rounds (2016) 35 (2): 17. https://doi.org/10.1542/gr.35-2-17 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Three Years After Bariatric Surgery in Obese Adolescents. AAP Grand Rounds February 2016; 35 (2): 17. https://doi.org/10.1542/gr.35-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bariatric surgery, obesity, obesity, morbid Source: Inge TH, Courcoulas AP, Todd MJ, et al. Weight loss and health status 3 years after bariatric surgery in adolescents [published online ahead of print November 6, 2015]. N Engl J Med. doi: https://doi.org/10.1056/NEJMoa1506699 Investigators at 5 pediatric tertiary care centers in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Consortium conducted a prospective study to determine the effects of bariatric surgery in obese adolescents. For the study, adolescents (≤19 years old) who underwent the procedure from 2007 through 2012 were enrolled. Standardized methods were used for data collection at baseline and at the 6-month and 1-, 2-, and 3-year postoperative visits. Data were collected on weight loss, coexisting conditions, weight-related quality of life, and micronutrient levels. Quality of life was measured using the total score on the Weight on Quality of Life-Kids instrument (scores range from 0–100). Information on surgical and endoscopic procedures performed between 31 days and 3 years after the bariatric surgery was also collected. Among the 242 study participants, Roux-en-Y gastric bypass was performed in 161, sleeve gastrectomy in 67, and adjustable gastric banding in 14. Because of the small size of the gastric band cohort their results were not included in the main analysis. At baseline, 29% of participants were 13–15 years old, 41% were 16–17 years old, and 30% were 18–19 years old. At baseline, the mean BMI was 53 (range 34–88) and 98% of participants had a BMI >40. Throughout the study interval, 99% (225/228) of the cohort actively participated and 88% (805/912) completed all of the postoperative visits. At 3-year follow-up, mean weight reduction was 41 kg with a mean 27% weight loss; 26% of the participants were no longer categorized as obese. However, 2% of the cohort who underwent gastric bypass and 4% of those who underwent sleeve gastrectomy exceeded their baseline weight. Compared to baseline, there was significant improvement in comorbidities in study participants by the 3-year follow-up. Hypertension was present in 96 participants at baseline, and normalized in 74% (71/94) of those at 3 years. New-onset hypertension developed in 4 participants. Dyslipidemia was present in 171 participants at baseline and normalized in 66% (112/171) without the use of lipid-lowering drugs. Incident dyslipidemia developed in 3 participants during the study interval. At baseline, 13% (29/233) of participants had type 2 diabetes (mean HgA1C = 6.3%), and at 3 years 19 of 20 participants on whom data were available were in remission. Newonset pre-diabetes developed in 1 participant. The mean quality-of-life score was 63 at baseline and increased to 83 by 3 years (P < .001). Micronutrient deficiencies either continued or worsened over the 3-year study period, including low ferritin levels, low B12 levels, vitamin A deficiency, and vitamin D deficiency. Within 3 postoperative years, 44 additional intra-abdominal surgical procedures related to the bariatric surgery were performed on 30 patients. In addition, upper endoscopic procedures were performed in 29 participants. The authors conclude that the majority of adolescents who had bariatric surgery experienced... You do not currently have access to this content.

Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey)

Introduction: Worldwide, overweight and obesity are known as posing serious health risks. Successful methods of prevention and therapy for overweight and obesity have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction. Patients and methods: In total 143/159 children and adolescents (90%) with overweight and obesity completed the prospective, multicenter trial (age 13.9 ± 2.4 years, BMI 31.2 ± 5.4 kg/m2, BMI-SDS 2.51 ± 0.57). During a six-week rehabilitation patients participated in a structured treatment and teaching program (STTP). Following the inpatient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, and standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress-management, social support, and actual body shape). Results: 66% of the children and adolescents showed non-normal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. Mean thickness of carotid intima-media was 0.53 ± 0.09 mm (range, 0.40–0.80); 15% of the patients showed a normal range (<0.45 mm), 40% slightly elevated (0.45–0.50 mm) and 45% an elevated (>0.50 mm) thickness. After an inpatient treatment lasting 40.4 ± 4.1 (range, 28–49) days, children and adolescents reached a mean weight reduction of 5.52 ± 3.94 (0.4–13.3) kg (p < 0.01) accompanied by a reduction of body fat mass. Performing multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): Well-being (β = −0.543), resilience (β = 0.434) and intrafamilial conflicts (β = 0.315). Conclusion: The different parameters (i.e., resilience, intrafamilial conflicts, structured daily schedule) have demonstrated their utility and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting.

