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Tag: obesity

  • Twin study finds epigenetic signature for obesity

    Twin study finds epigenetic signature for obesity

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    Newswise — PULLMAN, Wash. – A susceptibility to gain weight may be written into molecular processes of human cells, a Washington State University study indicates.

    The proof-of-concept study with a set of 22 twins found an epigenetic signature in buccal or cheek cells appearing only for the twins who were obese compared to their thinner siblings. With more research, the findings could lead to a simple cheek swab test for an obesity biomarker and enable earlier prevention methods for a condition that effects 50% of U.S. adults, the researchers said.

    “Obesity appears to be more complex than simple consumption of food. Our work indicates there’s a susceptibility for this disease and molecular markers that are changing for it,” said Michael Skinner, a WSU professor of biology and corresponding author of the study published in the journal Epigenetics.

    The study focused on twins to help eliminate the role of genetics and instead focus on epigenetics, molecular processes which are separate from DNA but influence how genes are expressed. The fact that the epigenetic signature was found in cheek cells rather than fat cells also suggests that the obesity signature is likely found throughout the human system.

    The signature’s systemic nature also suggests that something may have occurred early in one twin’s life that triggered obesity susceptibility, Skinner added. It’s also possible that it was inherited by one twin and not the other.

    For this study, Skinner worked with lead author Glen Duncan, director of the Washington State Twin Registry based at WSU, to identify 22 twin pairs, both identical and fraternal, who were discordant for obesity: one sibling had a body mass index of 30 or higher, the standard for obesity defined by the Centers of Disease Control and Prevention, while the other sibling was in the normal range of 25 and below.

    The research team analyzed cells from cheek swabs provided by the twins. In the cells from the twin siblings who were obese, they found similar epigenetic changes to DNA methylation regions, areas where molecular groups made of methane attach to DNA, regulating gene expression or turning genes on or off.

    The study would need to be replicated with larger groups of people to develop a biomarker test for obesity, the authors said.

    The goal would be able to identify people earlier in life before they become obese so health care providers might help create interventions such as lifestyle changes, medication or both, said Duncan. 

    “Ultimately we would like to have some kind of preventative measure instead of our usual approach which is treatment,” he said. “It’s a simple fact that it’s better to prevent a disease, then try to treat it after you have it.”

    This research was funded by the John Templeton Foundation and the National Institutes of Health.

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    Washington State University

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  • Metformin eases weight gain in youth on bipolar meds. Study finds.

    Metformin eases weight gain in youth on bipolar meds. Study finds.

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    Newswise — A new large-scale study led by researchers at the University of Cincinnati and Northwell Health, New York’s largest health care provider, found the drug metformin can help prevent or reduce weight gain in youth taking medication to treat bipolar disorder.

    The collaborative team presented its findings during a symposium at the American Academy of Child and Adolescent Psychiatry conference in New York City Oct. 27.

    Weight gain side effect

    Medications to treat bipolar disorder, known as second-generation antipsychotics (SGAs), are often effective at helping young patients’ mental health improve but can have significant side effects including elevated blood pressure and glucose, increased appetite and weight gain.

    “We, the clinicians naively justified that we’re improving your psychosis, so just deal with the weight gain,” said Victor Fornari, MD, a child/adolescent psychiatrist at Northwell Health. “But patients stopped taking their medicine because they said they didn’t want to gain weight.”

    UC’s Christina Klein, PhD, said in addition to patients not taking their medication, the weight gain side effects can lead to lifelong harmful health outcomes.

    “So you’re not just looking at the mental health, but you’re looking at the physical health of the whole person,” said Klein, a research scientist in UC’s Department of Psychiatry and Behavioral Neuroscience in the College of Medicine.

    Klein said a survey found patients want interventions to address the side effects as soon as possible, while doctors and caregivers prefer a wait and see approach. 

    Metformin, a medication typically used for Type 2 diabetes, is known to also prevent weight gain, but nearly all psychiatrists surveyed initially said they did not feel comfortable prescribing it, leading to the study testing metformin’s effect.

    Study design

    Klein said the study had a pragmatic design, meaning it had broad enrollment criteria and was conducted at a wide variety of clinics, even those without prior participation in research studies.

    “We wanted the regular person who was just going to their doctor,” Klein said. “It’s not this perfect patient where you have this disorder and nothing else, you’re only taking this medicine, you’re adherent to the medicine or you show up every time.”

    A total of 1,565 patients aged 8-19 with bipolar disorder taking SGAs were enrolled in the study, a “Herculean” accomplishment according to Fornari.

    “It was 60 sites across the country, and it was a large sample of patients to really demonstrate what’s going on,” he said. “I don’t know that anybody has done a study of this magnitude with almost 1,600 kids and their families.”

    Everyone enrolled in the trial received a lifestyle intervention with recommendations for healthy eating and exercise. Half of the youth were randomized to receive the healthy lifestyle intervention and were prescribed metformin. 

    “If patients weren’t doing well on the metformin, they could come off and stay in this study,” Klein said. “Really we’re just trying to meet the patients when and where they received services, seeing what happens to them over the course of two years.” 

    Prior to beginning the interventions, researchers collected information on youth living with bipolar disorders’ quality of life and adherence to taking their medication as prescribed. 

    While 87% of youth reported they took their medication regularly, a majority reported they were unhappy with their weight and/or had been sad, mad or frustrated about their weight. 

    Researchers also collected baseline metabolic data to determine if youth had metabolic syndrome, which Northwell’s Claudine Higdon, MD, said is a common consequence of taking SGAs that places youth at risk for diabetes and cardiovascular disease. The study found 33% of youth enrolled in the study had metabolic syndrome at the start. 

    “The key elements of metabolic syndrome are obesity, high blood pressure, elevated triglycerides and elevated glucose,” said Higdon, a child/adolescent psychiatrist. “It is important that clinicians monitor for metabolic syndrome when treating youth with second-generation antipsychotics.” 

    Study results

    UC’s Jeffrey Welge, PhD, said in the short-term six-month follow-up data, metformin had a modest but significant effect at preventing and in some cases reversing weight gain in the study’s patient population. The drug was also found to be safe, with some gastrointestinal distress symptoms being the only side effects reported.

    “It’s not a drug you take and weight falls off of you, but it tends to reduce that out of control appetite which we think then makes it easier for patients to adhere to a healthy diet and as they lose some weight maybe also make it easier for them to engage in more exercise,” said Welge, professor in UC’s Department of Psychiatry and Behavioral Neuroscience and Department of Environmental and Public Health Sciences. “So, the lifestyle is really what’s driving good outcomes, but metformin is in some cases putting the wind at their back to help with that.”

