Long-term effects of non-surgical therapy for obesity on cardiovascular risk management: a weighted empirical review

Weight loss affects cardiovascular risk profiles in obese patients. Surgery is not a plausible or viable response to the public health problem of obesity, given that more than 30% of adults are obese in some countries. However, most studies investigating the effects of weight loss on the cardiovascular risk profile are focussed on weight loss and limited to short-term effects. Since newer data show a rebound of cardiovascular risks in studies that complete a short-term follow-up, the question arises whether, and to what extent, long-term treatments offer a more sustained cardiovascular benefit beside the extensive or less marked weight loss. Aims The purpose of this article is to critically review existing data on the long-term cardiovascular effects of weight loss in obese and overweight patients treated with dietary interventions, physical activity programmes, behavioural therapy and pharmacological treatments and their combination. Method Inclusion criteria were peer-reviewed, randomized controlled trials (RCT) in the English language which presented data on cardiovascular effects at a follow-up of at least 18months during or after weight reduction interventions. The search was limited to adults and the publication years between 1990 and 2007. Studies of patients with diagnoses such as coronary heart disease and cancer, and medically treated diabetes and hypertension were excluded. Results Twenty-three studies measured cardiovascular risk factors after 18months or more. Mean BMI was 33.9kg/m2 including 13,733 patients. Mean duration of the studies was 37months with a dropout rate of 16.1% on average. Regardless of the absolute amount of weight loss a positive effect on cardiovascular risk factors such as blood pressure, lipids and glucose tolerance was foun

Serum Metabolites Responding in a Dose-Dependent Manner to the Intake of a High-Fat Meal in Normal Weight Healthy Men Are Associated with Obesity

Although the composition of the human blood metabolome is influenced both by the health status of the organism and its dietary behavior, the interaction between these two factors has been poorly characterized. This study makes use of a previously published randomized controlled crossover acute intervention to investigate whether the blood metabolome of 15 healthy normal weight (NW) and 17 obese (OB) men having ingested three doses (500, 1000, 1500 kcal) of a high-fat (HF) meal can be used to identify metabolites differentiating these two groups. Among the 1024 features showing a postprandial response, measured between 0 h and 6 h, in the NW group, 135 were dose-dependent. Among these 135 features, 52 had fasting values that were significantly different between NW and OB men, and, strikingly, they were all significantly higher in OB men. A subset of the 52 features was identified as amino acids (e.g., branched-chain amino acids) and amino acid derivatives. As the fasting concentration of most of these metabolites has already been associated with metabolic dysfunction, we propose that challenging normal weight healthy subjects with increasing caloric doses of test meals might allow for the identification of new fasting markers associated with obesity

The NutriChip project - translating technology into nutritional knowledge

Advances in food transformation have dramatically increased the diversity of products on the market and, consequently, exposed consumers to a complex spectrum of bioactive nutrients whose potential risks and benefits have mostly not been confidently demonstrated. Therefore, tools are needed to efficiently screen products for selected physiological properties before they enter the market. NutriChip is an interdisciplinary modular project funded by the Swiss programme Nano-Tera, which groups scientists from several areas of research with the aim of developing analytical strategies that will enable functional screening of foods. The project focuses on postprandial inflammatory stress, which potentially contributes to the development of chronic inflammatory diseases. The first module of the NutriChip project is composed of three in vitro biochemical steps that mimic the digestion process, intestinal absorption, and subsequent modulation of immune cells by the bioavailable nutrients. The second module is a miniaturised form of the first module (gut-on-a-chip) that integrates a microfluidic-based cell co-culture system and super-resolution imaging technologies to provide a physiologically relevant fluid flow environment and allows sensitive real-time analysis of the products screened in vitro. The third module aims at validating the in vitro screening model by assessing the nutritional properties of selected food products in humans. Because of the immunomodulatory properties of milk as well as its amenability to technological transformation, dairy products have been selected as model foods. The NutriChip project reflects the opening of food and nutrition sciences to state-of-the-art technologies, a key step in the translation of transdisciplinary knowledge into nutritional advic

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p<0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p<0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Kultur- und migrationsspezifische Aspekte funktioneller Bauchschmerzen

