Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been linked to beneficial effects on cardiovascular risk factors, blood pressure, body weight, and lipid profile, according to a substantial ...body of literature. Significant cardiac and renal benefits with the use of SGLT2 inhibitors have been shown in patients with type 2 diabetes, as well as in those with heart failure and/or chronic kidney disease (CKD), regardless of diabetes status, in subsequent large cardiovascular outcome trials. Thus, SGLT2 inhibitors have become a mainstay of therapy for type 2 diabetes in patients with established cardiovascular disease and CKD due to their benefits for the heart and kidneys. Based on data from randomized controlled trials and meta-analyses, this article attempts to present a thorough review of the mechanism of action, as well as the benefits of SGLT2 inhibitors for cardiac and renal protection. On the basis of a growing body of literature on diabetes and other conditions, clinical practice guidelines have been updated to suggest the use of SGLT2 inhibitors in specific patient populations. These modifications will also be concisely described, based on evidence-based medicine principles.
Globally, the COVID-19 pandemic altered adults’ and children’s lifestyles and habits, causing an increase in body weight. Adolescents are sensitive to habit changes and, because of their insufficient ...capacity to deal with the unexpected COVID-19 changes, were at greater risk of noncommunicable disease development due to the consequences of adopting unhealthy habits. The survey aimed to reveal the changes in nutritional status and lifestyle habits of school children in Croatia and to assess their nutrition knowledge and emotional state and feelings about COVID-19 lockdown. Self-reported data from 1370 school children aged 10 to 15 years were obtained to examine the influence of the lockdown on their nutritional status, lifestyle and emotional status, and to assess their nutrition knowledge. The study revealed that the COVID-19 lockdown has caused an increase in the proportion of overweight and obesity among Croatian school children who changed their lifestyle habits towards being less physically active, spending more time using screen-based media and revealing potential psychological distress. However, the schoolchildren had a high adherence to the Mediterranean diet assessed with the Mediterranean Diet Quality Index for children and adolescents KIDMED index and had good nutrition knowledge. Public health programs promoting a healthy lifestyle and involving the whole family, in a school environment, could provide children with a healthy adulthood.
Obesogens – new global health problem? Ćurić, Melany; Klobučar Majanović, Sanja; Detel, Dijana ...
Periodicum biologorum,
07/2022, Letnik:
123, Številka:
3-4
Journal Article
Odprti dostop
Obesity is a serious global public health problem. It is a complex disease caused by a combination of several factors including overeating and a sedentary lifestyle, genetic susceptibility and ...environmental factors. Substantial scientific evidence indicates that increase in obesity prevalence correlates with increase in production and human exposure to environmental chemicals, suggesting that a long list of chemical compounds that can be found all around us may play a role in the etiology of obesity.Endocrine disrupting compounds (EDCs) are chemicals that can interfere with the function of endocrine system. A subclass of EDCs that can disrupt a great number of metabolic processes including normal development of adipose tissue and balance of lipid metabolism thus leading to obesity are called obesogens. They can be found in electronics, plastics, furniture, clothes, cosmetics and also in the air, water and food that people consume. Persistent organophosphate pesticides, flame retardants, nicotine and plastics have all been linked to obesity particularly if exposure occurs during early life (in utero, newborns). Early development is the most vulnerable period for obesogen exposure leading to epigenetic changes that persist throughout life.Current knowledge on obesogens is probably just „the tip of the iceberg“ and future research is needed as well as increasing public awareness of this problem and its implications to human health. It is important to establish control over obesogens and try to prevent or at least limit the exposure of people, especially children and pregnant women, to these dangerous and harmful chemical compounds.
