Significant Improvements In Weight Research Articles

The Role of Intermittent Fasting on Metabolic Syndrome: A Systematic Review and Meta-Analysis.

Intermittent fasting has gained popularity as a dietary intervention to improve metabolic health. Metabolic syndrome may benefit from intermittent fasting by improving weight, cholesterol levels, blood pressure (BP), and glucose control.This study aims to assess the effects of intermittent fasting on weight, BMI, cholesterol levels, BP, and glucose in individuals with metabolic syndrome.This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included 11 studies examining the effects of intermittent fasting on metabolic syndrome. A comprehensive search of PubMed and Google Scholar identified 6,451 studies, of which 11 met the inclusion criteria. Data on weight, BMI, cholesterol, BP, and glucose levels were extracted, and a random effects meta-analysis was conducted to assess outcomes. Analysis showed significant improvements in weight, with a mean reduction of 3.59 kg (95% CI: -4.59 to -2.59, p < 0.0001) and a decrease in BMI of 1.39 kg/m2 (95% CI: -1.87 to -0.92, p < 0.0001). Low-density lipoprotein (LDL) cholesterol levels dropped by 56.22 mg/dL (95% CI: -80.14 to -32.29, p < 0.0001), and systolic BP decreased by 5.54 mmHg (95% CI: -7.55 to -3.53, p < 0.0001). However, high-density lipoprotein (HDL) cholesterol showed minimal changes, and glucose levels remained stable. Intermittent fasting led to significant reductions in weight, BMI, LDL cholesterol, and BP, making it a promising non-pharmacological strategy for managing metabolic syndrome. Further research is needed to explore long-term effects and optimal fasting protocols for different populations.

Changes in Transient Elastography with Glucagon-Like Peptide-1 Receptor Agonist Use in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Analysis.

Introduction: Current guidelines recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD), especially in patients with comorbid diabetes and obesity. This study investigated the effects of GLP-1RAs on hepatic steatosis and fibrosis in patients with MASLD, as measured by changes in vibration-controlled transient elastography (VCTE) and other clinical parameters in a real-world clinical setting. Methods: We conducted a single-center, retrospective analysis of 96 patients with MASLD from a multidisciplinary care clinic who completed VCTE at baseline and follow-up within 6-24 months to compare changes in controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as well as other metabolic markers, between GLP-1RA users and nonusers using two-sample t-tests and Wilcoxon rank-sum tests. We also assessed whether improvements in hepatic steatosis, defined as a change in CAP >38 dB/m as previously described in the literature, were associated with improvement in fibrosis. Results: GLP-1RA use resulted in significant improvements in weight (-8.1 kg vs. -3.5 kg, P = 0.009), body mass index (BMI) (-2.9 kg/m2 vs. -1.3 kg/m2, P = 0.012), alanine aminotransferase (-15.0 IU/L vs. -4.0 IU/L, P = 0.017), aspartate aminotransferase (-5.0 IU/L vs. -1.0 IU/L, P = 0.021), glycated hemoglobin (HbA1c) (-0.7% vs. 0.1%, P = 0.019), and CAP (-59.9 dB/m vs. -29.1 dB/m, P = 0.016). Responders also had significant improvements in weight (-9.2 kg vs. -1.9 kg, P < 0.001), BMI (-3.3 kg/m2 vs. -0.7 kg/m2, P < 0.001), diastolic blood pressure (-6.1 mmHg vs. -0.7 mmHg, P = 0.028), HbA1c (-0.8% vs. 0.3%, P < 0.001), and LSM (-1.5 kPa vs. 0.1 kPa, P < 0.001). Conclusions: Patients with MASLD treated with GLP-1RAs showed significant improvements in hepatic steatosis and multiple other metabolic parameters, with weight loss as the proposed mechanism for this liver improvement. In addition, change in CAP >38 dB/m was associated with improvements in LSM and other metabolic parameters, suggesting the clinical utility of VCTE in the surveillance of MASLD.

