Metabolic Risk Reduction Research Articles

Can a small island nation build resilience? The significance of resource‐use patterns and socio‐metabolic risks in The Bahamas

AbstractResource‐use patterns may entail systemic risks and cascade effects, which consequently inhibit the ability to deliver socioeconomic services. Identifying resource‐use patterns exhibiting systemic risks and reshaping their combinations is a potential lever in realizing the transition to a sustainable, resilient, and resource‐secure system. Using an island context to assess the quantity and composition of resource throughput enables a more comprehensive analysis of these risks. This article presents the first mass‐balance account of socio‐metabolic flows for The Bahamas in 2018, to identify socio‐metabolic risks and cascading effects. Socio‐metabolic risks are systemic risks related to critical resource availability, material circulation integrity, and (in)equities in cost and benefit distributions. We utilize the economy‐wide material flow accounting framework to map the material flow patterns across the economy. In 2018, annual direct material input was estimated at 9.4 t/cap/yr, of which 60% were imports. High masses of waste (1.4 t/cap/yr) remained unrecovered due to the lack of recycling. Total domestic extraction (DE) were dominated by non‐metallic minerals with more than 80%, while marine biomass makes up barely 1% of total DE. Due to its linear, undiversified metabolism, and heavy imports dependency, the system is susceptible to socio‐metabolic risks and cascading effects including low levels of self‐sufficiency, high vulnerability to shocks, commodity price fluctuations, threats to sensitive ecosystems, health impacts, and economic losses, among others. A holistic resource management strategy and nature‐based solutions that consider the trade‐offs and synergies between different resource‐use patterns are critical when exploring potential plans for metabolic risk reduction.

Cardiovascular disease risk profile of Indian young adults with type 1 diabetes compared to general population – A sub-study from the Young Diabetes Registry (YDR), India

ObjectiveWe estimated the prevalence of traditional CVD risk factors among young adults with type 1 diabetes and compared them with the general population without diabetes. MethodsParticipants were young adults (aged 20 years and above) with type 1 diabetes, from the Delhi and Chennai sites of the ICMR -Young Diabetes Registry (YDR) and their age, gender and location matched controls, without diabetes from the CARRS (Cardio metabolic Risk Reduction in South Asia) cohort. YDR and CARRS used similar standard methodologies to quantify the CVD risk factors. Linear and logistic regression models were used to compare the adjusted means and proportions of risk factors. ResultsIndividuals with type 1 diabetes had lower levels of mean BMI (21.9 kg/m2 vs 24.3 kg/m2), waist circumference (76.8 cm vs 82.1 cm), favourable lipid profile (lower LDL and higher HDL), higher mean systolic blood pressure (122.1 mmHg vs 118.7 mmHg) and hypertension (29.2% vs 21.0%), compared to controls. The extent of clustering of two or more traditional CVD risk factors was higher among general population compared to people with type 1 diabetes. ConclusionWe found that young adults with type 1 diabetes have relatively low prevalence and clustering of traditional CVD risk factors compared to general population.

Sodium-glucose cotransporter 2 inhibitors at the intersection of cardiovascular, renal and metabolic care: an integrated and multidisciplinary approach to patient-centered care.

The management of individuals who live with type 2 diabetes requires an integrated and multifaceted approach. Sodium-glucose cotransporter 2 inhibitors effectively prevent and treat cardiorenal complications in the presence of type 2 diabetes. They also reduce death and disease progression in those with established heart failure (with reduced ejection fraction) in the absence of diabetes. Close collaborations between primary care physicians, cardiovascular specialists, endocrinologists and nephrologists are necessary to optimize cardiovascular, renal and metabolic risk reduction in their shared patients.

Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): −0.49 (−0.85, −0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%–18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI.Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn

Redukcja ryzyka metabolicznego u chorych na schizofrenię przyjmujących leki przeciwpsychotyczne – zalecenia Polskiego Towarzystwa Psychiatrycznego

Patients with schizophrenia are susceptible to physical illnesses, which reduces their life expectancy by an average of 20 years compared with the general population. The most common physical illnesses amongst patients with schizophrenia are metabolic disorders and cardiovascular diseases. The aim of this paper is to present recommendations on metabolic risk reduction in patients with schizophrenia treated with antipsychotics, accepted as a position statement of the Polish Psychiatric Association for use in the management of persons suffering from schizophrenia in Poland. A routine assessment of metabolic risk is recommended for the early detection of metabolic disorders and to monitor the safety of the antipsychotic treatment. It includes: medical history, physical examination, laboratory tests. Each patient should undergo this assessment before the initiation of treatment, after 6 and 12 weeks of treatment, and at least once a year thereafter. In men and women suffering from schizophrenia who are over the age of 40 and 50 years, respectively, a cardiovascular risk assessment using the SCORE charts is also recommended. (1) Antipsychotics with a low potential to cause metabolic disorders should be preferred and administered at the appropriate dose in order to reduce metabolic risk. (2) If other agents found to cause metabolic disorders are used, the treatment should be modified by augmentation or by switching to another antipsychotic with a lower potential to cause metabolic disorders. (3) Consultation by an internal medicine specialist and medical treatment should be recommended. (4) Patients should be assisted in developing healthy eating habits, encouraged to pursue regular physical activity and (5) to quit smoking, drinking alcohol and using psychoactive substances.

