Effects of Weight Reduction, Exercise, and Diet Modification on Lipids and Apolipoproteins A-l and B in Severely Obese Persons

We assessed the lipid and apolipoprotein effects of hypocaloric dieting, increased physical activity, and dietary modification in severely overweight adults (body mass index [BMI] 43.05 kg/m-). The 34 women and four men enrolled in the ambulatory weight control program donated blood before, during, and after hypocaloric dieting (420 kcal/day). Mean values before dieting included cholesterol of 223 mg/dL, high-density lipoprotein (HDL) cholesterol of 43 mg/dL, and cholesterol/HDL cholesterol of 5.90. This placed our subjects at high risk for coronary artery disease. Other values included triglycerides of 138 mg/dL, apolipoprotein A-l of 152 mg/dL. and apolipoprotein B/apolipoprotein A-l of 0.64. Significant reductions during hypocaloric dieting included mean cholesterol of 171 mg/dL, triglycerides of 99 mg/dL. and apolipoprotein A-l of 120 mg/dL. During weight maintenance (mean BMI 36.08 kg/m²). significant reductions compared to baseline included a mean cholesterol of204 mg/dL and cholesterol/HDL cholesterol of 4.60. Also, a significant increase occurred in HDL cholesterol (51 mg/dL). but a nonsignificant elevation was observed in apolipoprotein A-l (180 mg/dL). In four subjects, discordant ratios of cholesterol/HDL cholesterol or apolipoprotein B/apolipoprotein A-1 were seen. and one ratio improved in two subjects despite relapse of obesity. Changes in both HDL composition and HDL particle concentration may explain elevations of HDL cholesterol and apolipoprotein A-l after dieting. Discordance between lipid and apolipoprotein ratios may occur. Improvement in lipids or apolipoproteins may be seen despite regained weight

Diabetes in Older Adults: A Consensus Report

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95492/1/jgs12035.pd

The metabolic syndrome in hypertension: European society of hypertension position statement

, on behalf of the Scientific Council of the European Society of Hypertension The metabolic syndrome considerably increases the risk of cardiovascular and renal events in hypertension. It has been associated with a wide range of classical and new cardiovascular risk factors as well as with early signs of subclinical cardiovascular and renal damage. Obesity and insulin resistance, beside a constellation of independent factors, which include molecules of hepatic, vascular, and immunologic origin with proinflammatory properties, have been implicated in the pathogenesis. The close relationships among the different components of the syndrome and their associated disturbances make it difficult to understand what the underlying causes and consequences are. At each of these key points, insulin resistance and obesity/proinflammatory molecules, interaction of demographics, lifestyle, genetic factors, and environmental fetal programming results in the final phenotype. High prevalence of end-organ damage and poor prognosis has been demonstrated in a large number of cross-sectional and a few number of prospective studies. The objective of treatment is both to reduce the high risk of a cardiovascular or a renal event and to prevent the much greater chance that metabolic syndrome patients have to develop type 2 diabetes or hypertension. Treatment consists in the opposition to the underlying mechanisms of the metabolic syndrome, adopting lifestyle interventions that effectively reduce visceral obesity with or without the use of drugs that oppose the development of insulin resistance or body weight gain. Treatment of the individual components of the syndrome is also necessary. Concerning blood pressure control, it should be based on lifestyle changes, diet, and physical exercise, which allows for weight reduction and improves muscular blood flow. When antihypertensive drugs are necessary, angiotensinconverting enzyme inhibitors, angiotensin II-AT1 receptor blockers, or even calcium channel blockers are preferable over diuretics and classical b-blockers in monotherapy, if no compelling indications are present for its use. If a combination of drugs is required, low-dose diuretics can be used. A combination of thiazide diuretics and b-blockers should be avoided

The comparison of the effects of lifestyle activity and structured cardiovascular exercise on obesity-related risk factors of African-American women ages 22-55.

The purpose of this study was to examine the effects of lifestyle activity modification (LA) and structured exercise (Cardio) on obesity-related factors in sedentary African American women. Subjects were randomized to a control group, a Cardio group, or LA group for a twelve week intervention. The study examined the intervention effects on physical activity patterns, blood lipids, glucose & insulin response, blood pressure, cardiovascular fitness and body composition. Analysis of variance (ANOVA) for pre-post differences in the dependent variables revealed significant baseline differences between groups for LDL cholesterol only. Thus, pre-post treatment differences for LDL were assessed using an ANCOVA model, with baseline LDL as the covariate. Significant pre-post effects were observed for cardiorespiratory fitness (p = 0.024), physical activity level (p=0.000), total cholesterol (p=0.006), and HDL cholesterol (p=0.017). Significant pre-post by treatment condition interaction effects were observed for body weight (p=0.001), body composition (percent body fat) (p<0.001), and cardiorespiratory fitness (predicted VO2max) (p=0.024). Although post-hoc analysis failed to reveal significant differences among groups, there were slight trends (which merit further investigation) toward decreasing obesity-related risk within the 2 activity groups, when compared to Control