Abstract B053: A pilot study of a digital weight loss program for cancer prevention among obese individuals from four diverse cohorts

Abstract Background: Obesity and physical inactivity increase the risk of many types of cancer. Effective weight management, healthy diet, and physical activity are critical to reduce cancer risk. This pilot study of a technology-based weight loss program evaluated the program feasibility, weight loss, and improvement of healthy behaviors and quality of life among minority and medically underserved participants with obesity for cancer prevention. Methods: Participants in this pilot study were included from four cohorts: 1) Mano a Mano Mexican American Cohort (MAC; family dyads) 2) Project CHURCH (African-American men), 3) High- Risk Breast Cohort (HRBC; women), and 4) Mammography Cohort (women who participated in mammography screening). A 16-week weight loss program using the Diabetes Prevention Program was provided for healthy eating, physical activity, and portion control. Participants received program materials, text messages, Fitbit, and Wi-Fi connected scale. Weight, physical activity, dietary intake, weight-related health behaviors, and quality of life were assessed at baseline and follow-up. Program feasibility including retention and satisfaction were assessed after the program. Changes in outcomes from pre- to post- program were examined using paired t-tests and chi-squared tests. Results: Among 48 enrolled participants, 37 participants completed the program (total=77%; MAC=59%; Project CHURCH=90%; HRBC=90%; Mammography=90%). During the program, 46% participants measured and recorded their weights at least one day per week (MAC=17%; Project CHURCH=60%; HRBC=80%; Mammography=50%); 65% wore the Fitbit at least 2 days per week (MAC=44%; Project CHURCH=90%; HRBC=80%; Mammography=60%); 77% responded to text messages 15 out of 30 times (MAC=61%; Project CHURCH=90%; HRBC=90%; Mammography=80%); and 92% were satisfied with the program (MAC=100%; Project CHURCH=100%; HRBC=78%; Mammography=89%). After the program, we observed about 2% weight loss in average (self- report: p=0.009; scale measured: p=0.010). There were significant improvements in weight- related eating behaviors (routine restraint: +0.55, p=0.001; compensatory restraint: +0.49, p=0.001; susceptibility to external cues: -0.41, p=0.026; and emotional eating: -0.57, p=0.001). Stage of change for weight control showed significant shifts from action to maintenance stage (p=0.012). Furthermore, dietary habits significantly changed after the intervention with decreased 30% of total energy intake (p&amp;lt;0.001), increased 14% protein intake (p=0.044), and decreased 56% added-sugar intake (p&amp;lt;0.001). Conclusions: This digital weight loss program was determined as feasible and effective for weight loss and improving eating behaviors and dietary intake among minority and medically underserved individuals with obesity. The MAC showed a higher drop-out rate and less engaged in the program compared to other cohort, and therefore, this cohort may need adapted and more support that a low touch digital weight loss program can provide to improve the feasibility. Citation Format: Che Young Lee, Thuan Le, Carrie R Daniel, Larkin L. Strong, Scherezade K Mama, Lorna H McNeill, Abenaa Brewster, Samir Hanash, Karen Basen-Engquist. A pilot study of a digital weight loss program for cancer prevention among obese individuals from four diverse cohorts [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B053.

Long-Term Effectiveness of Off-Label Risperidone Treatment in Children and Adolescents: A Randomized, Placebo-Controlled Discontinuation Study.

