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1.
Purpose of Review
Obesity and type 2 diabetes (T2D) are closely linked metabolic diseases. Most individuals with T2D are overweight or obese, which raises their cardiovascular risk. The etiology of both diseases is multifaceted, thus requiring a multidisciplinary approach to control them. This review describes the most effective multidisciplinary approach to weight management in patients with T2D in real-world clinical practice.Recent Findings
Weight management programs in real-world clinical settings lead to long-term weight loss for up to 5 years.Summary
Multidisciplinary approach to manage obesity and T2D through weight reduction is feasible in real-world clinical practice and is recommended as part of the treatment plan for patients with T2D who are overweight or obese. Recent data demonstrates that multidisciplinary approach to weight management in patients with T2D results in long-term weight loss and is associated with improved cardiovascular risk factors.2.
Abstract
Obesity and its related complications remain a major threat to public health. Efforts to reduce the prevalence of obesity are of paramount importance in improving population health. Through these efforts, our appreciation of the role of gut-derived hormones in the management of body weight has evolved and manipulation of this system serves as the basis for our most effective obesity interventions.Purpose of the review
We review current understanding of the enteroendocrine regulation of food intake and body weight, focusing on therapies that have successfully embraced the physiology of this system to enable weight loss.Recent findings
In addition to the role of gut hormones in the regulation of energy homeostasis, our understanding of the potential influence of enteroendocrine peptides in food reward pathways is evolving. So too is the role of gut derived hormones on energy expenditure.Summary
Gut-derived hormones have the ability to alter feeding behavior. Certain obesity therapies already manipulate this system; however, our evolving understanding of the effects of enteroendocrine signals on hedonic aspects of feeding and energy expenditure may be crucial in identifying future obesity therapies.3.
Tatjana van Strien 《Current diabetes reports》2018,18(6):35
Purpose of the Review
Eating in response to negative emotions (EE) may be an explanatory factor of the weight regain of many dieters. This narrative review presents evidence on possible causes of EE and the association of EE with depression and obesity and discusses implications of these findings for the treatment of obesity.Recent Findings
Possible causes of EE are high dietary restraint, poor interoceptive awareness, alexithymia, emotion dysregulation and a reversed hypothalamic pituitary adrenal (HPA) stress axis. EE may be the outcome of inadequate parenting or depressive feelings in interaction with genetic susceptibility. There is also robust evidence that EE is a mediator between depression and obesity.Summary
The association of EE with depression and poor emotion regulation skills suggests that the treatment of obese people with high EE should not focus on calorie-restricted diets but on emotion regulation skills. The DEBQ (Dutch Eating Behavior Questionnaire) enables such a matched treatment of obesity.4.
GLP-1 Receptor Agonists and Cardiovascular Disease: a Meta-Analysis of Recent Cardiac Outcome Trials
Xiaoming Jia Mahboob Alam Yumei Ye Mandeep Bajaj Yochai Birnbaum 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2018,32(1):65-72
Purpose
The aim of this study is to examine the cardioprotective properties of Glucagon-like peptide-1 receptor agonist, a class of antihyperglycemic therapy, via meta-analysis of four recently published cardiovascular outcomes trials.Methods
Meta-analysis was performed pooling data from the ELIXA, LEADER, SUSTAIN-6 and EXSCEL trials. A random effects model was used to generate risk ratio with 95% confidence interval for cardiovascular and safety outcomes.Results
A total of 33,457 patients were included in the meta-analysis. Based on the study, GLP-1R agonists significantly reduced all-cause mortality (RR 0.89; 95% CI 0.82 to 0.96) and cardiovascular mortality (RR 0.88; 95% CI 0.80 to 0.97) when compared to placebo. When long-acting agents were analyzed alone, reduction in major adverse cardiac events (RR 0.88; 95% CI 0.81 to 0.97) and non-fatal strokes (RR 0.87; 95% CI 0.76 to 0.99) also showed significance.Conclusion
Overall, GLP-1R agonists appear to have cardioprotective properties likely via modification of metabolic parameters such as glycemic control, weight loss, and improvement in blood pressure. Additional studies are warranted to compare cardiovascular outcomes among the different agents.5.