    “It’s safe, effective and very inexpensive. It’s an intervention that has the potential to have widespread applicability,” Fornari added. “It’s not a medicine that you need to have an endocrinologist or a pediatrician prescribe, and I think it really speaks to the fact that the psychiatrist needs to be caring for the entire person, the physical and the mental health of the patient.”

    While having an effect on weight gain, metformin was not found to have a significant effect on youth’s metabolic syndrome in the short term, Welge said. 

    “Further research is needed on effective interventions for metabolic syndrome,” Higdon said.

    Patient-centered partnership

    The study received funding from the Patient-Centered Outcomes Research Institute (PCORI), and included patient and caregiver advocate input throughout.

    “We really could not have done it without the support of youth living with bipolar disorders and their caregivers, and their continued recommendations on how to keep the trial patient-centered throughout the study,” Klein said. 

    Most research studies take about 15-17 years from being published to being widely applied in clinics across the country, so PCORI has additionally supported the research team with a dissemination grant so the knowledge can be spread more quickly.

    Klein said the team will conduct focus groups with youth living with bipolar disorders, as well as their caregivers and clinicians, to see how they want information to be presented to them. 

    UC’s Melissa DelBello, MD, served as the trial’s principal investigator

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    University of Cincinnati

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  • Diabetes Associations Recognize Plant-Based Diets  | NutritionFacts.org

    Diabetes Associations Recognize Plant-Based Diets  | NutritionFacts.org

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    Plant-based diets are the single most important—yet underutilized—opportunity to reverse the pending obesity and diabetes-induced epidemic of disease and death. 

    Dr. Kim Williams, immediate past president of the American College of Cardiology, started out an editorial on plant-based diets with the classic Schopenhauer quote: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” In 2013, plant-based diets for diabetes were in the “ridiculed” stage in the official endocrinology practice guidelines and placed in the “Fad Diets” section. The guidelines acknowledged that strictly plant-based diets “have been shown to reduce the risk for T2DM [type 2 diabetes] and improve management of T2DM” better than the American Diabetes Association recommendations, then inexplicably went on to say that it “does not support the use of one type of diet over another” with respect to diabetes or in general. “The best approach for a healthy lifestyle is simply the ‘amelioration of unhealthy choices’”—whatever that means. 

    But, by 2015, the clinical practice guidelines from the same professional associations explicitly endorsed a plant-based diet as its general recommendation for diabetic patients. The times they are a-changin’! 

    As I discuss in my video Plant-Based Diets Recognized by Diabetes Associations, the American Diabetes Association itself is also now on board, listing plant-based eating as one of the dietary patterns acceptable for the management of the condition. The Canadian Diabetes Association, however, has really taken the lead. “Type 2 diabetes mellitus is considered one of the fastest growing diseases in Canada, representing a serious public health concern,” so it isn’t messing around and recommends plant-based diets for disease management “because of their potential to improve body weight and A1C [blood sugar control], LDL-cholesterol, total cholesterol and non-HDL-cholesterol levels, in addition to reducing the need for diabetes medications.” The Canadian Diabetes Association uses the Kaiser Permanente definition for that eating pattern: “a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs, as well as all refined and processed foods,” that is, junk. 

    It recommends that diabetes education centers in Canada “improve patients’ perceptions of PBDs [plant-based diets] by developing PBD-focused educational and support as well as providing individualized counseling sessions addressing barriers to change.” The biggest obstacle identified to eating plant-based was ignorance. Nearly nine out of ten patients interviewed “had not heard of using a plant-based diet to treat or manage T2DM.” Why is that? “Patient awareness of (and interest in) the benefits of a plant-based diet for the management of diabetes…may be “influenced by the perception of diabetes educators and clinicians.” Indeed, most of the staff were aware of the benefits of plant-based eating for treating diabetes, yet only about one in three were recommending it to their patients.  

    Why? One of the common reasons given was they didn’t think their patients would eat plant-based, so they didn’t even bring it up, but “[t]his notion is contrary to the patient survey results that almost two-thirds of patients were willing” to at least give it a try. The researchers cite the PCRM Geico studies I’ve covered in other videos, in which strictly plant-based diets were “well accepted with over 95% adherence rate,” presumably because the study participants just felt so much better, reporting “increased energy level, better digestion, better sleep, and increased satisfaction when compared with the control group.” 

    A number of staff members also expressed they were unclear about the supportive scientific evidence as their second reason for not recommending this diet, but it’s been shown to be more effective than an American Diabetes Association–recommended diet at reducing the use of diabetes medications, long-term blood sugar control, and cholesterol. It’s therefore possible that the diabetes educators were simply behind the times, as there is “a lag-time” in the dissemination of new scientific findings from the literature to the clinician and finally to the patient. Speeding up this process is one of the reasons I started NutritionFacts.org. 

    As Dr. Williams put it, “the ‘truth’ (i.e., evidence) for the benefits of plant-based nutrition continues to mount. This now includes lower rates of stroke, hypertension, diabetes mellitus, obesity, myocardial infarction, and mortality [heart attacks and cardiac death], as well as many non-cardiac issues that affect our patients in cardiology, ranging from cancer to a variety of inflammatory conditions.” We’ve got the science. The bigger challenge is overcoming the “inertia, culture, habit, and widespread marketing of unhealthy foods.” He concludes, “Reading the existing literature and evaluating the impact of plant-based nutrition, it clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes-induced epidemic of morbidity and mortality,” disease and death. 

    I highlighted the PCRM Geico studies in my videos Slimming the Gecko and Plant-Based Workplace Intervention. 

    Aren’t plant-based diets high in carbs? Get the “skinny” by checking out my video Flashback Friday: Benefits of a Macrobiotic Diet for Diabetes. 

    To learn more about diet’s effect on type 2 diabetes, see the related videos below. 

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    Michael Greger M.D. FACLM

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  • Science’s Take On Marijuana For A Lean Physique

    Science’s Take On Marijuana For A Lean Physique

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    It is the time of year when we are watching the weight and trying to look our best.  Fasting, running, diet plans, pilates and cross training are all the table.  But what is science’s take on marijuana for a lean physique?

    Let’s start with some basic body chemistry. The pancreas creates insulin, a hormone that moderates blood sugar levels. It helps use sugar/glucose from carbohydrates for instant energy or stored as fat for later. That is the very process cannabis can influence, according to a growing body of research. It begins at a micro level. 