Objectives: Risperidone is commonly prescribed off-label in children and adolescents to manage disruptive behavior. This study aimed to investigate continued benefits of risperidone after at least 1 year of treatment and effects of discontinuation on physical health. Methods: Thirty-five youths (aged 6-18 years, intelligence quotient [IQ] >70) who were treated with risperidone for at least 1 year in regular clinical practice receiving outpatient care were randomly assigned to double-blind continuation of risperidone during 16 weeks or continuation for 2 weeks, gradual dose lowering over 6 weeks, and placebo for 8 weeks. Primary outcome was the total Disruptive Behavior (D-total) score of the parent-reported Nisonger Child Behavior Rating Form-Typical IQ (NCBRF-TIQ). Secondary outcome measures were the clinician-rated Clinical Global Impressions-Improvement scale (CGI-I), the parent, child, and teacher-rated Strengths and Difficulties Questionnaire (SDQ), the parent-rated Retrospective Modified Overt Aggression Scale (R-MOAS), and several health parameters (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale [UKU-SERS], dyskinesia, akathisia, parkinsonism, body mass index (BMI), waist circumference, and laboratory outcomes). Mixed models for repeated measures were conducted for continuous outcomes and a chi-square test for the CGI-I. Results: Discontinuation of risperidone, as compared with continuation, was not associated with significant changes in parent-reported disruptive behaviors. However, discontinuation was related to significant deterioration in parent-rated verbal aggression, teacher-rated behavioral functioning, clinician-rated general functioning, and significant improvements in weight, BMI, waist circumference, and glucose, insulin, and prolactin levels. Although 56% of participants in the discontinuation group experienced relapse, causing premature withdrawal from the study, 44% was able to successfully discontinue risperidone. Conclusion: Discontinuation of risperidone was associated with deterioration on some, but not all behavioral measures according to this explorative study. Discontinuation was associated with important health gains. Despite long-term benefits of risperidone, attempts to withdraw risperidone should be undertaken in individual children. This is a crucial step in preventing harm and fostering health.

Effectiveness of a hybrid approach in integrating GLP-1 agonists and lifestyle guidance for obesity and pre-diabetes management: RWE retrospective study

AimEmerging anti-obesity pharmacotherapy provides an option to correct maladaptive physiological and hormonal changes associated with obesity. One of the widely used medications in this context is glucagon-like peptide 1 (GLP-1) agonists. However, the misuse of these medications without any guidance and monitoring of lifestyle modifications can lead to unfavorable outcomes. The study aims to evaluate the effectiveness of a hybrid care model, incorporating GLP-1 and GLP-1/GIP agonist therapies, in managing obese patients with/without pre-diabetes. This study showcases the midway results of a 6-month program, which includes a multidisciplinary care team and digital technology for continuous engagement and monitoring of patients, both in-clinic and remotely. MethodsIn a retrospective observational study, 115 participants were treated with GLP-1s (semaglutide, tirzepatide, and liraglutide). Physicians, dietitians, and coaches worked together to support behavioral changes using a dedicated app provided to patients. At the care team end, an integrated portal enabled continuous data flow allowing for the care team to provide personalized care via chat at regular intervals. Data collected included food logs, continuous glucose monitoring (CGM), and digital biomarkers such as sleep and activity. ResultsAt the midpoint of the program, participants exhibited statistically significant improvements in various metabolic parameters. Mean weight reduction was 8 %, with significant reductions in BMI, fat mass, and cholesterol levels. 24 (20.9 %) of patients lost ≥5 % of body weight, 55 (47.8 %) patients lost ≥10 % weight, and 36 (31.3 %) patients lost ≥15 % weight. Sub-analysis of pre-diabetic patients (n=36) demonstrated substantial improvements, including control of pre-diabetes in 80.6 % of cases and reduced HbA1c levels back to normoglycemia (5.39 ± 0.27). ConclusionThe Zone.Health's program, which combines pharmacotherapy with continuous engagement and monitoring to enable sustainable lifestyle modifications, demonstrated significant improvements in weight, body composition, and metabolic markers. Pre-diabetes was also effectively addressed. It is necessary to conduct further research to assess the long-term sustainability and optimal adoption of such care models into clinical practice.

Empowering Medical Students: Unveiling the Benefits of Nutrition Seminars and Plant-Based Diets in Medical School Education.

