Significant Reduction In BMI Research Articles

The effects of repetitive transcranial magnetic stimulation on eating behaviors and body weight in obesity: A randomized controlled study

BackgroundAlthough some studies have reported significant reductions in food cravings following repetitive transcranial magnetic stimulation (rTMS), none have examined changes in body weight. ObjectiveWe conducted 2-week randomized, sham-controlled, single-blind, parallel-group trial to examine the effect of rTMS on body weight in obese patients. MethodsSixty obese patients (body mass index [BMI] ≥25 kg/m2) aged between 18 and 65 years were recruited. A total of 4 sessions of rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) was provided over a period of 2 weeks, with a follow-up assessment conducted two weeks after treatment had finished. The primary outcome measure was weight change in kilograms from baseline to 4 weeks. Secondary endpoints included changes in anthropometric measures, cardiovascular risk factors, food intake, and appetite. ResultsOf the 60 volunteers, 57 completed the 4-week follow-up (29 in the TMS group and 28 in the sham treatment group). Participants in the rTMS group showed significantly greater weight loss from baseline following the 4 session of rTMS (p = 0.002). Consistent with weight loss, there was a significant reduction in BMI, fat mass and VAT at week 4 in the rTMS group compared with the control group (p < 0.05). After the 4 sessions of rTMS, the TMS group consumed fewer total kilocalories per day than the control group (p < 0.01). ConclusionsrTMS delivered to the left DLPFC was effective in decreasing food intake and facilitating weight loss in obese patients. The results of this study suggest that rTMS could be an effective treatment option for obesity. Trial registrationClinical trial registered with the Clinical Trials Tegistry at https://cris.nih.go.kr (KCT0001455).

Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables.

Various criteria have been used so far for the diagnosis of malnutrition or sarcopenia in patients suffering from chronic obstructive pulmonary disease (COPD). To determine the prevalence of malnutrition and sarcopenia in COPD, as defined by international diagnostic criteria, and determine their relationships with raw BIA variables. Two-hundred and sixty-three COPD patients (185 males and 78 females) underwent both clinical examination and respiratory, anthropometric, bioelectrical impedance analysis (BIA raw variables: phase angle and impedance ratio), handgrip strength (HGS), 4m gait speed and biochemical measurements. Malnutrition and sarcopenia were diagnosed based on European Society for Clinical Nutrition and Metabolism (ESPEN) criteria and European Working Group on Sarcopenia in Older People (EWGSOP) criteria, respectively. The overall prevalence of malnutrition and sarcopenia was 19.8% and 24.0% respectively, increasing with disease severity. The prevalence of sarcopenia was significantly higher in patients with malnutrition (71.2% vs 12.3%; p<0.001), especially in those with systemic inflammation (cachectic patients) (85.7% vs 61.3%; p<0.001). Malnourished patients with sarcopenia had a significant reduction in BMI, fat-free mass and HGS compared to non-sarcopenic patients. Finally, impedance ratio significantly increased and phase angle decreased in patients with severe sarcopenia and in cachectic patients. A relatively high prevalence of malnutrition and sarcopenia was found in COPD patients applying international standard criteria, with some discrepancy between the two diagnoses. In addition, clear-cut changes in raw BIA variables were observed in malnourished patients with systemic inflammation and sarcopenic patients.

Effect of Integrated Yoga Therapy on Arterial Stiffness: A Pilot Study on Young and Older Adults with Obesity

