The effects of the Endoluminal Duodeno-Jejunal bypass liner on eating behaviour in humans

Background: The Endoluminal Duodeno-Jejunal Bypass Liner (DJBL) is a thin, flexible, sleeve-like device, made of a single use 60cm fluoropolymer. The DJBL is inserted endoscopically through the mouth and anchored to the proximal small intestine to acts as a physical barrier between the walls of the duodenal and the food ingested. The DJBL is currently being used for the treatment of diabetes in patients with obesity. Therefore, this device offers the unique opportunity to apply a reductionist approach and interrogates the contribution of bypassing the proximal bowel in the regulation of eating behaviour. This is the first study to assess eating behaviour in DJBL patients using direct and indirect measures of behaviour. Aims: To assess whether the DJBL affects eating behaviour 6-months post intervention compared to Best Medical Practice for the treatment of obesity and Type 2 Diabetes. Objective: To investigate the effect of DJBL on: 1. Food choices and calories intake 2.  Eating behaviour 3. The sensory domain of taste. 4. The appetitive behaviour subdomain of the hedonic ingestive motivation domain. 5. The consummatory behaviour subdomain of the hedonic ingestive motivation domain. Methods: This was a randomised controlled study of 42 subjects (23 DJBL, 19 SMT) with Type 2 Diabetes Mellitus who receive the DJBL device or standard medical therapy alone. All patients (40% female) were studied at baseline and followed up for 6-months post intervention. Food choices and calories intake were assessed using Food Diaries, Food Frequency Questionnaire, and 24hr Diet Recall. Psychology and personality traits linked to eating behaviour were assessed with questionnaires, whereas appetite and hunger scores were assessed with Visual Analogue Scales. The intensity of sweet taste stimuli was measured using (a direct behavioural technique) to determine the taste detection threshold using the method of constant stimuli. The appetitive reward of sweet taste stimuli was assessed using a progressive ratio task (a direct behavioural technique). Finally, the consummatory reward value of taste was assessed using visual analogue scales (indirect behaviour technique). Results: 1. Total food intake reduced from at 6-months reduced albeit not significantly and DJBL patients had a modest healthier shift in food preferences. 2. A shift towards healthier eating behaviour and psychological factors was found, which was specific to the treatment type. However, no change in the reported appetite ratings was found. 3. No changes in sucrose detection threshold after DJBL. 4. No change in the appetitive reward value of sweet and fatty tastant after DJBL. 5. No change in the consummatory reward value of sweet taste after DJBL. Conclusion: I conclude, that despite not adding extra benefits on total weight loss, the DJBL could potentially make weight loss an easier task due to the modest changes in food preferences and eating behaviour and psychological traits. In addition, the DJBL did not affect any of the taste dimensions. Therefore, the bypass of the proximal small bowel is not behind the changes in eating behaviour observed post RYGB or that RYGB alters eating behaviour via a combined/synergistic effect of the multiple components and the profound changes in the GI tract. This study contributes to the clinical benefits of the use of DJBL for weight loss and also to the research field on the physiological mechanisms behind RYGB operation.Open Acces

Obesity Treatments to Improve Type 1 Diabetes (OTID): a randomized controlled trial of the combination of glucagon-like peptide 1 analogues and sodium-glucose cotransporter 2 inhibitors—protocol for Obesity Treatments to Improve Type 1 Diabetes (the OTID trial)

Background: The guidelines of the American Diabetes Association and European Association for the Study of Diabetes suggest that patients with obesity type 2 diabetics and chronic kidney disease need either glucagon-like peptide 1 receptor analogues or sodium-glucose cotransporter-2 inhibitors. If neither achieve metabolic control, then the recommendation is to combine both drugs. The evidence base for combining glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors is not well researched, and hence, the impact of the guidelines is limited. The aim of this randomized controlled trial is to test the impact of the combination of glucagon-like peptide 1 receptor analogues/sodium-glucose cotransporter-2 inhibitors on body weight and kidney damage, in patients with type 1 diabetes and chronic kidney disease. In addition, we will explore the associated changes in the metabolic pathways with each of the treatments used in this randomized controlled trial. Methods: In this 6-month randomized control trial, 60 participants aged between 21 and 65 years, with a body mass index above 25 kg/m2, and type 1 diabetics with chronic kidney disease will be randomized to receive 1 of 5 possible treatments: (1) standard care (control), (2) glucagon-like peptide 1 receptor analogues alone, (3) sodium-glucose cotransporter-2 inhibitors alone, (4) combination of glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors and (5) combination of glucagonlike peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors with intensive lifestyle advice. The primary objective will be the percentage change in total body weight from baseline at 6 months. The secondary objectives are to compare the change in glycaemia; blood pressure; dyslipidaemia; albuminuria; proportion of participants reaching weight loss of ≥ 5%, ≥ 10% and ≥ 15%; and change in BMI (kg/m2) from baseline and change in waist circumference (cm). All the experiments will be conducted at the Dasman Diabetes Institute after approval from the local research and ethics committee. Discussion: The present randomized controlled trial aims to investigate the impact of the combination of glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors on body weight and kidney damage in patients with type 1 diabetes mellitus and chronic kidney disease, as well as exploring the associated changes in the metabolic pathways with each of the treatments used. This study addresses the current gap in the evidence base regarding the combination of these two drugs, which is particularly relevant given the American Diabetes Association and European Association for the Study of Diabetes guidelines recommending their combined use for patients with obesity, type 2 diabetes, and chronic kidney disease who do not achieve metabolic control with either drug alone. Trial registration: ClinicalTrials.gov Identifier: NCT05390307 Trial registration date - 25th May 202