Purpose of Review
This review aims to summarize the type 1 diabetes (T1D) and weight literature with an emphasis on barriers associated with weight management, the unique T1D-specific factors that impact weight loss success, maladaptive and adaptive strategies for weight loss, and interventions to promote weight loss.Recent Findings
Weight gain is associated with intensive insulin therapy. Overweight and obese weight status in individuals with T1D is higher than the general population and prevalence is rising. A variety of demographic (e.g., female sex), clinical (e.g., greater insulin needs), environmental (e.g., skipping meals), and psychosocial (e.g., depression, stress) factors are associated with overweight/obese weight status in T1D. Fear of hypoglycemia is a significant barrier to engagement in physical activity. Studies evaluating adaptive weight loss strategies in people with T1D are limited.Summary
There is a growing literature highlighting the prevalence and seriousness of overweight and obesity among both youth and adults with T1D. There is an urgent need to develop evidence-based weight management guidelines and interventions that address the unique concerns of individuals with T1D and that concurrently address glycemic control.6.
Anita D. Misra-Hebert Bo Hu Glen Taksler Robert Zimmerman Michael B. Rothberg 《Journal of general internal medicine》2016,31(8):871-877
Background
Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse.Objective
To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals.Design
Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008–December 2012.Participants
Employee patients with diabetes covered by the organization’s self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance.Intervention
Financial incentives for employer-sponsored disease management program participation and achieving goals.Main Measures
Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight.Results
A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p?<?0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change ?0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p?=?0.04) and (2.3 kg vs. 0.1 kg, DIC p?<?0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p?>?0.05).Conclusions
Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.7.
Sherly X. Li Fumiaki Imamura Matthias B. Schulze Jusheng Zheng Zheng Ye Antonio Agudo Eva Ardanaz Dagfinn Aune Heiner Boeing Miren Dorronsoro Courtney Dow Guy Fagherazzi Sara Grioni Marc J. Gunter José María Huerta Daniel B. Ibsen Marianne Uhre Jakobsen Rudolf Kaaks Timothy J. Key Kay-Tee Khaw Cecilie Kyrø Francesca Romana Mancini Elena Molina-Portillo Neil Murphy Peter M. Nilsson N. Charlotte Onland-Moret Domenico Palli Salvatore Panico Alaitz Poveda J. Ramón Quirós Fulvio Ricceri Ivonne Sluijs Annemieke M. W. Spijkerman Anne Tjonneland Rosario Tumino Anna Winkvist Claudia Langenberg Stephen J. Sharp Elio Riboli Robert A. Scott Nita G. Forouhi Nicholas J. Wareham 《Diabetologia》2018,61(6):1325-1332
Aims/hypothesis
Gene–macronutrient interactions may contribute to the development of type 2 diabetes but research evidence to date is inconclusive. We aimed to increase our understanding of the aetiology of type 2 diabetes by investigating potential interactions between genes and macronutrient intake and their association with the incidence of type 2 diabetes.Methods
We investigated the influence of interactions between genetic risk scores (GRSs) for type 2 diabetes, insulin resistance and BMI and macronutrient intake on the development of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct, a prospective case-cohort study across eight European countries (N?=?21,900 with 9742 incident type 2 diabetes cases). Macronutrient intake was estimated from diets reported in questionnaires, including proportion of energy derived from total carbohydrate, protein, fat, plant and animal protein, saturated, monounsaturated and polyunsaturated fat and dietary fibre. Using multivariable-adjusted Cox regression, we estimated country-specific interaction results on the multiplicative scale, using random-effects meta-analysis. Secondary analysis used isocaloric macronutrient substitution.Results
No interactions were identified between any of the three GRSs and any macronutrient intake, with low-to-moderate heterogeneity between countries (I2 range 0–51.6%). Results were similar using isocaloric macronutrient substitution analyses and when weighted and unweighted GRSs and individual SNPs were examined.Conclusions/interpretation
Genetic susceptibility to type 2 diabetes, insulin resistance and BMI did not modify the association between macronutrient intake and incident type 2 diabetes. This suggests that macronutrient intake recommendations to prevent type 2 diabetes do not need to account for differences in genetic predisposition to these three metabolic conditions.8.
