Significant Improvements In Weight Research Articles

Effect of aripiprazole as an adjunct to atypical antipsychotics on weight and metabolic profile: a 12-week open-label trial.

Background:Atypical antipsychotics are widely prescribed, yet have been associated with weight gain and metabolic syndrome.Aim:To study the effect of adjunct low-dose aripiprazole on weight and metabolic parameters of subjects on atypical antipsychotics (olanzapine, clozapine or risperidone).Methods:The study was carried out as an open-label trial with a fixed dose of 5 mg aripiprazole added to the patient’s current antipsychotic for 12 weeks. The primary outcome measure was mean change in weight, while secondary outcome measures included change in waist circumference; fasting blood glucose; HbA1c; triglycerides; total, HDL and LDL cholesterol levels; functioning; and neurocognition.Results:For the overall study (n = 55), there was no significant effect of adjunct aripiprazole on the weight of the subjects. However, the clozapine group achieved significant weight loss (p = 0.002) and also had significant improvements in total cholesterol (p < 0.001), HDL (p = 0.016), LDL (p = 0.044) and triglyceride levels (p = 0.038). The olanzapine group had significant improvement in triglycerides (p = 0.001), and other metabolic parameters for this group showed improvement trends, but did not reach statistical significance. The risperidone group did not show any significant improvement in weight or metabolic parameters.Conclusions:The study adds support to the adjunctive use of aripiprazole to clozapine for weight loss and improvement in metabolic profile, and for reduction in cardiometabolic risk for patients on olanzapine.Trial Registration:Clinicaltrials.gov identifier: NCT02949752

Body mass index changes after transjugular intrahepatic portosystemic shunt in individuals with cirrhosis

ObjectivesLiver cirrhosis is often accompanied by portal hypertension and malnutrition, two common complications that seriously affect treatment efficacy and quality of life. This study aimed to investigate the effect of transjugular intrahepatic portosystemic shunt (TIPS) on body mass index (BMI) and metabolism in individuals with cirrhotic portal hypertension, and the risk factors that affect changes of BMI. MethodsA retrospective study was performed to collect basic information before and after TIPS. This study included 77 participants. For each participant, we assayed body nutrition parameters: change of weight and BMI, routine liver and kidney function tests, and free fatty acids. In addition, we evaluated glucose and biochemical indexes. We used analysis of variance and regression analysis to investigate the effect of TIPS on BMI and metabolism in individuals with cirrhotic portal hypertension, and the risk factors that affect changes of BMI and metabolic components. ResultsAfter TIPS, there was significant improvement in weight, BMI, red blood cell count, blood platelet count, hemoglobin, and Child–Pugh score in individuals with cirrhotic portal hypertension. Average weight and BMI increased after TIPS by 3.2% and 3.4%, respectively (P < 0.05). After 36 months, there were no significant differences in weight and BMI between before and after TIPS. We also observed a dose-response association of pre-TIPS blood ammonia and increased post-TIPS BMI (P = 0.05) in men. ConclusionsThis study suggests that individuals with cirrhosis treated with TIPS may see improvement in overall clinical and physical status, as measured by increased weight and BMI. Our data also indicate that pre-TIPS blood ammonia is positively associated with post-TIPS BMI.

Utility of late pulmonary artery banding in single-ventricle physiology: A mid-term follow-up.

Background:The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period.Materials and Methods:This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding.Results:The median age of the patients was 5.5 months (3.5–96 months), and the median body weight was 4.7 kg (3.2–22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7–23 months). There was a statistically significant improvement in weight for age Z scores following PA band (P = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (±3.6), 22.7 (±5.7), and 33.3 (±12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (±0.5), 2.45 (±0.7), and 3.5 (±1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery.Conclusions:Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.

