Background
A survey of obesity medicine specialists was conducted before the approval of new obesity medications in 2012.
Methods
An Internet survey was sent to obesity medicine specialists inquiring ...about their practice and prescribing habits.
Results
Twenty-five percent of 1992 obesity medicine specialists responded. They used stimulant obesity medication for longer and at higher doses than recommended in the package insert. Medications for other indications were used off-label alone and in combination for obesity treatment. Only 15 % saw surgical patients.
Conclusions
The survey is a baseline for when more obesity medications exist in 5 years. We hope discovering a lack of collaboration between obesity medical specialists and obesity surgeons will stimulate more team work that will benefit obese patients contemplating or undergoing obesity surgery.
Although parental supervision is associated with reduced risk of injury to young children, supervision by older siblings has been shown to increase this risk. The current study, conducted in Guelph, ...Canada, explored how this differential risk of injury may arise. It compares the supervision behaviors of mothers to those of their older children when each was the designated supervisor of a young child, shown on a videotape to engage in no risk, risk, and rule violation behaviors in a home situation. The mothers and older child supervisors were told to imagine the toddler on the videotape was the young child in their own family, and to stop the tape and speak to the child whenever they would in real life. Results indicated that supervisees were allowed to engage in more risk behaviors when supervised by older siblings than by mothers. Sibling supervisors reacted to risk behaviors with more prohibitions, whereas mothers adopted a teaching orientation and gave more explanations and directions in response to risk behaviors by the supervisee. Implications for injury prevention and directions for future research are discussed.
Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study ...was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer.
In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95% CIs were estimated from ordinal and binary logistic regression models.
5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22–120), and median age was 72 years (IQR 66–79). The CCC19 geriatric risk index identified 2365 (41·7%) patients as standard risk, 2217 (39·1%) patients as intermediate risk, and 1089 (19·2%) as high risk. 36 (0·6%) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95% CI 6·20–8·45). 920 (16·2%) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8%) of 2365 standard-risk patients, 409 (18·5%) of 2217 intermediate-risk patients, and 350 (32·1%) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95% CI 8·54–13·5) than standard-risk patients.
The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality.
US National Institutes of Health National Cancer Institute Cancer Center.
Hypogonadism in males is associated with increased body fat and altered postprandial metabolism, but mechanisms remain poorly understood. Using a cross‐over study design, we investigated the effects ...of short‐term sex hormone suppression with or without testosterone add‐back on postprandial metabolism and the fate of dietary fat. Eleven healthy males (age: 29 ± 4.5 year; BMI: 26.3 ± 2.1 kg/m2) completed two 7‐day study phases during which hormone levels were altered pharmacologically to produce a low sex hormone condition (gonadotropin releasing hormone antagonist, aromatase inhibitor, and placebo gel) or a testosterone add‐back condition (testosterone gel). Following 7 days of therapy, subjects were administered an inpatient test meal containing 50 μCi of 1‐14C oleic acid. Plasma samples were collected hourly for 5 h to assess postprandial responses. Energy metabolism (indirect calorimetry) and dietary fat oxidation (14CO2 in breath) were assessed at 1, 3, 5, 13.5, and 24 h following the test meal. Abdominal and femoral adipose biopsies were taken 24 h after the test meal to determine uptake of the labeled lipid. Postprandial glucose, insulin, free‐fatty acid, and triglyceride responses were not different between conditions (P > 0.05). Whole‐body energy metabolism was also not different between conditions at any time point (P > 0.05). Dietary fat oxidation trended lower (P = 0.12) and the relative uptake of 14C labeled lipid into femoral adipose tissue was greater (P = 0.03) in the low hormone condition. Short‐term hormone suppression did not affect energy expenditure or postprandial metabolism, but contributed to greater relative storage of dietary fat in the femoral depot. ClinicalTrials.gov Identifier: NCT03289559.
Hypogonadism in males is associated with increased adiposity and altered dietary fat metabolism, but the specific role of low testosterone in these age‐related changes is not well understood. Using a pharmacological model of gonadal aging in young men (GnRH antagonist ± testosterone), we found that low testosterone was not associated with altered energy expenditure, fuel utilization, or postprandial metabolism. However, low testosterone did contribute to greater storage of dietary fat in the femoral depot.
Young adult Mexican Americans (MA) exhibit lower insulin sensitivity (Si) than nonHispanic whites (NHW), even when controlling for fitness and adiposity. It is unclear if MA are as responsive to the ...same lifestyle intervention as NHW.
We developed a model to examine cardiometabolic plasticity (i.e., changes in Si and plasma lipids) in MA compared to NHW adults in response to a diet-exercise intervention.