Purpose of Review
We review recent studies discussing the impact of pharmacologic agents for weight loss on clinical cardiovascular events, as well as cardiometabolic risk factors.Recent Findings
Pharmacotherapy with current FDA-approved medications for weight loss can significantly improve known risk factors for the development of cardiovascular disease such as hypertension, hyperlipidemia, insulin resistance, inflammatory biomarkers, and the quantity of visceral fat, as well as non-alcoholic fatty liver disease. However, data regarding the actual reduction in clinical cardiovascular events with the use of weight loss medications is scarce.Summary
Pharmacotherapy for weight loss may have additional benefit in optimizing patient’s cardiometabolic comorbidities and improving their clinical cardiovascular outcomes, but each drug should be carefully selected based upon individual patient characteristics.9.
Ashley H. Noriea Feenalie N. Patel Debra A. Werner Monica E. Peek 《Current diabetes reports》2018,18(5):24
Purpose of Review
Diet-related chronic diseases result from individual and non-individual (social, environmental, and macro-level) factors. Recent health policy trends, such as population health management, encourage assessment of the individual and non-individual factors that cause these diseases. In this review, we evaluate the physician’s perspective on the individual and non-individual causes and management of obesity.Recent Findings
Physicians generally rated individual-level causes (i.e., biology, psychology, and behavior) as more important than social or environmental factors in the development of obesity, and utilized individual-level strategies over social or environmental strategies to manage obesity.Summary
This review suggests that clinicians perceive individual characteristics to be more important in the development and management of obesity than social or environmental factors. Additional research is needed to understand why.10.
Molly E. Waring Danielle E. Jake-Schoffman Marta M. Holovatska Claudia Mejia Jamasia C. Williams Sherry L. Pagoto 《Current diabetes reports》2018,18(6):34
Purpose of Review
Social media is widely used and has potential to connect adults with obesity with information and social support for weight loss and to deliver lifestyle interventions. The purpose of this review is to summarize recent observational and intervention research on social media and obesity.Recent Findings
Online patient communities for weight loss abound but may include misinformation. Systematic reviews and meta-analyses suggest that social media-delivered lifestyle interventions modestly impact weight, yet how social media was used and participant engagement varies widely.Summary
The rapidly changing social media landscape poses challenges for patients, clinicians, and researchers. Research is needed on how patients can establish supportive communities for weight loss and the role of clinicians in these communities. Emerging research on meaningful engagement in, and the efficacy and cost-effectiveness of, social media-delivered lifestyle interventions should provide insights into how to leverage social media to address the obesity epidemic.11.
Purpose of Review
The objective of this review is to critically assess the contributing role of the gut microbiota in human obesity and type 2 diabetes (T2D).Recent Findings
Experiments in animal and human studies have produced growing evidence for the causality of the gut microbiome in developing obesity and T2D. The introduction of high-throughput sequencing technologies has provided novel insight into the interpersonal differences in microbiome composition and function.Summary
The intestinal microbiota is known to be associated with metabolic syndrome and related comorbidities. Associated diseases including obesity, T2D, and fatty liver disease (NAFLD/NASH) all seem to be linked to altered microbial composition; however, causality has not been proven yet. Elucidating the potential causal and personalized role of the human gut microbiota in obesity and T2D is highly prioritized.12.
Purpose of Review
Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control.Recent Findings
Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications. Studies evaluating tight glucose control do not demonstrate improvement in clinical outcomes, although the risk for hypoglycemia increases substantially. Additional studies are needed to evaluate tight glucose goals relative to our current standard of care and the role of permissive hyperglycemia.Summary
Given the limited data to guide glycemic management in these patient populations, it is recommended that general guidelines for inpatient glycemic control be followed. Special considerations should be made to address factors that may impact glucose management, including neurological deficits and clinical changes that occur in the postoperative state.13.