Background/Aims: The studies on the effect of integrated yoga therapy have shown significant results in improving the overall health. However, the effect of integrated yoga therapy on arterial stiffness is not yet established. The aim of the study was to investigate the effect of integrated yoga therapy on arterial stiffness measured at the radial artery. Methods: A total of 18 participants were included in the study. The participants were divided into three groups based on their age and body mass index. There were 5 participants in group 1 who were considered as nonobese, 7 younger adults with obesity were included in group 2, and 6 older adults with obesity were included in group 3. A 1-week integrated approach of yoga therapy (IAYT) was given as an intervention to the participants. The pulse data was acquired from participants using Nadi Tarangini at the beginning and end of the yoga program. The stiffness index (SI) and reflection index (RI) were computed from the pulse data. The data were analyzed using the paired-samples t test. Results: There was a significant reduction in SI (p < 0.05) after IAYT in young participants with obesity. There was a significant reduction in BMI after IAYT in older adults, but the SI was only significantly low in young adults. There were no significant changes in RI after IAYT. Conclusion: The pilot study has shown that arterial stiffness measured at the radial artery using Nadi Tarangini has decreased significantly after 1 week of IAYT in young adults with obesity compared to older adults.

Can psychobiotics intake modulate psychological profile and body composition of women affected by normal weight obese syndrome and obesity? A double blind randomized clinical trial

BackgroundEvidence of probiotics effects on gut function, brain activity and emotional behaviour were provided. Probiotics can have dramatic effects on behaviour through the microbiome–gut–brain axis, through vagus nerve. We investigated whether chronic probiotic intake could modulate psychological state, eating behaviour and body composition of normal weight obese (NWO) and preobese–obese (PreOB/OB) compared to normal weight lean women (NWL).Methods60 women were enrolled. At baseline and after a 3-week probiotic oral suspension (POS) intake, all subjects underwent evaluation of body composition by anthropometry and dual X-ray absorptiometry, and psychological profile assessment by self-report questionnaires (i.e. EDI-2, SCL90R and BUT). Statistical analysis was carried out using paired t test or a non-parametric Wilcoxon test to evaluate differences between baseline and after POS intake, one-way ANOVA to compare all three groups and, where applicable, Chi square or t test were used to assess symptoms.ResultsOf the 48 women that concluded the study, 24% were NWO, 26% were NWL and 50% were PreOB/OB. Significant differences in body composition were highlighted among groups both at baseline and after a POS (p < 0.05). After POS intake, a significant reduction of BMI, resistance, FM (kg and %) (p < 0.05), and a significant increase of FFM (kg and %) (p < 0.05) were observed in all subjects in NOW and PreOB/OB. After POS intake, reduction of bacterial overgrowth syndrome (p < 0.05) and lower psychopathological scores (p < 0.05) were observed in NWO and PreOB/OB women. At baseline and after POS intake, all subjects tested were negative to SCL90R_GSI scale, but after treatment subjects positive to BUT_GSI scale were significantly reduced (8.33%) (p < 0.05) compared to the baseline (33.30%). In NWO and PreOB/OB groups significant differences (p < 0.05) in response to the subscales of the EDI-2 were observed. Significant improvement of the orocecal transit time was observed (p < 0.05) after POS intake. Furthermore, significant differences were observed for meteorism (p < 0.05) and defecation frequency (p < 0.05).ConclusionsA 3-week intake of selected psychobiotics modulated body composition, bacterial contamination, psychopathological scores of NWO and PreOB/OB women. Further research is needed on a larger population and for a longer period of treatment before definitive conclusions can be made.Trial registration ClinicalTrials.gov Id: NCT01890070

Five-Year Outcomes: Laparoscopic Greater Curvature Plication for Treatment of Morbid Obesity.