    THC is the compound in cannabis that causes people to feel “high.” While it may be the most famous cannabinoid, there are more than 100 in existence and they occur naturally in our bodies as endocannabinoids. The endocannabinoid system is present in all vertebrate animals and helps regulate sleep, energy, appetite and metabolism just to name a few. It helps create balance or homeostasis at a cellular level. This is why marijuana as medicine can be so effective. It is seen not as an invader, but as a familiar substance to the body’s cannabinoid receptors and works like a lock and key.

    RELATED: How I Lost 50 Pounds Using Marijuana

    But getting leaner by using cannabis? Are you serious? This is not just a pipe dream. Researchers studying diabetes, metabolism and obesity have become increasingly interested in how cannabis may be an effective therapy for human systems out of balance.

    While much of this research has been conducted on rats, human cannabis users have been shown to have significantly lower obesity rates and have trimmer waistlines than non-users. The cannabinoid THC has also been shown to suppress appetite. These findings have been further validated in studies with huge sample sizes.

    Photos by: Roberto Valdivia via Unsplash, 377873 via rawpixel

    Age, sex and race do not seem to matter; the effect is across the board. This has led to a deeper look and call for more research into how the endocannabinoid system may be manipulated to help people with obesity and blood sugar metabolism.

    The strange, good news does not end there. Cannabis users have also been shown to have lower cholesterol and triglycerides in their blood. The makers of statin drugs popular in common therapy for these conditions are watching these developments closely.

    RELATED: Federal Study Aims To Learn More About Marijuana And Weight Loss

    Jake Felice, a naturopath working in Washington State and California, has long been an advocate for appropriate cannabis therapy. While there is much promising research, Felice reminds patients:

    “While cannabis has not been shown to be a weight loss agent, it is associated with lower BMI (body mass index) and can have a positive influence on the body’s ability to regulate sugar levels. Additionally, cannabis can positively affect stress hormones associated with weight gain.” 

    Cannabis alone will not help you to have a lower BMI if you don’t exercise and have unhealthy eating habits. But, if researchers are right, it can help people to be more in balance and aid in maintaining a healthy body weight.

    Granted, we have a long way still to go on research, but stay tuned. Maybe one day the advice from the Surgeon General will be, “Just Say Grow.”

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    Trey Reckling

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  • Drug used in diabetes treatment Mounjaro helped dieters shed 60 pounds, study finds

    Drug used in diabetes treatment Mounjaro helped dieters shed 60 pounds, study finds

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    The medicine in the diabetes drug Mounjaro helped people with obesity or who are overweight lose at least a quarter of their body weight, or about 60 pounds on average, when combined with intensive diet and exercise, a new study shows.

    By comparison, a group of people who also dieted and exercised, but then received dummy shots, lost weight initially but then regained some, researchers reported Sunday in the journal Nature Medicine.

    “This study says that if you lose weight before you start the drug, you can then add a lot more weight loss after,” said Dr. Thomas Wadden, a University of Pennsylvania obesity researcher and psychology professor who led the study.

    The results, which were also presented Sunday at a medical conference, confirm that the drug made by Eli Lilly & Co. has the potential to be one of the most powerful medical treatments for obesity to date, outside experts said.

    “Any way you slice it, it’s a quarter of your total body weight,” said Dr. Caroline Apovian, who treats obesity at Brigham and Women’s Hospital and wasn’t involved in the study.

    The injected drug, tirzepatide, was approved in the U.S. in May 2022 to treat diabetes. Sold as Mounjaro, it has been used “off-label” to treat obesity, joining a frenzy of demand for diabetes and weight-loss medications including Ozempic and Wegovy, made by Novo Nordisk.

    All the drugs, which carry retail price tags of $900 a month or more, have been in shortage for months.

    Tirzepatide targets two hormones that kick in after people eat to regulate appetite and the feeling of fullness communicated between the gut and the brain. Semaglutide, the drug used in Ozempic and Wegovy, targets one of those hormones.

    The new study, which was funded by Eli Lilly, enrolled about 800 people who had obesity or were overweight with a weight-related health complication — but not diabetes. On average, study participants weighed about 241 pounds (109.5 kilograms) to start and had a body-mass index — a common measure of obesity — of about 38.

    After three months of intensive diet and exercise, more than 200 participants left the trial, either because they failed to lose enough weight or for other reasons. The remaining nearly 600 people were randomized to receive tirzepatide or a placebo via weekly injections for about 16 months. Nearly 500 people completed the study.

    Participants in both groups lost about 7% of their body weight, or almost 17 pounds (8 kilograms), during the diet-and-exercise phase. Those who received the drug went on to lose an additional 18.4% of initial body weight, or about 44 pounds (20 kilograms) more, on average. Those who received the dummy shots regained about 2.5% of their initial weight, or 6 pounds (2.7 kilograms).

    Overall, about 88% of those taking tirzepatide lost 5% or more of their body weight during the trial, compared with almost 17% of those taking placebo. Nearly 29% of those taking the drug lost at least a quarter of their body weight, compared with just over 1% of those taking placebo.

    That’s higher than the results for semaglutide and similar to the results seen with bariatric surgery, said Apovian.

    “We’re doing a medical gastric bypass,” she said.

    Side effects including nausea, diarrhea and constipation were reported more frequently in people taking the drug than those taking the placebo. They were mostly mild to moderate and occurred primarily as the dose of the drug was escalated, the study found. More than 10% of those taking the drug discontinued the study because of side effects, compared with about 2% of those on placebo.

    Lilly is expected to publish the results soon of another study that the firm says shows similar high rates of weight loss. The U.S. Food and Drug Administration has granted the company a fast-track review of the drug to treat obesity, which Eli Lilly may sell under a different brand name. A decision is expected by the end of the year.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • ‘Miracle drug’ euphoria: Experts warn widespread use of weight loss medicine faces major hurdles

    ‘Miracle drug’ euphoria: Experts warn widespread use of weight loss medicine faces major hurdles

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    Two experts see major challenges facing the adoption of new obesity drugs.

    Dr. Kavita Patel, a physician and NBC News medical contributor, believes fresh data from Novo Nordisk on Ozempic’s ability to delay the progression of chronic kidney disease is among the strongest supporting evidence for secondary uses of the drug.

    However, she considers data supporting the use of obesity drugs for other conditions including Alzheimer’s and alcohol addiction as underdeveloped.