Background: Whole-food, plant-based (WFPB) dietary patterns can be used as a lifestyle modification to lower blood pressure and lose weight. This study aimed to observe the effects of WFPB dietary patterns and improve nutrition education in medical school. Methods: Forty-six medical students participated in the four-week Plant Plunge challenge, which consisted of a pre- and post-challenge health screening, weekly nutrition seminars, and the personal challenge to eat more WFPB. Afterward, an anonymous survey was sent to participants to analyze nutrition education quality in medical school. Results: The Wilcoxon Signed Rank test indicated statistically significant improvement in weight and blood pressure (BP) (N = 33). The median (interquartile range) difference in weight from pre- to post- was -.9 (-2.2, .0, P < .0461) pounds, whereas the differences in systolic and diastolic BP were -5.0 (-9.0, -.5, P < .049) and -7.0 (-11.0, -2.0, P < .0037) mmHg, respectively. Participants were significantly more likely to advocate for the integration of nutrition information into the medical school curriculum (P = .0162). Conclusions: Short-term lifestyle modifications with WFPB dietary patterns help reduce weight and BP. Incorporating nutrition seminars in medical education may improve long-term patient outcomes.

Dedalo Vola project: The effect of choral singing on physiological and psychosocial measures. An Italian pilot study

Several studies have been conducted that show the crucial role of active participation in music in health promotion (e.g. Dingle et al., 2021; Sheppard & Broughton, 2020); however, little research has focused on the biopsychosocial effects of choral singing. The present study aims to evaluate the effectiveness, in terms of improving physiological and psychosocial factors, of a choral program for middle-aged and older individuals. We integrated our study with qualitative observations of the atmosphere and flow state experienced by the choristers. The data were collected before and after 12 weeks of training, with 23 participants took part in the study. They experienced significant improvements in weight, oxygen saturation, heart rate, and satisfaction of psychological needs. A beneficial trend, although not statistically significant, were observed for blood pressure, cholesterol, triglycerides, stress, psychological needs, and mental health. The observations progressively revealed a more cohesive and focused group. Our findings support the potential for cross-disciplinary collaboration between healthcare and arts policy to promote and enhance health and well-being throughout the lifespan.

Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment

BackgroundMalnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery.MethodsChildren 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively.ResultsForty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score − 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score − 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable.ConclusionMalnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.

Alterations in muscle strength among patients with GI cancers receiving oral nutritional support as soon as malnutrition was detected: ONMUS study.

741 Background: The main goal of our multicenter study, focusing on patients with gastrointestinal (GI) cancers receiving nutritional support, was to monitor the alterations in muscle strength among individuals who began oral nutritional support (ONS) as soon as malnutrition was detected. Additionally, our study had secondary objectives, which included assessing the adherence to ONS, examining the impact of ONS on anthropometric measurements, analyzing chemotherapy compliance, and evaluating the overall quality of life. Methods: The ONMUS study was conducted at 8 centers in Turkey. The study aimed to involve patients with GI cancer who had used ONS for a minimum of 1 week and had an ECOG performance score of 0-1. Patients underwent evaluations by both a dietitian and an oncologist during the baseline visit, as well as at the 2nd and 3rd month visits. Various parameters, including age, gender, performance status, disease stage, treatment adherence, food consumption records, anthropometric measurements, muscle function measured with a handgrip device, and quality of life scales, were assessed. Results: The study comprised 426 patients. The median age was 62 years, with a range spanning from 19 to 90 years. Colorectal cancer was the primary diagnosis in 51% of the patients, while hepatobiliary, gastric, esophageal, and small bowel cancers accounted for 20.9%, 20.7%, 6.5%, and 1% of cases, respectively. A significant majority, 78.2% (n=319), of the patients were diagnosed at stage 4, and nearly all, 99.3% (n=411), were undergoing chemotherapy. Patients who adhered to ONS at or above 75% of the recommended usage were categorized as compliant. Among this group, there was a significant increase in body mass index ( P=0.005). Handgrip measurements for assessing muscle strength demonstrated a statistically significant increase, with handgrip weight rising from 24.9 ± 8.9 kg at the first visit to 26.1 ± 8.9 kg at the third visit ( P=0.009). ONS-compliant patients also showed statistically significant improvements in weight, total body water, basal metabolic rate, and calf circumference measurements. The proportion of ONS-compliant patients decreased from 80.5% (n=343) at the first visit to 62.4% (n=93) at the third visit. Additionally, a statistically significant improvement was observed in food consumption records ( P=0.004). In assessments using the EORTC QLQ-C30, there were significant improvements noted in general health status, fatigue, pain, and insomnia scales, as well as in physical, emotional, and social functioning. Furthermore, a significant difference was identified between visits 1 and 2 in PG-SGA scoring ( P&lt;0.001). Conclusions: ONS compliance is evident in the significant improvement observed in muscle strength, anthropometric measurements, and quality of life data. The importance of addressing malnutrition in patients with GI cancer cannot be overstated. Therefore, it is imperative to maintain regular monitoring of their nutritional status and adherence to ONS.