Laparoscopic greater curvature plication (LGCP) is a newer metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report outcomes in a cohort of LGCP patients at 5-year follow-up. Body mass index (BMI, kg/m2) evolution, excess weight loss (%EWL), excess BMI loss (%EBMIL), and total weight loss (%TWL) were recorded. Repeated measures analysis of variance (ANOVA) was used to assess BMI change over 5years. Two-step cluster analysis was used to profile LGCP patients according to significant characteristics relative to successful 5-year weight loss. Of patients entering the study between 2010 and 2011 with complete weight data through 5-year follow-up (86.9%, 212/244), mean age was 45.8±10.9years; mean baseline BMI, 41.4±5.5 (81.6% women); 58 patients (27.4%) had type 2 diabetes. Mean operative time was 69.0min; mean hospitalization, 38h (24-72). ANOVA indicated a significant BMI reduction out to 2years (p<0.001), a plateau at 3 and 4years, and a moderate but significant BMI increase at 5years (p<0.01). EBMIL at 1, 2, 3, 4, and 5years was as follows: 50.7±9.1%, 61.5±8.1%, 60.2±7.0%, 58.5±7.0%, and 56.8±6.3%. At 5years, 79.2% (168/212) of patients were successful; 20.8% (44/212) experienced a suboptimal weight outcome; mean weight regain, 9.2%. Cluster analysis identified four distinct LGCP patient profiles. Diabetes improvement rate was 65.5%. There were 12 reoperations (4.9%): 4 emergency (1.6%) and 8 (3.3%) elective. There was no mortality. At 5-year follow-up, LGCP proved to be safe and effective, with 56.8% EBMIL and a low rate of complications.

Myoinositol combined with alpha-lipoic acid may improve the clinical and endocrine features of polycystic ovary syndrome through an insulin-independent action

The aim of our study was to investigate the effects of a combined treatment with alpha-lipoic acid (ALA) and myoinositol (MYO) on clinical, endocrine and metabolic features of women affected by polycystic ovary syndrome (PCOS). In this pilot cohort study, forty women with PCOS were enrolled and clinical, hormonal and metabolic parameters were evaluated before and after a six-months combined treatment with ALA and MYO daily. Studied patients experienced a significant increase in the number of cycles in six months (p < 0.01). The free androgen index (FAI), the mean androstenedione and DHEAS levels significantly decreased after treatment (p < 0.05). Mean SHBG levels significantly raised (p < 0.01). A significant improvement in mean Ferriman–Gallwey (F–G) score (p < 0.01) and a significant reduction of BMI (p < 0.01) were also observed. A significant reduction of AMH levels, ovarian volume and total antral follicular count were observed in our studied women (p< 0.05). No significant changes occurred in gluco-insulinaemic and lipid parameters after treatment. The combined treatment of ALA and MYO is able to restore the menstrual pattern and to improve the hormonal milieu of PCOS women, even in the absence of apparent changes in insulin metabolism.

Abstract MP001: The Number of Low and High Energy Dense Foods Consumed Affects Body Mass Index Reduction in a Randomized Controlled Weight Loss Trial

Background: Decreasing dietary energy density is recommended to promote weight loss. However, it is unclear whether decreasing dietary energy density is best accomplished by increasing the number of low energy dense (LED) foods (≤1 kcal/g) or by decreasing the number of high energy dense (HED) foods (≥3 kcal/g) in the diet, and whether these actions have different effects on weight loss. We explored how the number of LED and HED foods consumed affected dietary energy density and change in BMI during the 6-month weight-loss phase of an 18-month weight loss trial. Methods: A secondary analysis of 202 adults 21-65y with a BMI between 27 and 45 kg/m 2 participating in a weight loss trial was conducted. Participants were randomized to 1 of 2 conditions – a standardized lifestyle intervention or a standardized lifestyle intervention plus a goal to limit consumption of non-nutrient-dense, energy-dense foods to 2 foods. Dietary intake, assessed via 3, 24-hour recalls, and BMI were measured at baseline and 6 months. Generalized linear models were used to examine the association between residualized changes in LED foods and HED foods and dietary energy density and change in BMI between baseline and 6 months. All analyses were adjusted for age, sex, race, education, treatment group, change in energy intake, and number of LED or HED foods. Results: At baseline, participants had a daily average energy density of 1.25 kcal/g, which decreased to 0.82 kcal/g at 6-months (p&lt;0.0001). Similarly, daily number of LED foods consumed increased from 4.46 to 5.64 foods/day while daily HED foods consumed decreased from 4.02 to 2.98 foods/day (p&lt;0.0001). In fully-adjusted models, a 1-unit increase in LED foods was associated with a 0.07 decrease in the overall energy density of the diet while a 1-unit decrease in HED foods was associated with a 0.08 decrease in energy density (p&lt;0.05); no significant changes in BMI were detected. However, when we examined changes in BMI among those who decreased (&gt;1 unit), maintained (&lt; 1-unit), or increased (&gt;1 unit) the number of LED or HED foods, significantly greater changes in BMI were observed among those with stable (-3.3 ± 0.4 kg/m 2 ) or increased LED food intake (-3.5 ± 0.4 kg/m 2 ) compared to those who decreased LED foods (-2.4 kg ± 0.5 kg/m 2 , p&lt;0.05). No differences in BMI were observed among those who decreased, maintained, or increased the number of HED foods, though similar decreases in energy density were observed among those who decreased HED foods or increased LED foods (-0.6 kcal/g). Conclusions: Decreasing HED foods and increasing LED foods both reduced the overall ED of the diet, but increasing LED foods was associated with significant reductions in BMI.