Sedentary subjects (20 NHW: 11F, 9M, 23.0 y, 25.5 kg/m(2); 17 MA: 13F, 4M, 22.7 y, 25.4 kg/m(2)) consumed their habitual diets and remained sedentary for 7 days, after which fasting blood samples were obtained, and a 3-h intravenous glucose tolerance test (IVGTT) was performed with the insulin area under the curve (IAUC) used to estimate Si. Subjects then completed a 7-day diet/exercise intervention (diet: low saturated fat, low added sugar, high fiber; exercise: cycling, six total sessions lasting 40-45 min/session at 65% VO(2) max). Pre-intervention tests were repeated.
Pre intervention IAUC was 28% higher (p<0.05) in MA (IAUC pre = 2298 µU*180 min/mL) than in NHW (IAUC = 1795 µU*180 min/mL). Following the intervention, there was a significant reduction in IAUC in MA (29%) and NHW (32%), however, the IAUC remained higher (p<0.05) for MA (post = 1635 µU*180 min/mL) than for NHW (post = 1211 µU*180 min/mL). Pre test plasma lipids were not different in MA compared to NHW. Plasma cholesterol and TG concentrations significantly improved in both groups, but concentrations of low density lipoprotein-cholesterol and small dense LDL particles significantly improved only in the NHW.
With a short-term diet-exercise intervention, the magnitude of improvements in Si and serum cholesterol and TG in Hispanics are similar to those in NHW. However, because at the outset MA were less insulin sensitive compared to NHW, within the short timeframe studied the ethnic gap in insulin sensitivity remained.
The regulation of the cellular actions of the hormone insulin is essential to the maintenance of macronutrient metabolism, body weight regulation, and a surprisingly diverse range of other ...integrative physiologic functions. Because of the diverse targets of insulin action, any dysfunction in insulin is likely to have systemic consequences. Although type 1 and type 2 diabetes are the most obvious clinical consequences of impaired insulin synthesis and insulin action, respectively, there are also subclinical disorders that attend defects in the function of insulin. In humans and horses, the “metabolic syndrome” is characterized by a cluster of metabolic sequelae that arise as a result of insulin resistance. Importantly, both diet and exercise can regulate insulin action and can thus be leveraged as treatment tools to prevent and treat the metabolic syndrome. The aim of this review is to characterize the integrative biology of insulin action and to describe the role of diet and exercise in regulating tissue responsiveness to insulin.
Angiogenesis, the growth of new vessels from pre‐existing vessels, is vital to wound healing in the cases of myocardial infarction and peripheral arterial disease. Adipose‐derived stromal vascular ...fraction (SVF), consisting of endothelial cells, endothelial progenitor cells, pericytes, smooth muscle cells, fibroblasts and immune cells, can be transplanted to assist in wound healing as seen in various clinical trials. However, the spatiotemporal incorporation of the SVF within living tissues remains largely unknown. As such, understanding where and how SVF cells contribute to microvascular growth and remodeling will help guide their therapeutic use. The objective of this study was to evaluate the impact of SVF cells and their fate during microvascular growth utilizing a novel tissue culture model that enables time‐lapse observation of cell dynamics across intact networks. SVF was isolated from adipose of an adult male Wistar rat, labeled with DiI, and seeded onto mesentery tissues harvested from the same rat before culturing in MEM + 10% fetal bovine serum and 1% PenStrep for 3 days. Tissues were then labeled for lectin to identify vessels. Alternatively, SVF was isolated from adipose harvested from adult male or female SD‐EGFP rats, seeded onto lectin labeled mesentery from adult male Wistar rats, placed under the same culture conditions, and imaged every 24 hours. Vascularized area was increased in SVF treated versus control tissues (SVF = 84.5±1.3%; Control = 56.5%; p < 0.001; n = 4 tissues per group). The SVF related microvasculature was characterized by asterisk‐shaped clusters. GFP tracking of SVF revealed vessel segment formation via vasculogenesis containing endothelial cells and pericytes in previously avascular areas. In pre‐vascularized regions, SVF cells contributed to new vessel growth and integration with and along native vessels. SVF cells were observed both in apparent endothelial cell and wrapping pericyte locations. Interestingly, examples of new vessel segments derived from SVF cells were observed along LYVE‐1 positive lymphatic vessels. These results suggest that SVF transplantation increases vascular area through vasculogenesis and contributes to angiogenesis of pre‐existing vasculature. The results also support the use of the rat mesentery culture model as a novel tool for elucidating SVF cell transplant dynamics in an intact tissue environment.
Support or Funding Information
Funded by NIH R01AG049821
This is from the Experimental Biology 2019 Meeting. There is no full text article associated with this published in The FASEB Journal.
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