Weight Loss In Group Research Articles

Weight loss and its impact on outcome in head and cancer patients during chemo-radiation

BackgroundWeight loss during chemotherapy and its impact on the cancer outcomes have been invariably reported in the literature. We also did a post-hoc analysis of a randomized phase III trial to see the same. Materials and methodsThe database of a recently published randomized study comparing cisplatin-radiation with nimotuzumab cisplatin-radiation was used for this analysis. Week-wise weight loss during the course of treatment was noted. The impact of severe weight loss (grade 2–3) on progression-free survival (PFS), locoregional control (LRC) and overall survival (OS) was studied using the Kaplan Meier method. Binary logistic regression analysis was used to see the effect of various factors. ResultsOut of a total of 536 patients, weight loss was captured in 524. Out of these 524 patients, any degree of weight loss was seen in 293 (55.91%) patients. Grade 1 weight loss was noted in 192 (36.6%) patients, grade 2 in 96 (18.3%) and grade 3 in 5 (1%) patients. The 2-year PFS was 53% and 57.1% in severe and non-severe weight loss groups respectively (p-value = 0.36). The 2-year LRC was 60% in patients with severe weight loss, while it was 63.5% in those with non-severe weight loss (p-value = 0.47). The 2-year OS was 59.3% versus 62.2% in severe and non-severe weight loss cohorts respectively (p-value = 0.21). None of the factors was found to be associated with severe weight loss. ConclusionSevere weight loss was uncommon in our patients. Weight loss during treatment was not associated with poor survival outcomes.

WISER Survivor Trial: Combined Effect of Exercise and Weight Loss Interventions on Insulin and Insulin Resistance in Breast Cancer Survivors.

Obesity-associated breast cancer recurrence is mechanistically linked with elevated insulin levels and insulin resistance. Exercise and weight loss are associated with decreased breast cancer recurrence, which may be mediated through reduced insulin levels and improved insulin sensitivity. This is a secondary analysis of the WISER Survivor clinical trial examining the relative effect of exercise, weight loss and combined exercise and weight loss interventions on insulin and insulin resistance. The weight loss and combined intervention groups showed significant reductions in levels of: insulin, C-peptide, homeostatic model assessment 2 (HOMA2) insulin resistance (IR), and HOMA2 beta-cell function (β) compared to the control group. Independent of intervention group, weight loss of ≥10% was associated with decreased levels of insulin, C-peptide, and HOMA2-IR compared to 0–5% weight loss. Further, the combination of exercise and weight loss was particularly important for breast cancer survivors with clinically abnormal levels of C-peptide.

Changes in Cardiometabolic Risk Among Older Adults with Obesity: An Ancillary Analysis of a Randomized Controlled Trial Investigating Exercise Plus Weight Maintenance and Exercise Plus Intentional Weight Loss by Caloric Restriction

BackgroundObesity imposes risk to cardiometabolic health; however, intentional weight loss among older adults with obesity remains controversial. ObjectiveTo explore the influence of exercise plus weight maintenance and exercise plus intentional weight loss by caloric restriction on changes in cardiometabolic risk among older adults with obesity assessed by four risk-scoring tools. DesignUsing longitudinal data from the Calorie Restriction and Changes in Body Composition, Disease, Function, and Quality of Life in Older Adults study (CROSSROADS) (ClinicalTrials.gov identifier: NCT00955903; May 2009 to October 2014), scores were calculated using baseline and 12-month data according to criteria from the International Diabetes Federation, National Cholesterol Education Program's Adult Treatment Panel, Framingham Risk Score, and Cardiometabolic Disease Staging. Participants and settingParticipants (39% men, 23% African American, aged 70.2 ± 4.7 years) were randomized to exercise (n = 48), exercise plus nutrient-dense weight maintenance diet (n = 44), or exercise plus weight loss by moderate caloric restriction (n = 42). Main outcome measuresTo evaluate effects of exercise plus weight maintenance and exercise plus intentional weight loss on changes in cardiometabolic risk. Statistical analyses performedGeneralized estimating equations were used to assess changes in risk with ethnicity, biological sex, and age as covariates. ResultsGroup-time interaction was only significant for Framingham and Cardiometabolic Disease Staging (P = 0.005 and 0.041, respectively). Upon post hoc analysis, significant within-group improvements in Framingham scores were observed for exercise plus weight maintenance (P < 0.001; r = –1.682) and exercise plus weight loss (P = 0.020; r = –0.881). In analysis of between-group differences in Framingham scores, significant decreases were observed in the exercise plus weight maintenance group (P = 0.001; r = –1.723) compared with the exercise group. For Cardiometabolic Disease Staging, the exercise plus weight loss group had significant within-group improvements (P = 0.023; r = –0.102). For between-group differences in Cardiometabolic Disease Staging, the exercise plus weight loss group showed significant risk reduction (P = 0.012; r = –0.142) compared with the exercise group. ConclusionsAmong risk scores evaluated, Framingham and Cardiometabolic Disease Staging showed significantly greater sensitivity to change in cardiometabolic risk. Older adults with obesity can significantly lower cardiometabolic risk through exercise plus weight maintenance or exercise plus weight loss by moderate caloric restriction.