Posterior retroperitoneoscopic adrenal surgery for clinical and subclinical Cushing’s syndrome in patients with bilateral adrenal disease

The treatment of hypercortisolism for patients with bilateral adrenal disease (BAD) is controversial. Bilateral total adrenalectomy results in permanent hypocortisolaemia requiring lifelong steroid replacement. A more conservative surgical approach, with less than bilateral total adrenalectomy (leaving functional adrenal tissue either unilaterally or bilaterally), represents an alternative option; however, long-term outcome or recurrence data are limited. We report our experience with the surgical management of hypercortisolism caused by BAD. Between 2004 and 2016, 42 patients (12 male, 30 female; mean age 58±10years) with clinical or subclinical Cushing's syndrome (CS/sCS) caused by BAD underwent adrenal surgery via the posterior retroperitoneoscopic approach. Adrenal surgery was defined as "adrenalectomy" when total gland excision was performed or "resection" when a partial or subtotal adrenal resection was performed. Clinical, radiological and biochemical parameters were evaluated preoperatively and postoperatively. Seventy adrenal operations performed in total included unilateral resection (n=3), unilateral adrenalectomy (n=15), bilateral resection (n=9), adrenalectomy and contralateral resection (n=14) and bilateral total adrenalectomy (n=3). Median operating time was 47.5min (30-150) with no difference between unilateral and bilateral (synchronous included) procedures (p=0.15). Mortality was zero. Clavien-Dindo grade of postoperative complications was I (n=5) and IV (n=3). All but one patient with CS and 17/31 patients with sCS received postoperative steroid supplementation for a median duration of 20 (1.5-129) months. After median follow-up of 40months (3-129), the remission rate was 92%; 11 patients required ongoing steroid supplementation. There were three biochemical recurrences (two underwent contralateral resection); two patients with new/progressive radiological nodularity are biochemically eucortisolaemic. A significant reduction in BMI (p=0.01) and antihypertensive requirements (p=0.04) was observed postoperatively. A surgical approach which facilitates the conservation of functional adrenal tissue represents a suitable strategy for hypercortisolism caused by BAD. This approach avoids the necessity for lifelong steroid replacement in the majority of cases with low rates of adrenal insufficiency and recurrence.

121: THE COMPARISON OF THE EFFECTS OF PIOGLITAZONE AND METFORMIN ON REDUCING INSULIN RESISTANCE IN 8 TO 15 YEARS OLD CHILDREN WITH OBESITY IN GORGAN BETWEEN 2012–2013

Background and aims:Insulin resistance is one of the metabolic complications of obesity in childhood. Metformin and pioglitazone are medications that have beneficial effects in improving insulin sensitivity via different mechanisms....

Effects of an Intensive Lifestyle Intervention to Treat Overweight/Obese Children and Adolescents.