Low serum insulin-like growth factor-1 level is a predictor of low total weight loss percentage after sleeve gastrectomy

Obesity is a leading cause of metabolic disorders and mortality. Laparoscopic sleeve gastrectomy (LSG) confers beneficial effects not only on weight but also on metabolic disorder development. However, some patients show insufficient weight loss after LSG. A total weight loss percentage (%TWL) <20% after LSG is defined as insufficient. The prediction of patients with insufficient weight loss after LSG before the procedure is performed may prove helpful. To determine predictors of %TWL after LSG. Longitudinal study in a university hospital. We retrospectively reviewed 90 obese patients who underwent LSG and were followed up for 12 months thereafter. We analyzed the relationship between %TWL and preoperative clinical parameters, such as age, sex, body mass index, lipid and glucose metabolism, and some hormones. Patients were divided into 2 groups, %TWL <20% and 20% ≤ %TWL. Multiple regression model and logistic regression models were performed. LSG led to significant improvements in weight, liver, and kidney function, and lipid and glucose metabolism. The serum insulin-like growth factor-1 (IGF-1) level was significantly lower in patients with %TWL <20%. Sex, diabetes presence, body mass index, and IGF-1 were independent predictors of %TWL. Receiver operating characteristic curve analysis showed that the cutoff value of IGF-1 for %TWL <20% was 100.0ng/mL. Male sex, diabetes presence, lower preoperative BMI, and IGF-1 values were independently associated with lower %TWL (%TWL <20%). Serum IGF-1 can be used to screen for patients at risk of low %TWL after LSG.

Enhancing employee wellness: Translating an effective community behavioral weight-loss treatment to the worksite.

As rates of obesity continue to rise in the USA, there is a need for effective treatments for excess adiposity. Behavioral weight-loss interventions can produce clinically meaningful weight reduction through life-style modifications. However, few studies have evaluated the effectiveness of high-intensity behavioral weight-loss interventions at worksites. The present research investigated the effectiveness of a previously validated behavioral weight-loss intervention in a Hawai'i worksite. Thirty-six participants were recruited from the employee population of a local employer. Participants received six months of group behavioral weight-loss treatment from trained providers. Anthropomorphic, physiological, psychological, and behavioral assessments were collected pre and post treatment. Select physiological and behavioral assessments were collected every four sessions. Sixty-one percent of participants adhered to treatment, and 78% of participants completed treatment. From pre to post treatment, results found that participants achieved clinically significant improvements in weight, body mass index (BMI), and waist circumference, with accompanying physiological, psychological, and behavioral improvements (F(12, 2)=101.379, p=0.010, partial η2=0.998). Analyses revealed that participants also achieved significant changes in weight, BMI, and waist circumference across time points, as well as improvements in specific eating habits. The present study demonstrated the efficacy of a worksite behavioral weight-loss program. The present intervention produced clinically significant weight losses for a large proportion of participants, accompanied by significant improvements in physiological, behavioral, and psychological outcomes. This research is promising for the ongoing implementation of behavioral weight-loss approaches.

Longitudinal Study of Body Composition and Energy Expenditure in Overweight or Obese Young Adults

The aim of this study was to compare the effects of an aerobic training program with a strength training program on body composition and energy expenditure in overweight or obese (29.06 ± 3.49 kg/m2) young adults (21.96 ± 1.90 years). Subjects (N = 109) were randomly assigned to one of three groups: a control group (CG), an aerobic training (AT) group and a strength training (ST) group. Training took place over twelve weeks comprising three sessions per week with each session lasting 60 to 90 minutes. Before and after the program, weight, height, body mass index, lean mass percentage and fat mass percentage were evaluated. In addition, The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to estimate energy expenditure. The results of both aerobic training and strength training produced statistically significant improvements in weight (AT-CG = −2.892 kg; ST-CG = −2.986 kg); BMI (AT-CG = −1.075 kg/m2; ST-CG = −1.118 kg/m2); total body fat (AT-CG = −1529.172 g; ST-CG = −763.815); and total body fat percentage (AT-CG = −1.421%; AT-ST = −0.855%). These two exercise prescription models were therefore useful in reducing overweight and obesity, which could have an impact on improving the health and quality of life of individuals with these characteristics.

