Polyphenols as Suitable control for Obesity and Diabetes

Modern life is characterized by physical inactivity and poor food choices, which is often a prerequisite for unhealthy weight gain and overweight/obesity. These factors unlock the emergence of a number of diseases including diabetes, cardiovascular problems, different types of cancer, etc. The pursuit of scientists to seek strategies to prevent, relieve and cure the patient leads to the usage of natural compounds of potential beneficial effect. Polyphenols are a large group of naturally occurring secondary metabolites mainly found in plants and beverages. The presence of these secondary metabolites seems to decrease the manifestation of miscellaneous disease-causing symptoms. The purpose of this review is to synthesize information about polyphenols and their potential in controlling obesity and diabetes. Polyphenols are considered as health-beneficial sources and thus could be involved in novel strategies for preventing diabetes and obesity complications

Beyond Weight Loss: Added Benefits Could Guide the Choice of Anti-Obesity Medications

Purpose of ReviewTo highlight the added benefits of approved and upcoming, centrally-acting, anti-obesity drugs, focusing not only on the most common metabolic and cardiovascular effects but also on their less explored clinical benefits and drawbacks, in order to provide clinicians with a tool for more comprehensive, pharmacological management of obesity.Recent FindingsObesity is increasingly prevalent worldwide and has become a challenge for healthcare systems and societies. Reduced life expectancy and cardiometabolic complications are some of the consequences of this complex disease. Recent insights into the pathophysiology of obesity have led to the development of several promising pharmacologic targets, so that even more effective drugs are on the horizon. The perspective of having a wider range of treatments increases the chance to personalize therapy. This primarily has the potential to take advantage of the long-term use of anti-obesity medication for safe, effective and sustainable weight loss, and to concomitantly address obesity complications/comorbidities when already established.SummaryThe evolving scenario of the availability of anti-obesity drugs and the increasing knowledge of their added effects on obesity complications will allow clinicians to move into a new era of precision medicine

Macrophage polarization and obesity complications: what we can learn from experimental studies

Clinical and experimental evidences pointed to the role of immune cells and inflammatory mediators on the development of diseases in obese patients. Therefore, it is our objective to explore experimental studies that approach the relationship between the different types of inflammatory reaction inside the adipose tissue, particularly the macrophage polarization and the development of obesity complications. Further, we intend to speculate how to translate this knowledge, obtained from experimental studies, to treatments applicable to the human diseases. PubMed database was sought using the terms “obesity”, “macrophage” and “polarization”. After applying the filters “Language - English” and “Species - Animals”, we arrived to 90 references. Sixty-two were excluded for being reviews or not related to the main subject. Results in experimental models of obesity pointed a relevant correlation between the macrophage polarization to a type 1 response (M1) inside white adipose tissue and the development of insulin resistance, diabetes and other complications of obesity. Several articles report strategies to shift to a type 2 phenotype (M2), using drugs or lifestyle changes. How these findings could be translated to new human treatments is still an open question that only well designed researches could answer.Evidências clínicas e experimentais apontam para o papel das células do sistema imunológico e mediadores inflamatórios no desenvolvimento de doenças em pacientes obesos. Nosso objetivo neste trabalho é explorar estudos experimentais que abordam a relação entre os diferentes tipos de reação inflamatória no tecido adiposo, particularmente a polarização de macrófagos e o desenvolvimento de complicações da obesidade. Além disso, temos a intenção de especular como traduzir esse conhecimento, obtido a partir de estudos experimentais, em tratamentos aplicáveis às doenças humanas. Para tanto, foi realizada busca no banco de dados PubMed, usando-se os termos “obesidade”, “macrófago” e “polarização”. Depois de aplicados os filtros “Idioma - Inglês” e “espécies - Animais”, chegamos a 90 referências. Sessenta e duas dessas foram excluídas por serem revisões ou não estarem relacionados com o assunto principal. Os resultados em modelos experimentais de obesidade indicaram uma correlação significativa entre a polarização de macrófagos para uma resposta do tipo 1 (M1) no interior do tecido adiposo branco e o desenvolvimento de resistência à insulina, diabetes e outras complicações da obesidade. Vários artigos relatam estratégias de mudança para o fenótipo tipo 2 (M2), como uso de drogas ou mudanças de estilo de vida. Ainda é uma questão em aberto o modo como estas descobertas podem ser traduzidas para novos tratamentos em seres humanos, o que só poderá ser respondido por pesquisas bem elaboradas

Can Weight Loss Improve the Cardiovascular Outcomes of Patients with Obesity and Obstructive Sleep Apnea?

