The effect of Mediterranean diet on oxidation stress in obese patients

Kontinuirana progresija prevalencije pretilosti tijekom proteklih desetljeća i njezina terapijska tvrdokornost uvrstile su pretilost u red globalno najvažnijih javnozdravstvenih, socioekonomskih i kliničkih tema. Prema recentnim smjernicama, najvažnije mjesto u liječenju pretilosti zauzima promjena životnih navika s naglaskom na dijetu i tjelesnu aktivnost. U posljednje se vrijeme ističu dobrobiti mediteranske dijete za koju danas postoji sve veći broj dokaza, ali točan mehanizam djelovanja mediteranske dijete još nije u potpunosti razjašnjen. Svrha ovoga rada bila je istražiti djelovanje mediteranske dijete na oksidativni stres kao primarnu mjeru ishoda te time pridonijeti boljem razumijevanju mehanizma njezina djelovanja u pretilih bolesnika. Sekundarne mjere ishoda obuhvaćale su antropometrijske mjere te kliničke i biokemijske čimbenike rizika u pretilih osoba. U istraživanje su bila uključena 124 pretila bolesnika (spol: 32 M i 92 Ž; dob: 47,5 ± 12,42 godina; ITM: 41,59 ± 7,32 kg/m2), randomiziranih u skupine na mediteranskoj (MD) (n = 63) ili standardnoj hipolipemičkoj dijeti (SHD) (n = 61), od čega je njih 84 završilo studiju (40 ispitanika u MD skupini i 44 ispitanika u SHD skupini). Ispitanici su bili uključeni u program mršavljenja koji se temeljio na promjenama životnih navika, a u sklopu kojega je bila petodnevna edukacija te pet kontrolnih pregleda unutar dvanaestomjesečnog razdoblja. Rezultati ovog istraživanja pokazali su da je MD bila značajno učinkovitija u povećanju ukupnog antioksidativnog kapaciteta (TAC); TAC je nakon dvanaest mjeseci iznosio 2,47 ± 0,45 mmolTE/L u MD skupini i 2,31 ± 0,51 mmolTE/L u SHD skupini (P < 0,001 za učinak vremena, P = 0,009 za učinak interakcije vremena i dijete). Metodom multiple regresije, vrsta dijete pokazala se kao jedini značajan čimbenik za promjenu TAC-a (P = 0,013), dok tjelesna aktivnost, spol, promjena tjelesne mase i koncentracija urata nisu značajnije doprinijeli promjeni koncentracije TAC-a. U ovom istraživanju nije primijećen statistički značajan učinak vremena niti ispitivanih intervencija na oxLDL, OLAB ili njihov omjer. Istraživanje je također potvrdilo povoljan utjecaj ispitivanih intervencija na mršavljenje; obje su intervencije utjecale na značajno smanjenje tjelesne mase (P < 0,001), opsega struka (P < 0,001) i ITM-a (P < 0,001) tijekom vremena. Osim toga, ovaj je rad potvrdio bolju učinkovitost MD u smanjenju sistoličkog arterijskoga tlaka (pad od 8,27 ± 18,32 mmHg u MD skupini vs 1,25 ± 18,34 mmHg u SHD skupini) i u povišenju vrijednosti HDL-kolesterola (porast od 0,11 ± 0,24 mmol/L u MD skupini i 0,003 ± 0,19 mmol/L u SHD skupini) u usporedbi s SHD. Stoga ovi rezultati potvrđuju hipotezu da MD dovodi do redukcije većeg broja čimbenika metaboličkog sindroma. Ovo istraživanje po prvi put je na uzorku pretilih bolesnika hrvatske populacije ustanovilo važne čimbenike uspješnosti mršavljenja uz primijenjene nefarmakološke mjere. Pored toga, dobiveni rezultati pridonijeli su razumijevanju pretpostavljenog antioksidativnog mehanizma djelovanja mediteranske prehrane, dajući dobru osnovu za daljnja usmjerena istraživanja u ovom području.The rise in global obesity rates over the last decades and its non-responsiveness to the therapeutic measures have been substantial, presenting obesity as a major public health, socioeconomic and clinical issue. The recent guidelines for the management of obesity recommend lifestyle changes with diet and physical activity as the most important therapeutic measure. Numerous evidence point to the benefits of Mediterranean diet (MD); however, its exact mechanism of action is still ambiguous. Therefore, the aim of this work was to explore the effect of MD on oxidative stress as the primary endpoint what could lead to the better understanding of the mechanism of action of MD in obese patients. 124 obese patients participated in study (sex: 32 M and 92 F, age: 47.5 ± 12.42, BMI: 41.59 ± 7.32 kg/m2), and were randomized to either MD (n = 63) or standard hypolipemic diet (SHD) (n = 61) group. 84 subjects (40 in MD and 44 in SHD group) completed the study. All subjects participated in a weight reduction programme, involving intensive 5-day educational intervention on diet, physical activity and behavioural therapy, followed by five follow-up visits during the twelve months. The results imply MD beneficial effect on total antioxidant capacity (TAC); twelve months mean (± SD) TAC values were 2.47 ± 0,45 mmolTE/L and 2.31 ± 0.51 mmolTE/L in MD and SHD, respectively (P < 0.001 for time effect; P = 0.005 for time-diet interaction effect). Multiple regression model identified type of diet as the only significantly contributing factor to TAC change (P = 0.013), while physical activity, gender, body weight change and urate concentration did not contribute significantly. We did not observe the statistically significant time or diet effect on oxLDL, OLAB or their ratio. This study confirmed the beneficial effect of both interventions in weight management, measured as reduction in body weight (P < 0.001), waist circumference (P < 0.001) and BMI (P < 0.001). Compared with the SHD, systolic blood pressure (SBP) decreased (8.27 ± 18.32 mmHg and 1.25 ± 18.34 mmHg in MD and SHD group, respectively) and HDL cholesterol increased (0.11 ± 0.24 mmol/L and 0.,003 ± 0.19 mmol/L in MD and SHD group, respectively) significantly in the MD group. Therefore, these results confirm the hypothesis that adherence to the MD is associated with more prominent reduction of the metabolic syndrome components. This is the first study identifying variables predictive of successful weight loss among obese Croatian patients. Additionally, the obtained results contribute to the understanding of proposed antioxidative mechanism of MD and could be used as the basis for further research in this area

