Improvement in coronary circulatory function in morbidly obese individuals after gastric bypass-induced weight loss: relation to alterations in endocannabinoids and adipocytokines

Aims To investigate the effect of surgical gastric bypass-induced weight loss and related alterations in endocannabinoids (ECs) and adipocytokine plasma levels on coronary circulatory dysfunction in morbidly obese (MOB) individuals. Methods and results Myocardial blood flow (MBF) responses to cold pressor test (CPT) from rest (ΔMBF) and during pharmacologically induced hyperaemia were measured with 13N-ammonia PET/CT in 18 MOB individuals with a body mass index (BMI) > 40 kg/m2 at baseline and after a median follow-up period of 22 months. Gastric bypass intervention decreased BMI from a median of 44.8 (inter-quartile range: 43.3, 48.2) to 30.8 (27.3, 34.7) kg/m2 (P < 0.0001). This decrease in BMI was accompanied by a marked improvement in endothelium-related ΔMBF to CPT and hyperaemic MBFs, respectively [0.34 (0.18, 0.41) from 0.03 (−0.08, 0.15) mL/g/min, P = 0.002; and 2.51 (2.17, 2.64) from 1.53 (1.39, 2.18) mL/g/min, P < 0.001]. There was an inverse correlation between decreases in plasma concentrations of the EC anandamide and improvement in ΔMBF to CPT (r = −0.59, P = 0.009), while increases in adiponectin plasma levels correlated positively with hyperaemic MBFs (r = 0.60, P = 0.050). Conversely, decreases in leptin plasma concentrations were not observed to correlate with the improvement in coronary circulatory function (r = 0.22, P = 0.400, and r = −0.31, P = 0.250). Conclusions Gastric bypass-related reduction of BMI in MOB individuals beneficially affects coronary circulatory dysfunction. The dysbalance between ECs and adipocytokines appears to be an important determinant of coronary circulatory function in obesit

Effectiveness of Therapeutic Patient Education Interventions in Obesity and Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Diabetes mellitus (DM) and obesity account for the highest burden of non-communicable diseases. There is increasing evidence showing therapeutic patient education (TPE) as a clinically and cost-effective solution to improve biomedical and psychosocial outcomes among people with DM and obesity. The present systematic review and meta-analysis present a critical synthesis of the development of TPE interventions for DM and obesity and the efficacy of these interventions across a range of biomedical, psychosocial and psychological outcomes. A total of 54 of these RCTs were identified among patients with obesity and diabetes and were thus qualitatively synthesized. Out of these, 47 were included in the quantitative synthesis. There was substantial heterogeneity in the reporting of these outcomes (I2 = 88.35%, Q = 317.64), with a significant improvement noted in serum HbA1c levels (standardized mean difference (SMD) = 0.272, 95% CI: 0.118 to 0.525, n = 7360) and body weight (SMD = 0.526, 95% CI: 0.205 to 0.846, n = 1082) in the intervention group. The effect sizes were comparable across interventions delivered by different modes and delivery agents. These interventions can be delivered by allied health staff, doctors or electronically as self-help programs, with similar effectiveness (p &lt; 0.001). These interventions should be implemented in healthcare and community settings to improve the health outcomes in patients suffering from obesity and DM

Elevated endocannabinoid plasma levels are associated with coronary circulatory dysfunction in obesity

Aims Aim of this study was to evaluate a possible association between endocannabinoid (EC) plasma levels, such as anandamide (AEA) and 2-arachidonoylglycerol (2-AG), and coronary circulatory function in obesity. Methods and results Myocardial blood flow (MBF) responses to cold pressor test (CPT) and during pharmacological vasodilation with dipyridamole were measured with 13N-ammonia PET/CT. Study participants (n = 77) were divided into three groups based on their body mass index (BMI, kg/m2): control group 20≤ BMI <25 (n = 21); overweight group, 25≤ BMI <30 (n = 26); and obese group, BMI ≥30 (n = 30). Anandamide plasma levels, but not 2-AG plasma levels, were significantly elevated in obesity as compared with controls, respectively [0.68 (0.53, 0.78) vs. 0.56 (0.47, 0.66) ng/mL, P = 0.020, and 2.2 (1.21, 4.59) vs. 2.0 (0.80, 5.90) ng/mL, P = 0.806)]. The endothelium-related change in MBF during CPT from rest (ΔMBF) progressively declined in overweight and obese when compared with control group [0.21 (0.10, 0.27) and 0.09 (−0.01, 0.15) vs. 0.26 (0.23, 0.39) mL/g/min; P = 0.010 and P = 0.0001, respectively). Compared with controls, hyperaemic MBFs were significantly lower in overweight and obese individuals [2.39 (1.97, 2.62) vs. 1.98 (1.69, 2.26) and 2.10 (1.76, 2.36); P = 0.007 and P = 0.042, respectively)]. In obese individuals, AEA and 2-AG plasma levels were inversely correlated with ΔMBF to CPT (r = −0.37, P = 0.046 and r = −0.48, P = 0.008) and hyperaemic MBFs (r = −0.38, P = 0.052 and r = −0.45, P = 0.017), respectively. Conclusions Increased EC plasma levels of AEA and 2-AG are associated with coronary circulatory dysfunction in obese individuals. This observation might suggest increases in EC plasma levels as a novel endogenous cardiovascular risk factor in obesity, but needing further investigation