Dlaczego warto stosować walsartan i jego skojarzenia u pacjentów z nadciśnieniem tętniczym?

The most recent guidelines for the treatment of arterial hypertension have set blood pressure targets of below 130/80 mm Hg in most patients, recommending a single-pill combination (SPC) consisting of two drugs for treatment initiation. In addition to its strong antihypertensive effect, the use of valsartan is associated with a reduction in metabolic risk and in the incidence of hypertension-mediated organ damage and cardiovascular events. Valsartan is the only angiotensin receptor blocker of choice both in patients with hypertension and concomitant coronary artery disease, and in patients with heart failure. The combination of valsartan with amlodipine or hydrochlorothiazide is associated with a proven stronger hypotensive effect due to the synergistic effect of both molecules on the one hand, and a reduction in the frequency of side effects (such as peripheral oedema with amlodipine monotherapy or hypokalemia with hydrochlorothiazide monotherapy) on the other.

The Combined Effect of Promoting the Mediterranean Diet and Physical Activity on Metabolic Risk Factors in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration’s tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (n = 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (p < 0.001) of a beneficial effect of promoting the MD and PA on body weight (−3.68 kg, 95% CI (confidence intervals) −5.48, −1.89), body mass index (−0.64 kg/m2, 95% CI −1.10, −0.18), waist circumference (−1.62 cm, 95% CI −2.58, −0.66), systolic (−0.83 mmHg, 95% CI −1.57, −0.09) and diastolic blood pressure (−1.96 mmHg, 95% CI −2.57, −1.35), HOMA-IR index (−0.90, 95% CI −1.22, −0.58), blood glucose (−7.32 mg/dL, 95% CI −9.82, −4.82), triglycerides (−18.47 mg/dL, 95% CI −20.13, −16.80), total cholesterol (−6.30 mg/dL, 95% CI −9.59, −3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk.

The Effect of the Traditional Mediterranean-Style Diet on Metabolic Risk Factors: A Meta-Analysis.

The Mediterranean-style diet (MedSD) has gained attention for its positive effects on health outcomes, including metabolic risk factors. However, it is unknown as to which components of MedSD interventions are most beneficial in reducing risk. The objective of this meta-analysis was to obtain effect sizes for metabolic risk factors and explain the variability across the current literature based on study design, sample, and diet characteristics. Six electronic databases were searched from inception until 9 February 2016. Data from 29 studies (N = 4133) were included. There were significant effects in favor of the MedSD for waist circumference, triglycerides, blood glucose, systolic blood pressure, and diastolic blood pressure (d+ = −0.54; d+ = −0.46; d+ = −0.50; d+ = −0.72; d+ = −0.94, respectively). The MedSD was significantly beneficial when the intervention was longer in duration, was conducted in Europe, used a behavioral technique, and was conducted using small groups. The traditional MedSD had significant beneficial effects on five of the six metabolic risk factors. Results from this study provide support for population specific dietary guideline for metabolic risk reduction.

Integrated Healthcare in a Community-Based Mental Health Center: A Longitudinal Study of Metabolic Risk Reduction

ABSTRACTPeople living with serious mental illness (SMI) are at increased risk for metabolically related disease. This study aimed to examine the impact of a collaborative care intervention that targeted metabolically related health risk in adults diagnosed with SMI in a community mental health center. Markers of physical health were collected from a sample of 169 adults served by a federally funded integrated healthcare project. At the six-month follow-up, significant decreases in weight, cholesterol, and cigarette use were found. These findings highlight the important role social work practitioners hold for improving the health status of persons living with SMI.