Pilot evaluation of an online weight management programme

This intervention examined the efficacy of a six-week online weight loss programme. Students and staff of a third level institution (n=183) were recruited to the programme which provided individualised dietary advice for weight loss. Eighty-five participants (mean age 29.7 years, mean BMI 28.9kg/m2, 33% male) met the minimum inclusion criterion of logging on to the study website at least twice. All participants who completed the full six-week programme lost weight (n=31), with significant reductions in mean weight (2.8kg), BMI (0.9kg/m2) and waist circumference (4.1cm) observed between the start and end of the programme (all P 5% of their bodyweight, with reductions in biscuit and alcohol consumption being most predictive of weight loss. These findings suggest that individualised online dietary advice is effective in achieving short-term weight loss, especially in males.

A181 - Psychiatric Disorders and weight Change in a Prospective Study of Bariatric Surgery Patients: A 3-Year Follow-Up

session per week. The pulsometer was checked weekly to record the exercise sessions. Descriptive statistics and t student for paired samples were done. SPSS Statistics version 21.0 was used for statistical analysis. Any p value r0.05 was considered as statistically significant. Results: A total of 17 patients entered the program. There were 9 patients who abandoned the treatment, within the first 4 week. From the total of 8 participants who finished the program, there were 6 women and 2 men with a mean age of 51.37 10.43 years, and a mean BMI of 34.2 4.7 Kg/m Mean fat mass (FM) was 44.3 8.3 kg, and mean waist circumference 110 13.4cm. At the end of the program, there was a mean weight reduction of 3.3 Kg (po0.007), BMI reduced from 34.2 4.7 Kg/m to 33.4 5.3 Kg/ m (po0.031) and FM from 43.8 7.8 kg to 43.6 6.1 kg (po0.017). Patients exhibited a 3.5 4.05 cm decrease in waist circumference. Adherence to both, diet and exercise was poor throughout the intervention. During follow up, psychological selfefficacy increased from 8.3 2.4 to 8.7 1.4 and self-confidence diminished from 7.8 1.4 to 6.8 3.7 (po0.001). Exercise frequency increased from 0 to 2.5 1.5 days/week, time of exercise increased from 0 to 126 93.3 minutes/week and energy expenditure during exercise increased from 0 to 675 534.4 cal/week. Conclusions: A 12 week multidisciplinary strategy is marginally effective in reducing weight, BMI, fat mass and anthropometric measures. Lack of adherence is the main cause of the result. Patients who fail to bariatric surgery seem have psychological conditions that limit the adherence to recommendations established by a multidisciplinary team. Better strategies for the evaluation and treatment of this particular group are needed.

Effect of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials.

Orlistat is an effective adjunctive treatment to lifestyle modifications in the treatment of obesity. While the majority of current evidence is on the effect of orlistat in obese patients without diabetes, some studies suggest that patients who are obese and have diabetes mellitus lose more weight and have greater improvements in diabetic outcomes when treated with orlistat plus a lifestyle intervention than when treated by lifestyle interventions alone. The aim of this study was to review the evidence of the effects of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes. A systematic review of randomized controlled trials of orlistat in people with type 2 diabetes reporting diabetes outcomes in studies published between January 1990 and September 2013 was conducted. We searched for articles published in English in MEDLINE and EMBASE. Inclusion criteria included all randomized controlled trials of orlistat carried out on adult participants with a body mass index of 25 kg m(-2) or over diagnosed with type 2 diabetes, which reported weight change and at least one diabetic outcome. A total of 765 articles were identified out of which 12 fulfilled the inclusion criteria. The overall mean weight reduction (3, 6 and 12 months) in the orlistat group was -4.25 kg (95% CI: -4.5 to -3.9 kg). The mean weight difference between treatment and control groups was -2.10 kg (95% CI: -2.3 to -1.8 kg, P < 0.001), the mean HbA1c difference was -6.12 mmol mol(-1) (95% CI: -10.3 to -1.9 mmol mol(-1) , P < 0.004) and the mean fasting blood glucose difference was -1.16 mmol L(-1) (95% CI: -1.4 to -0.8 mmol L(-1) , P < 0.001). Treatment with orlistat plus lifestyle intervention resulted in significantly greater weight loss and improved glycaemic control in overweight and obese patients with type 2 diabetes compared with lifestyle intervention alone.