Therapeutic patient education as the basis for diabetes long-term follow-up

Diabetes treatment and management depends on a multitude of parameters, both medication-related and patients’ lifestyle-related. Diabetologists do not consider enough the hidden facets of diabetes having an important and extraordinary role in glucose homeostasis regulation. Health care providers and particularly doctors are often problem-solving oriented, having no training in long-term follow-up of chronic diseases. Diabetes needs to be understood as a chronic and complex metabolic dysregulation to which only the patient could have the key how to restore the equilibrium. For that, this patient needs understanding and positive attitudes of his doctor who unfortunately misses training in therapeutic patient education

Prevention of Diabetic Foot Ulcers: From Biomechanics to Therapeutic Patient Education

Diabetic foot disease is one of the most invalidating long-term complications of diabetes. Given the dramatically increasing prevalence of types 1 and 2 diabetes mellitus worldwide, the medical community must be prepared for the number of diabetic foot ulcers and lower extremity amputations that will follow this “epidemic” of diabetes. In addition to economic costs, the psychological and biosocial aspects of people suffering from diabetes and diabetic foot disease must be considered. Studies have indicated that the implementation of validated guidelines and international standards of diabetic foot care into clinical practice could reduce lower extremity amputation rates by up to 85%. However, in many countries, such a decrease in lower extremity amputation rates is more of an isolated example than a rule. Reduction of the plantar pressure is mandatory for the treatment and prevention of foot ulcers in patients with diabetes and peripheral neuropathy. The recurrence rate of ulcers is extremely high. After ulcer healing, the persisting high plantar pressure during walking causes repeated soft tissue breakdown at each step. In this population, the development of a new walking strategy could alter the plantar pressure distribution under the feet, thus improving patient outcomes and preventing amputation. We have developed and implemented a biofeedback-based technique delivered by an electronic insole. When combined with therapeutic patient education, this method may be a valuable tool for the treatment of foot ulcers and prevention of lower extremity amputations in high-risk patients with diabetes

Quel traitement pour nos patients en situation d’obésité ?

Les médecins ont longtemps pensé que pour perdre du poids, le conseil « manger moins et bouger plus » pourrait suffire. Mathématiquement, il est juste de dire que si la personne réduit ses apports caloriques et augmente sa dépense énergétique, elle perdra du poids. Mais si cette théorie était vraie, pourquoi y aurait-il toujours autant de patients qui n’arrivent pas à perdre du poids ou, malgré une perte initiale, reprennent-ils facilement des kilos ? Pourquoi est-il si difficile de changer nos habitudes et ceci durablement

Maigrir durablement, c'est possible !: approches scientifiques et psychologiques de l'obésité

Selon l'Organisation mondiale de la santé, l'obésité a pris des "proportions épidémiques à l'échelle mondiale" au cours des dernières décennies. Les personnes qui souffrent de cette maladie développent de nombreuses complications physio logiques et psychologiques graves : hypertension, diabète, syndromes métabolique et inflammatoire, dépression, etc. Face á un tel constat, les auteurs de ce livre - spécialistes comptant plus de 25 ans d'expérience au sein de l'Ecole de Genève - définissent scientifiquement et expliquent les causes multiples ä l'origine de cette maladie : les facteurs génétiques, le rôle des hormones et du métabolisme, l'impact du stress et de l'environnement, la flore intestinale, les troubles du comportement alimentaire. En réponse, plusieurs solutions peuvent être mises en place de manière progressive. En plus de suivre un régime alimentaire adapté au mode de vie, les auteurs conseillent aux patients de pratiquer une activité physique ou de détente afin de combattre la sédentarité et de mieux gérer leur anxiété. En fin d'ouvrage, ils présentent également les nouvelles techniques de chirurgie spécialisées. En vous donnant les moyens de contrer les symptômes de cette maladie, l'objectif de ce livre est de vous aider à améliorer votre qualité de vie et à prendre soin de vous durablement