    “Those trials … are nowhere near as robust as the data we have on [Novo Nordisk trial] FLOW, on sleep apnea, cardiovascular risks, on diabetes control — double-blind placebo, randomized controlled trials that are incredible,” she told CNBC’s “Fast Money” on Wednesday. “We have a long way to go for that. I’ve seen a lot of miracle drugs before.”

    Novo Nordisk halted FLOW on Tuesday. According to the company’s press release, it happened more than a year after an interim analysis showed that Ozempic could treat chronic kidney disease in Type 2 diabetic patients.

    As of Friday’s close, Novo Nordisk is up 9.82% since its announcement. Its obesity drug maker competitor Eli Lilly is up 5.16% in the same period.

    Patel believes efficacy is just one of the major hurdles the medication needs to clear before it can be approved for uses outside of diabetes management.

    “We know this drug works really well in diabetics. But there are so many barriers to getting there —including cost, adherence, prescriber rate,” said Patel, who also served as a White House Health Policy Director under President Obama.

    Patients opting to use GLP-1 drugs — a group of medications initially designed to control diabetes — for weight management often must pay out-of-pocket.

    “Right now, we are seeing active employers, entire states that are declining to cover on the weight loss indication,” Patel said.

    What other industries could weight loss drugs disrupt?

    If the U.S. Food and Drug Administration approves Ozempic for use in Type 2 diabetics with chronic kidney disease, which Patel believes will happen, it could force the hand of insurance companies to expand their coverage of the drug.

    “We’ll see a final package of data that will just be so compelling, that it would be wrong not to cover this, because it should be superior to what we have available to us,” she noted. “That is something that I think the insurance companies will have a difficult time [with].”

    Mizuho Health Care Sector Strategist Jared Holz also expects challenges related to insurance coverage as more patients begin taking GLP-1 drugs, which could limit overall adoption.

    “The payers, at some point, are going to be saying, ‘We get it, but we cannot pay for these at this volume without seeing the benefit, which may be 10 years from now, 20 years from now, 30.’ We have no idea when the offset is going to be,” he also told CNBC’s “Fast Money.”

    Holz also pointed out the divide emerging in the health care sector between Novo Nordisk, Eli Lilly and their pharmaceutical peers.

    “We haven’t seen this kind of valuation disconnect between the peer group, maybe in the history of the sector,” he said.

    The growth trend may not be sustainable for Novo Nordisk and Eli Lilly, based on current supply constraints that have left patients unable to secure dosages.

    “The companies can’t make enough, I don’t think, to actually put out revenue that’s going to appease investors, given where the stocks are trading,” said Holz.

    A Novo Nordisk spokesperson did not offer a comment due to the company’s quiet period ahead of earnings. Eli Lilly did not immediately respond to a request for comment.

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  • New insights into heart disease risk, prevention, and management

    New insights into heart disease risk, prevention, and management

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    Newswise — DALLAS, Oct. 9, 2023 — Health experts are redefining cardiovascular disease (CVD) risk, prevention and management, according to a new American Heart Association presidential advisory published today in the Association’s flagship journal Circulation.

    Various aspects of cardiovascular disease that overlap with kidney disease, Type 2 diabetes and obesity support the new approach. For the first time, the American Heart Association defines the overlap in these conditions as cardiovascular-kidney-metabolic (CKM) syndrome. People who have or are at risk for cardiovascular disease may have CKM syndrome.

    The new approach detailed in the presidential advisory includes:

    • CKM syndrome stages ranging from 0, or no risk factors and an entirely preventive focus, to Stage 4, the highest-risk stage with established cardiovascular disease. Stage 4 may also include kidney failure. Each stage correlates to specific screenings and therapies.
    • Screening for and addressing social factors that impact health.
    • Collaborative care approaches among multiple specialties to treat the whole patient.
    • Suggested updates to the algorithm, or risk calculator, that helps health care professionals predict a person’s likelihood of having a heart attack or stroke. The update adds a risk prediction for heart failure, which estimates risk for “total cardiovascular disease” — heart attack, stroke and/or heart failure.
    • The writing group suggest the updated algorithm provide both 10- and 30-year cardiovascular disease risk estimates.

    According to the American Heart Association’s 2023 Statistical Update, 1 in 3 U.S. adults have three or more risk factors that contribute to cardiovascular disease, metabolic disorders and/or kidney disease. CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver. However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart and more.

    “The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, writing committee chair and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore. “Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”

    CKM syndrome is a consequence of the historically high prevalence of obesity and Type 2 diabetes in both adults and youth, according to the advisory. Type 2 diabetes and obesity are metabolic conditions — the “M” in CKM — that are also risk factors for cardiovascular disease. Moreover, the most common cause of death for people with Type 2 diabetes and chronic kidney disease is cardiovascular disease.

    “We now have several therapies that prevent both worsening kidney disease and heart disease,” Ndumele said. “The advisory provides guidance for health care professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome.”

    With multiple conditions to manage, Ndumele noted fragmented care is a concern in treating patients with CKM syndrome, particularly for those with barriers to care. “The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient.” Additionally, the advisory emphasizes the importance of systematically screening for and addressing social factors that act as determinants, or drivers, of health, such as nutrition insecurity and opportunities for exercise,  as key aspects of optimal CKM syndrome care.”

    A companion article published with the presidential advisory, a new American Heart Association scientific statement, “A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome,”, documents the evidence for the writing committee’s proposed approach. The scientific statement brings together evidence from current guidelines and large research studies and describes where gaps remain in knowledge needed to further improve CKM health.

    CKM screening, stages and treatment

    CKM-related screening is intended to detect cardiovascular, metabolic and kidney health changes early; identify social and structural barriers to care; and prevent progression to the next stage of CKM syndrome.

    The advisory addresses care for adults. However, studies suggest CKM syndrome is progressive and begins early in life. Therefore, the advisory aligns with the American Academy of Pediatrics’ recommendations for children and youth to have annual assessments of weight, blood pressure, and mental and behavioral health, starting at age 3.

    Stage 0 – No CKM risk factors. The goal at this stage is preventing CKM syndrome by achieving and maintaining ideal health based on the American Heart Association’s Life’s Essential 8 recommendations. The recommendations include healthy eating, physical activity and sleep habits; avoiding nicotine; and maintaining optimal weight, blood pressure, blood sugar and cholesterol levels. The advisory suggests screening adults in Stage 0 every three to five years to assess blood pressure, triglycerides, HDL (good) cholesterol and blood sugar.