Effects of total fat intake on body weight.

In order to prevent overweight and obesity in the general population we need to understand the relationship between the proportion of energy from fat and resulting weight and body fatness in the general population. To assess the effects of proportion of energy intake from fat on measures of weight and body fatness (including obesity, waist circumference and body mass index) in people not aiming to lose weight, using all appropriate randomised controlled trials (RCTs) and cohort studies in adults, children and young people We searched CENTRAL to March 2014 and MEDLINE, EMBASE and CINAHL to November 2014. We did not limit the search by language. We also checked the references of relevant reviews. Trials fulfilled the following criteria: 1) randomised intervention trial, 2) included children (aged ≥ 24 months), young people or adults, 3) randomised to a lower fat versus usual or moderate fat diet, without the intention to reduce weight in any participants, 4) not multifactorial and 5) assessed a measure of weight or body fatness after at least six months. We also included cohort studies in children, young people and adults that assessed the proportion of energy from fat at baseline and assessed the relationship with body weight or fatness after at least one year. We duplicated inclusion decisions and resolved disagreement by discussion or referral to a third party. We extracted data on the population, intervention, control and outcome measures in duplicate. We extracted measures of weight and body fatness independently in duplicate at all available time points. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity and funnel plot analyses. We included 32 RCTs (approximately 54,000 participants) and 30 sets of analyses of 25 cohorts. There is consistent evidence from RCTs in adults of a small weight-reducing effect of eating a smaller proportion of energy from fat; this was seen in almost all included studies and was highly resistant to sensitivity analyses. The effect of eating less fat (compared with usual diet) is a mean weight reduction of 1.5 kg (95% confidence interval (CI) -2.0 to -1.1 kg), but greater weight loss results from greater fat reductions. The size of the effect on weight does not alter over time and is mirrored by reductions in body mass index (BMI) (-0.5 kg/m(2), 95% CI -0.7 to -0.3) and waist circumference (-0.3 cm, 95% CI -0.6 to -0.02). Included cohort studies in children and adults most often do not suggest any relationship between total fat intake and later measures of weight, body fatness or change in body fatness. However, there was a suggestion that lower fat intake was associated with smaller increases in weight in middle-aged but not elderly adults, and in change in BMI in the highest validity child cohort. Trials where participants were randomised to a lower fat intake versus usual or moderate fat intake, but with no intention to reduce weight, showed a consistent, stable but small effect of low fat intake on body fatness: slightly lower weight, BMI and waist circumference compared with controls. Greater fat reduction and lower baseline fat intake were both associated with greater reductions in weight. This effect of reducing total fat was not consistently reflected in cohort studies assessing the relationship between total fat intake and later measures of body fatness or change in body fatness in studies of children, young people or adults.

IStent with Phacoemulsification versus Phacoemulsification Alone for Patients with Glaucoma and Cataract: A Meta-Analysis.