Comparing enhanced versus standard Diabetes Prevention Program among indigenous adults in an urban setting: a randomized controlled trial

BackgroundIndigenous people in the United States are at high risk for diabetes. Psychosocial stressors like historical trauma may impede success in diabetes prevention programs.MethodsA comparative effectiveness trial compared a culturally tailored diabetes prevention program (standard group) with an enhanced one that addressed psychosocial stressors (enhanced group) in 2015 to 2017. Participants were 207 Indigenous adults with a body mass index (BMI) of ≥30 and one additional criterion of metabolic syndrome, and were randomized to the standard or enhanced group. Both groups received a culturally tailored behavioral diabetes prevention program. Strategies to address psychosocial stressors were provided to the enhanced group only. Change in BMI over 12 months was the primary outcome. Secondary outcomes included change in quality of life, and clinical, behavioral, and psychosocial measures at 6 and 12 months.ResultsThe two groups did not significantly differ in BMI change at 12 months. The two groups also did not differ in any secondary outcomes at 6 or 12 months, with the exception of unhealthy food consumption; the standard group reported a larger mean decrease (95% CI) in consumption of unhealthy food compared with the enhanced group (− 4.6 [− 6.8, − 2.5] vs. -0.7 [− 2.9, 1.4], p = 0.01). At 6 months, significant improvements in weight and the physical component of the quality of life measure were observed for both groups compared with their baseline level. Compared with baseline, at 12 months, the standard group showed significant improvement in BMI (mean [95% CI], − 0.5 [− 1.0, − 0.1]) and the enhanced group showed significant improvement in the physical component of the quality of life (2.9 [0.7, 5.2]).ConclusionsAdding strategies to address psychosocial barriers to a culturally tailored diabetes prevention program was not successful for improving weight loss among urban Indigenous adults.Trial Registration(if applicable): NCT02266576. Registered October 17, 2014 on clinicaltrials.gov. The trial was prospectively registered.

Clinical and biochemical outcome of patients with polycystic ovary syndrome managed with life style modification or combination with metformin

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder with diverse reproductive and metabolic features. It is caused by insulin resistance that is exacerbated by obesity. Lifestyle modification is the first line treatment in PCOS, but it is associated with low adherence and sustainability. In small studies, metformin improves outcomes such as menstrual cycle problem, reduces the features of hyperandrogenism (hirsutism) and metabolic parameters (lipid profile). This study aimed to compare clinical and biochemical outcome of patients with polycystic ovary syndrome managed with life style modification or combination with metformin.&#x0D; Methods: This prospective interventional study was carried out at Endocrine OPD, BIRDEM, from November 2016 to March 2018. Newly detected cases of PCOS were taken as study sample. Sampling technique was purposive and then randomly selected into two groups; Group A (n=40) with lifestyle modification and Group B (n=40) with lifestyle modification plus metformin (500mg TDS). The clinical [weight, body mass index (BMI), waist circumference, menstrual problem, hirsutism) and biochemical [serum testosterone, LH, FSH, fasting lipid profile] outcome of intervention with lifestyle modification and combination with metformin was studied.&#x0D; Results: Baseline characteristics of both groups had no significant difference. After 12 months, there was significant improvement in hirsutism, menstrual problem and significant decrease in weight, BMI, waist circumference in both groups. Among hormonal profile there was significant reduction of testosterone in Group B (p=0.01), whereas LH, FSH and LH: FSH ratio showed no significant difference. There was significant improvement of HDL (in both groups) and reduction of triglyceride (TG) (p=0.005, in group B). Outcome differences between two groups had shown significant improvement in weight, BMI, testosterone, HDL, TG level and on menstrual regulation. But there was no significant difference in waist and Ferriman-Gallwayscore in between groups.&#x0D; Conclusion: lifestyle management is the first and most important step in the management of PCOS and addition of metformin to lifestyle modification appears to provide additional advantages. These results suggest the combination of lifestyle with metformin has a role to play in weight management: a key concern for women with PCOS. Addition of metformin also causes reduction of TG and testosterone, which is vital for PCOS management and found in this study.&#x0D; Birdem Med J 2020; 10(1): 26-33

Effect of the herbal medicines in obesity and metabolic syndrome: A systematic review and meta-analysis of clinical trials.

