Effect of glycerol on weight loss and hunger in obese patients

The effectiveness of oral glycerol as a dietary component or as a supplement to a 1000-kcal/day diet was examined in two studies involving obese patients. Glycerol did not differ from an equicaloric dose of glucose in its effect on hunger ratings, diet compliance or overall weight loss. We conclude that oral glycerol is not a useful adjunct to weight reduction programs.     

Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy

OBJECTIVE: To evaluate the effect and safety of treatment with low-calorie formula diet on renal function and proteinuria in obese patients with diabetic nephropathy. DESIGN: Prospective study on safety and efficacy of a 4-week low-calorie (11-19 kcal/kg/day) normal-protein (0.9-1.2 g/kg/day) diet partly supplemented with formula diet. SUBJECTS: In all, 22 obese patients with diabetic nephropathy (BMI: 30.4+/-5.3 kg/m(2), HbA1c: 7.1+/-1.4%, serum creatinine: 172.4+/-57.5 micromol/l, urinary protein: 3.3+/-2.6 g/day). RESULTS: The mean body weight decreased by 6.2+/-3.0 kg. The mean systolic blood pressure, creatinine, blood urea nitrogen, urinary protein, and 8-hydroxydeoxyguanosine decreased significantly by 7.5+/-12.7 mmHg, 41.6+/-23.9 micromol/l, 1.50+/-1.61 mmol/l, 1.8+/-1.7 g/day, and 3.1+/-3.6 ng/mg creatinine, respectively. No patient had increased serum creatinine and urinary protein. Mean creatinine clearance (40.6+/-17.9 to 46.1+/-14.6 ml/s/1.73 m(2)) and serum albumin showed no significant changes. Delta serum creatinine and Delta urinary protein correlated with Delta body weight (r=0.62 and 0.49, respectively) and Delta visceral fat area (r=0.58 and 0.58, respectively), but did not correlate with Delta systolic blood pressure, Delta fasting blood glucose and Delta subcutaneous fat area. CONCLUSION: These results suggested that weight reduction using formula diet might improve renal function and proteinuria safely for a short term in obese patients with diabetic nephropathy.     

减重治疗对肥胖患者血清C反应蛋白水平的影响

肥胖患者常伴有胰岛素抵抗 ,与糖尿病、高血压和脂代谢紊乱构成代谢综合征 (ＭＳ)。许多证据表明ＭＳ明显增加心血管疾病的危险性〔1,2〕。研究发现肥胖患者血清中Ｃ反应蛋白 (ＣＲＰ)的水平与动脉粥样硬化、缺血性心血管疾病的患病率、死亡率相关。本研究旨在观察减重治疗是否可以改变患者血清ＣＲＰ水平 ,并且了解与体重变化以及与胰岛素敏感性的关系。一、对象和方法1.对象 :研究对象与全国 6家医院进行的奥利司他有效性和安全性分析研究为同一批病人。我中心共 72人入选。入选标准与排除标准见文献〔3〕。2 .试验方法 :入选的肥胖患者按…     

Effect of weight loss on the ECG of normotensive morbidly obese patients

BACKGROUND: Morbid obesity produces a variety of ECG alterations, including leftward shifts of the P-wave, QRS, and T-wave axes; disproportionately high frequencies of low QRS voltage; left ventricular hypertrophy and left atrial abnormality; and a high frequency of T-wave flattening in the inferior and lateral leads. This study was designed to assess the effects of substantial weight loss on the ECG in morbid obesity. METHODS: We performed a resting 12-lead ECG on 60 normotensive patients (48 women and 12 men; mean +/- SD age, 37 +/- 7 years), whose body weight was twice their ideal body weight prior to and at the time of maximum weight loss after bariatric surgery. RESULTS: Mean weight decreased from 136 +/- 7 to 85 +/- 3 kg. Weight loss produced significant decreases in the frequencies of low QRS voltage; Romhilt-Estes point score > or = 5 points; SV(1) + RV(5) or V(6) > 35 mm; RV(5) or V(6) > 26 mm; RaVL > 11 mm; RaVL > or = 7.5 mm; SaVR > 14 mm; P-terminal force more negative than - 0.04 mm.s in lead V(1); and T-wave flattening in the inferior, lateral, and inferolateral leads. Weight loss significantly shifted the mean P-wave, QRS, T-wave axes rightward, and significantly reduced mean RaVL and mean SaVR voltage. CONCLUSION: Substantial weight loss is capable of reversing many of the ECG alterations associated with morbid obesity.     