BackgroundMinimally invasive glaucoma surgeries (MIGS) have attracted significant attention, as they have been reported to lower intra-ocular pressure (IOP) and have an excellent safety profile. The iStent is an example of a minimally invasive glaucoma device that has received particular attention due to its early and wide spread utilization. There is a growing body of evidence supporting its use at the time of phacoemulsification to help lower IOP. However, it is still not clear how much of the IOP lowering effect can be attributed to the iStent, the crystalline lens extraction or both when inserted concurrently at the time of phacoemulsification. This has been an important issue in understanding its potential role in the glaucoma management paradigm.PurposeTo conduct a systematic review and meta-analysis comparing the IOP lowering effect of iStent insertion at the time of phacoemulsification versus phacoemulsification alone for patients with glaucoma and cataracts.MethodsA systematic review was conducted utilizing various databases. Studies examining the IOP lowering effect of iStent insertion in combination with phacoemulsification, as well as studies examining the IOP lowering effect of phacoemulsification alone were included. Thirty-seven studies, reporting on 2495 patients, met the inclusion criteria. The percentage reduction in IOP (IOPR%) and mean reduction in topical glaucoma medications after surgery were determined. The standardized mean difference (SMD) was computed as a measure of the treatment effect for continuous outcomes taking into account heterogeneity. Fixed-effect and random-effect models were applied.ResultsA 4% IOP reduction (IOPR%) from baseline occurred following phacoemulsification as a solo procedure compared to 9% following an iStent implant with phacoemulsification, and 27% following 2 iStents implants with phacoemulsification. Compared with cataract extraction alone, iStent with phacoemulsification resulted in significant reduction in the post-operative IOP (IOPR%) (SMD = -0.46, 95% CI: [-0.87, -0.06]). A weighted mean reduction in the number of glaucoma medications per patient was 1.01 following phacoemulsification alone compared to 1.33 after one iStent implant with phacoemulsification, and 1.1 after 2 iStent implants with phacoemulsification. Compared to cataract extraction alone, iStent with cataract extraction showed a significant decrease in the number of glaucoma medications (SMD = -0.65, 95% CI: [-1.18, -0.12]). Funnel plots suggested the absence of publication bias.ConclusionBoth iStent implantation with concurrent phacoemulsification and phacoemulsification alone result in a significant decrease in IOP and topical glaucoma medications. In terms of both reductions, iStent with phacoemulsification significantly outperforms phacoemulsification alone.

Surgery for the treatment of obesity in children and adolescents.

Child and adolescent overweight and obesity have increased globally, and are associated with significant short and long term health consequences. To assess the effects of surgical interventions for treating obesity in childhood and adolescence. We searched the Cochrane Library, MEDLINE, PubMed, EMBASE as well as LILACS, ICTRP Search Portal and ClinicalTrials.gov (all from database inception to March 2015). References of identified studies and systematic reviews were checked. No language restrictions were applied. We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months follow-up. Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded. Pregnant females were also excluded. Two review authors independently assessed risk of bias and extracted data. Where necessary authors were contacted for additional information. We included one RCT (a total of 50 participants, 25 in both the intervention and comparator group). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle group, respectively which was conducted in a private hospital, receiving funding from the gastric banding manufacturer. The study authors were unable to blind participants, personnel and outcome assessors which may have resulted in a high risk of performance and detection bias. Attrition bias was noted as well. The study authors reported a mean reduction in weight of 34.6 kg (95% confidence interval (CI) 30.2 to 39.0) at two years, representing a change in body mass index (BMI) of 12.7 (95% CI 11.3 to 14.2) for the surgery intervention; and a mean reduction in weight of 3.0 kg (95% CI 2.1 to 8.1) representing a change in BMI of 1.3 (95% CI 0.4 to 2.9) for the lifestyle intervention. The differences between groups were statistically significant for all weight measures at 24 months (P < 0.001). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was low. Adverse events were reported in 12/25 (48%) participants in the intervention group compared to 11/25 (44%) in the control group (low quality evidence). A total of 28% of the adolescents undergoing gastric banding required revisional surgery. No data were reported for all-cause mortality, behaviour change, participants views of the intervention and socioeconomic effects. At two years, the gastric banding group performed better than the lifestyle group in two of eight health-related quality of life concepts (very low quality evidence) as measured by the Child Health Questionnaire (physical functioning score (94 versus 78, community norm 95) and change in health score (4.4 versus 3.6, community norm 3.5)). Laparoscopic gastric banding led to greater body weight loss compared to a multi component lifestyle program in one small study with 50 patients. These results do not provide enough data to assess efficacy across populations from different countries, socioeconomic and ethnic backgrounds, who may respond differently. This systematic review highlights the lack of RCTs in this field. Future studies should assess the impact of the surgical procedure and post operative care to minimise adverse events, including the need for post operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.

Past and present of antiobesity agents: focus on monoamine modulators.