Obesity is a medical situation in which excess body fat has gathered because of imbalance between energy intake and energy expenditure. In spite of the fact that the variety of studies are available for obesity treatment and management, its "globesity" still remains a big challenge all over the world. The current systematic review and meta-analysis aimed to evaluate the efficacy, safety, and mechanisms of effective herbal medicines in the management and treatment of obesity and metabolic syndrome in human. We systematically searched all relevant clinical trials via Web of Science, Scopus, PubMed, and the Cochrane database to assess the effects of raw or refined products derived from plants or parts of plants on obesity and metabolic syndrome in overweight and obesity adult subjects. All studies conducted by the end of May 2019 were considered in the systematic review. Data were extracted independently by two experts. The quality assessment was assessed using Consolidated Standards of Reporting Trials checklist. The main outcomes were anthropometric indices and metabolic syndrome components. Pooled effect of herbal medicines on obesity and metabolic syndrome were presented as standardized mean difference (SMD) and 95% confidence interval (CI). A total of 279 relevant clinical trials were included. Herbals containing green tea, Phaseolus vulgaris, Garcinia cambogia, Nigella sativa, puerh tea, Irvingia gabonensis, and Caralluma fimbriata and their active ingredients were found to be effective in the management of obesity and metabolic syndrome. In addition, C. fimbriata, flaxseed, spinach, and fenugreek were able to reduce appetite. Meta-analysis showed that intake of green tea resulted in a significant improvement in weight ([SMD]: -0.75 [-1.18, -0.319]), body mass index ([SMD]: -1.2 [-1.82, -0.57]), waist circumference ([SMD]: -1.71 [-2.66, -0.77]), hip circumference ([SMD]: -0.42 [-1.02, -0.19]), and total cholesterol, ([SMD]: -0.43 [-0.77, -0.09]). In addition, the intake of P. vulgaris and N. sativa resulted in a significant improvement in weight ([SMD]: -0.88, 95 % CI: [-1.13, -0.63]) and triglyceride ([SMD]: -1.67, 95 % CI: [-2.54, -0.79]), respectively. High quality trials are still needed to firmly establish the clinical efficacy of the plants in obesity and metabolic syndrome.

Effects of Bariatric Surgery in Male Obesity-Associated Hypogonadism.

The prevalence of obesity has grown exponentially over the last several decades. Research has linked male obesity to changes in the gonadal axis, which can induce functional hypogonadism. Bariatric surgery provides sustained weight loss and metabolic improvement. This was a retrospective cohort study to evaluate the male gonadal axis and metabolic profiles of obese individuals during the bariatric pre- and post-operative periods while comparing them to a normal body mass index (BMI) group. Twenty-nine obese men, who underwent bariatric surgery between 2012 and 2016 at the Federal University of Santa Catarina Hospital and a control group (CG) of 29 age-matched men with normal BMI, were analyzed. Bariatric pre- and 6-month post-operative data were compared with the CG. The study group (G1) presented an average age, weight, and BMI of 42.8 ± 9.5years, 155.2 ± 25.8kg, and 50.6 ± 7.1kg/m2, respectively. The pre-operative total testosterone (TT) G1 values were different from the CG (229.5 ± 96.4 versus 461.5 ± 170.8ng/dL, p < 0.01). Bariatric surgery promoted a statistically significant improvement in weight, TT, and metabolic profiles in surgical patients. Functional hypogonadism is prevalent in obese men, and we must be aware of this diagnosis. Although studies defining the best diagnostic parameters and indication of adequate hormone replacement therapy are lacking, an increase in TT levels during the first 6months after bariatric surgery was identified in our study. Previous studies have shown that gonadal function can normalize after metabolic improvement.

Protein Phosphatase 2A Affects the Symptoms of Depressive Rats by Regulating Extracellular Signal-regulated Kinases/Glycogen Synthase Kinase 3β Signaling Pathway