Social comparisons between group members during behavioural weight loss treatment: comparison direction, scale, and associations with weight loss maintenance

Objective To examine distinct types of social comparisons (i.e. self-evaluations relative to others) in behavioural weight loss groups and their relations with weight loss maintenance. Design Participants (N = 127, MBMI = 35.66 kg/m2) reported on their comparisons at mid-treatment (6 months), including identification of their primary individual comparison target (group member) and perceptions of their own treatment adherence versus that of their group and identified target. Main Outcome Measures Weight was assessed at baseline, mid-treatment, end-of-treatment (12 months), and 18- and 24-month follow-ups. Results Comparisons with individual targets perceived as more successful with weight loss were most frequent (i.e. upward comparisons), though comparisons differed based on group versus individual targets and specific treatment behaviours (e.g. self-monitoring). Comparisons did not align with participants’ own treatment progress, suggesting that comparisons reflect more than just their objective weight loss relative to others. Relations between participants’ initial weight loss and maintenance was moderated by the type of individual target identified at mid-treatment (p = 0.02, sr = 0.27). Conclusions Social comparisons in group-based weight loss treatment are multifaceted and predict long-term weight loss maintenance. Additional work is needed to determine how best to harness comparison processes to promote success in behavioural weight loss treatment.

Enhancing community weight loss groups in a low socioeconomic status area: Application of the COM-B model and Behaviour Change Wheel.

Obesity rates are higher among people of lower socioeconomic status. While numerous health behaviour interventions targeting obesity exist, they are more successful at engaging higher socioeconomic status populations, leaving those in less affluent circumstances with poorer outcomes. This highlights a need for more tailored interventions. The aim of this study was to enhance an existing weight loss course for adults living in low socioeconomic communities. The Behaviour Change Wheel approach was followed to design an add-on intervention to an existing local authority-run weight loss group, informed by mixed-methods research and stakeholder engagement. The COM-B analysis of qualitative data revealed that changes were required to psychological capability, physical and social opportunity and reflective motivation to enable dietary goal-setting behaviours. The resulting SMART-C booklet included 6 weeks of dietary goal setting, with weekly behavioural contract and review. This paper details the development of the theory- and evidence-informed SMART-C intervention. This is the first report of the Behaviour Change Wheel being used to design an add-on tool to enhance existing weight loss services. The process benefitted from a further checking stage with stakeholders.

Exercise in the maintenance of weight loss: health benefits beyond lost weight on the scale

A cavalier description of weight loss is that it only requires overweight people to eat less and move more. Such simplicity is, however, much harder to effect in the practice...

Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records.