    Preventing unhealthy weight gain is important for CKM syndrome prevention because of the connection of obesity to Type 2 diabetes, high blood pressure and high triglycerides. At all stages, the advisory proposes yearly measurement of waist circumference and body mass index. Healthy lifestyle behaviors are also encouraged at every stage.

    Stage 1 – Excess body fat and/or an unhealthy distribution of body fat, such as abdominal obesity, and/or impaired glucose tolerance or prediabetes. Support for healthy lifestyle changes (healthy eating and regular physical activity) and a goal of at least 5% weight loss in people with Stage 1 are suggested, with treatment for glucose intolerance if needed. Screening every two to three years is advised to assess blood pressure, triglycerides, cholesterol and blood sugar.

    Stage 2 – Metabolic risk factors and kidney disease. Stage 2 includes people with Type 2 diabetes, high blood pressure, high triglycerides or kidney disease, and indicates a higher risk for worsening kidney disease and heart disease. The goal of care at this stage is to address risk factors to prevent progression to cardiovascular disease and kidney failure. Treatment may include medications to control blood pressure, blood sugar and cholesterol. In those with chronic kidney disease and in some people with Type 2 diabetes, SGLT2 inhibitors are advised to protect kidney function and reduce the risk of heart failure. SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with Type 2 diabetes. Glucagon-like peptide 1 (GLP-1) receptor agonists are also suggested for consideration in people with Type 2 diabetes to help reduce high glucose, facilitate weight loss and reduce risk for CVD. Other therapies to prevent worsening kidney function are also advised. Screening suggestions for Stage 2 CKM syndrome align with AHA/ACC guidelines, which include yearly assessment of blood pressure, triglycerides, cholesterol, blood sugar and kidney function.

    For those with increased risk of kidney failure based on kidney function assessments, more frequent kidney screening is recommended.

    Stage 3 – Early cardiovascular disease without symptoms in people with metabolic risk factors or kidney disease or those at high predicted risk for cardiovascular disease. The goal of care in Stage 3 is to intensify efforts to prevent people who are at high risk of progressing to symptomatic cardiovascular disease and kidney failure. This may involve increasing or changing medications, and additional focus on lifestyle changes. The writing committee advises coronary artery calcium (CAC) measurement in some adults to assess narrowing of the arteries when treatment decisions are unclear. CAC screening is used to guide decisions about cholesterol-lowering statin therapy. Test results indicating asymptomatic heart failure should lead to intensified therapy to prevent heart failure symptoms.

    The advisory also describes CKM syndrome regression, an important concept and public health message in which people making healthy lifestyle changes and achieving weight loss may regress to lower CKM syndrome stages and a better state of health. The best opportunity for patients to experience regression is in Stages 1, 2 and 3. Some may see improvements in glucose control, cholesterol and blood pressure levels, weight, kidney function and types of heart dysfunction.

    Stage 4 – Symptomatic cardiovascular disease in people with excess body fat, metabolic risk factors or kidney disease. Stage 4 CKM syndrome is divided into two subcategories: (4a) for those without kidney failure or (4b) for those with it. In this stage, people may have already had a heart attack or stroke or may already have heart failure. They also may have additional cardiovascular conditions such as peripheral artery disease or atrial fibrillation. The goal of care is individualized treatment for cardiovascular disease with consideration for CKM syndrome conditions.

    Predicting Risk

    A critical step in assessing risk and managing CKM syndrome is updating the risk prediction algorithm to help health care professionals predict cardiovascular disease in a way that includes CKM components: cardiovascular disease, chronic kidney disease and metabolic disorders.

    The Pooled Cohort Equation, the current risk calculator for atherosclerotic cardiovascular disease, established in 2013, estimates the risk of a heart attack or stroke in the next 10 years for people ages 40-75. It includes health and demographic factors about a person and is used to guide lifestyle recommendations and treatment decisions for people at risk for cardiovascular disease. The risk factors are age, sex and race (as white, Black and other); cholesterol levels; and systolic blood pressure. The equation also includes yes/no responses to whether a person is receiving treatment for high blood pressure Type 2 diabetes, or smokes cigarettes.

    The advisory proposes updating the risk calculator to include measures of kidney function, Type 2 diabetes control (using blood test results instead of a yes/no response) and social determinants of health for a more comprehensive risk estimate. Kidney function assessments include a measure of how well the kidneys filter waste from the blood and urine albumin levels, a measure of how well the kidneys reabsorb protein. Individual health measures in addition to demographic information will allow the calculator to produce an individual’s total CVD risk estimate.

    The writing group recommends the risk calculator updates be expanded to assess risk in people as young as age 30 and to calculate both 10- and 30-year CVD risk. More comprehensive CVD risk assessment at younger ages will allow for earlier preventive strategies to mitigate progression to advanced stages of CKM syndrome. In the long term, this will help to reduce gaps in treatment and health equity and improve outcomes.

    Calls to Action

    The advisory calls for systemic changes to optimize CKM health.

    “There is a need for fundamental changes in how we educate health care professionals and the public, how we organize care and how we reimburse care related to CKM syndrome,” Ndumele said. “Key partnerships among stakeholders are needed to improve access to therapies, to support new care models and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health.”

    Investing in research is important for advancing CKM care. Key research gaps include:

    1. better understanding the pathways leading to heart disease in CKM syndrome;
    2. better understanding of why some people may advance more quickly along CKM stages, while others may progress more slowly; and
    3. understanding the best way to use newer therapies with multiple effects on CKM syndrome, including to improve metabolic factors such as obesity and Type 2 diabetes, and to reduce worsening kidney disease and prevent heart disease.

    Co-authors and their disclosures are listed in the manuscript.

    This presidential advisory was prepared by the volunteer writing group on behalf of the American Heart Association. Presidential advisories and scientific statements promote greater awareness about cardiovascular diseases and stroke and help facilitate informed health care decisions. They outline what is known about a topic and what areas need additional research. While scientific statements and advisories inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide official clinical practice recommendations.

    The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

    Additional Resources:

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  • Bet against America’s love for junk food? Morgan Stanley sees tough times ahead for snack stocks like Hostess

    Bet against America’s love for junk food? Morgan Stanley sees tough times ahead for snack stocks like Hostess

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  • Your boarding pass and weight, please: Why airlines are asking passengers to step on the scales

    Your boarding pass and weight, please: Why airlines are asking passengers to step on the scales

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    Starting Monday, passengers flying on Korean Air may be asked to step on a scale before boarding their flight.

