Impact of weight reduction on production of platelet-derived microparticles and fibrinolytic parameters in obesity

INTRODUCTION: Generation of platelet-derived microparticle (PMP) is implicated in cardiovascular disease (CVD). However, the influence of adiposity and weight reduction on PMP generation remains to be fully elucidated. We compared PMP generation and fibrinolytic parameters between 49 non-diabetic obese (obese group) and 37 age-matched non-obese subjects (control group), and compared the effects of weight reduction on the parameters between a 12-week calorie restricted diet and diet with aerobic exercise in obese subjects. MATERIALS AND METHODS: PMP, plasma levels of plasminogen activator inhibitor-1 (PAI-1) activity and tissue-type plasminogen activator (t-PA) antigen were measured before and after intervention. RESULTS: Before intervention, PMP, PAI-1 activity and t-PA antigen values were elevated in the obese group compared with the control group. In all 86 subjects of both groups, these three parameters correlated with body mass index, waist circumference and fat tissue mass. There was a positive correlation between plasma levels of fibrinolytic parameters and visceral fat area (VFA). PMP values correlated with subcutaneous fat area (SFA). The intervention significantly reduced PMP, PAI-1 activity and t-PA antigen levels. There was a significant correlation between percentages of changes in PMP values and those in BMI, fat tissue mass and VFA in the obese group. No additional effect of exercise on PMP or fibrinolytic parameters was observed. CONCLUSIONS: Overproduction of PMP and fibrinolytic abnormalities may be associated with excessive adipose tissue. Weight reduction by either calorie restriction with or without exercise improves fibrinolytic abnormalities and PMP overproduction, probably through reduction of adipose tissue.     

瑞格列奈联合二甲双胍治疗初发2型肥胖型糖尿病的疗效观察

目的:观察瑞格列奈联合二甲双胍治疗初发2型肥胖型糖尿病的疗效。方法:将我院于2005年1月-2010年2月收治的156例初发2型肥胖型糖尿病患者随机均分成瑞格列奈单独用药组、二甲双胍单独用药组和瑞格列奈联合二甲双胍治疗组,均治疗12周,检测、分析用药前、后的空腹血糖(FBG)、餐后2h血糖(2hBG)、糖化血红蛋白(HbA1c)、体重指数(BMI)。结果:与单独用药组比较,治疗组疗效更好(P<0.05)。治疗组治疗后FBG、2hBG、HbA1C、BMI分别为(6.5±0.58)mmol·L-1、(7.42±0.61)mmol·L-1、(6.32±1.98)%、(24.2±0.65)kg·m-2,且治疗期间未见严重不良反应。结论:瑞格列奈联合二甲双胍治疗初发2型肥胖型糖尿病疗效确切,不良反应轻微。     

Dihydromyricetin improves liver fat deposition in high-fat diet-induced obese mice

It has been reported that the histone/protein deacetylase SIRT1-AMP-activated protein kinase (SIRT1-AMPK) signaling pathway may play a role in the effects of dihydromyricetin (DHM) on improving triglyceride (TG) accumulation and insulin resistance in liver cells. Therefore, we aimed to further observe the effect of DHM on liver fat deposition in high-fat diet (HFD)-induced obese mice and explore its possible mechanism. C57BL/6J mice were fed with a normal diet (ND) and HFD and were treated with or without low-dose (125 mg/kg) or high-dose (250 mg/kg) DHM for 16 weeks, respectively. During the experiment, body weight was checked every 2 weeks. After 16 weeks, the orbital vein was bled, the animals were sacrificed, and the subscapular, epididymal, and inguinal fat were collected and weighed with an electronic scale. An automatic biochemical analyzer was used to determine the levels of serum triglyceride (TG), serum total cholesterol (TC), serum high-density lipoprotein (HDL), and serum low-density lipoprotein (LDL). The livers were stained with hematoxylin-eosin staining (H&E) and Oil Red O to detect liver fat deposition. A colorimetric method was used to detect liver MDA and SOD contents. Quantitative real-time PCR (qRT-PCR) was used to detect the gene expressions of related indicators, such as interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), acetyl-CoA carboxyl acetyl-CoA carboxylase (ACC), sterol regulatory element-binding protein-1c (SREBP-1), fatty acid synthetase (FAS), peroxisome proliferator activation receptor alpha (peroxisome proliferator-activated receptor-alpha, PPARα), palmitoyltransferase 1 (carnitine palmitoyltransferase 1, CPT1), SIRT1, and AMPK. Western blotting analysis was used to detect the protein expression levels of SIRT1, AMPK, SIRT1-AMPK, ACC, SREBP-1, FAS, PPARα, and CPT1. Results showed that compared with the ND group, the weight and body fat of the mice in the HFD group were increased significantly. The levels of TG, TC, and LDL were increased, the level of HDL was decreased, the volume of hepatocytes was increased, the number of lipid droplets, fat deposition, MDA, IL-6, IL-8, TNF-α, SREBP-1c, FAS, ACC1, SIRT1, and AMPK protein levels were significantly increased, and the SOD activity, PPARα, CPT1, SIRT1 mRNA, AMPK mRNA, PPARα, CPT1 levels were significantly decreased. DHM could significantly reverse the changes of the above indexes in HFD mice, while DHM had no significant effect on the above indexes in ND mice. Collectively, our findings revealed that DHM improved liver fat deposition in HFD-induced obese mice, and the mechanism might be related to inhibition of oxidative stress, inflammation, lipid synthesis, and promotion of lipid decomposition.     