Cross-sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD. We estimated the effect of 2-y weight change interventions on 7-y risk of CVD (CVD death, myocardial infarction, stroke, hospitalization from coronary heart disease, and heart failure) by emulating hypothetical interventions using electronic health records. We identified 138,567 individuals with 45-69 years of age without chronic disease in England from 1998 to 2016. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying confounders. We categorized each individual into a weight loss, maintenance, or gain group. Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for CVD compared with weight maintenance. Among overweight individuals, we observed moderately higher risk of CVD in both the weight loss [RD = 0.7% (-0.2% to 1.7%)] and the weight gain group [RD = 0.7% (-0.1% to 1.7%)], compared with maintenance. In the obese, those losing weight showed lower risk of coronary heart disease [RD = -1.4% (-2.4% to -0.6%)] but not of stroke. When we assumed that chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals. Among individuals with obesity, the weight-loss group had a lower risk of coronary heart disease but not of stroke. Weight gain was associated with increased risk of CVD across BMI groups. See video abstract at, http://links.lww.com/EDE/B838.

Association between body weight variability and incidence of Parkinson disease: A nationwide, population-based cohort study.

Although body weight variability has been associated with mortality, cardiovascular disease, and dementia, the relationship between body weight variability and Parkinson disease (PD) has rarely been studied. We aimed to investigate the longitudinal association between body weight variability and PD incidence. A nationwide population-based, cohort study was conducted using the database from the Health Insurance Review and Assessment Service of the whole Korean population. We analyzed 2,815,135 participants (≥40years old, mean age = 51.7 ± 8.6 years, 66.8% men) without a previous PD diagnosis. We determined individual body weight variability from baseline weight and follow-up visits. We used Cox proportional hazards regression models. The highest quartile group was associated with increased PD incidence compared with the lowest quartile group after adjustment for confounding factors (hazard ratio [HR] = 1.18, 95% confidence interval [CI] = 1.08-1.29). In contrast, baseline body mass index, baseline waist circumference, and waist circumference variability were not associated with increased PD incidence. In the body weight loss group, individuals within the quartile of the highest variation in body weight showed a higher HR of PD risk than those within other quartiles (HR = 1.41, 95% CI = 1.18-1.68). Body weight variability, especially weight loss, was associated with higher PD incidence. This finding has important implications for clinicians and supports the need for preventative measures and surveillance for PD in individuals with fluctuating body weight.

Weight Loss Improves Pregnancy and Livebirth Outcomes in Young Women with Early-Stage Endometrial Cancer and Atypical Hyperplasia.

PurposeTo evaluate the effects of body weight loss on reproductive outcomes in young women with early-stage endometrial cancer (EC) and atypical hyperplasia (AH) who underwent fertility-sparing therapy.Patients and MethodsPatients with well-differentiated EC (n=8, FIGO stage Ia) and AH (n=36) who achieved complete regression after fertility-sparing therapy were retrospectively reviewed. Patients were divided into a weight loss group (n=25) and a non-weight loss group (n=19). Subgroup analysis according to body mass index and relative weight loss were performed to investigate the effect of weight loss on pregnancy and live birth outcomes. Univariate and multivariate logistic regression analyses were undertaken to determine pregnancy-associated factors.ResultsMean body weight and body mass index at pre-progestin treatment and at fertility treatment initiation were 70.63±12.03 and 67.08±8.18 kg, respectively, 27.06±4.44 and 25.73±3.15 kg/m2, respectively. Twenty-five patients (56.82%) lost weight, the median absolute weight loss was 5.00 kg (1.00–34.50), and the median relative weight loss was 6.70% (1.00–36.00%) over a median of 12 months (5.00–97.00). A favorable pregnancy rate (65.91%) and live birth rate (50.00%) were achieved. The pregnancy and live birth rates were meaningfully higher in the weight loss group than in the non-weight loss group (88.00% vs 36.84%, P=0.000; 64.00% vs 31.58%, P=0.033); weight loss ≥5% significantly increased pregnancy and live birth rate in patients with BMI ≥25 kg/m2. The risk ratio of weight loss ≥5% in multivariate logistic analysis for pregnancy was 10.448 (1.102, 99.056, P=0.041).ConclusionWeight loss could positively affect pregnancy rate and improve live birth rate in overweight and obese women with early-stage EC and AH during/after fertility-sparing therapy. Weight loss ≥5% increased pregnancy and livebirth rates significantly in overweight and obese women.