Postural Control and Weight Bearing Symmetry Patterns in Patients Post Lumbar Spinal Decompression Surgery

Background Prolapsed intervertebral disc is one of the most common reasons for low back pain often causing altered postural control and weight bearing symmetry of foot. Although these components are known to be affected there is limited literature available explaining the postural control and weight bearing symmetry post spinal decompression surgical procedures.Objective The study was formulated with the objective to understand postural control and symmetry of weight bearing patterns among patients post lumbar spinal decompression surgery.Methods The study was conducted involving 65 patients who were assessed pre-and post-lumbar decompression surgery. Nintendo Wii balance board was used to assess the patients at all intervals.Results The post-surgical values at discharge showed a clinical improvement in postural control bilaterally left P0.068 and right P0.031 but showed deterioration at one month with right P0.076 and significant on left side P0.009. Contrary to this the follow up values at one month showed a significant improvement in weight bearing symmetry P0.001. Pain values both on activity and at rest taken at both follow-up intervals F1 and F2 showed a statistically significant reduction P0.001.Conclusion Postural control assessed with single limb stance shows worsening at one month post decompression procedure. Weight bearing symmetry parameters may demonstrate a decline immediately post lumbar decompression surgery but may show a significant improvement along with reduction in pain post surgically as early as one month.

Determinants of nutritional outcome among beneficiaries of Nutrition Rehabilitation Centre

Background: Under Mission Balam Sukham, children of 6 months to 5 years having severe acute malnutrition (SAM) along with complications are managed at Nutrition Rehabilitation Centre (NRC). They are admitted for 14 days with the provision of a nutritional diet and medicines. Objectives: To explore determinants of nutritional outcome of SAM children admitted at NRC Methods: A prospective cohort study was conducted comprising 63 children aged 6 months to 5 years having SAM along with complications admitted at NRC of New Civil Hospital, Surat (NCHS) for 10 months. Results: The majority of participants were boys (54%), 12-23 months of age (50.8%), and Grade III socioeconomic class (39.6%). The duration of stay ranged from 2-36 days. The average duration of stay was 12.78 + 6.49 days; 14.26 ± 5.99 days for boys and 11.10 + 6.73 for girls. 18.8% stayed at NRC for 14 days. The average weight gain was 5.46 g/kg/day. A significant improvement in weight was seen in boys (t=2.20, p&lt;0.05), working mothers (t=2.44, p&lt;0.01), exclusively breastfed children (t=3.62, p&lt;0.01) of 6-11 months, full-term children of 12-23 months (t=4.0, p&lt;0.05). The children of 12-23 months (t=2.90, p&lt;0.01) and boys (t=2.15, p&lt;0.05) showed significant improvement in underweight (WAZ). Wasting improved significantly in age below 36 months (p&lt;0.05). 20.6% could achieve the target weight. Conclusion: NRC is an effective life-saving modality for malnutrition but its outcome is associated with factors like boys, exclusive breastfeeding, and full-term.