A Comparison of Total Food Intake at a Personalised Buffet in People with Obesity, before and 24 Months after Roux-en-Y-Gastric Bypass Surgery

Long-term reductions in the quantity of food consumed, and a shift in intake away from energy dense foods have both been implicated in the potent bariatric effects of Roux-en-Y gastric bypass (RYGB) surgery. We hypothesised that relative to pre-operative assessment, a stereotypical shift to lower intake would be observed at a personalised ad libitum buffet meal 24 months after RYGB, driven in part by decreased selection of high energy density items. At pre-operative baseline, participants (n = 14) rated their preference for 72 individual food items, each of these mapping to one of six categories encompassing high and low-fat choices in combination with sugar, complex carbohydrate or and protein. An 18-item buffet meal was created for each participant based on expressed preferences. Overall energy intake was reduced on average by 60% at the 24-month buffet meal. Reductions in intake were seen across all six food categories. Decreases in the overall intake of all individual macronutrient groups were marked and were generally proportional to reductions in total caloric intake. Patterns of preference and intake, both at baseline and at follow-up appear more idiosyncratic than has been previously suggested by verbal reporting. The data emphasise the consistency with which reductions in ad libitum food intake occur as a sequel of RYGB, this being maintained in the setting of a self-selected ad libitum buffet meal. Exploratory analysis of the data also supports prior reports of a possible relative increase in the proportional intake of protein after RYGB

Does Bypass of the Proximal Small Intestine Impact Food Intake, Preference, and Taste Function in Humans? An Experimental Medicine Study Using the Duodenal-Jejunal Bypass Liner

The duodenal-jejunal bypass liner (Endobarrier) is an endoscopic treatment for obesity and type 2 diabetes mellitus (T2DM). It creates exclusion of the proximal small intestine similar to that after Roux-en-Y Gastric Bypass (RYGB) surgery. The objective of this study was to employ a reductionist approach to determine whether bypass of the proximal intestine is the component conferring the effects of RYGB on food intake and sweet taste preference using the Endobarrier as a research tool. A nested mechanistic study within a large randomised controlled trial compared the impact of lifestyle modification with vs. without Endobarrier insertion in patients with obesity and T2DM. Forty-seven participants were randomised and assessed at several timepoints using direct and indirect assessments of food intake, food preference and taste function. Patients within the Endobarrier group lost numerically more weight compared to the control group. Using food diaries, our results demonstrated similar reductions of food intake in both groups. There were no significant differences in food preference and sensory, appetitive reward, or consummatory reward domain of sweet taste function between groups or changes within groups. In conclusion, the superior weight loss seen in patients with obesity and T2DM who underwent the Endobarrier insertion was not due to a reduction in energy intake or change in food preferences

Effectiveness of integrating a pragmatic pathway for prescribing liraglutide 3.0mg in weight management services (STRIVE study): a multicentre, open-label, parallel-group, randomized controlled trial

Summary. Background: An effective prescribing pathway for liraglutide 3 mg, an approved obesity pharmacotherapy, may improve treatment access. This trial compared a targeted prescribing pathway for liraglutide 3 mg with multiple stopping rules in specialist weight management services (SWMS) to standard SWMS care. Methods: This phase four, two-year, multicentre, open-label, parallel-group, real-world randomized clinical trial (ClinicalTrials.gov: NCT03036800) enrolled adults with BMI ≥35 kg/m2 plus prediabetes, type 2 diabetes, hypertension or sleep apnoea from five SWMS in Ireland and UK. Participants were randomly allocated (2:1, stratified by centre and BMI) to SWMS care plus a targeted prescribing pathway for once daily subcutaneous liraglutide 3 mg (intervention) with stopping rules at 16 (≥5% weight loss, WL), 32 (≥10% WL) and 52 weeks (≥15% WL) or to SWMS care alone (control) through an online randomization service. The primary outcome was WL ≥15% at 52 weeks, assessed by complete cases analysis. All randomized participants were included in safety analysis. Findings From November 28, 2017 to February 28, 2020, 434 participants were screened, and 392 randomized (260 intervention; 132 control), while 294 (201 intervention; 93 control) included in the 52 weeks complete case analysis. More intervention than control participants achieved WL ≥15% at 52 weeks [51/201 (25.4%) vs 6/93 (6.5%); odds ratio 5.18; 95% CI 2.09, 12.88; p < 0.0001]. More adverse events occurred in the intervention (238/260, 91.5%; two deaths) than control (89/132, 67.4%; no deaths) group. Interpretation: A targeted prescribing pathway for liraglutide 3 mg helps more people achieve ≥15% WL at 52 weeks than standard care alone