Eight weeks of intermittent fasting versus calorie restriction does not alter eating behaviors, mood, sleep quality, quality of life and cognitive performance in women with overweight

Human trials that compare intermittent fasting (IF) to calorie restriction (CR) with psychological, behavioral and cognition outcomes are limited. We hypothesized that there would be no difference between CR and IF on perceived eating behaviors, mood, sleep quality, quality of life (QOL) and cognition in women with overweight and obesity. In this prespecified secondary analysis of an open-label, single center, parallel assignment, randomized controlled trial, healthy women with overweight or obesity (N = 46, mean [SD] age 50 [9] years, BMI 32.9 [4.4] kg/m2), without a diagnosed eating disorder and who were randomized into 2 weight loss groups (prescribed 70% of calculated energy requirements as IF or CR) were included. Measurements were assessed in both IF and CR groups following a 12-hour overnight fast during baseline and week 8 and additionally following a 24-hour fast in the IF group only at week 8. We observed that IF produced greater weight and body fat loss than CR (P < .001). We did not detect any statistical difference between groups for the change in dietary restraint, disinhibition, hunger, mood, sleep quality, and QOL. An increase in cognitive performance was found in both IF (P = .036) and CR (P = .006) groups in one of the cognitive tasks, but there was no statistical difference between groups. Perceived eating behaviors, mood, sleep quality and cognitive performance were not changed by an acute 24-hour fast within the IF group (all P > .05). IF may be a viable alternative to CR for weight loss, in the short-term, without adversely impacting eating behaviors, mood, sleep quality, QOL or cognition in healthy women with overweight or obesity. However, larger and long term trials are required.

Circulating extracellular vesicles are a biomarker for NAFLD resolution and response to weight loss surgery

There is increasing interest in the development of minimally invasive biomarkers for the diagnosis and prognosis of NAFLD via extracellular vesicles (EV). Plasma EVs were isolated by differential ultracentrifugation and quantified by nanoparticle tracking analysis from pre (n = 28) and post (n = 28) weight loss patients. In the pre weight loss group 22 had NAFLD. Nanoplasmon enhanced scattering (nPES) of gold nanoparticles conjugated to hepatocyte-specific antibodies was employed to identify hepatocyte-specific EVs. Complex lipid panel and targeted sphingolipids were performed. Logistic regression analysis was used to identify predictors of NAFLD. Plasma levels of EVs and hepatocyte-derived EVs are dynamic and decrease following NAFLD resolution due to weight loss surgery. Hepatocyte-derived EVs correlate with steatosis in NAFLD patients and steatosis and inflammation in NASH patients. Plasma levels of small EVs correlate with EV sphingolipids in patients with NASH. Hepatocyte-derived EVs measured by the nPES assay could serve as a point-of-care test for NAFLD.

Long-Term Food Choice and Weight Loss on a Mobile Program With Food Color System

ObjectivesIt is unclear if individuals sustain healthy food choices long-term on a mobile, self-directed weight loss program, or how those choices influence weight loss. We examined differences in food choice and dietary quality by weight lost at 18 months on a mobile behavior change weight loss program with a traffic light food system designed to encourage healthier eating behaviors. We expected that users with greater amounts of weight loss would show healthier food choices and dietary quality. MethodsOn the program, users are encouraged to consume a ratio of 30% green (low-calorie, high-volume, nutrient-rich foods), 45% yellow, and 25% red (high-calorie, low-volume) foods. They are also provided information on behavior change principles. We evaluated food ratios and self-reported dietary quality in 148 adults 18 months after starting the program with a retrospective cohort design. Food ratios were measured via food intake self-reported on the program. Dietary quality was measured using a validated questionnaire assessing adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (DASH-Q). Respondents were categorized into high (>10%, n = 71), moderate (5–10%, n = 35), and low or no (<5%, n = 42) weight loss groups based on weight lost by 18 months. ANOVAs tested differences in food ratios and dietary quality between groups. ResultsBaseline BMI did not differ between weight loss groups (high: 36.9, moderate: 36.0, low: 36.5; P = 0.68). However, there were significant differences in green food ratios across weight loss groups for breakfast (high: 37%, moderate: 37%, low: 34%; P = .02), lunch (29%, 27%, 25%; P < .001), and dinner (22%, 20%, 16%; P < .001). Red food ratios also differed across groups for breakfast (21%, 27%, 26%; P < .001), lunch (34%, 35%, 37%; P < .002), and dinner (36%, 39%, 43%; P < .001). The weight loss groups also differed in DASH dietary pattern scores (high: 41.79, moderate: 42.52, low: 36.95; P = .02). ConclusionsUsers with greater weight loss ate more green foods, fewer red foods, and adhered more to the DASH diet than users with less weight loss. These differences were apparent even 18 months later. This highlights the role of food choice and dietary quality in weight loss and suggests that a mobile behavior change program with a traffic light system could aid in healthier long-term dietary consumption. Funding SourcesThis study was funded by Noom Inc.