A review of recently approved antiobesity medications, including their neuropharmacology, efficacy data from clinical trials, and important patient safety considerations, is presented. Obesity affects roughly 34% of Americans and is associated with increased risks of type 2 diabetes, hypertension, and coronary artery disease, as well as increased mortality and healthcare costs. Most pharmacologic agents used to treat obesity work by modulating monoamine neurotransmitters such as serotonin, norepinephrine, and dopamine. Since the U.S. market withdrawal of agents such as fenfluramine, dexfenfluramine, and sibutramine due to safety concerns, the Food and Drug Administration (FDA) has approved three monoamine modulators for long-term obesity management: the serotonergic agent lorcaserin (approved by FDA in 2012), a combination product containing phentermine and extended-release (ER) topiramate (also approved in 2012), and another combination product consisting of ER naltrexone and ER bupropion (approved in late 2014). In Phase III trials of the three products, mean weight reductions ranging from 4.7 to 10.2 kg over periods of one and two years were reported, with substantial percentages of patients achieving weight loss of ≥5%. Adverse effects reported among clinical trial participants were generally mild; however, as the trials excluded patients with significant cardiovascular risks (e.g., uncontrolled hypertension, valvular heart disease), cautious patient selection and monitoring are advised. Recently approved medications for long-term management of obesity include lorcaserin, phentermine-topiramate, and naltrexone-bupropion. When these drugs are used to facilitate weight loss, pharmacists can play an important role in helping to ensure appropriate patient selection and monitoring.

Tu1748 Impact of Prophylaxis Percutaneous Endoscopic Gastrostomy on Survival RATES and Nutritional Status in Patients With Nasopharyngeal Carcinoma Stage II-IV Undergoing Definitive Chemo-Radiation Therapy

Tu1748 Impact of Prophylaxis Percutaneous Endoscopic Gastrostomy on Survival RATES and Nutritional Status in Patients With Nasopharyngeal Carcinoma Stage II-IV Undergoing Definitive Chemo-Radiation Therapy Tanawat Pattarapuntakul*, Naichaya Chamroonkul, Pimsiri Sripongpun, Bancha Ovartlarnporn Internal Medicine, Prince of Songkla University, Hatyai, Thailand; Songklanagarind Hospital, NKC institute of Gastroenterology and Hepatology, Hatyai, Thailand Background: Prophylaxis percutaneous endoscopic gastrostomy (PPEG) is routinely used as a route for nutritional support in head and neck cancer patients undergoing chemo-radiation therapy (CCRT). The nasopharyngeal cancer (NPC) has less effect to alimentary tract than other head and neck cancers and the numbers of NPC patients included were rather small in previous studies. The benefits of PPEG on patients’ survival and nutritional status in NPC patients undergoing CCRT are still unknown. Aims: To assess the impact of PPEG on survival rates, completed treatment rates and nutritional status of patients with NPC stage II-IV treated with CCRT. Methods: All of the computerized medical records of NPC stage II-IV patients treated with CCRT from January 01, 2007 till September 30, 2011 in Songklanagarind hospital were retrospectively reviewed. The PPEG was done at the discretion of attending physicians. Prophylaxis PEG is defined as PEG placement before CCRT in patients without baseline severe malnourished (BMI! 18.5 kg/m). The three-year overall survival rates, completed treatment rates (CTR) and nutritional status (body weight) during CCRT between PPEG group and Non-PPEG group were compared. PEG utility rate and PEG related complications (PC) were analyzed. PEG related complications were classified as early (! 2 weeks) and late (R 2 weeks) after procedure and severe complications were defined as complications that needed hospitalization. Results: Two hundred and ninety two patients (216 males, 76 females with the mean age 48.7 13.7 years) were enrolled, 192 (65%) patients were classified as PPEG group and 100 patients were classified as Non-PPEG group. The demographic data, tumor staging and ECOG score were similar between the 2 groups. The three-year overall survival rates in PPEG and Non-PPEG group were not significantly different. The mean weight reduction in the Non-PPEG were significantly higher than in the PPEG group during weeks 4-7 of CCRT and the proportion of patients with O10% weight reduction in Non-PPEG were significantly higher than in the PPEG group during weeks 4-7 of CCRT. The PPEG group showed a trend of having a higher CTR than the Non-PPEG group (94.3% vs 87% (P Z 0.055)). PEG related complications occurred in 44 patients (23%), 2 with early and 42 with late complications, and severe complications were observed in 6 patients (3.1%). 161 of 192 patients (83.8%) were available for interview and PEG utility rate as the route of feeding during CCRT was 96.3% (155/161). Conclusion: PPEG lessened weight loss in NPC patients undergoing CCRT and showed a trend in improving the completed treatment rate with minimal serious complications.