Cardiovascular events are the primary cause of mortality in patients with obstructive sleep apnea and obesity. The rising prevalence of obstructive sleep apnea in recent decades has been linked to increasing rates of obesity. Obstructive sleep apnea has also been linked with many different cardiovascular diseases including coronary artery disease, stroke, heart failure, hypertension, and atrial fibrillation. Obesity is an increasing health concern globally, in part because obesity complications such as hypertension, diabetes, and obstructive sleep apnea increase the risk of cardiovascular diseases. More than 10% weight loss may be required to prevent or reverse obesity complications. Treatment approaches to obesity include nutritional therapy, exercise therapy, pharmacotherapy, and surgical therapies. This review intends to identify the effects of weight loss on cardiovascular outcomes in patients with obesity and obstructive sleep apnea. Despite the strong association between cardiovascular diseases and obstructive sleep apnea, randomized trials have failed to demonstrate that treatment of obstructive sleep apnea reduces cardiovascular events, even in patients with established cardiovascular diseases. Weight loss in patients with obstructive sleep apnea improves HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides, but thus far no changes in cardiovascular events have been shown. The combination of weight loss with continuous positive airway pressure (CPAP) appears more beneficial than either treatment in isolation. Large well-controlled trials in patients with obstructive sleep apnea to assess the effects of different weight reduction programs on cardiovascular disease are still needed

Immune and Inflammatory Pathways in Non-Alcoholic Steatohepatitis (NASH). An update

Non-alcoholic steatohepatitis (NASH), also known as fatty liver disease (FLD), is a major public health problem. It is considered to be the hepatic manifestation of the metabolic syndrome. Chronic inflammation of the liver is an essential key in the progression from simple hepatic steatosis to steatohepatitis, the evolutionary stage of fatty liver disease. Moreover, the innate immune system plays a crucial role in the progression of hepatic inflammation. For this reason, it is of utmost importance to elucidate the connections between immune mechanisms, Toll-like receptor cytokine signalling, in order to find new effective treatments. Further studies are necessary to test theories presented in this paper. The elucidation of mechanisms underlying the progression of hepatic steatosis towards steatohepatitis is essential for the development of useful diagnosis and treatment for medical practice

European Guidelines for Obesity Management in Adults

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management. (C) 2015 S. Karger GmbH, Freibur

The impact of thyroid function on the occurrence of metabolic syndrome in obese children and adolescents