Abstract MP15: Promoting Lifestyle Change Via Real-time Feedback: Short-term Weight Loss Outcomes In The Smarter Trial

Background: Obesity is a major risk factor for CVD. Standard behavioral treatment (SBT) typically requires face-to-face sessions, is expensive, has limited evidence for sustained weight loss, and critically, is not available to many with obesity. Using innovative mobile technology to provide real-time tailored feedback (FB) to the self-monitoring (SM) of diet, physical activity, and weight can improve lifestyle and weight management habits. It can be accessible to those without access to SBT, or to those not wishing to participate in a structured, in-person program. We report short-term, 6-month weight findings from the SMARTER Trial. Methods: SMARTER tests the efficacy of adding automated FB to smartphone SM compared to SM alone on weight loss. We randomized 502 adults with overweight/obesity to either 1) SM alone (n=251) or 2) SM+FB (n=251). The SM+FB group received up to 3 FB pop-up messages/day on their smartphone which were tailored to data in SM entries and delivered at random times during waking hours. Participants used a smartphone app to self-report diet, a Fitbit Charge 2 to monitor physical activity, and a digital Bluetooth scale for weight tracking. At baseline, all had a 90-min one-on-one session with a dietitian on behavioral changes to target weight loss. Percent weight loss from baseline to 6 months and the percentage of participants having at least a 5% weight loss at 6 months were compared between treatment groups using an intention to treat (ITT) approach with either parametric or non-parametric group comparisons. Missing assessment weights at 6 months were imputed using participants’ weight tracking data. Results: Groups had similar demographic characteristics and anthropometric measures at baseline (all p≥.05). The sample was mostly female (79.5%,399/502) and white (84.3%, 423/502) with mean BMI of 33.10 ± 3.93 kg/m 2 . There was no difference between groups in having weight data available at 6 months (SM: 84.9%, 213/251), SM+FB: 83.7%, 210/251); p=.713). Based on ITT analyses, there was no significant difference between the two groups in mean percent weight loss from baseline to 6 months (SM: Mean= -3.24% [SD=5.27], SM+FB: Mean= -3.16% [SD=5.50]; p=.860). Similar results were obtained using non-parametric methods, further supporting no difference in percent weight loss between the groups (SM: Median= -2.25% [IQR=5.53], SM+FB: Median= -2.45% [IQR=6.88]; p=.962). Overall, 30.1%,151/502) achieved at least 5% weight loss at 6 months, with similar percentages between treatment groups (SM: 28.3%,71/251, SM+FB: 31.9%, 80/251); p=.381). Conclusions: These findings demonstrate excellent 6-month assessment completion rates. We did not support our hypothesis that participants in the SM+FB group would show greater weight loss at 6 months than those in the SM group. It is possible that weight loss outcomes may differ between groups in the second half of the 12-month intervention.

Self-Reported Nutritional Factors Are Associated with Weight Loss at 18 Months in a Self-Managed Commercial Program with Food Categorization System: Observational Study.