The Impact Once-Weekly Semaglutide 2.4 mg Will Have on Clinical Practice: A Focus on the STEP Trials

Obesity is a complex and chronic disease that raises the risk of various complications. Substantial reduction in body weight improves these risk factors. Lifestyle changes, including physical activity, reduced caloric ingestion, and behavioral therapy, have been the principal pillars in the management of obesity. In recent years, pharmacologic interventions have improved remarkably. The Semaglutide Treatment Effect in People with Obesity (STEP) program is a collection of phase-III trials geared toward exploring the utility of once-weekly 2.4 mg semaglutide administered subcutaneously as a pharmacologic agent for patients with obesity. All the STEP studies included diet and exercise interventions but at different intensities. This review paper aims to explore the impact of the behavioral programs on the effect of semaglutide 2.4 mg on weight loss. The results of the STEP trials supported the efficacy of high-dose, once-weekly 2.4 mg semaglutide on body weight reduction among patients with obesity with/without diabetes mellitus. Semaglutide was associated with more gastrointestinal-related side effects compared to placebo but was generally safe and well tolerated. In all the STEP studies, despite the varying intestines of the behavioral programs, weight loss was very similar. For the first time, there may be a suggestion that these behavioral programs might not increase weight reduction beyond the effect of semaglutide. Nevertheless, the importance of nutritional support during substantial weight loss with pharmacotherapy needs to be re-evaluated

Apunts. Educació física i esports

Resumen tomado del autor. Contiene gráficas y tablas de datos y resultadosSe realiza un estudio del ritmo con la finalidad de validar una batería de pruebas de ritmo. Esta batería se ha aplicado a tres muestras que presentan diferentes tipos y niveles de experiencia respecto de la capacidad rítmica. Grupo 1: nula o escasa experiencia; grupo 2: profesores de música; grupo 3: gimnastas de gimnasia rítmica. Como conclusiones más destacables del estudio se expone que, en primer lugar, el 'tempo' de las pruebas condiciona el ajuste temporal. En segundo lugar, se constata que existen diferencias significativas entre el Grupo 2 -músicos- y el resto de los grupos en algunas pruebas rápidas (estructuras ternaria y cuaternaria), lentas (estructuras ternaria y cuaternaria) y muy lentas (todas las estructuras). En tercer lugar, se destaca que las pruebas de estructura simple presentan mejores resultados que las de estructura ternaria y éstas mejores resultados que las de estructura cuaternaria.CataluñaUniversitat de les Illes Balears. Redined Balears; Edifici Guillem Cifre de Colonya. Ctra. de Valldemossa, Km 7,5; 07122 Palma; +34971172792; +34971173190; [email protected]

The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids

Background &amp; aims: Duodenal-jejunal bypass liners (DJBLs) prevent absorption in the proximal small intestine, the site of fatty acid absorption. We sought to investigate the effects of a DJBL on blood concentrations of essential fatty acids (EFAs) and bioactive polyunsaturated fatty acids (PUFAs). Methods: Sub-study of a multicentre, randomised, controlled trial with two treatment groups. Patients aged 18–65 years with type-2 diabetes mellitus and body mass index 30–50 kg/m 2 were randomised to receive a DJBL for 12 months or best medical therapy, diet and exercise. Whole plasma PUFA concentrations were determined at baseline, 10 days, 6 and 11.5 months; data were available for n = 70 patients per group. Results: Weight loss was significantly greater in the DJBL group compared to controls after 11.5 months: total body weight loss 11.3 ± 5.3% versus 6.0 ± 5.7% (mean difference [95% CI] = 5.27% [3.75, 6.80], p &lt; 0.001). Absolute concentrations of both EFAs, linoleic acid and α-linolenic acid, and their bioactive derivatives, arachidonic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid, were significantly lower in the DJBL group than in the control group at 6 and 11.5 months follow-up. Total serum cholesterol, LDL-cholesterol and HDL-cholesterol were also significantly lower in the DJBL group. Conclusion: One year of DJBL therapy is associated with superior weight loss and greater reductions in total serum cholesterol and LDL-cholesterol, but also depletion of EFAs and their longer chain derivatives. DJBL therapy may need to be offset by maintaining an adequate dietary intake of PUFAs or by supplementation. Trial registration: ClinicalTrials.gov Identifier NCT02459561. </p

Aetiology of obesity in adults

Biology determines the intensity of an individual's drive to eat and the strength of inhibition of the processes of satiation and satiety. These processes are interpreted in relation to the existence of an obesogenic environment that encourages over consumption. The majority of obesity has a complex multifactorial/polygenic aetiology. This chapter focuses on the physiology of obesity and the key peripheral and central signals involved in the regulation of body weight. It presents the evidence for cross-sectional and longitudinal associations between physical activity, physical fitness and sedentary behaviour with overweight and obesity in adults. The chapter then discusses the relationships between current physical activity guidelines and weight gain prevention. The potential effect of obesogenic medications is considered when evaluating individuals presenting for weight management. Effective advice and support to avoid or minimise weight gain would be the optimal approach in patients receiving treatment with obesogenic medications