Objective The purpose of the present study is to examine the effects of a multidisciplinary lifestyle intervention to treat overweight/obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were (1) changes in body composition; (2) adherence to a Mediterranean diet; and (3) physical performance. Method The study involved 74 overweight/obese children or adolescents. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures (height, body weight, body mass index or BMI, waist circumference, and body composition), cardiometabolic risk index (waist-to-height ratio or WHTR), and nutrition habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures. Results After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance. Conclusion A family-based multidisciplinary approach is effective in the short term in ameliorating the health status, the nutrition habits, and physical performance in children and adolescents.

Effects of Laparoscopic Mini Gastric Bypass (MGB) on Weight Loss and Biomarker Parameters in Morbidly Obese Patients: A 6-Month Follow-Up.

Mini-gastric bypass is a bariatric surgical procedure prevalent in many focuses because of shorter length, simpler system, and fabulous weight reduction comes about. The point of this review was to assess the weight reduction and biomarker parameter changes amid 6-months time frame taking after MGB in Iraqi excessively fat patients. The study was conducted on 30 subjects (18 females and 12 males), age 34± 7.5 years, with BMI 51.7 ± 7.1 Kg/m² presented for MGB during the period from July 2016 until the end of February 2017. FBG, HbA1c, total cholesterol, TG and HDL were measured before, 2 and 6 months after MGB procedure. Six months after surgery caused a significant reduction in body weight and BMI (p< 0.001). The mean weight of the participants decreased to 88.1 Kg, mean BMI decreased to 32.55 Kg/m2. The mean loss in the EBL percent was 74.6 % and %WL was 34.9%. There was a significant reduction in FBG, HbA1c, cholesterol, TG, LDL and VLDL (p < 0.001). Meanwhile use of MGB procedure caused a significant increase in HDL level (p< 0.001). Conclusion: MGB has all the earmarks of being a protected and compelling technique in extremely obese patients. Six month after strategy brings about weight reduction, lessening in obesity comorbidities, enhance glucose homeostasis and lipid profile, expanding HDL, and diminishing other measured biochemical parameters.

Vaspin and selected indices of bone status in girls with anorexia nervosa.

In vitro studies indicate that vaspin may act as a regulator of bone metabolism. The aim of the study was to evaluate the relationship between vaspin and bone metabolism in girls with anorexia nervosa (AN), as well as the potential involvement of OPG and RANKL in this relationship. Serum vaspin, OC, CTx, OPG, and sRANKL were determined by ELISA in 50 girls with AN and in 30 healthy controls aged 13 to 17 years. Girls with AN exhibited significant reduction in body weight, BMI, and Cole index as well as a significant increase in serum level of vaspin compared to healthy participants. These changes were associated with a significant decrease in serum OC and CTx levels and a significant increase in OPG and sRANKL, while the OPG/sRANKL ratio was significantly decreased. BMI and Cole index correlated negatively and significantly with CTx levels in the control group (C), girls with AN, and all study participants (C+AN). Girls with AN showed a significant negative correlation between BMI, the Cole index, and OPG levels. The combination group (C+AN) showed a significant positive correlation between BMI, Cole index, and the OPG/sRANKL ratio. In this group of girls vaspin levels correlated positively and significantly with sRANKL and negatively with body weight, BMI, Cole index, and OPG/sRANKL ratio. Girls with AN showed a significant negative correlation between vaspin levels and the OPG/sRANKL ratio. Undernourishment and associated deficit of adipose tissue may result in inadequate vaspin production and bone metabolism disorders in girls with AN. Vaspin acts as a coordinator of the dynamic balance between bone formation and resorption processes; its action is affected by the cytokines of the RANKL/RANK/OPG system. Changes in the relationships between vaspin, bone markers, OPG, and RANKL might contribute to the development of osteoporosis in girls with AN. (Endokrynol Pol 2016; 67 (6): 599-606).

A pilot study of D-chiro-inositol plus folic acid in overweight patients with type 1 diabetes.