Effect of medical and surgical weight loss on endothelial vasomotor function in obese patients

We prospectively examined brachial artery endothelial function using vascular ultrasound in 41 obese subjects treated with medical or surgical (gastric bypass) weight loss interventions. Surgical intervention produced greater weight loss and more pronounced improvement in endothelial function than medical treatment alone. Improved endothelial function with weight loss correlated strongly with fasting glucose but not with alteration in blood pressure, lipids, degree of weight loss, or plasma resistin concentrations. These data demonstrate that weight loss in markedly obese patients improves endothelial function and glycemic control that may represent important mechanisms of the cardiovascular benefit associated with weight reduction.     

Effect of weight loss on insulin sensitivity and cardiovascular risk factors in glucose tolerant and intolerant obese subjects

We observed 170 obese patients during 55 weeks in order to study the influence of insulin resistance and insulin sensitivity on cardiovascular risk factors in such patients as well as the changes occurring on these subjects as a result of weight loss. At the beginning of the study, the patients were divided into two groups, according to the results of an oral glucose tolerance test (OGTT) performed with 75 g of glucose: Group A, glucose tolerant subjects (n = 81), Group B, glucose intolerant subjects (n = 89). Initially Group B patients showed higher values for fasting blood glucose, 2 h after OGTT, systolic and diastolic blood pressure, cholesterol, triglycerides and cholesterol/HDL-cholesterol ratio when compared to Group A patients (p less than 0.05). Fasting and 1 h-post glucose load serum insulin levels in both Group A and Group B patients were higher than those found out in non over-weight tolerant subjects, but there were no differences between both groups. The serum glucose descent slope after an insulin tolerance test (ITT) was lower for group B than for group A (p less than 0.05), whereas both groups demonstrated lower descent slopes than non overweight tolerant subjects (p less than 0.05). After a 55 weeks follow-up period, the patients in Group A had lost 4.6 +/- 0.7 kg and those in Group B 6.2 +/- 1.1 kg. In both groups, the values for SBP, DBP, FBG, triglycerides and cholesterol/HDL-cholesterol ratio had dropped significantly, with a rise in the HDL-cholesterol level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of different methods to assess body composition of weight loss in obese and diabetic patients

Recombinant human epidermal growth factor (REGEN-D 150), which was cloned and over expressed in E. coli, has shown enhanced healing of chronic diabetic foot ulcers (DFU) by significantly reducing the duration of healing in addition to providing excellent quality of wound healing and reepithelization. Post-marketing surveillance (PMS) study of REGEN-D 150 in 135 patients of DFU in India was compared with Phase III clinical trial data of REGEN-D 150 in India. Statistical analysis of study data determined that the empirical survival probability distribution, in terms of non-healing of ulcers, was lowest in the case of PMS study, better than that for Phase III; more DFU patients were healed in PMS study. Percentage of patients cured in any given week (e.g., in week 10) is above 90% in PMS study, as compared to 69% in Phase III clinical trial; this percentage was around 18% for the control group with placebo in the Phase III trial. The average wound healing time was significantly lower in PMS study, 4.8 weeks, while it was 9 weeks in Phase III clinical trials while the average wound healing with REGEN-D 150 was found to be 86% in this study. REGEN-D 150 has been found to result in healthy granulation and stimulate epithelization, thus leading to final wound closure. The PMS study has established the efficacy of REGEN-D 150 in faster healing of diabetic foot ulcers.     

地特胰岛素对2型糖尿病肥胖及非肥胖患者血糖及体重的影响

目的观察地特胰岛素治疗24周对2型糖尿病（T2DM）肥胖及非肥胖患者血糖及体重的影响。方法选取既往未接受过胰岛素治疗的T2DM患者54例,根据BMI分为肥胖（Ob）组24例和非肥胖（NOb）组30例,检测治疗前后体重、FBG、HbA1C,计算BMI、胰岛素用量等。结果地特胰岛素治疗24周后,Ob组和NOb组FBGE（7．3±1．2）mmol／L、（6．7±1．5）mmol／L]、HbA1C[（7．3±0．9）％、（6．5±0．8）％]均较基线值{FBGE（9．4±2．5）mmol／L、（8．1±1．7）mmol／L]、HbA1cE（8．2±1．1）％、（7．6±1．9）％]}明显下降（P〈0．05）;Ob组治疗前后BMI变化[（-1．51±1．10）kg／m2]与NOb组[（0．15±1．00）kg／m2]比较,差异有统计学意义（P〈0．05）。结论地特胰岛素治疗可有效降低肥胖和非肥胖T2DM患者血糖,且无明显体重增加效应。     