Purpose of Review
Adult obesity and cardiovascular diseases are closely linked. Yet, the relationship of childhood and adolescent obesities with cardiovascular diseases in adulthood requires additional evidence. The goal of the review is to inspect the relationship between childhood- and adolescent-increased body mass index (BMI) and cardiovascular risk factors, fatal and non-fatal cardiovascular diseases in adulthood.Recent Findings
Cardiovascular diseases in adulthood are linked by most of the studies to childhood and adolescent obesities.Summary
Studies showed that childhood and adolescent obesities increased the incidence of cardiovascular disease risk factors and were linked to higher risk of cardiovascular morbidity and mortality in adulthood. Childhood and adolescent obesities were also associated, likely with a causal relationship, with an increased likelihood for various cardiovascular morbidities including ischemic heart disease, stroke, but also non-ischemic heart disease-related cardiac pathologies.14.
Giovanni B. Gaeta Massimo Puoti Nicola Coppola Teresa Santantonio Raffaele Bruno Antonio Chirianni Massimo Galli 《Infection》2018,46(2):183-188
Aim
This paper is aimed at providing practical recommendations for the management of acute hepatitis C (AHC).Methods
This is an expert position paper based on the literature revision. Final recommendations were graded by level of evidence and strength of the recommendations.Results
Treatment of AHC with direct-acting antivirals (DAA) is safe and effective; it overcomes the limitations of INF-based treatments.Conclusions
Early treatment with DAA should be offered when available.15.
Mitsuaki Ishioka Kouichi Miura Shinichiro Minami Yoichiro Shimura Hirohide Ohnishi 《Digestive diseases and sciences》2017,62(2):396-406
Background
Although several types of diet have been used in experimental steatohepatitis models, comparison of gut microbiota and immunological alterations in the gut among diets has not yet been performed.Aim
We attempted to clarify the difference in the gut environment between mice administrated several experimental diets.Methods
Male wild-type mice were fed a high-fat (HF) diet, a choline-deficient amino acid-defined (CDAA) diet, and a methionine-choline-deficient (MCD) diet for 8 weeks. We compared the severity of steatohepatitis, the composition of gut microbiota, and the intestinal expression of interleukin (IL)-17, an immune modulator.Results
Steatohepatitis was most severe in the mice fed the CDAA diet, followed by the MCD diet, and the HF diet. Analysis of gut microbiota showed that the composition of the Firmicutes phylum differed markedly at order level between the mice fed the CDAA and HF diet. The CDAA diet increased the abundance of Clostridiales, while the HF diet increased that of lactate-producing bacteria. In addition, the CDAA diet decreased the abundance of lactate-producing bacteria and antiinflammatory bacterium Parabacteroides goldsteinii in the phylum Bacteroidetes. In CDAA-fed mice, IL-17 levels were increased in ileum as well as portal vein. In addition, the CDAA diet also elevated hepatic expression of chemokines, downstream targets of IL-17.Conclusions
The composition of gut microbiota and IL-17 expression varied considerably between mice administrated different experimental diets to induce steatohepatitis.16.
Purpose of Review
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have positive effects on weight loss, blood pressure, hyperlipidemia, and glycemic control. They exhibit a broad range of effects on the cardiovascular system that are independent of changes in blood glucose. Cardiovascular outcome trials have demonstrated safety of GLP-1 RAs but results for cardiovascular efficacy were varied. The aim of the present review is the assessment of the effects of GLP-1 RAs on cardiovascular risk factors, and major cardiovascular events.Recent Findings
Use of GLP-1 RAs was associated with relative risk reduction in cardiovascular mortality and all-cause mortality with no significant differences for the incidence of severe hypoglycemia, pancreatitis, pancreatic cancer, or medullary thyroid cancer when compared to placebo. Although there are differences between individual medications with respect to their effects on cardiovascular events, GLP-1 RAs offer a favorable risk-benefit profile.Summary
The present review confirms the cardiovascular safety and efficacy vs placebo of GLP-1 RAs in patients with type 2 diabetes at moderate-to-high atherosclerotic cardiovascular risk without significant side effects. Although professional guidelines recommend metformin as the sole first-line agent, GLP-1 RAs can be used as first-line therapy in individuals with type 2 diabetes who either are intolerant to metformin or have high cardiovascular risk factors.17.
