Adipokines and dietary interventions in human obesity

Obesity is a multisystem disorder associated with cardiovascular and metabolic complications. According to recent studies, it is characterized as a condition of low‐grade inflammation with altered adipose tissue function and secretion of various adipokines. One of the strategies in obesity treatment is dietary intervention (DI) that could modulate cytokine levels in a favourable way. The aim of this review was to summarize the results of studies performed in the last 13 years investigating DI programmes accompanied with weight loss in relation to profile of adipokines at different level (adipose tissue mRNA, adipose tissue secretion and circulating level) and identify whether modulations of adipokines are implicated in the positive effects of DIs. The overall finding is that DIs leading to 5–10% weight loss modulate production of certain adipokines and generally induce improvement of clinical parameters, e.g. insulin sensitivity, but the amelioration of obesity complications is not coherent with the pattern of adipokine regulation, except maybe for leptin. Global analysis of the adipose tissue secretome and measurement of panels of adipokines may prove more informative than studies on individual molecules.     

Managing childhood obesity: when lifestyle change is not enough

The management of childhood obesity is a clinical dilemma. Paediatricians will see those children whose weight is at the severe end of the spectrum with obesity-related co-morbidities and for whom more intensive weight loss therapies may be appropriate. A literature review was performed (January 1995-January 2010) of the roles of pharmacotherapy or bariatric surgery in the management of childhood obesity. Three hundred and eighty-three abstracts were reviewed and 76 full-text articles were requested. Of these, 34 were excluded and a total of 21 pharmacotherapy papers and 22 papers on surgery were reviewed in detail. All studies involved adolescents. Pharmacotherapy: Most studies were small and of short duration, the notable exceptions being two large RCTs of sibutramine and orlistat. Sibutramine led to a mean estimated change in BMI from baseline of -3.1 kg/m(2) vs. -0.3 kg/m(2) for placebo over 12 months. Orlistat was also beneficial with a mean reduction in BMI of 0.55 vs. an increase of 0.31 kg/m(2) in the placebo group at 12 months. Bariatric surgery: Most papers presented clinical observations and there were no randomised controlled trials (RCTs). Robust selection criteria were not used and ideal candidate selection remains unclear. Most papers showed a significant benefit of surgery in severely obese adolescents in the short term but long-term data were sparse. There were a surprisingly large number of papers examining the benefits of intensive weight management in obese adolescents. The study design of many was inadequate and the role of pharmacotherapy or surgery in childhood obesity remains unclear.     

Dietary prescriptions for the overweight patient: the potential benefits of low-carbohydrate diets in insulin resistance

Obesity in the USA continues to be a medical problem of epidemic proportions, affecting one-third of American adults. This increase in body weight and body mass index (BMI) is a risk factor for insulin resistance; individuals with insulin resistance are at increased risk for the development of type 2 diabetes and cardiovascular disease. The identification of effective dietary treatments (e.g. low-carbohydrate diet, low-fat diet) for patient populations with insulin resistance remains controversial. While a variety of dietary approaches will result in weight and cardiac risk factor reduction, individuals who have been identified as insulin-resistant may derive additional short-term weight loss results from a low-carbohydrate diet compared to a low-fat diet.     

Barriers to and enablers of healthy lifestyle behaviours in adolescents with obesity: a scoping review and stakeholder consultation

Healthy lifestyle behaviours are key to successful weight management, but have proven to be challenging to attain for adolescents with obesity. The purpose of our scoping review was to (i) describe barriers and enablers that adolescents with obesity encounter for healthy nutrition, physical activity, sedentary behaviour and sleep habits and (ii) identify gaps in the literature. We adhered to established methodology for scoping reviews. Six databases were searched (1980–June 2016) for original articles published in English or French that focused on lifestyle behaviours of 13‐ to 17‐year‐olds in paediatric weight management. Following screening and data extraction, findings of selected articles were synthesized thematically using a social ecological framework. Stakeholder consultation (n = 20) with adolescents with obesity and health professionals was completed to enhance methodological rigour. Our search yielded 17 articles for inclusion, including 546 unique participants. Barriers to healthy nutrition and physical activity were more consistently related to individual‐level and interpersonal‐level factors; enablers tended to be linked with interpersonal‐level factors. Knowledge gaps identified related to sedentary behaviour and sleep as well as environmental and policy levels of influence. Our review revealed that some barriers and enablers were unique to adolescents with obesity, which were either within or beyond their control. These findings highlight the importance of multilevel interventions to enable healthy lifestyle behaviours for weight management.     