The antioxidative protecting role of the Mediterranean diet [Antioksidativno protektivno djelovanje mediteranske dijete]

Recent meta-analysis shows that adherence to a Mediterranean diet (MD) can significantly decrease the risk of overall mortality, mortality from cardiovascular diseases, as well as incidence of mortality from cancer, and incidence of Parkinson's and Alzheimer's disease. All of these diseases could be linked to oxidative stress (OS) as antioxidative effect of MD is getting more attention nowadays. Although a lot of research has been done in this area and it suggests antioxidative protective role of MD, the presented evidence is still inconclusive. The aim of this paper is to review studies investigating the effect of MD on OS, as well as to identify the areas for further research

Metabolic Syndrome

Metabolički sindrom (MetS) podrazumijeva skup metaboličkih poremećaja koji povećavaju rizik od šećerne bolesti tipa 2, srčanožilnih bolesti, moždanog udara, masne jetre, određenih malignih i nekih drugih bolesti. U ovome preglednom radu raspravljeni su koncept, definicija i terapija MetS pri čemu su uzete u obzir trenutačne smjernice i dostupni dokazi u liječenju stanja povezanih s MetS. U liječenju MetS ključno je rano prepoznavanje osoba s MetS i poduzimanje mjera koje će smanjiti prisutnost rizičnih čimbenika. Najvažnija terapijska intervencija je promjena životnih navika (zdrava prehrana i povećanje tjelesne aktivnosti), dok je terapiju lijekovima (primjerice antihipertenzivima, antidijabeticima, hipolipemicima) potrebno uvesti tek ako nefarmakološkim mjerama nisu postignute ciljne vrijednosti individualnih komponenata MetS.Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that confer an increased risk for type 2 diabetes mellitus, cardiovascular diseases, stroke, fatty liver, certain cancers, etc. This article reviews the concept, definition and treatment of MetS taking into consideration current guidelines and available evidence for treatment of conditions associated with MetS. Management of MetS focuses on recognizing patients with MetS and introducing measures to decrease their risk factors. Primary recommendations are lifestyle changes (healthy diet and physical activity), while pharmacologic treatment (e.g. antihypertensive, antidiabetic, antihyperlipidemic) is indicated only if lifestyle changes were not effective and did not result in the achivement of recommended goals