Effect of weight loss and exercise on frailty in obese older adults

BACKGROUND: Obesity exacerbates the age-related decline in physical function and causes frailty in older persons. However, appropriate treatment for obese older persons is unknown. We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons. METHODS: We screened 40 obese older volunteers and eventually randomized 27 frail obese older volunteers to treatment or control groups. Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week. Physical function was evaluated with measurements of frailty (Physical Performance Test, peak oxygen consumption, and Functional Status Questionnaire); strength, gait, and balance tests; body composition with dual-energy x-ray absorptiometry; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey. Results are reported as mean +/- SD. RESULTS: Two subjects in the treatment group did not comply with the intervention, and 1 subject in the control group withdrew. Analyses included all 27 subjects originally randomized to the treatment and control groups. The treatment group lost 8.4% +/- 5.6% of body weight, whereas weight did not change in the control group (+0.5% +/- 2.8%; P<.001). Compared with the control group, fat mass decreased (-6.6 +/- 3.4 vs +1.7 +/- 4.1 kg; P<.001), without a change in fat-free mass (-1.2 +/- 2.1 vs -1.0 +/- 3.5 kg; P = .75) in the treatment group. The Physical Performance Test score (2.6 +/- 2.5 vs 0.1 +/- 1.0; P = .001), peak oxygen consumption (1.7 +/- 1.6 vs 0.3 +/- 1.1 mL/min per kilogram; P = .02), and Functional Status Questionnaire score (2.9 +/- 3.7 vs -0.2 +/- 3.9; P = .02) improved in treated subjects compared with control subjects. Treatment also improved strength, walking speed, obstacle course, 1-leg limb stance time, and health survey physical subscale scores (all P<.05). CONCLUSION: These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults.Trial Registration clinicaltrials.gov Identifier: NCT00146133.     

Effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension

OBJECTIVE: To investigate the effects of long-term weight management with orlistat on blood pressure in obese hypertensive patients. DESIGN: A meta-analysis of data from five multicenter, randomized, placebo-controlled studies, conducted in Europe and the USA, was performed. PATIENTS: Obese adults [body mass index (BMI) 28-43 kg/m(2) ] with uncontrolled diastolic hypertension or isolated systolic hypertension (ISH) were eligible for inclusion. INTERVENTIONS: Following a 4-week placebo lead-in period, patients were randomized to orlistat 120 mg or placebo three times daily, in conjunction with a mildly reduced calorie diet for 1 year. MAIN OUTCOME MEASURES: Change in body weight was the primary efficacy parameter. Blood pressure, heart rate and systolic workload were assessed as secondary efficacy parameters. RESULTS: A total of 628 patients were included in the intent-to-treat (ITT) analysis. After 56 weeks, orlistat-treated patients had lost significantly more body weight than placebo recipients (8.0 versus 4.0%; P<0.001). Among patients with ISH, mean systolic pressure was reduced to a significantly greater degree after 1 year with orlistat compared to placebo (-9.4 versus -4.6 mmHg; P= 0.022). Similarly, reductions in mean diastolic pressure in patients with diastolic hypertension were greater with orlistat than with placebo (-7.7 versus -5.6 mmHg; P= 0.017). Weight loss of >or= 10% was associated with significant reductions in blood pressure, heart rate and systolic workload. CONCLUSIONS: Orlistat promotes clinically meaningful weight loss that is associated with significant reductions in blood pressure and heart rate, and may therefore have a role in the management of hypertension in overweight and obese patients.     

Effect of massive weight loss on hypothalamic-pituitary-gonadal function in obese men