The effect of group‐based lifestyle interventions on risk factors and insulin resistance in subjects at risk for metabolic syndrome: the Tabaruzaka Study 1

Aim: The aim of this study was to evaluate the efficacy of two group‐based lifestyle interventions in ameliorating the risk factors of metabolic syndrome (MS) and insulin resistance. Methods: Ninety‐eight subjects who had at least one component of MS were randomized into standard intervention (SI) (4‐month intervention; n = 50) and extended intervention (EI) (10‐month intervention; n = 48) groups, and 39 subjects were followed up for a control group. The effects of intervention were evaluated after 10, 22 and 34 months. Results: At month 10, the standard and EI groups showed improved body mass index (BMI) (SI, ?0.28; EI, ?0.47; control, ?0.09), high‐density lipoprotein (HDL) cholesterol, fasting plasma glucose and A1c and a decreased mean number of components of MS (SI, ?0.37; EI, ?0.51; control, 0.08). At month 34, the effects on BMI (SI, ?0.66; EI, ?0.60; control, ?0.05) and HDL‐cholesterol were sustained for both the intervention groups. In controls, the increases in fasting plasma glucose and the mean number of components of MS from the baseline to month 34 were greater than those in the standard and EI groups. Whole body insulin sensitivity index and hepatic insulin resistance index were also improved at month 10. Conclusions: Group‐based lifestyle intervention could be an efficient way to prevent MS. Its effects were sustainable, at least in part, for 2 years. These effects may be mediated by an improvement in insulin sensitivity.     

Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines

This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first‐line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low‐energy diet (n = 4), protein‐sparing modified fast (n = 2), and very low‐carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.     

Oxidative stress and potential interventions to reduce oxidative stress in overweight and obesity

PURPOSE: Obesity may be a state of chronic oxidative stress. Oxidative stress may be the mechanism underlying the development of co-morbidities in obesity. This review provides a summary of the available evidence regarding systemic oxidative stress in young, older and clinical obese populations. METHODS: Medline was searched for all available articles published between 1975 and 2006 that evaluated oxidative stress biomarkers in resting conditions or following various interventions in overweight and obese humans. RESULTS: Obesity elevates oxidative stress in young, old and clinical populations as shown by elevations in lipid peroxidation (malondialdehyde, hydroperoxides, 4-hydroxynonenal, isoprostanes, conjugated dienes) or protein oxidation (8-hydroxy-deoxyguanosine). Lipid peroxidation is associated with several indices of adiposity and a low systemic antioxidant defence (i.e. antioxidant enzymes, tissue dietary antioxidants, glutathione). Oxidative stress may be exacerbated with acute exercise, advancing age or co-existing clinical conditions and may be corrected by improving antioxidant defences through fat volume reduction via surgery, pharmacological agents, exercise and/or dietary modification. CONCLUSION: Oxidative stress is related to chronic disease in obesity, but is reversible with one or more interventions described above.     

Diagnosis and management of the metabolic syndrome in obesity

The metabolic syndrome is a constellation of interrelated abnormalities that increase the risk for cardiovascular disease and progression to type 2 diabetes. The prevalence of this syndrome is increasing because of the 'obesity epidemic'. The National Cholesterol Education Program Adult Treatment Panel III defined practical criteria for the diagnosis of the metabolic syndrome and established the basic principles for its management. Also, the International Diabetes Federation recently proposed another definition. The metabolic syndrome is a secondary target for cardiovascular risk reduction. Clinicians should identify individuals with this condition, assess their cardiovascular risk and treat them by an aggressive and multifaceted approach. The most effective therapeutic intervention in patients with the metabolic syndrome should focus on modest weight reduction and regular physical activity. Adoption of a healthier diet and smoking cessation are necessary. Drug therapy may be needed to achieve recommended goals if therapeutic lifestyle changes are not sufficient. Low-density lipoprotein cholesterol is the primary target of therapy (new aggressive goals should be achieved). Statins are probably the drugs of choice. Fibrates and nicotinic acid are also useful options. Hypertension should be managed aggressively probably starting with an inhibitor of the renin-angiotensin system or a calcium channel blocker and adding a low dose of a thiazide diuretic if necessary. Aspirin should be administered if the cardiovascular risk is high. In the future acarbose, metformin, meglitinides and thiazolidinediones may be used in patients with the metabolic syndrome to delay the onset of type 2 diabetes and reduce cardiovascular risk. Such an intense and multifactorial approach is likely to reverse the bad prognosis associated with the metabolic syndrome.     

