利拉鲁肽联合二甲双胍治疗肥胖型2型糖尿病的效果及对氧化应激指标的影响

目的 分析利拉鲁肽联合二甲双胍治疗肥胖型2型糖尿病的效果及对氧化应激指标的影响.方法 回顾性选取2019年1月至2021年1月本院收治的96例肥胖型2型糖尿病患者为研究对象,依据治疗方法将其分为利拉鲁肽联合二甲双胍治疗组(联合治疗组)和二甲双胍单独治疗组(单独治疗组),各48例.比较两组患者的BMI、血糖指标、临床疗效...     

Relationships between circulating leptin concentrations and other hormonal parameters in obese and non-obese women with polycystic ovary syndrome

Aim: To clarify the role of leptin in women with polycystic ovary syndrome (PCOS), we analyzed whether serum leptin levels correlate with other hormonal parameters in obese and non-obese women with PCOS.
Methods: We studied 20 obese (body mass index, BM ≥25 kg/m²) and 20 non-obese (BMI <25 kg/m²) women with PCOS diagnosed by the existence of menstrual disturbance, elevated serum level of luteinizing hormone (LH) with normal follicle-stimulating hormone (FSH) and the characteristic polycystic appearance of the ovaries on transvaginal ultrasound images. Blood samples for LH, FSH, estradiol, testosterone (T), androstenedione (Δ₄) and leptin were obtained, and the relationships between variables were examined by calculating Spearman correlation coefficients.
Results: Mean levels of leptin, T and Δ₄ in obese PCOS women were significantly higher than those in non-obese PCOS women, but this was not the case for BMI, bodyweight and waist to hip ratio. In all the 40 PCOS women considered together, there were significant positive correlations of leptin with BMI, waist to hip ratio, and Δ₄ levels. However, in each group separately, serum leptin levels in obese PCOS women correlated only with BMI and bodyweight, whereas serum leptin levels in non-obese PCOS women correlated with serum A4 levels.
Conclusion: Although further study is needed to assess the role of leptin on ovarian function in non-obese women with PCOS, present findings do not support the fact that leptin is involved in the development of hormonal abnormalities in obese women with PCOS. (Reprod Med Biol 2002; 1 : 49–54)     

Peri-operative care considerations for primary total knee arthroplasty in the obese patient

In the United States an increasing obesity epidemic compounded with growth in total knee arthroplasty (TKA) utilization is increasing the incidence of TKA in the obese population. Arthroplasty surgeons are directly affected by the obesity epidemic and need to understand how to safely offer a range of peri-operative care for these patients in order to ensure good clinical outcomes. Preoperative care for the obese patient involves nutritional counseling, weight loss methods, consideration for bariatric surgery, physical therapy, metabolic workup with diagnosis, and management of frequent comorbid conditions. Obese patients must also be counseled on their increased risk of complications following TKA. A successful surgical result is dependent on early risk mitigation techniques including weight loss, co-morbidity management, and nutritional optimization. In the operating room several steps can be taken to improve successful outcomes when performing TKA on obese patients. Peri-operative techniques including adequate surgical exposure, component positioning, and implant selection play an important role in the longevity of the implant in the obese TKA population who are at risk for post-operative tibial loosening and increased re-operation rates. Appropriate weight-adjusted antibiotic dosing, sterile surgical techniques, wound closure and coverage are essential in reducing infection in this susceptible population. Post-operative care of the obese patient following TKA involves several unique considerations. Chronic pain and obesity are frequent comorbid conditions and post-operative pain control regimens need to be tailored to these patients to improve function and surgical outcome. Obese patients can have a higher rate of all complications compared to healthy weight. All infection and deep infection increased in obese patients and patients must be counseled on their risks pre-operatively to encourage an active role in risk mitigation in the peri-operative period.     

Association between short sleeping hours and overweight in adolescents: results from a US Suburban High School survey

Insufficient sleep may lead to adverse health effects, influencing body weight. This study quantified the prevalence of short sleep and the association between sleep duration and overweight in a sample of suburban students. Cross-sectional study was conducted in 2004, involving 529 students from Bay High School, Bay Village, OH, USA, using self-administered questionnaires assessing lifestyle and sleep behaviors. Students with a body mass index Z Score >85th percentile for sex and age were deemed overweight. Ninety percent of students reported average sleep time less than 8 h on school nights, with 19% reported less than 6 h of sleep per night. Twenty percent of the sample were overweight. Overweight was significantly associated with the male gender, increased caffeine consumption, and short sleep duration. Compared with students sleeping >8 h, the age and gender-adjusted odds ratio of overweight was 8.53 (95% CI: 2.26, 32.14) for those with <5 h sleep (P = 0.0036); 2.79 (1.03, 7.55) for those with 5–6 h sleep; 2.81 (1.14, 6.91) for those with 6–7 h sleep; and 1.29 (0.52, 3.26) for those with 7–8 h sleep. Short sleep duration was common and associated with overweight with evidence of a “dose–response” relationship. These results confirm a high prevalence of short sleep among suburban high school students and provide additional support suggesting significant association between short sleeping hours and overweight. There are no financial disclosures from any of the authors.     