Little is known about nutritional factors during weight loss on digital commercial weight loss programs. We examined how nutritional factors relate to weight loss for individuals after 4 and 18 months on a mobile commercial program with a food categorization system based on energy density (Noom). This is a two-part (retrospective and cross-sectional) cohort study. Two time points were used for analysis: 4 months and 18 months. For 4-month analyses, current Noom users who met inclusion criteria (n = 9880) were split into 5% or more body weight loss and stable weight loss (0 ± 1%) groups. Individuals who fell into one of these groups were analyzed at 4 months (n = 3261). For 18-month analyses, individuals from 4-month analyses who were still on Noom 18 months later were invited to take a one-time survey (n = 803). At 18 months 148 participants were analyzed. Noom has a system categorizing foods as low-, medium-, and high-energy-dense. Measures were self-reported proportions of low-, medium-, and high-energy-dense foods, and self-reported nutritional factors (fruit and vegetable intake, dietary quality, nutrition knowledge, and food choice). Nutritional factors were derived from validated survey measures, and food choice from a novel validated computerized task in which participants chose a food they would want to eat right now. ANOVAs compared participants with 5% or more body weight loss and participants with stable weight (0 ± 1%) at 4 months on energy density proportions. Analyses at 18 months compared nutritional factors across participants with >10% (high weight loss), 5–10% (moderate weight loss), and less than 5% body weight loss (low weight loss), and then assessed associations between nutritional factors and weight loss. Individuals with greater weight loss reported consuming higher proportions of low-energy-dense foods and lower proportions of high-energy-dense foods than individuals with less weight loss at 4 months and 18 months (all ps < 0.02). Individuals with greater weight loss had higher fruit and vegetable intake (p = 0.03), dietary quality (p = 0.02), nutrition knowledge (p < 0.001), and healthier food choice (p = 0.003) at 18 months. Only nutrition knowledge and food choice were associated with weight loss at 18 months (B = −19.44, 95% CI: −33.19 to −5.69, p = 0.006; B = −5.49, 95% CI: −8.87 to −2.11, p = 0.002, respectively). Our results highlight the potential influence of nutrition knowledge and food choice in weight loss on a self-managed commercial program. We also found for the first time that in-the-moment inclination towards food even when just depicted is associated with long-term weight loss.

Metformin Affects Gut Microbiome Composition and Function and Circulating Short-Chain Fatty Acids: A Randomized Trial.

OBJECTIVETo determine the longer-term effects of metformin treatment and behavioral weight loss on gut microbiota and short-chain fatty acids (SCFAs).RESEARCH DESIGN AND METHODSWe conducted a 3-parallel-arm, randomized trial. We enrolled overweight/obese adults who had been treated for solid tumors but had no ongoing cancer treatment and randomized them (n = 121) to either 1) metformin (up to 2,000 mg), 2) coach-directed behavioral weight loss, or 3) self-directed care (control) for 12 months. We collected stool and serum at baseline (n = 114), 6 months (n = 109), and 12 months (n = 105). From stool, we extracted microbial DNA and conducted amplicon and metagenomic sequencing. We measured SCFAs and other biochemical parameters from fasting serum.RESULTSOf the 121 participants, 79% were female and 46% were Black, and the mean age was 60 years. Only metformin treatment significantly altered microbiota composition. Compared with control, metformin treatment increased amplicon sequence variants for Escherichia (confirmed as Escherichia coli by metagenomic sequencing) and Ruminococcus torques and decreased Intestinibacter bartlettii at both 6 and 12 months and decreased the genus Roseburia, including R. faecis and R. intestinalis, at 12 months. Effects were similar in comparison of the metformin group with the behavioral weight loss group. Metformin versus control also increased butyrate, acetate, and valerate at 6 months (but not at 12 months). Behavioral weight loss versus control did not significantly alter microbiota composition but did increase acetate at 6 months (but not at 12 months). Increases in acetate were associated with decreases in fasting insulin. Additional whole-genome metagenomic sequencing of a subset of the metformin group showed that metformin altered 62 metagenomic functional pathways, including an acetate-producing pathway and three pathways in glucose metabolism.CONCLUSIONSMetformin, but not behavioral weight loss, impacted gut microbiota composition at 6 months and 12 months. Both metformin and behavioral weight loss altered circulating SCFAs at 6 months, including increasing acetate, which correlated with lower fasting insulin. Future research is needed to elucidate whether the gut microboime mediates or modifies metformin’s health effects.