    The exercise, which will last about three weeks, is required by law and applies to all Korean flag carriers, a Korean Air representative told CNBC.

    The law requires airlines to weigh passengers and their carry-on luggage at least every five years and is “crucial for safety of flight operations,” the representative told CNBC.

    The announcement was met with backlash from the public, according to local media.

    A notice detailing the exercise — set to begin at Gimpo International Airport Monday, followed by Incheon Airport next month — has been removed from the airline’s website, due to “sufficient notice and media coverage,” according to the airline.

    Is it reasonable to weigh passengers?

    “Definitely not,” said Vance Hilderman, CEO of the aviation safety company Afuzion.

    At least not for the purpose of safety, he said.   

    “If you’re at a small Bombardier, a small Embraer jet, and we had 10 very obese people … it could make a small difference,” he said. “On commercial aircraft, anything from a 737 and above you know, 120 people, we have it built in.”

    Aviation software can adjust for weight changes, air density and other factors, which is why safety isn’t compromised even in situations where passenger makeup is atypical, such as an early morning flight of mostly businessmen, who tend to weigh more than the average traveler, he said.

    Overall, a significant weight increase per passenger would be eclipsed by the weight of fuel, cargo and the aircraft itself, said Hilderman. “Fuel is 20 times more than the passenger weight,” he said.

    Rather than focusing on passenger weight, it’s more important to adjust for additional cargo and the number of passengers on board, said Afuzion CEO Vance Hilderman.

    Casanowe | Istock | Getty Images

    But Shem Malmquist, an instructor at Florida Tech’s College of Aeronautics, said random weight samples are a good idea.

    “We use average weights of passengers, but people are getting a lot heavier,” he said. “Three hundred people that weigh more than average can put an airplane significantly over weight, and all of our performance calculations — runway length, climb, obstacle clearance, landing distances, altitude capabilities — all are dependent on weight, among other things.”

    Hilderman agrees that people are getting bigger, but he said passengers now differ in other ways too.

    “Americans are getting heavier. So are Chinese, so are Koreans,” he said. “But we’re also flying younger … so it’s actually offset the average human’s weight increase.”

    A study published in 2019 in the Journal of Transport & Health found that regions with higher obesity prevalence “may begin to see significantly compromised safety margins if increasing weight trends continue.”

    Jose Silva, an associate professor at Australia’s RMIT University’s School of Engineering and one of the study’s authors, told CNBC that he thinks airlines are reluctant to weigh passengers due to the sensitive nature of the topic.

    “There is also a lack of understanding of the safety gains which could be obtained if there were more accurate means to ascertain the passengers’ weight, instead of relying on standards,” he said.

    A whistleblower complaint filed in 2021 alleges that the U.S. Federal Aviation Administration has failed to recognize safety issues caused by relying on average passenger or baggage weights that no longer reflect the U.S. population.

    Where airlines weigh passengers

    Air New Zealand weighed passengers in June for reasons, it said, related to safety and fuel efficiency.

    Finnair did the same in 2017, and Hawaiian Air has conducted multiple passenger weight exercises on flights between Honolulu and American Samoa. (The now defunct Samoa Air used to charge passengers by their weight, according to Reuters.)

    Flyers in the United States likely won’t be weighed, said Hilderman, even though an FAA advisory circular published in 2019 stated that airlines can weigh passengers.

    It’s a different story in Europe, where carriers follow European Union Aviation Safety Agency (EASA) regulations.

    American airlines follow regulations set forth by the International Civil Aviation Organization, which does not require that passengers be weighed, said Hilderman.

    Simon2579 | E+ | Getty Images

    EASA weighed nearly 23,000 passengers in 2008 and 2009 and found that average passenger weight had increased by 3 to 5 kilograms (6.6 to 11 pounds). A subsequent report published in 2022 found that mean passenger weight increased slightly since 2009, for an average of 82 kg (181 pounds) for men and 68 kg (149 pounds) for women.

    Periodic weight assessments — of passengers and other items on board — can help airlines determine if weight estimates are still accurate to offset the amount of cargo they carry, said Hilderman.

    But “there’s a little more to this mystery,” he added.

    “In Europe, they’re a little more rigorous about individual rights with privacy,” he said. “With EASA, they want to protect the passengers and say: Look, the passengers are getting larger, so airlines, we want you to provide a minimum pitch distance on your seats.”

    Commercial airline seating is based on average passenger weight from the 1950s to 1970s, Hilderman said. Since then, people have gotten bigger, but airline seats have dwindled, he said — “29 inches in some cases, it’s absolutely ridiculous.”

    A hot-button topic

    Passenger size on planes is a controversial topic — with oversized flyers lodging discrimination allegations over Lilliputian plane aisles and seat sizes, and smaller travelers publicly venting about seat encroachment.  

    But unlike other industries that service heavy people — from makers of chairs to toilets to amusement park rides — the airline industry hasn’t enlarged seats.

    “Some have proposed that obese passengers be required to pay for two seats in order to not make other passengers uncomfortable, but that lets the airlines escape any responsibility,” said Nick Gausling, a consumer services business consultant and managing director of Romy Group LLC.

    Gausling noted that while other industries have been pressured to prioritize customer experience, “consumers have very little choice to take their business elsewhere” when it comes to airlines.

    Tigress Osborn, the executive director of the National Association to Advance Fat Acceptance, told CNBC that most major airlines have responded with three options for overweight travelers: pay for pricier tickets that come with bigger seats, purchase a second seat, or stay home.

    “Fat people deserve to travel for pleasure just like everyone else, and we also need to remember that air travel is for work, for family obligations, and for other responsibilities, too,” she said. “Our taxes help support this industry, and we deserve to be accommodated safely and comfortably, with access to accessible seating at all price levels.”

    Ideas to help larger passengers

    Hilderman said airlines can sell second seats to plus-size travelers at a heavily discounted rate.

    As people have gotten bigger, airline seats have gotten smaller, which has led to frequent complaints from air travelers of all sizes.

    Jodi Jacobson | Istock | Getty Images

    Or they can reserve half a dozen seats for larger people, which passengers could privately register for online, using height and weight details from their driver’s licenses, he said.

    Those seats could be sold at a small surcharge, and if not booked by qualified passengers the week before the flight, released to anyone willing to pay for them, he added.

    Any hope for wider seats?

    As to whether airlines will increase seat sizes for everyone, Hilderman said that while it’s mathematically possible, it’s not practical.