Effect of L-carnitine Supplementation on Circulating C-reactive Protein Levels: A Systematic Review and Meta-Analysis.

SummaryBackgroundC-reactive protein (CRP) has been proposed as a risk marker and risk factor of cardiovascular disease. There have been a number of clinical reports suggesting that supplementation with L-carnitine can modulate systemic inflammation and lower circulating CRP concentrations, but the results have not been consistent.MethodsA comprehensive literature search in Medline, Scopus and Cochrane Central Register of Controlled Trials was performed in December 2012 to identify clinical trials investigating the impact of oral L-carnitine supplementation on serum/plasma CRP concentration. A random effect method was used to calculate the combined effect size.ResultsSix studies comprising 541 cases and 546 controls met the inclusion criteria. Meta-analysis of included trials revealed a significant reduction of circulating CRP concentrations in subjects under L-carnitine intervention compared to the control treatment. The calculated combined weighted mean reduction in CRP concentrations was −0.39 mg/L [95% CI (−0.62 – −0.16)]. This effect size estimate was found to be robust and remained unaffected by the removal of each single study.ConclusionsThe overall findings of the present meta-analysis support the clinically relevant benefit of L-carnitine supplementation in lowering the circulating levels of CRP.

Do we need another SGLT2 inhibitor?

Do we need another <scp>SGLT2</scp> inhibitor?

Abstract W P153: HEALS Hypertension Control Program for Stroke Prevention in African American Communities

Stroke is the 4th leading cause of death and a leading cause of severe, long-term disability in US. African Americans (AAs) are at an elevated risk for cerebrovascular diseases. An approach of proven efficacy is to target a major modifiable risk factor for stroke, hypertension (HTN), and to do so using lifestyle changes (i.e., diet and exercise). The objective of this study was to implement and assess the efficacy of an evidence-based, socio-culturally tailored, lifestyle intervention called HEALS (Healthy Eating And Living Spiritually) adopted and modified from PREMIER and DASH studies in AA churches in Northeast Florida. Methods: 3- months HEALS program was delivered by trained church members to the high risk church members who were; a) church parishioners 25-75 years; and b) newly or known diagnosed with HTN/pre-HTN as per JNC-7 criteria. The outcomes were analyzed using ANOVA and Wilcoxon rank tests. Results: Of the 36 eligible, 32 (90%) provided complete information on outcomes and were included in the analysis. At baseline, 15 (42%) participants were pre-HTN, 9 (25%) had Stage 1 HTN, and 12 (33%) had Stage 2 HTN. Retention of 89% was observed at the end of 3- month HEALs intervention. After the completion of the 3-months intervention, the mean reduction in systolic blood pressure (SBP) and diastolic BP (DBP) were 6.72mmHg (p=.0425) and 4.00 mmHg (p=.0073), respectively. A mean weight reduction of 1.7 kg was also significant (p=0.0023). Further, positive trends in healthy eating occurred for the majority of the participants (60%), more than half consumed dark green or other vegetables frequently, while 75% consumed at least one fruit daily or weekly. Lower percentages (44%) reported consumption of 100% fruit juices or cooked beans regularly. Conclusion: The study provided much-needed information on the translation and sustainability of evidence-based lifestyle modification in community-based settings, particularly within churches, which represent the most influential institution in the community lives of AA. HEALS program can serve as a cost-effective model for stroke prevention. Future longitudinal randomized controlled studies on HEALS effectiveness are needed.

Reply to Schoeller et al. ,

Reply to Schoeller et al. ,

Liposuction-assisted medial brachioplasty after massive weight loss: an efficient procedure with a high functional benefit.

