Obesity and Physical Frailty in Older Adults: A Scoping Review of Lifestyle Intervention Trials

Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older adults to perform physical activities and increasing metabolic instability. Our scoping review explores the impact of being obese on physical frailty in older adults by summarizing the state of the science for both clinical markers of physical function and biomarkers for potential underlying causes of obesity-related decline. We used the 5-stage methodological framework of Arksey and O'Malley to conduct a scoping review of randomized trials of weight loss and/or exercise interventions for obesity (body mass index ≥ 30 kg/m²) in older adults (aged >60 years), examining the outcomes of inflammation, oxidative stress, and lipid accumulation in muscle, as well as direct measures of physical function. Our initial search yielded 212 articles; exclusion of cross-sectional and observational studies, cell culture and animal studies, disease-specific interventions, and articles published before 2001 led to a final result of 21 articles. Findings of these trials included the following major points. The literature consistently confirmed benefits of lifestyle interventions to physical function assessed at the clinical level. Generally speaking, weight loss alone produced a greater effect than exercise alone, and the best outcomes were achieved with a combination of weight loss and exercise, especially exercise programs that combined aerobic, resistance, and flexibility training. Weight loss interventions tended to reduce markers of inflammation and/or oxidative damage when more robust weight reduction was achieved and maintained over time, whereas exercise did not change markers of inflammation. However, participation in a chronic exercise program did reduce the oxidative stress induced by an acute bout of exercise. Weight loss interventions consistently reduced lipid accumulation in the muscle; however, in response to exercise, 3 studies showed an increase and 2 a decrease in muscle lipid infiltration. In summary, this scoping review identified strong clinical evidence that weight reduction and/or exercise interventions can improve physical function and biomarkers of physical dysfunction among overweight/obese older adults, supporting the suggestion that excessive adiposity contributes to physical frailty. However, the evidence also suggests a complexity of metabolic influences, both systemically and within muscle, which has not been elucidated to date. Considerable further study is needed to examine the mechanisms by which lifestyle interventions influence physical frailty before the net impact of such interventions can be fully understood.     

自拟降脂汤配合西药治疗脂肪肝随机对照研究

[目的]探讨自拟降脂汤与西药结合治疗脂肪肝的疗效。[方法]脂肪肝患者98例,随机分成治疗组50例和对照组48例。治疗组在基础治疗的同时,服用自拟降脂汤并配合西药,对照组口服西药治疗。[结果]治疗组有效45例,无效5例,总有效率90%;对照组有效35例,无效13例,总有效率72.9%。两组疗效比较有显著性差异(P<0.05)。并且在改善肝功能,降低血脂等方面,治疗组较对照组疗效显著,有显著性差异(P<0.05)。[结论]中西医结合治疗脂肪肝的疗效明显优于单纯西医治疗。     

降脂汤与西药结合治疗脂肪肝50例

[目的]探讨自拟降脂汤与西药结合治疗脂肪肝的疗效。[方法]脂肪肝患者98例,随机分成治疗组50例和对照组48例。治疗组在基础治疗的同时,服用自拟降脂汤并配合西药;对照组口服西药治疗。[结果]治疗组有效45例,无效5例,总有效率90.00%。对照组有效35例,无效13例,总有效率72.90%。两组疗效比较有显著性差异(P<0.05)。并且在改善肝功能,降低血脂等方面,治疗组较对照组疗效显著,有显著性差异(P<0.05)。[结论]中西医结合治疗脂肪肝的疗效明显优于单纯西医治疗。     

2012美国非酒精性脂肪性肝病诊疗指南简介

<正>非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)的诊断标准为存在肝细胞脂肪变的影像学或组织学依据,并能除外过量饮酒、药物或遗传性疾病等可导致肝脂肪变的其他病因,疾病谱包括非酒精性单纯性脂肪肝(nonalcoholic simple fatty liver,NAFL)、非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)以及肝硬化和隐源性肝硬化。肥胖、血脂紊乱、2型糖尿病和代谢综合征为NAFLD肯定的危险因素,而多囊卵巢综合征、甲状腺功能减退、睡眠呼吸暂停综合征、垂体功能减退、性腺功能减退以及胰十二指肠切除术则是其可能的危险因素。     

Aberrant lipid metabolism as a therapeutic target in liver cancer

Introduction: Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers. Progress has been made in treatment of HCC; however, improved outcomes are much needed. The increased metabolic needs of cancer cells underscore the importance of metabolic pathways in cancer cell survival. Lipid metabolism has a role in HCC development; aberrant overexpression of several key enzymes is seen in many solid human tumors.

Areas covered: We discuss aberrant lipid metabolism and the promise of multiple targets, in particular related to HCC treatment. We searched PubMed and clinicaltrials.gov for published and unpublished studies from 2000 to 2019. These terms were used: lipids, fatty acid metabolism, lipid metabolism, liver cancer, HCC, de novo fatty acid synthesis, ATP citrate lyase, stearoyl CoA denaturase, fatty acid synthase, acetyl coenzyme A carboxylase, CD147, KLF4, monoglyceride lipase, AMP activated protein kinase.

Expert opinion: The importance of dysregulation of fatty acid synthesis in cancer is a growing area of research. HCC demonstrates significant alteration in lipid metabolism, representing great potential as a target for novel therapeutics. Various agents have demonstrated promising anti-neoplastic activity. This strategy deserves further development for improved outcomes.     

Opioid-Sparing Analgesia and Enhanced Recovery After Total Knee Arthroplasty Using Combined Triple Nerve Blocks With Local Infiltration Analgesia

Background

Peripheral nerve block and local infiltration analgesia (LIA) have an increasing role as part of multimodal analgesia for enhanced recovery after total knee arthroplasty (TKA). We hypothesized that the combination of obturator nerve block (ONB) and tibial nerve block (TNB) would reduce pain and opioid consumption more than ONB or TNB alone when combined with continuous adductor canal block and LIA.

Acquisition and biosynthesis of saturated and unsaturated fatty acids by trypanosomatids

As components of phospholipids and glycosylphosphatidylinositol anchors, fatty acids are responsible for forming the core of biological membranes and the correct localization of proteins within membranes. They also contribute to anchoring proteins by direct acylation of specific amino acids. Fatty acids can be used as energy sources and serve as signaling molecules or precursors for their synthesis. All these processes highlight the important role of fatty acids in cell physiology, justifying the diverse strategies for their acquisition evolved by different organisms. This review describes several recent findings in the salvage and biosynthesis of fatty acids by parasitic protists belonging to the class Kinetoplastea. They include two biosynthetic routes, the mitochondrial one and a peculiar membrane-associated pathway, the synthesis of polyunsaturated fatty acids, and the scavenging of lysophospholipids and lipoproteins from host plasma. These different processes are also explored as putative targets for chemotherapy.