Impact of standard treatment on the quality of life of non-alcoholic fatty liver disease patients

ObjectiveGiven that non-alcoholic fatty liver disease (NAFLD) is a major concern in public health, this study evaluates the impact of a standard treatment for NAFLD on the quality of life of affected patients. MethodWe conducted this study on patients suffering from NAFLD at the gastroenterology clinic of Sina Hospital, Tehran. All patients underwent a standard treatment protocol. We collected information about the demographic, physical, biochemical parameters and the NAFLD fat and quality of life scores using the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Chronic Liver Disease Questionnaire (CLDQ) and evaluated the data at the baseline, three months, and six months post-treatment. Patients were categorized into two groups, namely those with significant weight loss (>5%) and non-significant weight loss (<5%) six months after the start of the treatment. The statistical analysis was performed via SPSS 22. ResultsA total of 400 patients (52.1% women, mean age of 49.93 ± 3.01 years) were evaluated. We noticed that 127 patients achieved significant weight loss (31.75%) during the six-month period, while 273 patients did not achieve the weight loss goal (68.25%). No significant differences in demographic parameters were found between the groups. As per the WHOQOL-BREF questionnaire and CLDQ, there were significant improvements in the significant weight loss group compared to the non-significant weight loss group. Regression analysis showed that the NAFLD fat scores and baseline alanine aminotransferase (ALT) levels were significantly correlated with WHOQOL-BREF outcomes. The CLDQ outcomes were significantly associated with the fibrosis stage, NAFLD activity score, and the presence of diabetes mellitus. ConclusionThis study concludes that a standard treatment protocol and weight loss regime can significantly improve the quality of life of NAFLD patients.

Once-weekly Subcutaneous Semaglutide 2.4 mg Reduces Body Weight in Adults with Overweight or Obesity Regardless of Baseline Characteristics (STEP 1)

Background: Semaglutide is a long-acting, subcutaneous (s.c.), glucagon-like peptide-1 analogue that is currently being investigated for obesity management in adults with overweight or obesity in the phase 3 STEP clinical trial program. Varying degrees of weight loss were observed with once-weekly s.c. semaglutide 2.4 mg in STEP 1, and a post-hoc analysis was conducted to investigate weight loss in subgroups of participants based on their baseline characteristics. Methods: STEP 1 was a randomized, double-blind, placebo-controlled, phase 3 trial (NCT03548935). Adults aged ≥18 years with either body mass index (BMI) ≥27 kg/m2 with ≥1 weight-related comorbidity or BMI ≥30 kg/m2, without type 2 diabetes, were randomized 2:1 to 68 weeks’ treatment with once-weekly s.c. semaglutide 2.4 mg or placebo, as adjunct to lifestyle intervention. A descriptive evaluation of categorical weight loss with semaglutide from baseline to week 68 (≥20%, 15-<20%, 10-<15%, 5-<10%) by baseline characteristics (age, sex, race [White, Asian, Black or African American, other], body weight, BMI, waist circumference, and glycemic status [normo-glycemia, pre-diabetes]) was conducted. Mean percent weight loss with semaglutide from baseline to week 68 was analyzed separately by sex (male, female) and baseline body weight (≥115 kg, 100-<115 kg, 90-<100 kg, <90 kg) using a mixed model for repeated measurements analysis with treatment, subgroup (of sex or baseline body weight), and the interaction between treatment and subgroup as factors, and baseline body weight as a covariate, all nested within visit (based on the trial product estimand [treatment effect assuming treatment adherence and without use of rescue intervention] for the on-treatment period). Results: STEP 1 included 1,961 randomized participants (mean age 46 years, body weight 105.3 kg, BMI 37.9 kg/m2; 74.1% female). For categorical weight loss, the observed proportions of participants with ≥20%, 15-<20%, 10-<15%, and 5-<10% weight loss at week 68 were 34.8%, 19.9%, 20.0%, and 17.5% with semaglutide vs 2.0%, 3.0%, 6.8%, and 21.2% with placebo, respectively. The distribution of participants across weight loss groups did not appear to be affected by any baseline characteristics, except sex and baseline body weight. Mean percent weight loss at week 68 with semaglutide was greater among females than males, and in participants with lower vs higher baseline body weight. Sex and baseline body weight were independently associated with weight loss with semaglutide vs placebo at week 68 (p<0.001 for both tests for subgroup interactions). Conclusion: In STEP 1, weight loss with once-weekly s.c. semaglutide 2.4 mg was seen in all subgroups evaluated, and was generally not influenced by baseline characteristics. The exception was sex and baseline body weight; female sex and a low baseline body weight were associated with a greater response to semaglutide.