To study the ability of weight loss to reverse the hyperestrogenemia-induced hypogonadotropic hypogonadism that occurs in obese men, we measured the 24-h mean plasma free and total estradiol (E2), total estrone, FSH, LH, and free and total testosterone concentrations in 11 healthy obese men (100-305% above desirable body weight) and again 5-39 months later after weight loss of 26-129 kg and restabilization at the new weight. Weight loss produced significant increases in mean plasma total testosterone [240 +/- 116 (+/- SD, 8.5 +/- 4.0) to 377 +/- 113 ng/dL (13.0 +/- 4.0 nmol/L); P less than 0.01], free testosterone [9.5 +/- 5.0 (329 +/- 173) to 13.4 +/- 4.3 ng/dL (464 +/- 149 pmol/L); P less than 0.025], and FSH (6.5 +/- 4.7 to 10.9 +/- 8.5 IU/L; P less than 0.025). Plasma LH was lower than levels in normal men before and after weight loss and did not change significantly (10.3 +/- 4.8 and 10.8 +/- 6.8 IU/L, respectively). There was no change in plasma total E2 [54 +/- 26 (196 +/- 94) to 50 +/- 13 pg/mL (180 +/- 50 pmol/L)], free E2 [1.48 +/- 0.7 (5.37 +/- 2.54) to 1.33 +/- 0.42 pg/mL (4.83 +/- 1.45 pmol/L)], or total estrone [75 +/- 38 (280 +/- 140) to 82 +/- 24 (300 +/- 90) pmol/L], and sex hormone-binding globulin rose from 9.2 +/- 3.2 to 12.9 +/- 5.4 nmol/L (P less than 0.005). The increases in plasma free and total testosterone and sex hormone-binding globulin were proportional to the degree of weight loss. Thus, the hypogonadotropic hypogonadism was largely reversed by the weight loss without any decrease in hyperestrogenemia, its presumed cause. We postulate a change in hypothalamic-pituitary function with weight loss, such that GnRH-gonadotropin secretion becomes less sensitive to suppression by a given amount of estrogen.     

Effect of weight loss on QTc dispersion in obese subjects.

OBJECTIVE: Increased QTc dispersion is a predictor for ventricular arrhythmias. The aim of this study was to investigate whether QTc dispersion decreases after weight loss program with diet and medical treatment. METHODS: Total 30 (24 women and 6 men, mean age: 44+/-8 years) obese subjects who lost at least 10% of their original weight after 12 week weight loss program were included in present study. Obesity was defined as > or =30 kg/m(2) of body mass index (BMI). Normal weight was defined as < or = 25 kg/m(2) of BMI. RESULTS: After 12 week weight loss program, BMI decreased from 42+/-5 kg/m(2) to 36+/-4 kg/m(2) (p<0.001) and mean weight of obese subjects decreased from 110+/-17 kg to 95+/-15 kg (p<0.001). The mean amount of weight loss was 14.5+/-5.0 kg (range 9-32 kg). The average percent of weight loss was 13% (10.0%-20.3%). Maximum QTc interval (from 446+/-19 ms to 433+/-27 ms, p=0.024) and QTc dispersion (from 66+/-18 ms to 52+/-25 ms, p=0.024) significantly decreased after weight loss program. A statistically significant correlation was found between decrease in level of QTc dispersion and amount of weight loss (r=0.487, p=0.007). CONCLUSION: Substantial weight loss in obese subjects is accompanied by significantly decreased QTc dispersion. The degree of QTc dispersion reduction is associated with amount of weight loss.     

Acetyl-L-carnitine infusion increases glucose disposal in type 2 diabetic patients

Little information is available in the literature on the effect of L-carnitine to improve glucose disposal in healthy control subjects and type 2 diabetic patients. No data are reported on the pharmacological properties of acetyl-L-carnitine (ALC) in type 2 diabetes mellitus. The present study evaluates glucose uptake and oxidation rates with either ALC or placebo administration in 18 type 2 diabetic patients. On different days, each patient received both a primed-constant infusion of ALC (5 mg/kg body weight [BW] priming bolus and either 0.025, 0.1, or 1.0 mg/kg BW/min constant infusion) and a comparable placebo formulation. During the infusion period, continuous indirect calorimetric monitoring and a euglycemic-hyperinsulinemic clamp (EHC) study were performed. The total end-clamp glucose tissue uptake (M value) was significantly increased by the administration of ALC (from 3.8 to 5.2 mg/kg/min, P = .006), and the dose dependence of this effect reached borderline statistical significance (P = .037). The increase in the M/I ratio was also highly significant after ALC administration (from 3.9 to 5.8 x 10(-2) mg/kg/min/(microUI/mL, P < .001), while no statistically significant effect was attributable to the different dosages. The increase in the M value was related to increased glucose storage (highly significant effect of ALC) rather than increased glucose oxidation (no statistical significance). In conclusion, the effect of ALC on glucose disposal has no relationship to the amount administered. This could be due to an effect of ALC on the enzymes involved in both the glycolytic and gluconeogenetic pathways, and a possible reversibility of glycogen synthase inhibition in diabetic subjects.     