Effect of Different Levels of FYM and Recommended Dose of Fertilizer and their Methods of Application on Groundnut in Western Uttar Pradesh

A two-year field experiment was conducted at the Research farm of Kisan Post Graduate College (Chaudhary Charan Singh University, Meerut), Simbhaoli, Hapur, Uttar Pradesh, from July-October of 2016 and 2017, respectively, to investigate the response of organic manures (farmyard manure) and chemical fertilizers and their method of application (broadcasting and root zone application) on Groundnut crop under assured irrigation. The soil of the field experiment was clay loam with chemical reaction 7.80, electrical conductivity (0.31 mm uS cm-1), low in organic carbon content (0.37%), low in available nitrogen and medium in phosphorus, and high in potassium. Results of the field experiment revealed that pod yield of groundnut improved by root zone placement of farmyard manure (FYM) and inorganic fertilizers mainly through a significant improvement in weight of 100 kernels. FYM and different NPK levels of fertilizers were applied as broadcasting and root zone placement in different treatments. Application of 14.0 tonnes of FYM ha-1 recorded significantly higher pod yield over the control plot. Root zone application of 75% of the recommended dose of 20 kg N, 80 kg P2O5, and 20 kg K2O ha-1 resulted in higher dry matter accumulation which leads to higher pod yield. Amid the interaction effect, a combination of 14.0 tonnes of FYM ha-1+75% RDF, 14.0 tonnes of FYM ha-1+root zone application and 100% RDF of NPK+root zone application obtained the highest pods yield as compared to other treatment combinations.

Feasibility and preliminary effectiveness of a cognitive-behavioral, family-centered partial hospitalization program for adolescents with anorexia nervosa and atypical anorexia nervosa at six- and twelve-month follow-up.

This study examined the feasibility and preliminary effectiveness of a cognitive-behavioral, family-centered partial hospitalization program (PHP) for adolescents with anorexia nervosa (AN) and atypical AN (AAN), and described the outpatient services received following discharge. Participants (N=31) completed anthropometric and self-report assessments at admission, discharge, and six and twelve months after discharge from the PHP. Descriptive statistics explored markers of feasibility. Paired samples t-tests evaluated changes in weight and eating disorder (ED) symptomatology from admission to discharge, admission to six-month follow-up, and admission to twelve-month follow-up. Descriptive statistics and effect sizes compared symptoms at each timepoint between participants with AN and AAN. Results indicated that we were successful at recruiting greater than 50% of adolescents approached for this study. We collected follow-up data from more than 70% of participants at discharge, but did not meet this retention benchmark at six-month and twelve-month follow-ups. The entire sample demonstrated significant improvements in weight and ED symptomatology from admission to discharge, and generally maintained these improvements at six- and twelve-month follow-up. While descriptive statistics suggested that participants with AN and AAN received similar outpatient services following discharge from the PHP, those with AN experienced greater improvement in self-reported ED symptomatology than those with AAN at six- and twelve-month follow-up. These findings provide preliminary support for the efficacy of PHPs in treating adolescents with AN and AAN. Further research with larger sample sizes should investigate whether adolescents with AAN experience poorer outcomes than those with AN following discharge from a PHP.

The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials.

As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.

1801-PUB: Efficacy and Safety of Once-Weekly Semaglutide in People with Type 1 Diabetes in Real-World Practice

Introduction: Semaglutide has shown significant improvements in weight and HbA1c in T2D, but the data about the efficacy and safety in people with T1D (PWT1D) are scarce. Aims &amp; Methods: We conducted a retrospective study including adults with T1D and obesity who had initiated once weekly (OW) semaglutide adjunct to insulin, to evaluate its efficacy and safety. Results: Twenty-one subjects were included (52.4% female, mean age 44.2 ± 12.9 years, diabetes duration 19.1 ± 10.8 years, HbA1c 7.7 ± 0.8%, BMI 38.3 ± 5.9 kg/m2). Of them, 47.6% had hypertension, 52.4% dyslipidaemia, 23.8% cardiovascular disease, and 19% renal disease. Mean treatment duration was 30.4 weeks. Mean OW semaglutide dose was 0.8 ± 0.2 mg. Significant reductions in HbA1c (-0,6 ± 0.7%), weight (-8.1 ± 6.1 kg; -7.5 ± 5.8%) and daily insulin dose (-20.7 ± 18.9 U/day) were achieved. An HbA1c reduction of ≥ 0.4% was seen in 61.9% of subjects. Weight loss ≥ 5% and ≥ 10% were achieved in 57.1% and 33.3% of cases, respectively. Significant improvements in time in range (+8.8 ± 13.4%) and time in hyperglycemia &amp;gt;250 mg/dL (-5.3 ± 5.1%) were attained. Four subjects experienced gastrointestinal adverse events, and two of them discontinued treatment. Conclusions: Adjunct treatment with OW semaglutide in PWT1D in a real-life setting resulted in promising results in glycemic control, weight, and insulin requirements, in a safe and well-tolerated manner. Disclosure V.Bellido: None. N.Gros herguido: None. S.Amuedo: None. L.Baena ariza: None. S.M.Alfonso: None.

