The glucagon-like peptide-1 receptor agonist family together with the renal sodium/glucose cotransporter-2 inhibitors have garnered interest as potential therapeutic agents for subjects with type 2 ...diabetes and obesity. In these patients, bariatric surgery is indicated based in a BMI ≥ 35 kg/m
. A 24-week non-blinded, randomized pilot study to assess the efficacy of subcutaneous exenatide 2.0 mg once weekly plus oral dapagliflozin 10 mg once daily (Group A) compared to a control group (Group B) in 56 patients with type 2 diabetes awaiting bariatric surgery was conducted (EudraCTid.: 2017-001,454-33). Both groups received an energy-deficit low-fat diet. The primary endpoint was the proportion of patients running off the criteria for bariatric surgery at the end of the follow-up period (BMI ≤ 35.0 kg/m
or a BMI ≤ 40.0 kg/m
plus an HbA1c ≤ 6.0%). Changes in the BMI were also of interest. The proportion of patients who ran off the criteria for bariatric surgery was larger in Group A than in the control group (45.8% vs. 12.0%, p = 0.010). Participants in Group A exhibited an absolute decrease in body weight and BMI of 8.1 kg (95%IC: - 11.0 to - 5.2) and 3.3 kg/m
(95%IC: - 4.5 to - 2.2), respectively (p < 0.001 for both in comparison with Group B). A higher percentage of participants in Group A reached a BMI < 35 kg/m
(45.8 vs 12.0%) and lost > 10% of their initial body weight (20.8 vs 0%) compared to Group B. The combination of exenatide plus dapagliflozin appears as a strategic option to reduce the waiting list for bariatric surgery, especially in those patients with type 2 diabetes.
Type 2 diabetes exerts a deleterious effect on lung function. However, it is unknown whether an improvement in glycemic control ameliorates pulmonary function.
Prospective interventional study with ...60 patients with type 2 diabetes and forced expiratory volume in 1 s (FEV1) ≤90% of predicted. Spirometric maneuvers were evaluated at baseline and after a 3-month period in which antidiabetic therapy was intensified. Those with an HbA
reduction of ≥0.5% were considered to be good responders (
= 35).
Good responders exhibited a significant improvement in spirometric values between baseline and the end of the study (forced vital capacity FVC: 78.5 ± 12.6% vs. 83.3 ± 14.7%,
= 0.029; FEV1: 75.6 ± 15.3% vs. 80.9 ± 15.4%,
= 0.010; and peak expiratory flow PEF: 80.4 ± 21.6% vs. 89.2 ± 21.0%,
= 0.007). However, no changes were observed in the group of nonresponders when the same parameters were evaluated (
= 0.586,
= 0.987, and
= 0.413, respectively). Similarly, the initial percentage of patients with a nonobstructive ventilatory defect and with an abnormal FEV1 decreased significantly only among good responders. In addition, the absolute change in HbA
inversely correlated to increases in FEV1 (
= -0.370,
= 0.029) and PEF (
= -0.471,
= 0.004) in the responders group. Finally, stepwise multivariate regression analysis showed that the absolute change in HbA
independently predicted increased FEV1 (
= 0.175) and PEF (
= 0.323). In contrast, the known duration of type 2 diabetes, but not the amelioration of HbA
, was related to changes in forced expiratory flow between 25% and 75% of the FVC.
In type 2 diabetes, spirometric measurements reflecting central airway obstruction and explosive muscle strength exhibit significant amelioration after a short improvement in glycemic control.