Brachioplasty frequently offers functional benefits but results in poor aesthetic scars and a relatively high complication rate. The authors describe the complications and risk factors inherent in liposuction-assisted medial brachioplasty and assess patient satisfaction with the functional and aesthetic benefits. A 5-year retrospective study was performed that included all patients who underwent liposuction-assisted medial brachioplasty. Complications were reviewed and analyzed by aesthetic and nonaesthetic categories, and patient satisfaction was rated. Sixty-six patients were included (mean age, 44.4 years). The average body mass index was 30.2 kg/m; mean weight reduction was 50.72 kg. Thirty-seven patients (56.1 percent) developed at least one complication, including six (9.1 percent) with a nonaesthetic complication versus 31 (47.0 percent) with an aesthetic complication. Complications were significantly associated with a longer operative time (p = 0.015), 233 minutes in the complication group versus 164 minutes in the no-complication group. Fifty-three patients answered the questionnaire. Forty-six (86.8 percent) stated that they would undergo this intervention again. Overall satisfaction was reported as excellent for 12 patients (22.6 percent) and pleasing for 24 (45.3 percent). All patients rated the functional outcome superior or equal to the aesthetic outcome. Quality of life was estimated to be better after than before the intervention for 41 patients (77.4 percent). Liposuction-assisted medial brachioplasty is a safe and efficient technique. It offers a functional benefit with a low nonaesthetic complication rate. Despite the inherent scars, the majority of patients would undergo this intervention again because of an important satisfaction rate and improvement in quality of life. Risk, III.

The efficacy of powered toothbrushes following a brushing exercise: a systematic review.

The primary objective was to determine, based on the available published evidence, the efficacy of powered toothbrushing following a brushing exercise and secondary to what magnitude this effect is dependent on the plaque index score, power supply and mode of action. The PubMed-MEDLINE and Cochrane CENTRAL databases were searched through and up to August 2014 to identify appropriate studies. The outcome measurement was the weighted mean (WM) percentage plaque score reduction of a full-mouth assessment following subject brushing. The search yielded 2420 titles and abstracts. Ultimately, 58 articles with 146 brushing exercises as separate legs were selected. The overall effect of a powered brushing exercise provides a 46% WM plaque score reduction. One hundred and six experiments provided data as assessed according to the Quigley and Hein plaque index. The WM reduction from baseline in plaque scores was 36%. A WM plaque score reduction of 65% was observed in 39 experiments using the Navy plaque index. Subanalysis on power supply and mode of action showed WM plaque score reductions ranging from 33% up to 71% depending on plaque index score. The efficacy in plaque removal following a brushing exercise using a powered toothbrush provides a WM plaque score reduction of 46% on average, with a range of 36-65% dependent on the index scale to score plaque. The available evidence indicates that the power supply (rechargeable or replaceable battery), mode of action, as well as brushing duration and type of instructions are factors which contribute to the variation in the observed efficacy.

Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years

Major weight loss causes body deformities. Lower circumferential dermolipectomy with autologous gluteal augmentation by a fat island flap can restore a part of the body contour, but this procedure is associated with a high incidence of complications. The aim of this study was to analyse the benefit/risk ratio and the patients' satisfaction. All patients who underwent this procedure at the Nancy University Hospital over a 3-year period (between January 2010 and 2013) were reviewed; the complications were analysed and the patients' satisfaction rated. A total of 55 patients were included with a mean age of 41.0 years. The average body mass index of the patients was 28.2kg/m² with a mean weight of 76.8kg at the time of the procedure and a mean weight reduction of 49.6kg. The mean operative time was 4.85h. The average hospital stay was 6.1 days. The average haemoglobin loss was 3.0g/dl, and 12 (21.8%) patients required a blood transfusion. Of the total number of patients, 22 (40%) developed at least one complication, including six (10.9%) major complications. Fifty-two patients answered the questionnaire; 49 (94.2%) patients would go through this procedure again. The overall satisfaction was rated as excellent by 29 (55.8%) patients and as pleasing by 22 (42.3%). The outcome was judged as excellent or pleasing for the abdomen by 29 (55.8%) and 20 (38.35%) patients, respectively, and for the buttocks by 17 (32.7%) and 29 (55.8%) patients, respectively. The quality of life was rated better after than before the intervention by 49 (94.2%) patients. Despite a high complication rate, the majority of patients confirmed that they would opt for this procedure again, showing an improvement in their quality of life with an aesthetic and functional benefit. III.