Effects of progressive neuromuscular stabilization exercise on the support surface on patients with high obesity with lumbar instability: A double-blinded randomized controlled trial

Background:Intensive neuromuscular stabilization exercise on highly obese patients with low back pain results in positive effects of body fat decline and prevention of complications. The purpose of this study is to investigate the effects of progressive neuromuscular stabilization exercise on unstable surface on pain, motor function, psychosocial factors, balance, and abdominal contraction with highly obese patients with lumbar instability.Methods:This study is a double-blinded randomized controlled trial. A total of 46 highly obese patients (body mass index [BMI] ≥ 30 kg/m²) with lumbar instability were assigned randomly to experimental group (n = 23) and control group (n = 23). The control group performed the intensive progressive exercise on a stable surface and the experimental group on an unstable surface.Result:Significant differences were shown for BMI, QVAS, K-ODI, FABQ, and balance ability for both groups before and after the intervention (P < .05), and only the experimental group showed significant difference for transverse abdominis muscle thickness in contraction and contraction rate (P < .05). Compared to the control group, the experimental group showed significant difference (P < .05) in the amount of changes for QVAS, K-ODI, balance ability, transverse abdominis muscle thickness in contraction, and contraction rate.Conclusion:Progressive neuromuscular stabilization exercise program on unstable surfaces demonstrated to be an effective and clinically useful method to decrease pain level, increase motor function, balance, and transverse abdominis muscle thickness in contraction and contraction rate for highly obese patients with lumbar instability.     

Endoscopic management of intragastric penetrated adjustable gastric band for morbid obesity

This report describes a case of successful endoscopic management of intragastric penetrated adjustable gastric band in a patient with morbid obesity. The favorable course of the case described here demonstrates that adjustable gastric bands in the process of migration need not be removed surgically in patients who are asymptomatic.     

Low HDL predicts differential blood pressure effects from two weight-loss approaches: a secondary analysis of blood pressure from a randomized, clinical weight-loss trial

Examining predictors of blood-pressure (BP) response to weight-loss diets might provide insight into mechanisms and help guide clinical care. We examined whether certain baseline patient characteristics (e.g. diet, medical history and laboratory tests) predicted BP response to two weight-loss diet approaches that differ in macronutrient content. One hundred and forty-six overweight adult outpatients were randomized to either a low-carbohydrate diet (N = 72) or orlistat plus a low-fat diet (N = 74) for 48 weeks. Predictors of BP reduction were evaluated using a structured approach and random effects regression models. Participants were 56% African-American, 72% male and 53 (±10) years-old. Of the variables considered, low baseline high-density lipoprotein (HDL) predicted greater reduction in BP in those patients who received the low-carbohydrate diet (p = 0.03 for systolic BP; p = 0.03 for diastolic BP and p = 0.02 for mean arterial pressure). A low HDL level may identify patients who will have greater BP improvement on a low-carbohydrate diet.     

Dietary intervention for the management of hypertension in Asia

Hypertension is among the leading global risks for premature death. As the risks substantially increase along with the elevated blood pressure, a small reduction of blood pressure could have prevented numerous cardiovascular events in general population. Evidence has shown that dietary intervention is a cost‐effective strategy that has been broadly advocated in the published guidelines. However, the implementation could be limited by different food cultures. This review details the mechanisms of each dietary intervention approach, evidence, and the implications in Asian populations, and the perspective of future research.