The Relationship of Lifestyle Factors with the Prevalence of Major Depressive Disorder by Ecological Factors

ObjectiveThe association between ecological/lifestyle factors and major depressive disorder (MDD) have been provided but was inconsistent as characteristics of population including race, gender, etc. MethodsData were extracted from the Korean National Health and Nutrition Examination Survey and consisted of 35,839 adults including 1,537 with MDD. Ecological factors included age, sex, married status, education, family income, residence, occupation, BMI, self-recognition stress, and history of non-communicable disease. Smoking, drinking, regular exercise, total energy intake, and sleep was consisted for lifestyle factors. The relationship between MDD and ecological/lifestyle factors, was evaluated using the multiple logistic regression model after adjustment for covariates. ResultsThe increased prevalence of MDD in men was related aged, unmarried, low educated, unoccupied, high BMI, and high self-recognition stress. To women, MDD prevalence was increased as aged, low educated and family income, resided in urban, unoccupied, high self-recognition stress and history of non-communicable disease. Current smoking/drinking and lack of sleep was positively related with prevalence of MDD in women. The relationship between lifestyle factors and MDD prevalence was influenced by ecological status, predominantly in women. ConclusionThe relationship of lifestyle factors with MDD prevalence were observed and could be attenuated by various ecological factors, in women.     

加味逍遥颗粒联合二甲双胍对肥胖型多囊卵巢综合征的疗效观察

正多囊卵巢综合征(polycystic ovary syndrome,PCOS)是临床常见的内分泌和代谢紊乱性疾病,好发于肥胖群体,是引起育龄期妇女月经紊乱、无排卵性不孕的主要因素,其病理特征主要为高雄激素血症、胰岛素抵抗、糖脂代谢紊乱~[1]。长期排卵稀发或无排卵、高雄激素血症、月经异常等是其常见临床表现~[2]。目前PCOS患者多伴随肥胖或超重现象,机体存在高胰岛素水平,糖脂代谢紊乱和性激素水平失     

Single‐port appendectomy in obese children: an optimal alternative?

Introduction: The aim of this study was to evaluate our experience with single‐port appendectomy (SPA) in obese children. Methods: From January 2003 to June 2009, 94 SPA (65 women and 29 men, mean age of 12.4 years) were performed in children with appendicitis. Sixty‐five of these patients were found to have normal weight, whereas 29 were obese. Patients’ records were evaluated regarding operative time, intra‐ and post‐operative complications, initiation of oral intake and histopathological findings. Results: There was no significant difference in operative time between obese and normal weight patients. In the obese group, one wound healing disturbance was documented. In the normal weight group, there were one post‐operative bleeding and one wound infection. There was no difference with regards to the introduction of feeds following appendectomy between the groups. Histological examinations revealed 15 normal, 32 acute, 21 phlegmonous, 20 chronic and two perforated cases of appendicitis, three neurogenic appendicopathies and one case of enterobius vermicularis related appendicitis. Conclusions: Our results indicate that the advantages of single‐port appendectomy in the evaluation of the peritoneal cavity, the minimal rate of intra‐operative incidents with this technique and superior cosmetics validate this alternative approach of minimal access appendectomy in obese children.     

Oxidative markers in children with severe obesity following low‐calorie diets supplemented with mandarin juice

Aim: To evaluate the effect of supplementing a hypocaloric diet with mandarin juice, a food with a high content of antioxidants (vitamin C, flavonoids and carotenoids), on biomarkers of oxidant/antioxidant status of severe obese children. Methods: Forty obese children were randomized into two groups pair‐wise in a 4‐week controlled intervention study. Both groups followed a hypocaloric diet. One group received additionally a supplementation of 500 mL of 100% mandarin juice daily. Clinical data, anthropometry, dietary intake and fasting blood samples were collected at baseline and after the intervention. Lipid peroxidation was assessed by circulating levels of malondialdehyde, and protein oxidation was determined by the concentration of plasma carbonyl groups. The antioxidant defence was evaluated by red cell‐reduced glutathione and plasma levels of α‐tocopherol and vitamin C. Results: The supplemented group experienced a decrease in the levels of malondialdehyde (?9.6%, p = 0.014) and carbonyl groups (?36.1%, p = 0.006) and an increase in antioxidants (α‐tocopherol +16.1%, p = 0.006, glutathione +36.1%, p < 0.0001, and vitamin C + 94.6%, p < 0.0001). Conclusion: The mandarin juice consumption with a reduced calorie diet positively affects the antioxidant defence and produces a decrease in biomarkers of oxidative stress in obese children.     

