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

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

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

Ljekarnička skrb temeljena na dokazima

Evidence based pharmacy, like evidence based medicine, is a shift from the traditional paradigm of practice, which was grounded in intuition, clinical experience, and pathophysiological rational to new paradigm which stresses the importance of best evidence from clinical research. The evidence based practice requires integrating individual clinical experience with the best available external clinical evidence and patient values. The evidence based practice process can be described in five steps: 1) asking a focused question; 2) acquiring the best evidence by searching the literature; 3) appraising the literature testing for validity, relevance, and applicability; 4) applying the results in clinical practice; 5) assessing the outcomes. A set of skills is needed in order to practice evidence based pharmacy, such as literature searching skills and critical apprasing skills, but personal attitude and commitment to change could be equally important

Development and Validation of Comprehensive Healthcare Providers’ Opinions, Preferences, and Attitudes towards Deprescribing (CHOPPED Questionnaire)

Successful implementation of deprescribing requires exploring healthcare professionals’ opinions, preferences, and attitudes towards deprescribing. The aim of this study was to develop and validate the questionnaire exploring healthcare providers’ opinions preferences and attitudes towards deprescribing (CHOPPED questionnaire). This was a cross-sectional on-line survey. A comprehensive 58-item questionnaire, in two versions (for pharmacists and physicians), was developed through an extensive literature review and interviews with experts. The questionnaire was validated, and its reliability was assessed through data collected from 356 pharmacists and 109 physicians. Exploratory factor analysis was performed, and 37- and 35-item questionnaires were developed. Ten factors were identified: knowledge, awareness, patient barriers and facilitators, competencies barriers and facilitators, collaboration barriers and facilitators, and healthcare system barriers and facilitators. The CHOPPED tool has satisfactory face, content (CVR > 0.62) (content validity ratio), construct, and criterion validity. The reliability statistics of all factors in both versions was acceptable with Cronbach’s alpha > 0.6. Test–retest reliability analysis showed that gamma rank correlations of total factor scores were strong and very strong (between 0.519 and 0.938). The CHOPPED tool can be used as a valid and reliable tool to explore healthcare providers’ opinions and attitudes toward discontinuing medications in the primary care setting in Croatia

Pregled dostupnih skala za procjenu opterećenja aritikolinergičkim lijekovima

Anticholinergic medications are frequently used by older adults. They act on muscarinic acetylcholine receptors and antagonise the effects of acetylcholine by competitively binding to these receptors. Usually, they are used to manage a wide range of clinical conditions, including urinary frequency, urgency and incontinence, irritable bowel syndrome, depression, psychosis, chronic obstructive pulmonary disease and Parkinson's disease. Unfortunately, simultaneously they are associated with a wide range of adverse effects to which elderly patients are particularly sensitive. Most common adverse effects include 1dry mouth, constipation, urinary retention, falls, blurred vision and delirium. Anticholinergic burden refers to the cumulative effect of taking multiple medications with anticholinergic effects. Over the past few decades many scales have been developed to measure anticholinergic burden. These scales usually rank the anticholinergic activity of medications into 3-5 levels, ranging from no anticholinergic activity (O) to definite anticholinergic activity (3 to 5). There is high variability in existing scales; there is still no consensus on the definition, and both the number and ranking of the anticholinetgic medications listed vary considerably between the scales. Also, some scales consider the impact of different routes of administration when ranking the anticholinergic activity of medications, while others exclude topical, ophthalmic, and inhaled preparations. Future imperative is developing of one reference composite anticholinergic scale which would be a useful tool for clinicians to identify medications with anticholinergic activity