Compared to Europe's mean immigrant contingent of 7.3 to 8.6 % Switzerland holds the highest contingent of foreign population with 23.5 %. Therefore it is of utmost importance that physicians have a knowledge of the specific characteristics of immigrant patients. The influence of personality factors (experience, behavior) is not independent from the influence of culturally-related environmental factors (regional differences in diet, pollutants, meanings, etc.). In addition, different cultural groups rate their quality of life differently. Psychological reasons for recurrent abdominal pain are stress (life events), effects of self-medication (laxatives, cocaine) and sexual abuse but also rare infectious diseases are more common among immigrants (e.g. tuberculosis, histoplasmosis, etc.). Migration-specific characteristics are mainly to find in the semiotics of the symptoms: not every abdominal pain is real pain in the abdomen. Finally, it is crucial to make the distinction between organic, functional and psychological-related pain. This can, however, usually only be accomplished in the context of the entire situation of a patient and, depending on the situation, with the support of a colleague from the appropriate cultural group or an experienced interpreter. In this review we limit ourselves to the presentation of the working population of the migrants, because these represent the largest group of all migrants. The specific situation of asylum seekers will also be refrained to where appropriate.Die Schweiz weist im Europäischen Quervergleich mit 23.5 % (2009) den höchsten Anteil an Ausländern auf. Der europäische Durchschnittsanteil beträgt andererseits lediglich zwischen 7.3 bis 8.6 %. Deshalb ist es für den praktisch tätigen Arzt wichtig, die Besonderheiten ausländischer Patientengruppen zu kennen. Der Einfluss der Persönlichkeit (Erleben, Verhalten) ist nicht unabhängig vom Einfluss kulturell bedingter Umweltfaktoren (regional unterschiedliche Ernährung, Schadstoffe, Bedeutungen u.a). Zudem beurteilen unterschiedliche kulturelle Gruppen auch die Lebensqualität unterschiedlich. Als psychologische Ursachen rezidivierender abdominaler Schmerzen stehen Belastungen (life events), Effekte der Automedikation (Laxantien, Kokain) und sexueller Missbrauch im Vordergrund; allerdings sind auch (seltene) infektiöse Ursachen bei Immigranten häufiger (z. B. Tbc, Histoplasmose etc.). Migrationsspezifische Besonderheiten sind vor allem in der Semiotik der Beschwerden zu suchen: nicht jeder Abdominalschmerz ist Schmerz im Abdomen gleichzusetzen. Schließlich ist es zentral, die Unterscheidung zwischen organischen, funktionellen und psychologisch-bedingten Schmerzen vorzunehmen. Diese lässt sich aber zumeist nur im Kontext der Gesamtsituation eines Patienten zuverlässig eruieren und erfordert je nach Situation die Unterstützung eines Kollegen aus dem entsprechenden Kulturkreis oder eines erfahrenen Dolmetschers. In dieser Übersicht beschränken wir uns auf die Darstellung der arbeitenden Migrationsbevölkerung, weil sie den größten Anteil aller Migranten ausmacht. Die Besonderheiten von Asylsuchenden werden jedoch, wo sinnvoll, ebenfalls beleuchtet

Mood-Enhancement mittels Antidepressiva. Ethische Aspekte zu Authentizität und Gerechtigkeit

Mood-Enhancement mittels Antidepressiva zielt auf die pharmakologische Verbesserung der Grundstimmung bei Gesunden durch Medikamente, die ursprünglich für die Behandlung von depressiven Störungen entwickelt wurden. Insbesondere seit der Entwicklung der Selektiven Serotonin-Wiederaufnahmehemmer (SSRIs) wurde diese Medikamentengruppe zunehmend zum Zweck des Mood-Enhancements eingesetzt, obwohl deren Wirksamkeit zur Stimmungsverbesserung bei Gesunden aus empirischer Sicht bis heute nicht eindeutig geklärt ist. Unabhängig von der medizinischen Wirksamkeit sollen im vorliegenden Artikel einige Überlegungen angestellt werden, die im Kontext von Mood-Enhancement auf schwierige ethische Fragen abzielen. Was ist im Falle, dass Mood-Enhancement die Authentizität von einzelnen Individuen zu verändern vermag, ethisch zu bedenken? Zu welchen ethischen Problemen führt der Anstieg in der Anwendung von Mood-Enhancement hinsichtlich der Gerechtigkeitsvorstellungen? Die vorliegende Analyse zeigt unter anderem, dass der scheinbar rationale ethische Diskurs über Mood-Enhancement von moralischen Intuitionen oder von Misstrauen geleitet sein kann

Pathological baroreceptor sensitivity in patients suffering from somatization disorders: do they correlate with symptoms?

We conducted a study to investigate whether patients with somatization disorders (ICD-10, F45.0) show abnormal values in autonomic testing

Benefit of Problem-Based Learning for Psychosocial Medicine: first experiences at the medical faculty of berne

Aim: Presentation of skills and knowledge of medical students in psychiatry or psychosocial medicine in basic study (year 1 to 3) after the introduction of a problem oriented learning curriculum at the Medical Faculty of Berne.Method: Description of the curriculum with the different teaching units, and the evaluation by means of formative tools used by students and tutors.Results: With reference to qualitative comparison students of the problem based learning track showed a better preparation of the different teaching units than did traditional students. Moreover, compared to classical teaching, students in problem based learning rated the commitment of the teachers higher. The formative results showed a better adherence to the teaching modules, a higher effort in self learning and a higher interest in psychological or psychiatric learning items.Discussion: The higher commitment of teachers and the explicit structuring of the teaching contents in psychiatry and psychosocial medicine showed positive effects in the learning strategy of students. Beside the fact that exams have been adapted to the new curriculum one can assume that the learning style has changed. This might be a result of the better learning environment in the new curriculum. However, there is not clear how and to what extent these changes will remain active until the final exams of the medical curriculum when psychosocial contents will be reexamined.Conclusions: The intense commitment of the teachers and the better structuring of the subject matter may lead to a better integration of psychosocial and psychiatric issues into the medical curriculum