    “Fuselage diameters have been predetermined,” he said, referencing the main body of the aircraft. “We currently have 29,000 commercial aircraft flying, and we only make about 1,500 per year, so it would take 20 years to replace the entire fleet.”

    Refitting planes with wider seats means narrowing the aisle, which is already a tight squeeze, he said. To widen the aisle, one seat from every row would need to be removed, resulting in a 20-25% ticket price increase across the board, he said.

    “Most people don’t look at what kind of aircraft they’re flying, and they have no idea what the seat pitch or width is,” said Hilderman. “They’re simply buying on price — and the airlines know that.”

    Arnold Barnett, a management science and statistics professor at the MIT Sloan School of Management, told CNBC that most flyers are willing to endure current seat sizes in return for lower fares.  

    If seating changed, “airfares would have to go up, and flying would become unaffordable to passengers on limited budgets.”

    For many, a tight airline seat is better than a seat on a bus, he said.

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  • Weight loss drug helps heart failure patients with obesity.

    Weight loss drug helps heart failure patients with obesity.

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    Newswise — Amsterdam, Netherlands – 25 Aug 2023: Semaglutide improves heart failure-related symptoms and physical function and results in greater weight loss compared with placebo in patients with heart failure with preserved ejection fraction (HFpEF) and obesity, according to late breaking research presented in a Hot Line session today at ESC Congress 2023.1

    Approximately half of patients with heart failure in the community have HFpEF.2 Most patients with HFpEF are overweight or obese, and growing evidence suggests that obesity and excess adiposity are not simply comorbidities, but may play a pivotal role in the development and progression of HFpEF.3 Patients with obesity-related HFpEF have an especially high burden of debilitating symptoms (shortness of breath, exertional intolerance, swelling/oedema) and physical limitations, which collectively result in a poor quality of life.4,5 Few treatment options are available, and there are no approved therapies specifically targeting the obesity phenotype of HFpEF.

    Semaglutide is a potent glucagon-like-peptide-1 receptor agonist which has previously been shown to produce substantial weight loss in people with overweight and obesity.6 The STEP-HFpEF trial tested the hypothesis that treatment with semaglutide can significantly improve symptoms, physical limitations and exercise function, in addition to weight loss, in patients with HFpEF and obesity.7

    STEP-HFpEF was a randomised, double-blind, placebo-controlled trial conducted at 96 sites in 13 countries in Asia, Europe, North America and South America. The trial included patients with HFpEF (left ventricular ejection fraction ≥45%), body mass index (BMI) ≥30 kg/m2, heart failure symptoms and functional limitations (New York Heart Association functional class II–IV and Kansas City Cardiomyopathy Questionnaire Clinical Summary Score [KCCQ-CSS] <90 points).

    Participants were randomly assigned in a 1:1 ratio to once-weekly subcutaneous semaglutide 2.4 mg or placebo for 52 weeks. The trial had two primary endpoints: change from baseline to week 52 in 1) KCCQ-CSS, a gold standard measure of heart failure-related symptoms and physical limitations; and 2) body weight. Confirmatory secondary endpoints included change in 6-minute walk distance (6MWD – a validated measure of exercise function); a hierarchical composite endpoint of death, heart failure events and change in KCCQ-CSS and 6MWD; and change in C-reactive protein (CRP – a measure of inflammation).

    The trial included 529 patients. The median age was 69 years and 56.1% were women. The median body weight and BMI at baseline were 105.1 kg and 37.0 kg/m2, respectively. At baseline, patients had a substantial degree of heart failure-related symptoms, physical limitations and poor exercise tolerance: 66.2% were NYHA class II and 33.8% were NYHA class III–IV; the median KCCQ-CSS was 58.9 points; and the median 6MWD was 320 meters.

    The trial met both primary endpoints and all confirmatory secondary endpoints. The mean change in KCCQ-CSS from baseline to week 52 was 16.6 points with semaglutide versus 8.7 points with placebo (estimated treatment difference [ETD]: 7.8 points, 95% confidence interval [CI] 4.8 to 10.9; p<0.001). The mean change in body weight from baseline to week 52 was -13.3% with semaglutide versus -2.6% with placebo (ETD: -10.7%, 95% CI -11.9% to -9.4%; p<0.001).

    Regarding secondary endpoints, the mean change in 6MWD was 21.5 meters for semaglutide versus 1.2 meters for placebo (ETD: 20.3 meters, 95% CI 8.6 to 32.1; p<0.001). For the hierarchical composite endpoint, semaglutide produced more wins than placebo (win ratio 1.72, 95% CI 1.37 to 2.15; p<0.001). The mean change in CRP was -43.5% and -7.3% with semaglutide and placebo, respectively (estimated treatment ratio 0.61, 95% CI 0.51 to 0.72; p<0.001).

    In terms of exploratory endpoints, the change in NTproBNP at 52 weeks was -20.9% and -5.3% for semaglutide versus placebo (estimated treatment ratio 0.84, 95% CI 0.71 to 0.98). One patient in the semaglutide group and 12 in the placebo group experienced an adjudicated event of heart failure hospitalisation or urgent visit (hazard ratio 0.08, 95% CI 0.00 to 0.42). Serious adverse events were reported in 35 (13.3%) and 71 (26.7%) participants with semaglutide and placebo, respectively (p<0.001).

    Principal investigator Dr. Mikhail Kosiborod of Saint Luke’s Mid America Heart Institute, Kansas City, US said: “In patients with HFpEF and obesity, treatment with semaglutide 2.4 mg produced large improvements in symptoms, physical limitations and exercise function, reduced inflammation, and resulted in greater weight loss and fewer serious adverse events as compared with placebo. To our knowledge, this is the first trial of a pharmacologic agent to specifically target obesity as a treatment strategy for HFpEF, and the magnitude of the benefits we observed is the largest seen with any agent in HFpEF. This will likely have a significant impact on clinical practice, especially since there is a dearth of efficacious therapies in this vulnerable patient group. We believe that these findings should also change the nature of the conversation about the role of obesity in HFpEF, as the STEP-HFpEF results clearly indicate that obesity is not simply a comorbidity in patients with HFpEF but a root cause and a target for therapeutic intervention.”

     

    References and notes

    1STEP-HFpEF will be discussed during Hot Line 1 on Friday 25 August at 11:15 to 12:15 CEST in room Amsterdam.

    2Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14:591–602.

    3Borlaug BA, Jensen MD, Kitzman DW, et al. Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc Res. 2023;118:3434-3450.