Impact of Dietary and Exercise Interventions on Weight Change and Metabolic Outcomes in Obese Children and Adolescents

Diet and exercise represent the mainstays of obesity treatment. No systematic review has been conducted comparing the effect of dietary and exercise intervention in reducing metabolic risks in overweight children. To compare the effects of diet-only intervention with those of diet plus exercise or exercise only on weight loss and metabolic risk reduction in overweight children. English-language articles from 1975 to 2010 available from 7 databases were reviewed. One person searched the databases. Two independent reviewers assessed abstracts and articles against the following eligibility criteria: randomized controlled trials conducted in overweight and obese children aged 18 years or younger, comparing dietary intervention with a diet plus exercise program or an exercise-only program. Study quality was critically appraised by 2 reviewers using established criteria. The main outcome measures were body mass index, body fat percentage, lean body mass, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting glucose, and fasting insulin. Fifteen studies were identified and included. Based on the small number of short-term trials currently available, both diet-only and diet plus exercise interventions resulted in weight loss and metabolic profile improvement. However, the addition of exercise to dietary intervention led to greater improvements in levels of high-density lipoprotein cholesterol (3.86 mg/dL [to convert to millimoles per liter, multiply by 0.0259]; 95% CI, 2.70 to 4.63), fasting glucose (-2.16 mg/dL [to convert to millimoles per liter, multiply by 0.0555]; 95% CI, -3.78 to -0.72), and fasting insulin (-2.75 μIU/mL [to convert to picomoles per liter, multiply by 6.945]; 95% CI, -4.50 to -1.00) over 6 months. The diet-only intervention caused greater reductions in levels of triglycerides (at the end of active intervention) and low-density lipoprotein cholesterol (at subsequent follow-up). This review provides insights into the impact of dietary and exercise interventions on metabolic risk reduction in the pediatric population. However, further studies are required to confirm the evidence with rigorous design, appropriate sample size, longer duration of follow-up, and better strategies to improve compliance and achieve long-term sustainability.

The “metabolic syndrome index”: A novel, comprehensive method for evaluating the efficacy of diabetes prevention programs

A myriad of diabetes prevention programs are carried out worldwide to fight against the current type 2 diabetes (T2D) pandemic. The lack of a unified criterion for evaluating the efficacy of T2D prevention programs, however, makes the interpretation of prevention program results difficult, and hinders clear and direct comparisons of different prevention programs. Metabolic syndrome is a strong indicator for diabetes and its complications, holding great promise to become the basis of an intervention evaluation method. The Metabolic Syndrome Index (MSI), proposed here, quantifies the metabolic risk for developing T2D and its complications. The MSI is a novel scale for evaluating the efficacy of diabetes prevention programs because it is a systematic, comprehensive, and stable indicator that reflects the metabolic risk reduction for diabetes and its complications at multiple levels and dimensions.

Effects of Sleep Restriction on Glucose Control and Insulin Secretion During Diet‐Induced Weight Loss

Insufficient sleep is associated with changes in glucose tolerance, insulin secretion, and insulin action. Despite widespread use of weight-loss diets for metabolic risk reduction, the effects of insufficient sleep on glucose regulation in overweight dieters are not known. To examine the consequences of recurrent sleep restriction on 24-hour blood glucose control during diet-induced weight loss, 10 overweight and obese adults (3F/7M; mean [SD] age 41 [5] y; BMI 27.4 [2.0] kg/m2) completed two 14-day treatments with hypocaloric diet and 8.5 or 5.5-h nighttime sleep opportunity in random order 7 [3] months apart. Oral and intravenous glucose tolerance test (IVGTT) data, fasting lipids and free-fatty acids (FFA), and 24-hour blood glucose, insulin, C-peptide, and counter-regulatory hormone measurements were collected after each treatment. Participants had comparable weight loss (1.0 [0.3] BMI units) during each treatment. Bedtime restriction reduced sleep by 131 [30] min/day. Recurrent sleep curtailment decreased 24-hour serum insulin concentrations (i.e. enhanced 24-hour insulin economy) without changes in oral glucose tolerance and 24-hour glucose control. This was accompanied by a decline in fasting blood glucose, increased fasting FFA which suppressed normally following glucose ingestion, and lower total and LDL cholesterol concentrations. Sleep-loss-related changes in counter-regulatory hormone secretion during the IVGTT limited the utility of the test in this study. In conclusion, sleep restriction enhanced 24-hour insulin economy without compromising glucose homeostasis in overweight individuals placed on a balanced hypocaloric diet. The changes in fasting blood glucose, insulin, lipid and FFA concentrations in sleep-restricted dieters resembled the pattern of human metabolic adaptation to reduced carbohydrate availability.

Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial

Obesity is associated with a reduction in life expectancy and an increase in mortality from cardiovascular diseases, cancer, and other causes. We therefore assessed the efficacy and safety of two doses of phentermine plus topiramate controlled-release combination as an adjunct to diet and lifestyle modification for weight loss and metabolic risk reduction in individuals who were overweight and obese, with two or more risk factors. In this 56-week phase 3 trial, we randomly assigned overweight or obese adults (aged 18-70 years), with a body-mass index of 27-45 kg/m(2) and two or more comorbidities (hypertension, dyslipidaemia, diabetes or prediabetes, or abdominal obesity) to placebo, once-daily phentermine 7·5 mg plus topiramate 46·0 mg, or once-daily phentermine 15·0 mg plus topiramate 92·0 mg in a 2:1:2 ratio in 93 centres in the USA. Drugs were administered orally. Patients were randomly assigned by use of a computer-generated algorithm that was implemented through an interactive voice response system, and were stratified by sex and diabetic status. Investigators, patients, and study sponsors were masked to treatment. Primary endpoints were the percentage change in bodyweight and the proportion of patients achieving at least 5% weight loss. Analysis was by intention to treat. This study is registered with Clinical Trials.gov, number NCT00553787. Of 2487 patients, 994 were assigned to placebo, 498 to phentermine 7·5 mg plus topiramate 46·0 mg, and 995 to phentermine 15·0 mg plus topiramate 92·0 mg; 979, 488, and 981 patients, respectively, were analysed. At 56 weeks, change in bodyweight was -1·4 kg (least-squares mean -1·2%, 95% CI -1·8 to -0·7), -8·1 kg (-7·8%, -8·5 to -7·1; p<0·0001), and -10·2 kg (-9·8%, -10·4 to -9·3; p<0·0001) in the patients assigned to placebo, phentermine 7·5 mg plus topiramate 46·0 mg, and phentermine 15·0 mg plus topiramate 92·0 mg, respectively. 204 (21%) patients achieved at least 5% weight loss with placebo, 303 (62%; odds ratio 6·3, 95% CI 4·9 to 8·0; p<0·0001) with phentermine 7·5 mg plus topiramate 46·0 mg, and 687 (70%; 9·0, 7·3 to 11·1; p<0·0001) with phentermine 15·0 mg plus topiramate 92·0 mg; for ≥10% weight loss, the corresponding numbers were 72 (7%), 182 (37%; 7·6, 5·6 to 10·2; p<0·0001), and 467 (48%; 11·7, 8·9 to 15·4; p<0·0001). The most common adverse events were dry mouth (24 [2%], 67 [13%], and 207 [21%] in the groups assigned to placebo, phentermine 7·5 mg plus topiramate 46·0 mg, and phentermine 15·0 mg plus topiramate 92·0 mg, respectively), paraesthesia (20 [2%], 68 [14%], and 204 [21%], respectively), constipation (59 [6%], 75 [15%], and 173 [17%], respectively), insomnia (47 [5%], 29 [6%], and 102 [10%], respectively), dizziness (31 [3%], 36 [7%], 99 [10%], respectively), and dysgeusia (11 [1%], 37 [7%], and 103 [10%], respectively). 38 (4%) patients assigned to placebo, 19 (4%) to phentermine 7·5 mg plus topiramate 46·0 mg, and 73 (7%) to phentermine 15·0 mg plus topiramate 92·0 mg had depression-related adverse events; and 28 (3%), 24 (5%), and 77 (8%), respectively, had anxiety-related adverse events. The combination of phentermine and topiramate, with office-based lifestyle interventions, might be a valuable treatment for obesity that can be provided by family doctors. Vivus.

Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity

Sleep loss can modify energy intake and expenditure. To determine whether sleep restriction attenuates the effect of a reduced-calorie diet on excess adiposity. Randomized, 2-period, 2-condition crossover study. University clinical research center and sleep laboratory. 10 overweight nonsmoking adults (3 women and 7 men) with a mean age of 41 years (SD, 5) and a mean body mass index of 27.4 kg/m² (SD, 2.0). 14 days of moderate caloric restriction with 8.5 or 5.5 hours of nighttime sleep opportunity. The primary measure was loss of fat and fat-free body mass. Secondary measures were changes in substrate utilization, energy expenditure, hunger, and 24-hour metabolic hormone concentrations. Sleep curtailment decreased the proportion of weight lost as fat by 55% (1.4 vs. 0.6 kg with 8.5 vs. 5.5 hours of sleep opportunity, respectively; P = 0.043) and increased the loss of fat-free body mass by 60% (1.5 vs. 2.4 kg; P = 0.002). This was accompanied by markers of enhanced neuroendocrine adaptation to caloric restriction, increased hunger, and a shift in relative substrate utilization toward oxidation of less fat. The nature of the study limited its duration and sample size. The amount of human sleep contributes to the maintenance of fat-free body mass at times of decreased energy intake. Lack of sufficient sleep may compromise the efficacy of typical dietary interventions for weight loss and related metabolic risk reduction. National Institutes of Health.