Correction to: Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment (Scientific Reports, (2024), 14, 1, (6235), 10.1038/s41598-024-56780-1)

Correction to: Scientific Reportshttps://doi.org/10.1038/s41598-024-56780-1, published online 14 March 2024 The original version of this Article contained an error in the Funding section. “All the research work was funded by the EuroAgeism H2020 project (ESR7 project), supported by the European Union research and innovation program under the Grant Agreement of the Marie Skłodowska-Curie Foundation Number MSCF-ITN-764632. Research works of Assoc. Prof. Daniela Fialová, PharmD, Ph.D. and members of her research team were supported by the Grants: InoMed, Reg. No CZ.02.1.01/0.0/0.0/18_069/0010046, the European Horizon 2020 I-CARE4OLD Grant No 965341, START/MED/093 EN.02.2.69/0.0/0.0/19_073/0016935, SVV 260 551 Grant and Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit: “Ageing, Polypharmacotherapy and Changes in Therapeutic Value of Drugs in the Aged’’, KSKF-I.), and NETPHARM project CZ.02.01.01/00/22_008/0004607. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.” now reads: “Publication of this work was supported by the I-CARE4OLD project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 96534. Views and opinions expressed are however those of the authors only and do not necessarily reflect those of the European Union. Neither the European Union nor the granting authority can be held responsible for them. More information on the I-CARE4OLD project can be found at http://www.icare4old.eu and https://cordis.europa.eu/project/id/965341. Except secondary analyses and works on the publication, data collection and teamwork were funded also by the EuroAgeism H2020 project (ESR7 project), supported by the European Union research and innovation program under the Grant Agreement of the Marie Skłodowska-Curie Foundation Number MSCF-ITN-764632. Research works of Assoc. Prof. Daniela Fialová, PharmD, Ph.D. and members of her research team were supported by grants: START/MED/093 EN.02.2.69/0.0/0.0/19_073/0016935, SVV 260 551, Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit: “Ageing, Polypharmacotherapy and Changes in Terapeutic Value of Drugs in the Aged’’, KSKF-I.), and NETPHARM project CZ.02.01.01/00/22_008/0004607.” The original Article has been corrected.Link to the corrected article:[ https://farfar.pharmacy.bg.ac.rs/handle/123456789/5571

Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment

Pharmacist’s geriatric assessment can provide valuable insights into potential deprescribing targets, while including important information on various health-related domains. Data collected from a geriatric assessment questionnaire, for 388 patients, from the Croatian cohort of the EuroAgeism H2020 ESR 7 international project, along with guideline-based deprescribing criteria, were used to analyse potentially inappropriate prescribing of four medication groups (benzodiazepines (BZN), proton pump inhibitors (PPI), opioids, and non-steroidal anti-inflammatory drugs (NSAID)), and to assess the deprescribing potential. Binary logistic regression was used to explore the effects of age, gender, number of medicines and diagnoses, self-reported health, frailty score, and healthcare utilization on the likelihood of needing deprescribing. More than half of participants (n = 216, 55.2%) are candidates for deprescribing, with 31.1% of PPI, 74.8% of NSAID, 75% of opioid, and 96.1% of BZN users meeting at least one criterion. Most common criteria for deprescribing were inappropriately long use and safety concerns. Women (aOR = 2.58; p < 0.001), those reporting poor self-reported health (aOR = 5.14; p < 0.001), and those exposed to polypharmacy (aOR = 1.29; p < 0.001) had higher odds of needing to have medicines deprescribed. The high rate of deprescribing potential warrants prompt action to increase patient safety and decrease polypharmacy. Pharmacist’s geriatric assessment and deprescribing-focused medication review could be used to lead a personalised approach.https://farfar.pharmacy.bg.ac.rs/handle/123456789/562

Author Correction: Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta‑analysis

Link to the corrected article: [https://farfar.pharmacy.bg.ac.rs/handle/123456789/4286

Exploring adherence in patients with advanced breast cancer: focus on CDK4/6 inhibitors