Subjects with sleep apnea-hypopnea syndrome (SAHS) show an increased carotid intima-media thickness. However, no data exist about earlier markers of atheromatous disease, such as the proliferation ...and expansion of the adventitial vasa vasorum (VV) to the avascular intima in this setting. Our aim was to assess carotid VV density and its relationship with sleep parameters in a cohort of obese patients without prior vascular events. A total of 55 subjects evaluated for bariatric surgery were prospectively recruited. A non-attended respiratory polygraphy was performed. The apnea-hypopnea index (AHI) and the cumulative percentage of time spent with oxygen saturation below 90% (CT90) were assessed. Serum concentrations of soluble intercellular adhesion molecule 1, P-selectin, lipocalin-2 and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. Contrast-enhanced carotid ultrasound was used to assess the VV density. Patients with SAHS (80%) showed a higher adventitial VV density (0.801±0.125 vs. 0.697±0.082, p = 0.005) and higher levels of sVCAM-1 (745.2±137.8 vs. 643.3±122.7 ng/ml, p = 0.035) than subjects with an AHI lower than 10 events/hour. In addition, a positive association exist between mean VV density and AHI (r = 0.445, p = 0.001) and CT90 (r = 0.399, p = 0.005). Finally, in the multiple linear regression analysis, female sex, fasting plasma glucose and AHI (but not CT90) were the only variables independently associated with the mean adventitial VV density (R2 = 0.327). In conclusion, a high VV density is present in obese subjects with SAHS, and chronic intermittent hypoxia is pointed as an independent risk factor for the development of this early step of atheromatous disease.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
Individuals with type 2 diabetes (T2D) should be considered a susceptible group for pulmonary dysfunction. So, we aimed to evaluate the sensation of breathlessness in this population by ...administering two well-validated questionnaires.
Methods
This is a crosssectional study with 592 people without known respiratory disease (353 with T2D) who answered the modified Medical Research Council (mMRC) questionnaire. In addition, 47% also responded to the St George Respiratory Questionnaire, a specific instrument designed to be applied to patients with obstructive airway disease.
Results
Patients with T2D showed a higher mMRC score in comparison to the control group 1.0 (0.0 – 4.0) vs. 0.0 (0.0 – 4.0), p<0.001. A higher prevalence of subjects with mMRC ≥2 was observed in T2D that in the control group (20.2%
vs
. 11.6%, p=0.004). Participants with T2D and mMRC ≥2 showed a higher HbA1c (8.2 ± 1.6% vs. 7.8 ± 1.6%, p=0.048), longer T2D evolution and higher prevalence of nephropathy. In the multivariate analysis, the presence of T2D OR=1.95 (1.19 to 3.22), p=0.008 in all the population, and HbA1c OR=1.19 (1.01 to 1.41), p=0.034 and the presence of diabetic nephropathy OR=2.00 (1.14 to 3.52), p=0.015 in patients with T2D, predicted a mMRC ≥2. Finally, no differences were observed regarding the SGRQ score among groups.
Conclusions
Patients with T2D showed a greater sensation of dyspnea than subjects with normal carbohydrate metabolism. Risk factors included poor metabolic control and the presence of renal disease.
A few studies showed that both adherence to Mediterranean diet (MedDiet) and physical activity practice have a positive impact on pulmonary function in subjects with lung disease. These associations ...are not well studied in subjects free from lung disease. In a cross-sectional study conducted in 3020 middle-aged subjects free of lung disease, adherence to the MedDiet using the Mediterranean Diet Adherence Screener, and physical activity practice using the International Physical Activity Questionnaire short form were recorded. Respiratory function was assessed using forced spirometry and the results were evaluated according to the Global initiative for Chronic Obstructive Lung Disease. Logistic regression models were used to analyze the associations between adherence to the MedDiet and physical activity practice with the presence of ventilatory defects. Participants with a high adherence to MedDiet, in comparison to those with low adherence, had both higher forced vital capacity (FVC; 100 (87⁻109) vs. 94 (82⁻105) % of predicted,
= 0.003) and forced expired volume in the first second (FEV1; 100 (89⁻112) vs. 93 (80⁻107) % of predicted,
< 0.001). According to their degree of physical activity, those subjects with a high adherence also had both higher FVC (100 (88⁻107) vs. 94 (83⁻105) % of predicted,
= 0.027) and FEV1 (100 (89⁻110) vs. 95 (84⁻108) % of predicted,
= 0.047) in comparison with those with low adherence. The multivariable logistic regression models showed a significant and independent association between both low adherence to MedDiet and low physical activity practice, and the presence of altered pulmonary patterns, with differences between men and women. However, no joint effect between adherence to MedDiet and physical activity practice on respiratory function values was observed. Low adherence to MedDiet and low physical activity practice were independently associated with pulmonary impairment. Therefore, the lung mechanics seem to benefit from heart-healthy lifestyle behaviors.