As one of the world's more common mental disorders, the incidence of depression has increased yearly, seriously affecting the lives and health of many people. Protein phosphatase 2A (PP2A) is a protein that is enriched in the brain tissue, is the major serine/threonine phosphatase in the central nervous system, and plays a very important role in many aspects of cellular function. To explore the role of PP2A in the pathogenesis of depression in our study, we constructed the depressive disorder model, which involves the exposure of Sprague Dawley rats to chronic unpredictable stress (CUS). The rats with depression were then treated with different concentrations (low, moderate, high) of okadaic acid (OA), and the optimal OA concentration (OOA) for the follow-up study was selected based on PP2A activity. The results showed that the use of higher OA concentrations corresponded with stronger inhibition of PP2A activity. Moreover, the behavioral test performed on the depression model rats showed that OOA group exhibited significant improvements in weight, as well as in their results in the sucrose preference test, open-field test, and Morris water maze test compared to the model group (P &lt; 0.05). Moreover, when compared with the model group, the amounts of NE and 5-HT increased significantly (P &lt; 0.05), and the expression levels of TH, ERK1, AKT1, as well as the phosphorylation of TH, ERK1, AKT1, and GSK-3β, were observed to be increased in the OOA group (P &lt; 0.05). Furthermore, the content of CORT decreased significantly (P &lt; 0.05), and the expression levels of GSK-3β were decreased in the OOA group (P &lt; 0.05). Thus, the potential mechanism of how OA ameliorates depression in model rats may be through the inhibition of PP2A activity, the increase in phosphorylation levels of AKT and GSK-3β, and through the PP2A/AKT/GSK-3β signal pathway; these components may serve as important intracellular targets for antidepressant drugs.

Promoting mealtime function in people with dementia: A systematic review of studies undertaken in residential aged care

BackgroundDementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person’s ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person’s ability to engage in a meal. ObjectivesThe objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability. DesignSystematic review using the Joanna Briggs Institute review methods. Data sourcesSeven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000–2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator. Review methodsStudies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format. Results136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation; meal styles; environment adaptations; skills training; music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index. ConclusionThere is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.

The Effect of Bariatric Surgery on Asian Patients with Type 2 Diabetes Mellitus and Body Mass Index < 30kg/m2: a Systematic Review and Meta-analysis.

The effect of bariatric surgery on the glycemic control of patients with obesity and type 2 diabetes mellitus is obvious. However, the effect in patients with body mass index (BMI) < 30kg/m2 especially Asian population has not been widely reported and acknowledged. We performed a literature search in Medline, Embase, and the Cochrane Library from January 2000 to March 2018. All the studies involving the effect of bariatric surgery on patients with type 2 diabetes and BMI < 30kg/m2 from Asian countries or regions were included in this meta-analysis. Twelve studies including 697 patients were examined in this meta-analysis. Clinical indexes in 6, 12, and 24months follow-up were analyzed, respectively. BMI and waist circumference reduced by 2.88kg/m2 and 12.92cm, respectively, at 12months postoperatively. There were reductions in fasting plasma glucose, 2-h postprandial plasma glucose, and glycated hemoglobin A1c at all the three time points after surgery, 3.13mmol/L, 5.46mmol/L, and 2.13% at 6months; 3.22mmol/L, 6.46mmol/L, and 2.38% at 12months; 1.99mmol/L, 5.84mmol/L, and 1.58% at 2years. Insulin only reduced by 1.70μU/ml at 12months. C-peptide reduced by 0.70ng/ml and 0.40ng/ml at 6months and 2years. Bariatric surgery led to reduction in total cholesterol, triglyceride, and low-density lipoprotein cholesterol, while augment in high-density lipoprotein cholesterol at 6 and 12months. Glucagon-like peptide 1 increased by 2.48pmol/L and 4.00pmol/L at half a year 1year. Asian patients with type 2 diabetes and BMI < 30kg/m2 could achieve significant improvement in weight, glycemic control, lipid profiles, and β-cell function in short and medium terms after bariatric surgery, but long-term follow-up is necessary to evaluate the effectiveness.

Evaluation of the serum prooxidant-antioxidant balance before and after vitamin D supplementation in adolescent Iranian girls