Impact of Obesity on Quality of Life,Psychological Distress,and Coping on Patients with Colon Cancer

BackgroundDespite the causal relationship between obesity and colon cancer being firmly established, the effect of obesity on the course of cancer calls for further elucidation. The objective of this study was to assess differences in clinical‐pathological and psychosocial variables between obese and nonobese individuals with colon cancer.Materials and MethodsThis was a prospective, multicentric, observational study conducted from 2015–2018. The sample comprised patients with stage II–III, resected colon cancer about to initiate adjuvant chemotherapy with fluoropyrimidine in monotherapy or associated with oxaliplatin and grouped into nonobese (body mass index <30 kg/m²) or obese (≥30 kg/m²). Subjects completed questionnaires appraising quality of life (European Organization for Research and Treatment of Cancer Quality of Life Core questionnaire), coping (Mini‐Mental Adjustment to Cancer), psychological distress (Brief Symptom Inventory 18), perceived social support (Multidimensional Scale of Perceived Social Support), personality (Big Five Inventory 10), and pain (Brief Pain Inventory). Toxicity, chemotherapy compliance, 12‐month recurrence, and mortality rate data were recorded.ResultsSeventy‐nine of the 402 individuals recruited (19.7%) were obese. Obese subjects exhibited more comorbidities (≥2 comorbidities, 46.8% vs. 30.3%, p = .001) and expressed feeling slightly more postoperative pain (small size‐effect). There was more depression, greater helplessness, less perceived social support from friends, and greater extraversion among the obese versus nonobese subjects (all p < .04). The nonobese group treated with fluoropyrimidine and oxaliplatin suffered more grade 3–4 hematological toxicity (p = .035), whereas the obese had higher rates of treatment withdrawal (17.7% vs. 7.7%, p = .033) and more recurrences (10.1% vs. 3.7%, p = .025). No differences in sociodemographic, quality of life, or 12‐month survival variables were detected.ConclusionObesity appears to affect how people confront cancer, as well as their tolerance to oncological treatment and relapse.Implications for PracticeObesity is a causal factor and affects prognosis in colorectal cancer. Obese patients displayed more comorbidities, more pain after cancer surgery, worse coping, and more depression and perceived less social support than nonobese patients. Severe hematological toxicity was more frequent among nonobese patients, whereas rates of withdrawal from adjuvant chemotherapy were higher in the obese cohort, and during follow‐up, obese patients presented greater 12‐month recurrence rates. With the growing and maintained increase of obesity and the cancers associated with it, including colorectal cancer, the approach to these more fragile cases that have a worse prognosis must be adapted to improve outcomes.     

Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer

ObjectiveAssess the effect of class III (body mass index [BMI, kg/m²] 40–49.9) and class IV obesity (≥ 50) on clinical pregnancy and live birth outcomes after first oocyte retrieval and fresh embryo transfer cycle.DesignCohort studySettingAcademic centerPatientsPatients undergoing their first oocyte retrieval with planned fresh embryo transfer in our clinic between 01/01/2012 and 12/31/2018. Patients were stratified by BMI: 18.5–24.9 (n = 4913), 25–29.9 (n = 1566) 30–34.9 (n = 559), 35–39.9 (n = 218), and ≥ 40 (n = 114).InterventionNoneMain outcome measureLive birth rateResultsFollowing embryo transfer, there were no differences in pregnancy rates across all BMI groups (p value, linear trend = 0.86). However among pregnant patients, as BMI increased, a significant trend of a decreased live birth rate was observed (p value, test for linear trend = 0.004). Additionally, as BMI increased, a significant trend of an increased miscarriage rate was observed (p value, linear trend = < 0.001). Compared to the normal-weight cohort, women with a BMI ≥ 40 had a significantly higher rate of cancelled fresh transfers after retrieval (18.4% vs. 8.2%, OR 2.51; 95%CI 1.55–4.08). Among singleton deliveries, a significant trend of an increased c-section rate was identified as the BMI increased (p value, linear trend = <0.001).ConclusionOverall, patients with a BMI > 40 have worse IVF treatment outcomes compared to normal-weight patients. After embryo transfer, their pregnancy rate is comparable to normal-weight women; however, their miscarriage rate is higher, leading to a lower live birth rate for pregnant women in this population. Patients with a BMI > 40 have a c-section rate that is 50% higher than normal-weight patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-020-02011-1.