Treatment adherence is crucial for optimal outcomes in advanced breast cancer, but can be challenging due to various factors, i.e. patients\u27 attitudes and behavior upon diagnosis, and complex therapies with high adverse effect rates. Our aim was to explore the adherence to oral anticancer medications (OAM) in women with advanced breast cancer, focusing on cyclin-dependent kinase 4 and 6 inhibitors (CDKI), and identify factors associated with the adherence. We conducted a cross-sectional study at the University Hospital Centre Zagreb, Croatia, involving women with stage IV advanced breast cancer receiving OAM. Data collection included a questionnaire assessing socio-demographic and clinical information, Beck Depression Inventory-II for depressive symptoms, Medication Adherence Report Scale (MARS-5) for adherence to OAM, and Beliefs about Medicines Questionnaire. Plasma concentrations of CDKI were confirmed by LC-MS/MS in three randomly selected participants. A total of 89 women were included. The most prescribed OAMs were anti-estrogen (71.3 %) and CDKI (60.9 %). MARS-5 scores (mean: 24.1 ± 1.6) correlated with CDKI plasma concentrations. Forgetfulness was the primary reason for non-adherence (25.9 %). Women receiving CDKI (p = 0.018), without depressive symptomatology (p = 0.043), and with more positive beliefs about medicines were more adherent (p < 0.05). This study enhances understanding of medication adherence in advanced breast cancer and identifies influential factors

Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta-analysis

We aimed to systematically review the prevalence of potentially inappropriate prescribing (PIP) in older adults in Central and Eastern Europe (CEE) in all care settings. We searched Embase and MEDLINE (up to June 2019) and checked the reference lists of the included studies and relevant reviews. Eligible studies used validated explicit or implicit tools to assess the PIP prevalence in older adults in CEE. All study designs were considered, except case‒control studies and case series. We assessed the risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and the certainty of evidence using the GRADE approach. Meta-analysis was inappropriate due to heterogeneity in the outcome measurements. Therefore, we used the synthesis without meta-analysis approach—summarizing effect estimates method. This review included twenty-seven studies with 139,693 participants. Most studies were cross-sectional and conducted in high-income countries. The data synthesis across 26 studies revealed the PIP prevalence: the median was 34.6%, the interquartile range was 25.9–63.2%, and the range was 6.5–95.8%. The certainty of this evidence was very low due to the risk of bias, imprecision, and inconsistency. These findings show that PIP is a prevalent issue in the CEE region. Further well-designed studies conducted across countries are needed to strengthen the existing evidence and increase the generalizability of findings

Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries

Background: The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. Methods: International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. Results: Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19–2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22–3.16), anxiety (OR 4.26, 95%CI 2.86–6.38), sleeping problems (OR 4.47, 95%CI 3.38–5.92), depression (OR 1.95, 95%CI 1.29–2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29–2.42), problems with syncope (OR 1.78, 95%CI 1.03–3.06), and loss of appetite (OR 0.60, 95%CI 0.38–0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32–0.75) in Spain to 0.01 (95%CI 0.00–0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79–1.56). Conclusions: Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users

Reimbursed medication adherence enhancing interventions in 12 european countries:Current state of the art and future challenges

Background: Medication non-adherence jeopardises the effectiveness of chronic therapies and negatively affects financial sustainability of healthcare systems. Available medication adherence-enhancing interventions (MAEIs) are utilised infrequently, and even more rarely reimbursed. The aim of this paper was to review reimbursed MAEIs across selected European countries. Methods: Data on reimbursed MAEIs were collected from European countries at the ENABLE Cost Action expert meeting in September 2021. The identified MAEIs were analysed and clustered according to their characteristics, direct vs. indirect relation to adherence, and the targeted adherence phase. Results: Out of 12 contributing countries, 10 reported reimbursed MAEIs, 28 in total, of which 20 were identified as MAEIs targeting adherence directly. Reimbursed MAEIs were most often performed by either doctors (n = 6), nurses (n = 6), or pharmacists (n = 3). The most common types of MAEIs were education (n = 6), medication regimen management (n = 5), and adherence monitoring feedback (n = 4). Only seven reimbursed MAEIs were technology-mediated, whereas 11 addressed two interlinked phases of medication adherence, i.e., implementation and persistence. Conclusion: Our review highlights the scarcity of reimbursed MAEIs across the selected European countries, and calls for their more frequent use and reimbursement