Purpose: Oxidative stress is caused by an imbalance between the antioxidant defenses and pro-oxidant production in favor of pro-oxidant production. Vitamin D has the potential for both pro- and anti-oxidative effects. The aim of this study was to assess the effect of high dose vitamin D supplementation on the prooxidant-antioxidant balance (PAB) in Iranian girls attending High School.Materials and methods: A total of 464 girls aged 12–18 years were asked to take vitamin D capsules containing 50000IU vitamin D3 once a week for a period of 9 weeks. All variables were determined at baseline and after 9 weeks of intervention. Fasting blood samples were taken from all subjects. The serum levels of 25OHD were measured using an electrochemiluminescence method. Serum PAB levels were determined using an ELISA reader at a wavelength of 450 nm.Results: Vitamin D supplementation was associated with an increase in serum PAB (P < 0.001) and a reduction in serum LDL-C (P < 0.001), total cholesterol (P < 0.001) and HDL-C (P < 0.01) serum levels in Iranian adolescent girls. The results obtained from the current study show that there were significant improvements in weight (P < 0.001), BMI (P < 0.001) and FBG (P = 0.02) in adolescent girls who had 50–74.9 nmol/L serum 25OHD levels compared to <50 nmol/L ones after the vitamin D supplementation. There was no significant association between the serum PAB and all biochemical factors (P > 0.05 for all variables).Conclusions: The results showed that vitamin D supplementation has increased the PAB levels in teenage girls.

Evaluation of Treatment Outcome of DOTS in Patients Attending Urban Health Centre in Southern India: A 15 Years Retrospective Study

Background Tuberculosis is among the leading cause of death in the world and the majority of the cases are concentrated in low and middle-income countries. Directly observed treatment short course is an internationally acclaimed strategy that was adopted in India in the mid-90s under the revised national tuberculosis control program.Objectives This study aimed to evaluate the treatment outcome of DOTS in patients attending the Urban Heath Centre area of a medical college.Methodology This was a cross-sectional study to evaluate the treatment outcome of 143 Tuberculosis patients who were registered and treated in the urban health center area of JSS Medical College Mysuru from 2003 to 2018. Details regarding age gender weight site of Tuberculosis and the outcome was obtained from the treatment cards of the patients. Data was entered in Microsoft Excel and analyzed using SPSS Version 23licensed to JSS AHER. Descriptive statistics like percentages mean and standard deviation and inferential statistical tests like paired t-test was used.Results Among the 143 patients 67 were males and 33 were females. 77 and 23 had pulmonary and extrapulmonary Tuberculosis respectively. At the end of the treatment period 47 were cured 36 completed the treatment 2 were treatment failures 7 defaulted 5 died and 3 migrated to other places and their data was not available. There was a significant improvement in weight among successfully treated patients.Conclusion The treatment success rate was 83 and positive treatment outcome was associated with significant improvement in weight.

Pharmacological management of cachexia in adult cancer patients: a systematic review of clinical trials

BackgroundCachexia is a multisystem syndrome characterized by weight loss, anorexia, loss of muscle mass, systemic inflammation, insulin resistance, and functional decline. Management of cachexia involves addressing multiple underlying biological mechanisms. Previous review on pharmacological management of cancer cachexia identified progestins and corticosteroids as effective agents for treatment of cachexia. However, to date no consensus exists on a single effective or standard treatment for management of cachexia. The aim of this systematic review is to determine the effectiveness of pharmacological treatments used to manage cachexia among adult cancer patients.MethodsWe performed literature searches of PubMed (NLM), Embase (Ovid), and Medline(Ovid) to identify clinical trials focused on pharmacological management of cancer cachexia among adult cancer patients from 2004 to 2018. Three reviewers screened a random selection of abstracts to measure for interrater reliability. After this step, each screener screened two-thirds of all abstracts and 177 studies were identified for full text review. The primary outcome was impact of pharmacological management on change in either weight or lean body mass in cancer patients.ResultsWe identified 19 articles (representing 20 RCTs) that focused on pharmacological management of cancer cachexia. Agents showing promising results included Anamorelin and Enobosarm. Anamorelin at 50 or 100 mg per day for 12 weeks showed a consistent benefit across all studies and resulted in significant improvement in weight as compared to baseline among cancer patients. Enobosarm at 1 and 3 mg per day was also effective in improving lean body mass and QOL symptoms among advancer stage cancer patients. Finally, use of combination agents provide evidence for targeting multiple pathways underlying cachexia mechanism to achieve maximum benefit. No agents showed functional improvement in cancer patients.ConclusionAnamorelin as a single agent shows promising results in improving cachexia related weight loss among cancer patients. Further research on combination therapies may be helpful to address critical gaps in cachexia management.