Wstęp: Zaburzenia funkcji osi tarczycowej są częste u pacjentów otyłych. Ich znaczenie w rozwoju metabolicznych powikłań otyłości pozostaje niejasny. Cel badania: Ocena wpływu zaburzeń funkcji tarczycy u pacjentów otyłych na wystąpienie u nich powikłań metabolicznych. Materiały i metody: Ocena funkcji tarczycy w grupie 100 pacjentów (59 dziewcząt, 41 chłopców; średni wiek 13,5 roku) z otyłością prostą (średni BMI SDS u chłopców 4,175 i u dziewcząt 4,723) z zespołem metabolicznym rozpoznanym na podstawie kryteriów IDF 2007 ZM (ZM, 25 pacjentów) i bez. U wszystkich wykonano oznaczenie stężeń TSH, fT4, fT3 przeciwciał przeciw tyreoperoksydazie tarczycowej (TPOAb) i przeciwciał przeciwko tyreoglobulinie (TGAb) w pojedynczej próbce krwi. Wyniki: W analizowanej grupie nie stwierdzono przypadku jawnej niedoczynności tarczycy. Nie było istotnych statystycznie różnic (p > 0,05) średniej wartości TSH, fT4 i fT3 u pacjentów z ZM i bez ZM (odpowiednio: 2,7 μIU/ml vs 3,0 μIU/ml, 14,5 vs 14,0 pmol/l i 5,6 vs 6,2 pmol/l). W grupie spełniającej kryteria ZM (n = 25) tylko dwie osoby (2/25; 8%) miały stężenie TSH powyżej górnej granicy normy (N: 0,3-4,0 μIU/ml). W grupie bez ZM zwiększone stężenie TSH stwierdzono u 18 (18/75; 24%) pacjentów. Maksymalną wartość TSH (10,44 μIU/ml) odnotowano u chłopca bez ZM. Dodatnie miano przeciwciał przeciwtarczycowych (TPOAb i/lub TGAb) było obecne u 11% pacjentów: 2 pacjentów (2/25; 8%) z ZM i u 9 (9/75; 12%) bez ZM. Wnioski: Izolowane zwiększenie stężenia TSH jest częste u otyłych nastolatków, chociaż nie występuje zależność pomiędzy stężeniem TSH, fT3 ani fT4 a wartością BMI SDS. Izolowane zwiększenie stężenia TSH nie ma związku z występowaniem ZM u młodzieży.Introduction: Thyroid axis abnormalities are common in obese patients. Their contribution in the development of metabolic obesity complications remains unclear. Aim of study: To assess the influence of thyroid axis dysfunction on the occurrence of metabolic obesity complications. Material and methods: A cross-sectional review of the thyroid function in 100 obese patients (59 girls and 41 boys, mean age 13.5 years) with alimentary obesity (mean standardised body mass index [BMI SDS] in boys 4.175 and girls 4.723) complicated by metabolic syndrome (MS) diagnosed on the basis of the IDF 2006 criteria (MS, 25 patients) and uncomplicated (75 patients). TSH, fT4, fT3 thyroid peroxidase antibodies (TPOAb), and thyroglobulin antibodies (TGAb) were assessed in a single fasting blood sample. Results: There was no case of overt thyroid disease within the whole analysed group. There were no significant differences in mean TSH, fT4, and fT3 levels in patients with and without MS (2.7 μIU/ml vs. 3.0 μIU/ml, 14.5 vs. 14.0 pmol/l, and 5.6 vs. 6.2, respectively; p > 0.05). In the MS group only two patients (8%) presented with a TSH level above the upper limit of the normal range; in the group without MS elevated TSH was noticed in 18 (24%) patients. The maximal value of TSH (10.44 μIU/ml) was noticed in one boy without MS. Positive TPOAb and/or TGAb were present in 11% of all patients: two patients (8%) with MS and nine (12%) without MS. Conclusions: Isolated increased TSH level is common in obese adolescents, although there is no correlation between TSH, fT3, and fT4 levels and BMI SDS value. Isolated increased TSH level is not associated with the occurrence of MS in obese adolescents. The occurrence of asymptomatic autoimmune thyroiditis (AITD) in obese adolescents is more common than in the general population

Association between adiposity indicators, metabolic parameters and inflammatory markers in a sample of female adolescents

The aim of this study was to investigate the association between total and abdominal adiposity with metabolic parameters and inflammatory markers, in female adolescents. The sample consisted of 53 adolescents aged 13 to 17 years from a public school in Curitiba, Brazil. The adiposity indicators studied were body mass index (BMI), waist circumference (WC), trunk fat mass (TKFM), total fat mass (TFM) and body fat percentage (BF%) measured by dual-energy X-ray absorptiometry. The metabolic and inflammatory parameters studied were systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, insulin, homeostasis model assessment index for insulin resistance (HOMA-IR), lipids, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), leptin, adiponectin and resistin. Eighty percent of WC variation, 87% of TKFM and TFM, and 73% of BF% were predicted by BMI variation. There was a significant positive correlation between all indicators of adiposity with SBP, DBP, insulin, HOMA-IR, CRP and leptin. Triglycerides were positively correlated with BMI and WC, and adiponectin correlated negatively with BMI. TNF-α, IL-6, glucose, total cholesterol, and high- and low-density lipoprotein cholesterol did not correlate to the studied variables. BMI showed a significant association with most of the parameters studied, and WC was slightly better than BMI to predict insulin resistance in this specific population.59432533

The ABCD of obesity: An EASO position statement on a diagnostic term with clinical and scientific implications

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO’s proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage

The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO’s proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage