Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Circulation, Год журнала: 2021, Номер 143(21)

Опубликована: Апрель 22, 2021

The global obesity epidemic is well established, with increases in prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. also leads development of disease mortality independently other factors. More recent data highlight abdominal obesity, as determined by waist circumference, a marker that independent body mass index. There have been significant advances imaging modalities characterizing composition, visceral adiposity. Studies quantify fat depots, ectopic fat, support excess adiposity an indicator poor outcomes. Lifestyle modification subsequent weight loss improve both metabolic syndrome associated systemic inflammation endothelial dysfunction. However, clinical trials medical not demonstrated reduction coronary artery rates. In contrast, prospective studies comparing patients undergoing bariatric surgery nonsurgical shown reduced surgery. this statement, we summarize impact on diagnosis, management, outcomes atherosclerotic disease, heart failure, arrhythmias, especially sudden cardiac death atrial fibrillation. particular, examine influence noninvasive invasive diagnostic procedures disease. Moreover, review function related failure preserved ejection fraction. Finally, describe effects lifestyle surgical interventions

Язык: Английский

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Obesity in adults: a clinical practice guideline

Canadian Medical Association Journal, Год журнала: 2020, Номер 192(31), С. E875 - E891

Опубликована: Авг. 3, 2020

KEY POINTS Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.[1][1] Epidemiologic studies define obesity using mass index (BMI; weight/height2), can stratify

Язык: Английский

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Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity

PEDIATRICS, Год журнала: 2023, Номер 151(2)

Опубликована: Янв. 9, 2023

Язык: Английский

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A Randomized, Controlled Trial of Liraglutide for Adolescents with Obesity

New England Journal of Medicine, Год журнала: 2020, Номер 382(22), С. 2117 - 2128

Опубликована: Март 31, 2020

Obesity is a chronic disease with limited treatment options in pediatric patients. Liraglutide may be useful for weight management adolescents obesity.In this randomized, double-blind trial, which consisted of 56-week period and 26-week follow-up period, we enrolled (12 to <18 years age) obesity poor response lifestyle therapy alone. Participants were randomly assigned (1:1) receive either liraglutide (3.0 mg) or placebo subcutaneously once daily, addition therapy. The primary end point was the change from baseline body-mass index (BMI; kilograms divided by square height meters) standard-deviation score at week 56.A total 125 participants group 126 group. superior regard BMI 56 (estimated difference, -0.22; 95% confidence interval [CI], -0.37 -0.08; P = 0.002). A reduction least 5% observed 51 113 20 105 percentage, 43.3% vs. 18.7%), 10% 33 9, respectively 26.1% 8.1%). greater than -4.64 percentage points) body -4.50 kg [for absolute change] -5.01 points relative change]). After discontinuation, increase 0.15; CI, 0.07 0.23). More had gastrointestinal adverse events (81 [64.8%] 46 [36.5%]) that led discontinuation trial (13 [10.4%] 0). Few serious (3 [2.4%] 5 [4.0%]). One suicide, occurred group, assessed investigator as unlikely related treatment.In obesity, use plus significantly (Funded Novo Nordisk; NN8022-4180 ClinicalTrials.gov number, NCT02918279.).

Язык: Английский

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Why primary obesity is a disease?

Journal of Translational Medicine, Год журнала: 2019, Номер 17(1)

Опубликована: Май 22, 2019

Obesity must be considered a real pathology. In the world wide, obesity represent one of major public health issue associated with increased morbidity and mortality. Overweight or obesity, in fact, significantly increases risk contracting diseases, such as: arterial hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, cerebral vasculopathy, gallbladder lithiasis, arthropathy, ovarian polycytosis, sleep apnea syndrome, some neoplasms. Despite numerous informative campaigns, unfortunately, fight against does not seem to work: last years, prevalence continued increase. The progressive rapid increase incidence which has characterized most economically advanced countries decade, been main stimulus for research mechanisms underlying this pathology related disorders. aims review is provide revision literature order define as secondly highlight limits inaccuracy common tools used diagnosis third thing strengthen concept complexity disease among political care providers. may viewed multifactorial chronic low-grade inflammatory disease. people affected by have greater developing comorbility morbility, respect healthy. Hence, absolute therapeutic benefit directly proportional basic risk. So, internationally interest on early growing avoid under- overdiagnosis consequences. Therefore, consequences are an aggravation like diabetes, cardiovascular cancer. widely parameter diagnosis, body mass index (BMI) suitable assessing fat. several studies demonstrate that BMI alone cannot consists so much weight gain excess fat mass. use assessment percentage combined clinical genetic analysis allowed identify different phenotypes explain various paradoxes obesity. It essential adopt all possible strategies able combat ameliorate suffering patients, reduce social treatment costs

Язык: Английский

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European Guidelines for Obesity Management in Adults with a Very Low-Calorie Ketogenic Diet: A Systematic Review and Meta-Analysis

Obesity Facts, Год журнала: 2021, Номер 14(2), С. 222 - 245

Опубликована: Янв. 1, 2021

<b><i>Background:</i></b> The very low-calorie ketogenic diet (VLCKD) has been recently proposed as an appealing nutritional strategy for obesity management. VLCKD is characterized by a low carbohydrate content (&#x3c;50 g/day), 1–1.5 g of protein/kg ideal body weight, 15–30 fat/day, and daily intake about 500–800 calories. <b><i>Objectives:</i></b> aim the current document to suggest common protocol summarize existing literature on its efficacy in weight management weight-related comorbidities, well possible side effects. <b><i>Methods:</i></b> This prepared adherence with Preferred Reporting Items Systematic Review Meta-Analyses (PRISMA) guidelines. Literature searches, study selection, methodology development, quality appraisal were performed independently 2 authors data collated means meta-analysis narrative synthesis. <b><i>Results:</i></b> Of 645 articles retrieved, 15 studies met inclusion criteria reviewed, revealing 4 main findings. First, was shown result significant loss short, intermediate, long terms improvement composition parameters glycemic lipid profiles. Second, when compared other interventions same duration, showed major effect reduction fat mass, waist circumference, total cholesterol triglyceridemia improved insulin resistance. Third, although also resulted glycemia, HbA1c, LDL cholesterol, these changes similar those obtained interventions. Finally, can be considered safe approach under health professional’s supervision since most effects are usually clinically mild easily manage recovery often spontaneous. <b><i>Conclusions:</i></b> recommended effective dietary treatment individuals after considering potential contra-indications keeping mind that any personalized. <b><i>Prospero Registry:</i></b> assessment composition, overweight obese subjects: (CRD42020205189).

Язык: Английский

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Effect of Bimagrumab vs Placebo on Body Fat Mass Among Adults With Type 2 Diabetes and Obesity

JAMA Network Open, Год журнала: 2021, Номер 4(1), С. e2033457 - e2033457

Опубликована: Янв. 13, 2021

Importance

Antibody blockade of activin type II receptor (ActRII) signaling stimulates skeletal muscle growth. Previous clinical studies suggest that ActRII inhibition with the monoclonal antibody bimagrumab also promotes excess adipose tissue loss and improves insulin resistance.

Objective

To evaluate efficacy safety on body composition glycemic control in adults 2 diabetes overweight obesity.

Design, Setting, Participants

This double-masked, placebo-controlled, 48-week, phase randomized trial was conducted among diabetes, mass index between 28 40, glycated hemoglobin (HbA_1c) levels 6.5% 10.0% at 9 US UK sites. The from February 2017 to May 2019. Only participants who completed a full treatment regimen were included analysis.

Interventions

Patients intravenous infusion (10 mg/kg up 1200 mg 5% dextrose solution) or placebo (5% every 4 weeks for 48 weeks; both groups received diet exercise counseling.

Main Outcomes Measures

primary end point least square mean change baseline week total fat (FM); secondary exploratory points lean (LM), waist circumference (WC), HbA_1clevel, weight (BW) changes 48.

Results

A 75 patients (n = 37; 23 [62.2%] women) 38; 12 [31.6%] women); 58 (77.3%) 48-week study. had (SD) age 60.4 (7.7) years; BMI 32.9 (3.4); BW 93.6 (14.9) kg; FM 35.4 (7.5) HbA_1clevel 7.8% (1.0%). Changes vs as follows: FM, −20.5% (−7.5 kg [80% CI, −8.3 −6.6 kg]) −0.5% (−0.18 −0.99 0.63 (P < .001); LM, 3.6% (1.70 1.1 2.3 −0.8% (−0.4 −1.0 0.1 WC, −9.0 cm (80% −10.3 −7.7 cm) 0.5 −0.8 1.7 −0.76 percentage −1.05 −0.48 points) 0.04 −0.23 0.31 .005); BW, −6.5% (−5.9 −7.1 −4.7 (−0.8 −1.9 0.3 .001). Bimagrumab’s tolerability profile consistent prior studies.

Conclusions Relevance

In this trial, led significant gain metabolic improvements during obesity diabetes. pathway may provide novel approach pharmacologic management adiposity accompanying disturbances.

Trial Registration

ClinicalTrials.gov number:NCT03005288

Язык: Английский

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Obesity: A preventable, treatable, but relapsing disease

Nutrition, Год журнала: 2019, Номер 71, С. 110615 - 110615

Опубликована: Окт. 17, 2019

Язык: Английский

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Obesity Treatment Among Adolescents

JAMA Pediatrics, Год журнала: 2020, Номер 174(6), С. 609 - 609

Опубликована: Март 23, 2020

Obesity in adolescence has reached epidemic proportions around the world, with prevalence of severe obesity increasing at least 4-fold over last 35 years. Most youths carry their excess adiposity into adulthood, which places them increased risk for developing obesity-driven complications, such as type 2 diabetes and cardiovascular disease, negatively affects social emotional health. Given that is a unique transition period marked by significant physiologic developmental changes, obesity-related complications can also affect adolescent growth trajectories.

Язык: Английский

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Obesity, kidney dysfunction, and inflammation: interactions in hypertension

Cardiovascular Research, Год журнала: 2020, Номер 117(8), С. 1859 - 1876

Опубликована: Ноя. 17, 2020

Abstract Obesity contributes 65–75% of the risk for human primary (essential) hypertension (HT) which is a major driver cardiovascular and kidney diseases. Kidney dysfunction, associated with increased renal sodium reabsorption compensatory glomerular hyperfiltration, plays key role in initiating obesity-HT target organ injury. Mediators dysfunction blood pressure include (i) elevated sympathetic nerve activity (RSNA); (ii) antinatriuretic hormones such as angiotensin II aldosterone; (iii) relative deficiency natriuretic hormones; (iv) compression by fat around kidneys; (v) activation innate adaptive immune cells that invade tissues throughout body, producing inflammatory cytokines/chemokines contribute to vascular injury, exacerbate HT. These neurohormonal, renal, mechanisms are interdependent. For example, excess adiposity increases adipocyte-derived cytokine leptin RSNA stimulating central nervous system proopiomelanocortin-melanocortin 4 receptor pathway. Excess visceral, perirenal sinus compress kidneys which, along RSNA, renin–angiotensin–aldosterone activation, although obesity may also activate mineralocorticoid receptors independent aldosterone. Prolonged obesity, HT, metabolic abnormalities, inflammation cause progressive making HT more resistant therapy often requiring multiple antihypertensive drugs concurrent treatment dyslipidaemia, insulin resistance, diabetes, inflammation. More effective anti-obesity needed prevent cascade cardiorenal, metabolic, disorders threaten overwhelm health care systems prevalence continues increase.

Язык: Английский

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