Aims
Patients with type 2 diabetes have been considered a susceptible group for pulmonary dysfunction. Our aim was to assess pulmonary function on the prediabetes stage.
Methods
Pulmonary function ...was assessed in 4,459 non-diabetic subjects, aged between 45 and 70 years, without cardiovascular disease or chronic pulmonary obstructive disease from the ongoing study ILERVAS. A “restrictive spirometric pattern”, an “abnormal FEV1” and an “obstructive ventilatory defect” were assessed. Prediabetes was defined by glycosylated hemoglobin (HbA1c) between 5.7 and 6.4% according to the American Diabetes Association criteria.
Results
Population was composed of 52.1% women, aged 57 53;63 years, a BMI of 28.6 25.8;31.8 kg/m
2
, and with a prevalence of prediabetes of 29.9% (
n
= 1392). Subjects with prediabetes had lower forced vital capacity (FVC: 93 82;105 vs. 96 84;106,
p
< 0.001) and lower forced expired volume in the first second (FEV1: 94 82;107 vs. 96 84;108,
p
= 0.011), as well as a higher percentage of the restrictive spirometric pattern (16.5% vs. 13.6%,
p
= 0.015) and FEV1 < 80% (20.3% vs. 17.2%,
p
= 0.017) compared to non-prediabetes group. In the prediabetes group, HbA1c was negatively correlated with both pulmonary parameters (FVC:
r
= − 0.113,
p
< 0.001; FEV1:
r
= − 0.079,
p
= 0.003). The multivariable logistic regression model in the whole population showed that there was a significant and independent association between HbA1c with both restrictive spirometric pattern OR = 1.42 (1.10–1.83),
p
= 0.008 and FEV1 < 80% OR = 1.50 (1.19–1.90),
p
= 0.001.
Conclusions
The deleterious effect of type 2 diabetes on pulmonary function appears to be initiated in prediabetes, and it is related to metabolic control.
Trial registration ClinicalTrials.gov
NCT03228459.
Paired cohort investigations assessing the evolution of anthropometric indices are scarce. Here we assessed the 10-year evolution of BMI, total body fat, and lean body mass in 50,019 participants ...aged 18-90 years at the time of first assessment.
A retrospective cohort study using an electronic database that contains anonymized, longitudinal data from Primary Care medical records covering the 2007-2008 and 2017-2018 periods. Total body fat was estimated using the Clínica Universidad de Navarra-Body Adiposity Estimator formula, and the Hume formula was applied to estimate lean body mass.
The mean BMI of participants <60 years old in the 2007-2008 period increased significantly, from 27.5 to 28.3 kg/m
(
< 0.001). However, the BMI of older subjects decreased during the next decade, from 28.9 to 28.3 kg/m
(
< 0.001). The estimated total body fat showed a continuous progressive increase over all ages. Finally, lean body mass showed a progressive increase until the 40s, with a plateau between 40-45 years old and an uninterrupted decrease until older ages. Also, subjects who increased their BMI by 2 kg/m
during the 10-year period were mainly women and younger at baseline, with a lower initial BMI and total body fat in comparison with those who experienced a BMI decrease of ≥2.0 kg/m
.
The evolutions of BMI and the estimated body compositions reported here confirm that the adverse decrease in lean body mass begins in middle age. The proportion of older subjects is important when evaluating overweight and obesity prevalence in cross-sectional studies.