The Drug Repurposing Ecosystem: Intellectual Property Incentives, Market Exclusivity, and the Future of New Medicines

The pharmaceutical industry is in a state of fundamental transition. New drug approvals have slowed, patents on blockbuster drugs are expiring, and costs associated with developing new drugs are escalating and yielding fewer viable drug candidates. As a result, pharmaceutical firms have turned to a number of alternative strategies for growth. One of these strategies is drug repurposing -finding new ways to deploy approved drugs or abandoned clinical candidates in new disease areas. Despite the efficiency advantages of repurposing drugs, there is broad agreement that there is insufficient repurposing activity because of numerous intellectual property protection and market failures. This Article examines the system that surrounds drug repurposing, including serendipitous discovery, the application of big data methods to prioritize promising repurposing candidates, the unorthodoxly regulated off-label prescription practices of providers, and related prohibitions on pharmaceutical firms\u27 off-label marketing. The Article argues that there is a complex ecosystem in place and that additional or disruptive IP or market exclusivity incentives may harm as much as help in promoting repurposing activity. To illustrate this threat, the Article traces the trajectory of metformin, a common diabetes drug that shows promise for conditions ranging from polycystic ovary syndrome to breast cancer. From the initial reasons for Bristol-Myers Squibb to refuse to invest in promising alternative uses, to the institutions, researchers, and regulators who identified possibilities for metformin treatment, this Article aims to map the role of intellectual property protection, market exclusivity, and search for capital that led to metformin\u27s ascent as a repurposed drug. The Article contributes a concrete understanding to an important problem in pharmaceutical law and policy, one for which scholars have quickly suggested more powerful patent and market exclusivity protection when doing so may undermine the very processes now leading to effective alternative uses for existing drugs

Exploring the potential of using mobile applications in diabetes management

Background Diabetes mellitus is a common chronic disease and a leading cause of morbidity, complications and mortality worldwide. The number of people living with diabetes is projected to rise sharply over the forthcoming decades. Diabetes care is complex and can overburden clinicians and nurses. There is a need for innovative, flexible and cost-effective technologies to enable successful diabetes management. This thesis explores the opportunities and challenges of the mobile application (app) technology as a potential tool to support diabetes care and management. Purpose The purpose was to develop and evaluate a mobile app that supports healthcare professionals (HCPs) in clinical decision-making. Methods A mixed-methods approach was used following the user-centred design (UCD) framework for the design and implementation of all studies. Quantitative and qualitative systematic reviews of studies reporting the use of mobile apps to support diabetes management were undertaken to identify, appraise and summarise available research evidence. An interview study was carried out with diabetes specialist nurses (DSNs), to explore their experiences and views, and to identify user requirements for apps. Lastly, a guidelines-based mobile clinical decision-support app was developed and tested with junior doctors and DSNs in a controlled environment to evaluate its usability and impact on adherence to clinical guidelines, and to explore how participants experienced the app and their suggestions for improvements. Results Both reviews found that the existing evidence base for mobile apps is weak and inadequate to draw conclusions about the impact of their use as interventions in diabetes management. The interview study identified that nurses lack experience in using apps in clinical practice, even though they believed it could facilitate and support their work. ‘Diabetes & CKD’, a simple mobile decision-support app, has been designed and built for the study to assist HCPs in management of patients with diabetes and kidney disease and was tested by 39 junior doctors and 3 DSNs. It had no impact on the accuracy of decisions. Feedback from participants after the pilot session and usability testing indicated a wish to integrate such apps into their clinical practice with a strong willingness to use them in the future. Conclusions Application of UCD methods was efficient as the app was well-accepted by both DSNs and junior doctors. Despite the positive views and the strong willingness to use such apps, they are not widely used. There is a need to regulate the use of medical apps in clinical practice. Further research with rigorous methodology is required upon which policymakers and practitioners can base their decision-making

The Drug Repurposing Ecosystem: Intellectual Property Incentives, Market Exclusivity, and the Future of New Medicines

The pharmaceutical industry is in a state of fundamental transition. New drug approvals have slowed, patents on blockbuster drugs are expiring, and costs associated with developing new drugs are escalating and yielding fewer viable drug candidates. As a result, pharmaceutical firms have turned to a number of alternative strategies for growth. One of these strategies is drug repurposing -finding new ways to deploy approved drugs or abandoned clinical candidates in new disease areas