Given the emerging role of endoscopic procedures in the treatment of obesity and rapid changes in endoscopic technologies and techniques, this review considers the current state of endoscopic ...management of obesity. Endoluminal interventions performed entirely through the GI tract by using flexible endoscopy offer the potential for an ambulatory weight loss procedure that may be safer and more cost- effective compared with current surgical approaches. Endoscopic techniques attempt to mimic the anatomic features of bariatric surgery. Accordingly, there are two main endoscopic weight loss modalities - restrictive and malabsorptive. Restrictive procedures act to decrease gastric volume by space-occupying prosthesis and/or by suturing or stapling devices, while malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. The former include intragastric balloon treatment, endoluminal vertical gastroplasty, transoral gastroplasty and transoral endoscopic restrictive implant system, while the latter include duodenojejunal bypass sleeve. Gastroduodenojejunal bypass sleeve is a combination of both procedures. Except for intragastric balloon, all mentioned procedures are rather new, tested on a small number of human subjects, with a high rate of success, but with limited knowledge on safety and long-term efficacy. The role of gastric electrical stimulation and intragastric injections of botulinum toxin in obesity treatment is also considered as is the role of minimally invasive bariatric endoscopic interventions.
Aim
Hypothyroidism is a common clinical problem that is successfully treated with hormone substitutes in the form of levothyroxine (LT4). LT4 is a drug with a narrow therapeutic index and is usually ...administered by strict rules, standardly at least half an hour before breakfast. The aim of this study was to investigate a possible effect of different timings of administration on thyroid function status and lipid profile.
Methods
The study included patients with the diagnosis of primary hypothyroidism, which were using a stable dose of levothyroxine. They were randomized into three different groups regarding the timing of LT4 administration in a crossover fashion. Each timing regimen lasted for at least 8 weeks; timing regimen A—half an hour before breakfast; timing regimen B—an hour before the main meal of the day; timing regimen C—at bedtime (minimally 2 h after dinner). The hormones (TSH, fT3, fT4) and lipid profile (triglycerides, HDL-, LDL-, and total cholesterol) were measured before the study, at the beginning of every timing regimen and at the end of the study.
Results
Altogether, 84 patients finished the study. Different timings of LT4 administration were non-inferior in comparison to the standard one and between each other. Median differences in TSH level between baseline and timing regimens were: baseline vs.
A
= −0.017 95% C.I. (−0.400–0.192); baseline vs.
B
= −0.325 95% C.I. (−0.562–0.023); baseline vs.
C
= −0.260 95% C.I. (−0.475–0.000). There were no statistically significant differences in either TSH, fT4, or fT3 when compared between all three timing regimens of LT4 administration and the baseline. There were no statistically significant differences in any of the lipid profile parameters (triglycerides, HDL-, LDL-, and total cholesterol) when compared between all three timing regimens of LT4 administration and the baseline.
Conclusion
The three investigated timing regimens of LT4 administration were equally efficient and offer additional options regarding the treatment individualization.
El objetivo de este estudio fue evaluar la relación entre las convicciones sobre las causas de enfermedad, control glucémico y estado afectivo de mujeres y hombres con sobrepeso y obesos que sufren ...de diabetes tipo 2. La muestra clínica incluyó 88 pacientes (46 hombres), a
la edad de entre 31 y 79 años. Los pacientes fueron examinados en la Clínica de consulta externa de endocrinología, diabetes y enfermedades metabólicas del Centro hospitalario clínico de Rijeka. Mediciones psicológicas incluían el Cuestionario Revisado de Percepción de Enfermedad y la Escala de Ansiedad y Depresión Hospitalarias. También se
obtuvieron el peso corporal, altura y control glucémico de los pacientes. Los resultados demuestran que el índice de masa corporal (IMC) no fue significativamente correlacionado con el nivel de HbA1c, ni
con las variables psicológicas mesuradas (atribuciones psicológicas de la enfermedad, ansiedad y síntomas de depresión). Convicción más fuerte que la enfermedad fue causada por los factores psicológicos fue correlacionada con más síntomas de ansiedad y depresión en los pacientes. Hubo un efecto principal significativo del género de paciente
en las atribuciones psicológicas y síntomas de ansiedad. Las mujeres mostraron convicciones más fuertes que los factores psicológicos podrían
causar su enfermedad y mostraron también niveles más altos de síntomas de ansiedad que los hombres. No hubo un efecto principal más significativo del control glucémico en las variables psicológicas. Los resultados sugieren que trabajando con los pacientes con la DMT2 es importante prestar atención a los aspectos psicológicos de enfermedad, teniendo en cuenta el género de paciente. Examinar las convicciones sobre las causas de diabetes y el estado emocional podría posibilitarnos
reconocer posibles obstáculos en proporcionar cuidados.