Purpose of Review
Type 2 diabetes is a growing concern worldwide with increasing incidence in youth. Development of preventive strategies in earlier stages of life is crucial. We aimed to examine epidemiological evidence of early-life exposures and their associations with childhood and later risk of obesity and diabetes, and to discuss potential mechanisms.Recent Findings
Parental obesity and diabetes in the preconception period may influence offspring’s obesity risk via epigenetic mechanisms influencing gametogenesis and early development that could have significant transgenerational effects. A more comprehensive understanding of these effects is needed to identify possible avenues for interventions in both fathers and mothers to be. In addition, current evidence suggests that growth and body weight trajectories in infancy and childhood are useful indicators of later obesity and type 2 diabetes. Moreover, the composition and variations in the microbiome in early life are associated with long-term health and could mediate associations between several early-life exposures and later risk of diseases.Summary
Altogether, the epidemiological evidence supports the need for preconception and early-life interventions to reduce the obesity and diabetes burden in later life.18.
Purpose of Review
Ethnicity has long been described as a major risk factor for the development of gestational diabetes mellitus (GDM), and it is widely recognised that women from ethnicities other than Europids are at higher risk of developing GDM. There are also described differences between ethnicities in key GDM pregnancy outcomes. This review describes some of the factors that relate to the ethnic disparities in GDM.Recent Findings
The global prevalence of GDM has been steadily increasing and estimated to be 16.2% from the International Diabetes Federation extrapolation. Reported prevalence rates may understate the true prevalence, due to factors of access and attitudes to GDM diagnosis and screening in low resource settings for foreign-born women and indigenous populations. Other factors may relate to genes associated with specific ethnicities, obesity, body composition and gestational weight gain.Summary
Various factors such as access to screening, body composition, genetics and gestational weight gain may result in ethnic disparities in the prevalence and outcomes of GDM.19.
Sridharan Raghavan Mark C. Pachucki Yuchiao Chang Bianca Porneala Caroline S. Fox Josée Dupuis James B. Meigs 《Journal of general internal medicine》2016,31(10):1127-1133
BACKGROUND
Obesity and diabetes family history are the two strongest risk factors for type 2 diabetes (T2D). Prior work shows that an individual’s obesity risk is associated with obesity in social contacts, but whether T2D risk follows similar patterns is unknown.OBJECTIVE
We aimed to estimate the relationship between obesity or diabetes in an individual’s social contacts and his/her T2D risk. We hypothesized that obesity and diabetes in social contacts would increase an individual’s T2D risk.DESIGN
This was a retrospective analysis of the community-based Framingham Offspring Study (FOS).PARTICIPANTS
FOS participants with T2D status, height and weight, and at least one social contact were eligible for this study (n?=?4797 at Exam 1). Participants’ interpersonal ties, cardiometabolic and demographic variables were available at eight exams from 1971 to 2008, and a T2D additive polygenic risk score was measured at the fifth exam.MAIN MEASURES
Primary exposures were T2D (fasting glucose?≥?7 mmol/L or taking diabetes medications) and obesity status (BMI?≥?30 kg/m2) of social contacts at a prior exam. Primary outcome was incident T2D in participants.KEY RESULTS
Incident T2D was associated with having a social contact with diabetes (OR 1.32, p?=?0.004) or with obesity (OR 1.21, p?=?0.004). In stratified analyses, incident T2D was associated with diabetes in siblings (OR 1.64, p?=?0.001) and obesity in spouses (OR 1.54, p =?0.0004). The associations between diabetes and obesity in social contacts and an individual’s incident diabetes risk were stronger in individuals with a high diabetes genetic risk score.CONCLUSIONS
T2D and obesity in social contacts, particularly siblings and spouses, were associated with an individual’s risk of incident diabetes even after accounting for parental T2D history. Assessing risk factors in an individual’s siblings and spouses can inform T2D risk; furthermore, social network based lifestyle interventions involving spouses and siblings might be a novel T2D prevention approach.20.