Indications and Long-Term Outcomes of Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass.

Long-term results on sleeve gastrectomy (SG) with more than 10 years report patients needing sleeve revision for weight loss failure, de novo gastroesophageal reflux (GERD), or sleeve complications. The aim of this study was to analyze the results of laparoscopic conversion of failed SG to Roux-en-Y gastric bypass (RYGB). Retrospective review of a prospectively institutional maintained database to identify patients who underwent conversion of SG to RYGB between 2012 and June 2020. Sixty patients(50 females) underwent conversion to RYGB. Average time to conversion was 5.6 years (2-11). Mean %WL and TWL after SG were respectively 26±8.8% and 33.2±14.1kg. Mean BMI at the time of RYGB was 38.1±7.1 kg/m2. Mean follow-up was 30.4±16.8 months (6-84). Available patients at each time of follow-up: 1 year 59 (98.3%); 2 years 47 (78.3%); 3 years 39 (71.6%); and 5 years 33 (55%). Patients were divided according to indication for revision in weight regain/insufficient weight loss (30 patients) group 1 and GERD/complications (25 patients) group 2. Percentage of excess weight loss at 1, 3, and 5 years follow-up after bypass was for group 1 40.3±17.6, 34.3±19.5, and 23.2±19.4 and for group 2 90.4±37, 62.6±28.2, and 56±35.02. Total weight loss at last follow-up since sleeve was respectively 31kg in group 1 and 46.7kg in group 2 (p=0.002). No mortality was observed. Thirty-day complication rate was 3.3%. RYGB after SG is a safe and effective revisional procedure to manage weight regain and de novo GERD, to address complications, and to improve comorbidities.

The Effect of Vagus Nerve Preservation on Gastrointestinal Function After One Anastomosis/Mini Gastric Bypass

Background: The effects of Vagus Nerve preservation or division during One Anastomosis/Mini Gastric Bypass (OAGB/MGB) have not been studied before. The aim of this study was to compare Vagus Dividing OAGB/MGB versus Vagus Preserving OAGB/MGB as regards Gastrointestinal Quality of Life, postoperative weight loss, and metabolic outcome. Methods: This randomized controlled study included 200 patients divided into two equal groups. Group I underwent Vagus Dividing OAGB/MGB (VD-OAGB/MGB). Group II underwent Vagus Preserving OAGB/MGB (VP-OAGB/MGB) in whom the neurovascular bundle was preserved till the gastric antrum. Both groups were compared for weight loss, metabolic outcome, postoperative complications, and Gastrointestinal Quality of Life Index (GIQLI) scores for 1 year after surgery. Results: One year after surgery 87 patients in Group I and 84 patients in Group II completed the follow-up. The postoperative GIQLI score significantly improved 1 year after surgery. Patients had improvement in the three domains of general health (social, physical, and emotional function). The domain of specific symptoms worsened after VD-OAGB/MGB and improved after VP-OAGB/MGB. There was no significant difference between both groups in complications, weight loss, or metabolic outcome. Conclusion: VP-OAGB/MGB results in similar weight loss and metabolic outcomes as VD-OAGB/MGB with a better GIQLI score.

Changes in physical activity during a one-year weight loss trial with liraglutide in participants with knee osteoarthritis: secondary analyses of a randomised trial

Changes in physical activity during a one-year weight loss trial with liraglutide in participants with knee osteoarthritis: secondary analyses of a randomised trial