Does Nordic walking helps to improve exercise capacity and weight control in patients with resistant hypertension?

Resistant high blood hypertension (HBPr) it's defined as arterial pressure that remains above goal in spite of concurrent use of three antihypertensive agents of different classes. HTAR is associated with an increased risk of cardiovascular disease, terminal chronic renal failure and mortality, compared to patients whose hypertension responds to treatment. The currently therapeutic pillar involves multidisciplinary management with pharmacotherapy, health education, nutritional control, psychological support and therapeutic physical exercise. The aim of this study it's to use therapeutic exercise to facilitate the control of the blood pressure to improve the aerobic resistance, the meters walked and the weight control. Prospective, compared quasi-experimental study (pre- and post-intervention). Five cases, all men, with a mean age 58.2 (SD 12.21) years and BMI 32.952 (SD 3.93) kg/m 2 , who were included in a multidisciplinary study entitled: “Study of biomarkers in patients with HBP resistance to antihypertensive treatment”, performed a Nordic walking training program. The principal outcome was the six minutes walking test (6′WT). Other outcomes were the functional capacity (VO 2 peek and VO 2 AT), weight control and the compliance of the program. The improvement of 6′WT was 16.4 meters ( P > 0.05). The initial VO 2 peek was 14.22 ± 2.64 mL/kg/min (64.6%), with an improved of 1.72 mL/kg/min after the program. There was no improvement in VO 2 AT. There was a significant improvement in weight and BMI after the intervention. The compliance of the program was 86.25% ± 9.27. The peak of TA at maximum effort improved in all cases after the program, improving even the hypertensive response of one of the patients. Nordic walking is an excellent therapeutic exercise in patients with HBPr, because improves the blood pressure control, the weight control and the exercise capacity.

Effects of Laparoscopic Sleeve Gastrectomy on Insulin Secretion Patterns in Young Obese Patients with Acanthosis Nigricans

Background: Acanthosis nigricans (AN) is a skin condition commonly often accompanied by insulin resistance and hyperinsulinemia. Patients with AN are prone to diabetes, especially in young obesity. Metformin were usually used to treat these patients. However, reports about the effectiveness of LSG surgery on young obese patients with AN are rare. Objective: The aim of our study was to evaluate the efficacy of LSG surgery on insulin secretion patterns and anthropometric variables for obese patients with AN. Methods: 30 young obese patients with AN were recruited for this study. Before and at 12 months after the LSG surgery, BMI and blood samples were collected. OGTT were used to evaluate the insulin level and its rhythm of secretion. AN extent and AN texture were determined according to the scale developed and validated. Results: For these patients, BMI decreased from 40.98±4.93 kg/m2 to 27.27±4.13 kg/m2 at 12 months after surgery. Along with weight loss, triglycerides and total cholesterol decreased significantly, and high-density lipoprotein cholesterol (HDL-C) increased significantly as of 12 months after surgery. But the change of low-density lipoprotein cholesterol (LDL-C) is not obvious. A significant decrease in insulin resistant (HOMA-IR) was observed. The insulin release curves showed hyperinsulinemia and abnormal rhythm of secretion before surgery. At 12 months after surgery the fasting, 2h postprandial insulin levels and the rhythm of insulin secretion were restored to normal level. But the insulin levels at 30min and 60min were higher than before surgery. The extent of AN for most patients were improved. Only 23.4% patients still were severe (vs. 59.3% before surgery). More than 50% patients were remission. Conclusion: In this study of LSG in obesity patients with AN, we found significant improvements in weight, dyslipidemia, hyperinsulinemia and AN extent. LSG will be a new effective therapeutic approach for young obesity patients with AN. Disclosure C. Qian: None. S. Qu: None. C. Zhu: None. J. Gao: None. F. Mei: None. L. Bu: None.