Change in cardiometabolic risk factors in a pilot safety-net plant-based lifestyle medicine program.

Interventions emphasizing healthful lifestyle behaviors are proliferating in traditional health care settings, yet there is a paucity of published clinical outcomes, outside of pay-out-of-pocket or employee health programs. We assessed weight, hemoglobin A1c (HbA1c), blood pressure, and cholesterol for 173 patients of the Plant-Based Lifestyle Medicine Program piloted in a New York City safety-net hospital. We used Wilcoxon signed-rank tests to assess changes in means, from baseline to six-months, for the full sample and within baseline diagnoses (i.e., overweight or obesity, type 2 diabetes, prediabetes, hypertension, hyperlipidemia). We calculated the percentage of patients with clinically meaningful changes in outcomes for the full sample and within diagnoses. The full sample had statistically significant improvements in weight, HbA1c, and diastolic blood pressure. Patients with prediabetes or overweight or obesity experienced significant improvements in weight and those with type 2 diabetes had significant improvements in weight and HbA1c. Patients with hypertension had significant reductions in diastolic blood pressure and weight. Data did not show differences in non-high-density lipoprotein cholesterol (non-HDL-C), but differences in low-density lipoprotein cholesterol (LDL-C) were approaching significance for the full sample and those with hyperlipidemia. The majority of patients achieved clinically meaningful improvements on all outcomes besides systolic blood pressure. Our study demonstrates that a lifestyle medicine intervention within a traditional, safety-net clinical setting improved biomarkers of cardiometabolic disease. Our findings are limited by small sample sizes. Additional large-scale, rigorous studies are needed to further establish the effectiveness of lifestyle medicine interventions in similar settings.

Enhancing Obesity Management Through a Nurse Practitioner-Guided Behavioral Counseling Program

Although the prevalence of obesity in the United States is increasing, its treatment in primary care remains subpar. Implementing obesity reduction programs can result in significant benefits to patients. This study demonstrates that the use of a nurse practitioner-led program can result in weight loss. Thirty-six participants who were overweight or had obesity received biweekly behavioral counseling sessions over a 10-week period. Significant improvement in weight, waist circumference, blood pressure, quality of life, and self-efficacy for exercise was noted. Implementing similar programs can help patients attain weight loss and have an overall improvement in quality of life.

Real-world Data of Glycemic Control in a Suburban Population in Northern India during the COVID-19 Pandemic