Carnitine improves peripheral glucose disposal in non-insulin-dependent diabetic patients.

To investigate the effects of carnitine on insulin sensitivity in non-insulin-dependent diabetes, insulin-mediated glucose disposal was measured in nine diabetic patients (age 54 +/- 3 years, BMI 27 +/- 1 kg/mq) during a primed (3 mmol) constant (1.7 mumol/min) intravenous infusion of carnitine. In control experiments, the same patients received saline instead of carnitine. Plasma glucose concentration was maintained constant at the level of 100 mg/dl during both studies while plasma insulin was raised to a plateau of 60 microU/ml. Despite similar insulin levels, whole-body glucose utilization was higher with carnitine (4.05 +/- 0.37 mg/kg/min) than saline infusion (3.52 +/- 0.36). Blood lactate concentrations were similar in the basal state and decreased significantly during carnitine infusion (P less than 0.05-0.005), whereas it remained substantially unchanged during saline infusion. Plasma FFA decreased to a similar level (0.1 mmol/l) in both studies. We conclude that an acute carnitine administration is able to improve insulin sensitivity in NIDDM patients. The lactate data suggest that this effect may at least in part be mediated by carnitine activation of pyruvate dehydrogenase.     

Effect of weight reduction on carbohydrate and fatty-acid metabolism in obese, maturity-onset diabetic patients]

In 35 adipose maturity-onset-diabetics (27 women, 8 men, average age 48 years) we examined the influence of a 4--5-week slimming cure on the carbohydrate and fat metabolism. A significant decrease showed the index of ideal weight, volume of adipozytes, fasting free fatty acids concentration, triglyceride content of the liver as well as systolic blood pressure. The decrease of the triglycerides, of cholesterol and of the uric acid level in the serum could not be ascertained statistically. The reduction of weight did not cause an essential change of the basal and stimulated insulin concentrations, whereas the glucose tolerance clearly improved. After an observation period of 36.5 months behaviour of weight and form of therapy are analysed.     

The effect of a rapid weight loss on lipid profile and glycemic control in obese type 2 diabetic patients

OBJECTIVE: To test the effect of low calorie diet (LCD) on body weight, lipid profile, and glycemic control in obese type 2 diabetes mellitus (DM) patients. DESIGN: Dietary intervention. SETTING: Department of Human Nutrition, Copenhagen. SUBJECTS: Outpatients: 11 type 2 DM patients (three males/eight females) (10 completed), four on oral hypoglycemic agents (OHA). Body mass index (BMI) 36.8 +/- 5.5 kg/m2 and age 62 +/- 5.7 y. INTERVENTIONS: In all, 8 weeks full meal-replacement diet: eight sachets of a nutrition powder (Nutrilett, 850 kcal/day). Lipid profile assessed by NMR spectroscopy. RESULTS: Mean body weight fell by 10.9 kg (approximately 11%, P<0.001). Fasting insulin, fasting blood glucose, hemoglobin A1c, fasting plasma triglycerides, total cholesterol, and low-density lipoprotein (LDL) cholesterol fell significantly. There were large positive changes (statistically insignificant) in LDL subclass distribution and a similar shift in high-density lipoprotein subclass distribution. Medication was discontinued in all four subjects taking OHA for 2 weeks prior to the intervention and throughout the whole 8-week intervention period. CONCLUSION: LCD is effective in improving glycemic control and blood lipids through weight loss in overweight type 2 DM patients.     

Prolonged weight loss with dexfenfluramine treatment in obese patients

17 patients with refractory obesity, who had gained an average of 0.7 +/- 1.9 kg during 12 weeks treatment with diet and placebo, lost a mean of 2.9 +/- 0.5 kg after 12 weeks sequential treatment with dexfenfluramine 15 mg twice daily (p less than 0.001). In a second trial, 29 patients were treated for 24 weeks with dexfenfluramine; average cumulative weight loss after 12 weeks in these patients (5.7 +/- 0.1 kg) was significantly greater than in the patients who had been treated initially with placebo. After 24 weeks of dexfenfluramine treatment there was a further significant increase in cumulative weight loss (7.0 +/- 0.8 kg; p = 0.05). The incidence of side effects in both trials was lower than that reported in previous studies of racemic dlfenfluramine. The clinically significant weight loss, and low incidence of unwanted effects, suggest that dexfenfluramine has a role in the treatment of refractory obesity.