To improve insulin sensitivity, insulin-sensitizing drugs such as metformin are commonly used in overweight and obese T1D patients. Similarly to metformin, D-chiro-inositol (DCI), as putative mediator of intracellular insulin action, can act as insulin sensitizer. The aim of this pilot study was to evaluate the hypothesis that DCI plus folic acid may improve glucose control reducing insulin resistance in overweight or obese T1D patients. A 24-week randomized control trial was carried out in 26 overweight or obese T1D patients, undergoing intensive insulin therapy. Patients were randomized to 1g DCI plus 400 mcg folic acid once daily (treated group) or to 400 mcg folic acid only once daily (control group). The primary end point was to evaluate the efficacy of DCI on metabolic control as assessed by HbA1c. As secondary endpoints, BMI and insulin requirement (IR) were evaluated. Paired t test (two tailed) and analysis of variance were used to evaluate differences in HbA1c, BMI and IR at different time points. A significant reduction in HbA1c levels in treated group versus control group (7.5%±0.9 vs. 7.9%±1.7, respectively, p<0.05) was observed. However, no significant reduction in BMI and IR was observed [(BMI 25.7±2.8 vs. 26.7±1.0, respectively, p NS); (IR 0.52±0.26 vs. 0.52±0.19, respectively, p NS)]. This trial demonstrated for the first time that DCI plus folic acid oral supplementation can improve metabolic control in overweight T1D patients. CLINICALTRIAL. NCT02730949.

Clinical and Biochemical Changes in Polycystic Ovarian Syndrome Patients in Response to 3 Different Oral Hypoglycemic Drugs: A Double Blind Randomized Controlled Study

Introduction: This study was done to evaluate other oral hypoglycemic medications; especially the new ones in the management of PCOS patients as alternatives to the standard medication used for this purpose Metformin. Patients and Methods: 105 patients were enrolled and randomly distributed into 3 groups according to sequence of computer-generated block-random numbers. Each group included 35 patients. This randomized double blind case controlled study was conducted at Tanta University Hospital from December 1, 2015 to October, 1, 2016. In group A (study group 1) the patients received Pioglitazobe 30 mg once a day for 6 months while in group B (study group 2) the patients received Vildagliptin 50 mg once daily. In Group C (control group) the patients received Metformin 500 mg tds. for 6 months. The clinical outcome measures of the study were the improvement in the regularity of the menstrual cycle, the BMI and the improvement in the modified Ferriman-Gallwey (F-G) score for hirsutism. The biochemical outcome measures will be the change in the Serum Free testosterone, dehydroepiandrosterone (DHEA), fasting insulin level, Glcosylated hemoglobin (Hb A1c) and fasting Low Density Lipoproteins (LDL) levels. Results: Pioglitazobe in the study group 1 patients showed a significant reduction of BMI (p = 0.016), Ferriman-Gallwey score (p = 0.003), free testosterone level (p = 0.003), DHEA level (p = 0.001), fasting insulin level (p = 0.036) and Hb a1c level (p = 0.000), and also significant reduction of menstrual irregularities (p = 0.035). When compared to Metformin in the control group 3, there were significant reduction of BMI (p = 0.010), Ferriman-Gallwey score (p = 0.002), free testosterone level (p = 0.034), Hb a1c (p = 0.000) level and significant reduction of menstrual irregularities (p = 0.004) only. This means that the clinical and metabolic effect of Pioglitazobe is better than Metformin in PCOS patients. On the contrary there were disappointing results of the new drug Vildagliptin in group 2; the patients in this group showed significant reduction of BMI (p = 0.001), Ferriman-Gallwey score (p = 0.046) and Hb a1c (p = 0.000) level only. Non significant effect on menstrual irregularities and non significant reduction of LDL level are noticed. But there is elevation of Ferriman-Gallwey score, free testosterone level, DHEA level and fasting insulin level. Conclusion: Pioglitazobe is an effective and safe alternative to Metformin in the management of PCOS patient although further studies including larger number of patients should be done while Vildagliptin should be omitted for use in PCOS patients.