The aim of this study was to assess the relationship between beliefs about the causes of illness, glycaemic control, and affective status of overweight and obese women and men with type 2 diabetes. The clinical sample included 88 patients (46 males), aged from 31 to 79 years. Patients were examined in the Outpatient Clinic for Endocrinology, Diabetes and Metabolic Diseases in the Clinical Medical Centre Rijeka. Psychological measurements included the Revised Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. Patients' body weight, height and glycaemic control (HbA1c) were also obtained.The
results show that body mass index (BMI) is not significantly correlated
with the level of HbA1c, nor with measured psychological variables (psychological attributions of illness, anxiety and depressive symptoms). A stronger belief that illness was caused by psychological factors is correlated with more symptoms of anxiety and depression in patients. There was a significant main effect of patients' sex on psychological attributions and anxiety symptoms. Women reported stronger
beliefs that psychological factors might have been the cause of their illness and showed higher levels of anxiety symptoms than men. There was
no significant main effect of glycaemic control on measured psychological variables. The results suggest that in working with T2DM patients it is important to pay attention to psychological aspects of illness, taking into account the patient's sex. Inquiring about diabetes
causation beliefs and emotional status may be a way of recognizing possible barriers towards providing care.
Dijabetes i debljina – začarani krug Klobučar Majanović, Sanja
Medicus (Zagreb, Croatia : 1992),
04/2018, Letnik:
27, Številka:
1 Debljina i ...
Journal Article
Recenzirano
Odprti dostop
Posljednjih desetljeća svjedoci smo dramatičnog porasta broja oboljelih od šećerne bolesti na globalnoj razini. Ova pandemija uvjetovana je ponajprije rastućom prevalencijom tipa 2 šećerne bolesti. ...Činjenica da više od 80% oboljelih ima prekomjernu tjelesnu masu upućuje na čvrstu povezanost debljine i rizika obolijevanja od šećerne bolesti tipa 2. Na razvoj navedenih epidemioloških pokazatelja najviše utječe suvremeni način života karakteriziran prekomjernom konzumacijom rafinirane, industrijski prerađene hrane s velikim udjelom zasićenih masti i jednostavnih ugljikohidrata udružen s niskom razinom tjelesne aktivnosti. Osim ukupne količine masnog tkiva važna odrednica rizika od nastanka šećerne bolesti jest i raspodjela masnog tkiva. Utvrđeno je da upravo promjene u visceralnome masnom tkivu i disregulacija imunosnog odgovora imaju ključnu ulogu u pokretanju i održavanju začaranog kruga inzulinske rezistencije, kronične sistemske upale i endotelne disfunkcije kao temeljnih patofizioloških mehanizama u podlozi šećerne bolesti tipa 2, ali i drugih manifestacija metaboličkog sindroma poput dislipidemije, arterijske hipertenzije, nealkoholne masne bolesti jetre te, na kraju, kardiovaskularne bolesti. Suočavanje s rastućim problemom debljine i poduzimanje svih mjera usmjerenih k prevenciji i liječenju važno je ne samo s aspekta prevencije šećerne bolesti tipa 2 već i drugih pridruženih čimbenika kardiovaskularnog rizika. Trajna promjena načina života usmjerena prema uravnoteženoj prehrani i redovitoj tjelesnoj aktivnosti temelj je terapijskog pristupa osobama sa šećernom bolešću. Pri odabiru medikamentne terapije prednost treba dati lijekovima koji povrh učinka na regulaciju glikemije povoljno djeluju i na tjelesnu masu. Metabolička kirurgija sve se više prepoznaje kao učinkovita metoda liječenja pretilih osoba sa šećernom bolesti tipa 2.
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