Clinical efficacy and feasibility of whey protein isolates supplementation in malnourished peritoneal dialysis patients: A multicenter, parallel, open-label randomized controlled trial

Poor dietary intake is commonly associated with malnutrition in the dialysis population and oral nutritional supplementation is strategized to redress dietary inadequacy. Knowledge on clinical efficacy of whey protein supplementation (WPS) as an option to treat malnutrition in continuous ambulatory peritoneal dialysis (CAPD) patients is limited. This multicenter, parallel, open-label, randomized controlled trial investigated the clinical efficacy of WPS in 126 malnourished CAPD patients with serum albumin <40g/L and body mass index (BMI) <24kg/m2. Patients randomized to the intervention group (IG, n=65) received protein powder (27.4g) for 6 months plus dietary counseling (DC) while the control group (CG, n=61) received DC only. Anthropometry, biochemistry, malnutrition-inflammation-score (MIS), dietary intake inclusive of dialysate calories, handgrip strength (HGS) and quality of life (QOL) were assessed at baseline and 6 months. Clinical outcomes were assessed by effect size (Cohen's d) comparisons within and between groups. Seventy-four patients (n=37 per group) completed the study. Significantly more IG patients (59.5%) achieved dietary protein intake (DPI) adequacy of 1.2g/kg per ideal body weight (p<0.001) compared to CG (16.2%) although difference in the adequacy of dietary energy intake between groups was non-significant (p>0.05). A higher DPI paralleled significant increases in serum urea (mean Δ: IG=+2.39±4.36mmol/L, p=0.002, d=0.57 vs CG=-0.39±4.59mmol/L, p>0.05, d=0.07) and normalized protein catabolic rate, nPCR (mean Δ: IG=+0.11±0.14g/kg/day, p<0.001, d=0.63 vs CG=+0.001±0.17g/kg/day, p>0.05, d=0.09) for IG compared to CG patients. Although not significant, comparison for changes in post-dialysis weight (mean Δ:+0.64±1.16kg vs+0.02±1.36kg, p=0.076, d=0.58) and mid-arm circumference (mean Δ:+0.29±0.93cm vs-0.12±0.71cm, p=0.079, d=0.24) indicated trends favoring IG vs CG. Other parameters remained unaffected by treatment comparisons. CG patients had a significant decline in QOL physical component (mean Δ=-6.62±16.63, p=0.020, d=0.47). Using changes in nPCR level as a marker of WPS intake within IG, 'positive responders' achieved significant improvement in weight, BMI, skinfold measures and serum urea (all p<0.05), while such changes within 'negative responders' were non-significant (all p>0.05). A single macronutrient approach with WPS in malnourished CAPD patients was shown to achieve DPI adequacy and improvements in weight, BMI, skin fold measures, serum urea and nPCR level. CLINICAL TRIAL REGISTRY: www.clinicaltrials.gov (NCT03367000).

The effects of lifestyle changes on serum lipid levels in children in a real life setting.

Studies have shown improvement in lipid levels after institution of lifestyle changes in children enrolled in closely monitored programs. There programs are difficult to mimic in real world clinics. We aim to determine if diet and exercise result in improvement in lipid levels in patients seen in a designated lipid clinic in a real life setting. Retrospective review of patients followed for dyslipidemia at the Texas Children's Hospital Lipid Clinic from May 1, 2012 to May 1, 2015. Patients included were seen more than once, had repeat lipid testing, and abnormal baseline lipid levels. Multivariate analysis using mixed models were performed to compare outcomes in patients who did and did not participate in lifestyle change. Of the 268 patients seen within the study period, 174 (56% male, 44% female) met inclusion criteria. Median age was 11 years. Compared to patients who did not make lifestyle changes: patients who made only diet changes demonstrated significant improvement in weight only (slope = -1.55, P-value = .014), and those who made only exercise changes demonstrated significant improvements in serum cholesterol (slope = -22.8, P-value = .017) and non-HDL cholesterol (slope = -28.7, P-value = < .01) levels. Patients who participated in both diet and exercise demonstrated significant improvement in weight (slope = -1.13, P-value = .011), diastolic blood pressure (slope = -1.82, P-value = < .01), and serum lipid levels: LDL (slope = -10.8, P-value = 0.017), HDL (slope = 1.52, P-value = .24), Triglycerides (slope = -0.11, P-value = .033) compared to those who did not make lifestyle changes. Outpatient management of dyslipidemia is difficult. Only patients who participated in both diet and exercise showed significant improvement in outcomes when compared to those who did not make lifestyle changes.