X-PERT: weight reduction with orlistat in obese subjects receiving a mildly or moderately reduced-energy diet: early response to treatment predicts weight maintenance

AIM: To determine the effect of two different levels of energy deficit on weight loss in obese patients treated with orlistat. METHODS: Patients (n=430) were randomized in a 1-year, multicentre, open-label, parallel group study conducted at 23 hospital centres and university medical departments worldwide. Obese outpatients (body mass index 30--43 kg/m(2)) aged 18--70 years with a body weight of >or=90 kg and a waist circumference of >or=88 cm (women) or >or=102 cm (men) were treated with orlistat 120 mg three times daily plus a diet that provided an energy deficit of either 500 or 1,000 kcal/day for 1 year. Orlistat treatment was discontinued in patients who did not achieve >or=5% weight loss after assessment at 3 and 6 months. The primary outcome measure was change in body weight from baseline at week 52. RESULTS: Reported mean difference in energy intake between the two groups (500-1,000 kcal/day deficit) at weeks 24 and 52 was actually 111 and 95 kcal/day respectively. Of the 430 patients involved in the study, 295 achieved >or=5% weight loss at both 3 and 6 months. In this population, at week 52, weight loss from baseline was similar for patients randomized to either the 500 or the 1,000 kcal/day deficit diet (-11.4 kg vs. -11.8 kg, respectively; p=0.778). After 12 months of treatment with orlistat, 84% (n=118/141) and 85% (n=131/154) of patients in the 500 and 1,000 kcal/day deficit groups, respectively, achieved >or=5% weight loss, and 50% (n=70/141) and 53% (n=82/154) of patients, respectively, achieved >or=10% weight loss. Patients in both the diet treatment groups showed similar significant improvements in blood pressure, lipid levels and waist circumference at week 52. CONCLUSIONS: Treatment with orlistat was associated with a clinically beneficial weight loss, irrespective of the prescribed dietary energy restriction (-500 or -1000 kcal/day). Patients who achieved >or=5% weight loss at 3 months achieved long-term, clinically beneficial weight loss with orlistat plus either diet. Therefore, identifying patients who lose at least 5% weight after 3 months and who maintain this weight loss up to 6 months is a valuable treatment algorithm to select patients who will benefit most from orlistat treatment in combination with diet.     

Morbid Obesity Causes Chronic Increase of Intraabdominal Pressure

Intraabdominal hypertension and the abdominal compartment syndrome are known to deleteriously affect a wide array of organ systems. We retrospectively reviewed 62 women who underwent either laparoscopic gastric bypass surgery or adjustable gastric banding. Their age, body mass index (BMI), and race were known. Their opening abdominal pressure was recorded by connecting a Verress needle to a pressure monitor. Linear regression was used to assess the contribution of age, race, and BMI to the observed variation in opening abdominal pressure. Neither variation in age or race explained the variation in opening pressure (P > .05). By contrast, variation in BMI explained 8% of the observed variation in opening pressure (P < .05). For every 1 kg/mm² increase in BMI, there was on average a 0.07 mm Hg increase in opening pressure. Increases in BMI are associated with increases in intraabdominal pressure.     

The prevalence and predictors of resistant hypertension in high‐risk overweight and obese patients: A cross‐sectional study based on the 2017 ACC/AHA guidelines

Obesity is significantly associated with uncontrolled blood pressure and resistant hypertension (RH). There are limited studies on the prevalence and determinants of RH in patients with higher body mass index (BMI) values. Since the hypertension guidelines changed in 2017, the prevalence of RH has become unknown and now is subject to be estimated by further studies. We conducted a cross‐sectional study in an urban Federally Qualified Health Center in New York City aiming to estimate the prevalence of RH in high‐risk overweight and obese patients based on the new hypertension definition, BP threshold ≥130/80 mm Hg, and also to describe the associated comorbid conditions in these patients. We identified 761 eligible high‐risk overweight and obese subjects with hypertension between October 2017 and October 2018. Apparent treatment‐RH was found in 13.6% among the entire study population. This represented 15.4% of those treated with BP‐lowering agents. True RH confirmed with out‐of‐office elevated BP was found in 6.7% of the study population and 7.4% among patients treated with BP‐lowering agents. Prevalence was higher with higher BMI values. Those with true RH were more likely to be black, to have diabetes mellitus requiring insulin, chronic kidney disease stage 3 or above and diastolic heart failure. In conclusion, obesity is significantly associated with RH and other significant metabolic comorbid conditions.