There is a close relationship between lifestyle behaviors and excess adiposity. Although body mass index (BMI) is the most used approach to estimate excess weight, other anthropometric indices have ...been developed to measure total body and abdominal adiposity. However, little is known about the impact of physical activity and adherence to a Mediterranean diet on these indices. Here we report the results of a cross-sectional study with 6672 middle-aged subjects with low to moderate cardiovascular risk from the Ilerda Vascular (ILERVAS) project. The participants' adherence to physical activity (International Physical Activity Questionnaire short form) and MedDiet (Mediterranean Diet Adherence Screener) was evaluated. Measures of total adiposity (BMI, Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), and Deurenberg's formula), central adiposity (waist and neck circumferences, conicity index, waist to height ratio, Bonora's equation, A body adiposity index, and body roundness index), and lean body mass (Hume formula) were assessed. Irrespective of sex, lower indices of physical activity were associated with higher values of total body fat and central adiposity. This result was constant regardless of the indices used to estimate adiposity. However, the association between MedDiet and obesity indices was much less marked and more dependent on sex than that observed for physical activity. Lean body mass was influenced by neither physical activity nor MedDiet adherence. No joint effect between physical activity and MedDiet to lower estimated total or central adiposity indices was shown. In conclusion, physical activity is related to lower obesity indices in a large cohort of middle-aged subjects. MedDiet showed a slight impact on estimated anthropometric indices, with no joint effect when considering both lifestyle variables. ClinTrials.gov Identifier: NCT03228459.
Around 30% of the patients that undergo bariatric surgery (BS) do not reach an appropriate weight loss. The OBEGEN study aimed to assess the added value of genetic testing to clinical variables in ...predicting weight loss after BS. A multicenter, retrospective, longitudinal, and observational study including 416 patients who underwent BS was conducted (Clinical.Trials.gov- NCT02405949). 50 single nucleotide polymorphisms (SNPs) from 39 genes were examined. Receiver Operating Characteristic (ROC) curve analysis were used to calculate sensitivity and specificity. Satisfactory response to BS was defined as at nadir excess weight loss >50%. A good predictive model of response area under ROC of 0.845 (95% CI 0.805–0.880), p < 0.001; sensitivity 90.1%, specificity 65.5% was obtained by combining three clinical variables (age, type of surgery, presence diabetes) and nine SNPs located in ADIPOQ, MC4R, IL6, PPARG, INSIG2, CNR1, ELOVL6, PLIN1 and BDNF genes. This predictive model showed a significant higher area under ROC than the clinical score (p = 0.0186). The OBEGEN study shows the key role of combining clinical variables with genetic testing to increase the predictability of the weight loss response after BS. This finding will permit us to implement a personalized medicine which will be associated with a more cost-effective clinical practice.
Introduction/Purpose
Adventitial vasa vasorum (VV) expansion to the avascular intima precedes an increase in carotid intima-media thickness. However, factors involved in the development of the ...atherosclerotic process and its reversibility remain unclear. We aimed to evaluate the VV signal in both morbid obesity and after bariatric surgery (BS).
Materials/Methods
We conducted a case-control study to examine the VV signal in the carotid of 40 morbidly obese patients and 40 non-obese controls. The effect of BS was evaluated in 33 patients. Contrast-enhanced carotid ultrasound was used to assess the VV signal.
Results
The mean VV density was higher in obese than in non-obese subjects (0.739 ± 0.117 vs. 0.570 ± 0.111,
p
< 0.001). The VV signal positively correlated with BMI (
p
< 0.001) and waist circumference (
p
= 0.001) but was not related to cIMT. The stepwise multivariate regression analysis revealed that waist circumference (beta = 0.507,
p
< 0.001) together with fasting plasma glucose (beta = 0.229,
p
= 0.024) were independently associated with the VV signal (
R
2
= 0.382). Before BS, the median VV signal correlated with soluble intercellular adhesion molecule 1 (
p
= 0.022). After a 12-month follow-up, a 12.0% decrease in VV (0.731 ± 0.126 vs. 0.643 ± 0.115,
p
= 0.003) was observed. In the univariate analysis, the decrease in VV was associated with the baseline VV density (
p
< 0.001), baseline systolic blood pressure (
p
= 0.019) and a decrease in sICAM (
p
= 0.005). However, only baseline systolic pressure (beta = 0.417,
p
= 0.024) independently predicted the absolute change in VV signal (
R
2
= 0.174).
Conclusions
Morbidly obesity is associated with increased VV density. In addition, BS appears to reduce the earlier expansion of the adventitial vasa vasorum.
PDF