Abstract Background: This study compared the 2-year glycemic outcomes with oral antidiabetic drugs (OADs) versus combination of OADs with insulin among the real-world patients at a single suburban center in India during the COVID-19 pandemic. Methods: Patients aged &gt;18 years on the treatment for type 2 diabetes mellitus were included and followed up for 2 years. The patients were divided into four groups according to their antidiabetic medication as follows: (1) sodium-glucose cotransporter-2 inhibitors (SGLT2i) + insulin + OADs; (2) SGLT2i + OADs; (3) insulin + OADs (excluding SGLT2i); and (4) OADs excluding SGLT2i. Patients who were reluctant to initiate insulin as add-on therapy or those already taking insulin but wanting to switch to OADs were prescribed SGLT2i as add-on therapy. The parameters measured at every follow-up were blood pressure, weight, fasting blood sugar (FBS), postprandial blood sugar, and HbA1c. Results: In all, 1204 patients were included in the study. The mean age of patients was 59.07 ± 13.08 years, and 729 (60.54%) were males. Out of 1204 patients, the HbA1c data were available for only 472 patients. All glycemic parameters were maintained in the SGLT2i + Insulin + OADs group over the period of 3 years with no significant change in their values. The number of patients in the SGLT2i + OADs group more than doubled over the 2 years of follow-up. There was a significant improvement in weight and FBS at year 2 in this group. A significant improvement in HbA1c and FBS was seen in patients with baseline HbA1c ≥10 at baseline. No statistically significant change was observed in any of the clinical parameters in patients in the Insulin + OADs (excluding SGLT2i) group. Only about 50% of those who were on insulin at baseline, continued insulin at the first and second follow-up. In the OADs (excluding SGLT2i) group, weight and post lunch blood sugar showed a significant decrease at the second follow-up. Among patients who remained on OADs throughout the study, there was a significant improvement in HbA1c from baseline at year 2, although other parameters did not show any significant improvement. Conclusion: Patients on various OAD regimens showed better glycemic control compared to those on combined insulin and OADs in this study in a suburban population in India.

Nutritional impact of CFTR modulators in children with cystic fibrosis.

Nutritional status is a major prognostic factor for breathing and the survival of patients with cystic fibrosis (CF). Since 2012, the development of CFTR modulators has considerably transformed the outcome of this disease. Indeed, both lung function and body mass index are improved by CFTR modulators, such as Lumacaftor/Ivacaftor. However, few data exist regarding the outcome of nutritional intakes under Lumacaftor/Ivacaftor. We conducted a prospective single-center study in children with CF treated with Lumacaftor/Ivacaftor to evaluate their nutritional intake before and after treatment. Thirty-four children were included in this study, with a median age of 12.4 years [11.9; 14.7]. There was no significant improvement in weight, height or BMI. Patients' total energy intake was not significantly changed with Lumacaftor/Ivacaftor, while carbohydrate intakes decreased significantly. We found that blood levels of vitamin E and Selenium were significantly increased under Lumacaftor/Ivacaftor, without a significant increase in supplementation. In patients with a BMI Z-score < 0 at treatment initiation, there was a significant improvement in weight and BMI Z-score, while TEI and carbohydrate intakes were significantly lower. We showed that treatment with Lumacaftor/Ivacaftor improved the nutritional status of patients without necessarily being associated with an increase in nutritional intake. Although these data need to be confirmed in larger cohorts, they support the hypothesis that weight gain under modulators is multifactorial, and may be related to a decrease in energy expenditure or an improvement in absorption.

Association between Body Composition Parameters and Heart Rate in a Sample of Adolescents with Anorexia Nervosa.

Eating disorders affect the physical and mental health of millions of Americans. Body composition trends in relation to heart rate in adolescents with eating disorders remain understudied. The aim of the present study was to determine whether body composition parameters (percent body fat, percent skeletal muscle mass) are correlated with heart rate in a sample of adolescents with anorexia nervosa. This study included patients 11 to 19 years old who presented to an outpatient eating disorder clinic (N = 49). Patients underwent bioelectrical impedance analysis to estimate body composition parameters. Descriptive statistics, linear regression, and paired t tests were used to evaluate the data. Heart rate was inversely associated with percent skeletal muscle mass (P < 0.001) and positively associated with percent body fat (P = 0.001). Patients demonstrated significant improvements in weight, body mass index percentile, skeletal muscle mass, percent body fat, and heart rate when comparing results at the first and last visits (P < 0.01). Overall, there was an inverse relation between percent skeletal muscle mass and heart rate and a positive association between body fat and heart rate. Our study demonstrates the importance of assessing percent body fat and skeletal muscle mass rather than weight or body mass index alone in adolescents with eating disorders.