Binge abstinence is associated with reduced energy intake after treatment in patients with binge eating disorder and obesity.

Binge eating disorder (BED) is strongly associated with obesity and related medical and psychiatric morbidities. Cognitive behavioral therapy (CBT) has consistently been shown to reduce binge eating frequency and improve psychological functioning, as well as to produce abstinence rates of roughly 50%. This study examined the relationship between binge abstinence and dietary and psychological outcomes after CBT for BED. Fifty adult patients with BED received 6-month treatments using a combination of CBT and dietary counseling. Trained interviewers conducted two 24-hour dietary recall interviews on randomly selected days at baseline and at 6 months. Participants had significant reductions in energy, macronutrient, and sugar intake and an increase in fruit intake. They reported significant reductions in BMI and binge eating frequency (from mean = 14.24 to mean = 1.90 binge eating episodes during the previous 28 days), as well as improvements in psychological functioning. Those who became binge abstinent reported eating roughly 400 fewer calories per day and experienced greater improvements in psychological functioning than those who did not. Findings from this study suggest that individuals who achieve complete cessation from binge eating have significantly improved dietary and psychological outcomes that could potentially improve weight status, compared with those who continue to binge eat post-treatment.

Mammography before and after bariatric surgery

BackgroundMorbidly obese women are at increased risk for breast cancer, and the majority of surgical weight-loss patients are older than 40 years old. ObjectiveThe purpose of the present study was to determine the technical and interpretive changes in mammography following bariatric surgery. SettingAccredited Academic Hospital. MethodsTwo breast-imaging radiologists reviewed screening mammograms performed on 10 morbidly obese women undergoing bariatric surgery both pre- and postoperatively. American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) density, imaging quality measurements, compression force, breast thickness, pectoral nipple line (PNL) length, and x-ray beam kilovoltage (kVp) and miliamperes per second (mAs) were recorded. ResultsThe average patient age was 56 years old, with mean age at menarche of 13 years old; 70% of patients were postmenopausal (average age 49 years at menopause) and 50% had a family history of breast cancer. There was a significant reduction in both BMI (-13.2 kg/m2, P<.01) and waist circumference (-32.0 cm, P<.01) following bariatric surgery. There was a significant reduction in breast thickness (-23.8 mm), reduction in PNL length (-1.9 cm), reduction in kVp (-1.2), and reduction in mAs (-16.7) even though there was no compression force change in pre- and postoperative mammograms detected. All breast densities were fatty or scattered though there were more scattered and fewer fatty images after surgery (P = .002). ConclusionMorbidly obese women can undergo quality mammograms before and after bariatric surgery; however, weight loss after bariatric surgery leads to only slightly denser mammograms. Furthermore, weight loss reduces mammographic radiation doses.

Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis.

BackgroundMost antipsychotics are associated with weight gain and other metabolic complications. Several randomized trials have shown metformin to be effective, but this still hasn’t been included in clinical guidelines on managing antipsychotic induced weight gain.MethodsAll double blind placebo controlled trials assessing the efficacy of metformin in the treatment of antipsychotic induced weight gain were included. Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched for the period January 2000-December 2015. Meta-analysis was carried out using the random effects model.ResultsMeta analysis of 12 published studies with a total of 743 patients found that in patients treated with antipsychotics, metformin treatment resulted in significantly better anthropometric and metabolic parameters than placebo. The mean change in weight was −3.27 kg (95 % CI −4.66 to −1.89) (Z = 4.64, p < 0.001). Metformin compared to placebo resulted in significant reduction in BMI [−1.13 kg/m2 (95 % CI −1.61 to −0.66)] and insulin resistance index [−1.49 (95 % CI −2.40 to −0.59)] but not fasting blood sugar [−2.48 mg/dl (95 % CI −5.54 to 0.57].ConclusionThis meta-analysis confirms that metformin is effective in treating antipsychotic induced weight gain in patients with schizophrenia or schizoaffective disorder.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1049-5) contains supplementary material, which is available to authorized users.

Brief Primary Care Obesity Interventions: A Meta-analysis.

Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear. To determine the effect of brief, primary care interventions for pediatric weight management on BMI. Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies. Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years. Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools. A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (-0.04, [95% confidence interval, -0.08 to -0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, -0.21 to 0.22]; P = .98). Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured. BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.

Limitations of the DiaRem Score in Predicting Remission of Diabetes Following Roux-En-Y Gastric Bypass (RYGB) in an ethnically Diverse Population from a Single Institution in the UK

PurposeThis study aimed to determine the predictive power of the DiaRem score following Roux-en-Y gastric bypass to identify patients who would have diabetes remission at 1 year in an ethnically diverse population.MethodsWe performed a retrospective review of 262 patients with type 2 diabetes mellitus who underwent RYGB at the Imperial Weight Centre, UK, from 2007 to 2014. Data was collected on the parameters required to calculate the DiaRem score as well as pre- and post-surgical weight and the ethnicity of the subjects.ResultsThe studied cohort was ethnically diverse (61.3 % Caucasian, 10.3 % Asian, 5.3 % black, 2.6 % mixed and 20.6 % other). At 1-year post-surgery, there were significant reductions in mean weight (133.4 to 94.3 kg) and BMI (46.7 to 33.3 kg/m2). The mean HbA1c decreased from 8.2 to 6.1 %, and 32.5 % of the cohort underwent either partial or complete remission. 67.8 % of the patients that were classified in group 1 of the DiaRem score (most likely to have remission) had complete remission. However, 22.9 % of the patients predicted to have the least chance of remission had either partial or complete remission.ConclusionsIn this ethnically diverse cohort, the DiaRem score remains a useful tool to predict diabetes remission in those that have a low DiaRem score (high chance for remission) but was more limited in its predictive power in those with a high DiaRem score (least likely to have remission). Caution must be used in the application of this model in populations other than the US white Caucasian population used to derive the score.

OS 28-06 BENEFICIAL EFFECTS OF A 12-WEEK YOGA-BASED LIFESTYLE INTERVENTION ON CARDIO-METABOLIC RISK FACTORS AND ADIPOKINES IN SUBJECTS WITH PRE-HYPERTENSION OR HYPERTENSION

Objective: To study the effects of 12 week yoga-based lifestyle intervention on cardio-metabolic risk factors and adipocytokines in overweight/obese subjects with pre-hypertension [systolic blood pressure (SBP) 130–139 mmHg or diastolic blood pressure (DBP) 85–89 mmHg] or hypertension (HTN). Design and Method: This prospective, single arm, lifestyle intervention study was conducted in overweight/obese (body mass index; BMI 23-24.9/ ≥ 25 kg/m2) subjects (n = 44), with pre-HTN or previously diagnosed HTN. The subjects underwent pre-tested yoga-based lifestyle intervention including asanas, pranayama, relaxation techniques, lectures, group support, nutrition awareness program and individualized advice under supervision for approx. 2 hrs each day for 2 week followed by continuation of the practices at home for next 10 week. Outcome measures included cardio-metabolic risk factors: SBP, DBP, weight, BMI, waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), fasting plasma glucose (FPG), serum lipid profile and adipocytokines (plasma leptin and adiponectin levels). These were assessed at baseline, after 2 weeks of intervention and at end of week 12. Results: The mean age of subjects was 40.3 ± 5.5 yrs; mean BMI was 32.1 ± 4.9 Kg/m2, SBP/DBP was 135.5 ± 13.2/85.6 ± 8.7 mmHg respectively. After intervention, there was significant reduction in weight, BMI, SBP, DBP, WC, HC, WHR, total cholesterol, and triglycerides (p Conclusions: These findings suggest that yoga-based lifestyle intervention might serve as an important treatment modality in reducing the risk of cardiovascular disease through weight loss, reduction in blood pressure, cardio-metabolic risk factors and adipocytokines in subjects with pre- HTN or HTN.