    4Reddy YNV, Lewis GD, Shah SJ, et al. Characterization of the obese phenotype of heart failure with preserved ejection fraction: a RELAX trial ancillary study. Mayo Clin Proc. 2019;94:1199–

    1209.

    5Reddy YNV, Rikhi A, Obokata M, et al. Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity. Eur J Heart Fail. 2020;22:1009–1018.

    6 Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989-1002.

    7Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Design and baseline characteristics of STEP-HFpEF program evaluating semaglutide in patients With obesity HFpEF phenotype. JACC Heart Fail. 2023;S2213-1779(23)00245-7.

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  • Consuming added sugars may increase risk of kidney stones

    Consuming added sugars may increase risk of kidney stones

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    Newswise — Between 7% and 15% of people in North America, between 5% and 9% of people in Europe, and between 1% and 5% of people in Asia suffer from kidney stones. Common symptoms are severe pain, nausea, vomiting, fever, chills, and bloody urine. But kidney stones don’t just reduce the quality of life: in the long run, they may lead to infections, swollen kidneys (hydronephrosis), renal insufficiency, and end-stage renal disease. Known risk factors for developing kidney stones include being an adult male, obesity, chronic diarrhea, dehydration, and having inflammatory bowel disease, diabetes, or gout.

    Now, a study in Frontiers in Nutrition has shown for the first time that an elevated consumption of added sugars should probably be added to the list of risk factors for kidney stones. Added sugars occur in many processed foods, but are especially abundant in sugar-sweetened sodas, fruit drinks, candy, ice cream, cakes, and cookies.

    “Ours is the first study to report an association between added sugar consumption and kidney stones,” said lead author Dr Shan Yin, a researcher at the Affiliated Hospital of North Sichuan Medical College, Nanchong, China. “It suggests that limiting added sugar intake may help to prevent the formation of kidney stones.”

    National Health and Nutrition Examination Survey

    Yin et al. analyzed epidemiological data on 28,303 adult women and men, collected between 2007 to 2018 within the US National Health and Nutrition Examination Survey (NHANES). Participants self-reported if they had a history of kidney stones. Each participant’s daily intake of added sugars was estimated from their recall of their most recent consumption of food and drinks, given twice: once in a face-to-face interview, and once in a telephone interview between three and 10 days later. For example, participants were asked if they had eaten syrups, honey, dextrose, fructose, or pure sugar during the past 24 hours. 

    Each participants also received a healthy eating index score (HEI-2015), which summarizes their diet in terms of the adequacy of beneficial diet components such as fruits, vegetables, and whole grains, and moderation of potentially harmful foods, for example refined grains, sodium, and saturated fats.

    The researchers adjusted the odds of developing kidney stones per year during the trial for a range of explanatory factors. These included gender, age, race or ethnicity, relative income, BMI, HEI-2015 score, smoking status, and whether the participants had a history of diabetes.

    At the start of the study, participants with a higher intake of added sugar tended to have a higher current prevalence of kidney stones, a lower HEI score, and a lower education level. The overall mean intake of added sugars was 272.1 calories per day, which corresponds to 13.2% of the total daily energy intake. 

    Positive association between added sugars and kidney stones

    The researchers showed that after adjusting for these factors, the percentage of energy intake from added sugars was positively and consistently correlated with kidney stones. For example, participants whose intake of added sugars was among the 25% highest in the population had 39% greater odds of developing kidney stones over the course of the study.

    Similarly, participants who derived more than 25% of their total energy from added sugars had a 88% greater odds than those who derived less than 5% of their total energy from added sugars.

    The results also indicated that participants from ‘Other’ ethnicities – for example Native American or Asian people – had higher odds of developing kidney stones when exposed to greater-than-average amounts of added sugars than Mexican American, other Hispanic, non-Hispanic White, and non-Hispanic Black people. People with a greater Poverty-Income Ratio (PIR; ie, the ratio between their income and the federal poverty level) had greater odds of developing kidney stones when exposed to more added sugars than people at or slightly above poverty level.

    Possibility of confounders 

    The mechanisms of the relation between consuming more added sugars and a greater risk of developing kidney stones is not yet known. Because this was an uncontrolled observational trial, it can’t yet be ruled out that unknown confounding factors might drive this association. 

    “Further studies are needed to explore the association between added sugar and various diseases or pathological conditions in detail,” cautioned Yin. “For example, what types of kidney stones are most associated with added sugar intake? How much should we reduce our consumption of added sugars to lower the risk of kidney stone formation? Nevertheless, our findings already offer valuable insights for decision-makers.”

    ###                                                                                                 

    For editors / news media: 

    Please link to the open access original research article “Association between added sugars and kidney stones in US adults: data from National Health and Nutrition Examination Survey 2007-2018” in Frontiers in Nutrition in your reporting:

    https://www.frontiersin.org/articles/10.3389/fnut.2023.1226082/full

     Expert contact 1’s affiliation: Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China 

    Frontiers is an award-winning open science platform and leading open access scholarly publisher. Our mission is to make research results openly available to the world, thereby accelerating scientific and technological innovation, societal progress and economic growth.

    We empower scientists with innovative open science solutions that radically improve how science is published, evaluated, and disseminated to researchers, innovators, and the public. Access to research results and data is open, free and customized online, thereby enabling rapid solutions to the critical challenges we face as humanity.

    For more information, visit http://www.frontiersin.org and follow @Frontiersin on Twitter 

    Please note the Frontiers press office business hours of Monday-Friday, 8:30 am-5.30 pm Central European Time, excluding Swiss and UK holidays. Queries received outside of these business hours will be answered the next business day.

    The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest 

    This work was supported by the Doctoral Fund Project of North Sichuan Medical College (grant number: CBY22-QDA26)

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  • Los investigadores de Mayo Clinic preparan el terreno para el tratamiento individualizado de la obesidad, adaptando las intervenciones a las necesidades de cada persona

    Los investigadores de Mayo Clinic preparan el terreno para el tratamiento individualizado de la obesidad, adaptando las intervenciones a las necesidades de cada persona

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    Newswise — ROCHESTER, Minnesota — En un estudio piloto de 165 personas, los investigadores de Mayo Clinic analizaron la eficacia de dos enfoques distintos para la pérdida de peso: una intervención estándar en el estilo de vida y tratamiento individualizado. La intervención estándar en el estilo de vida comprendía una dieta reducida, ejercicio y terapia conductual. El enfoque individualizado se basó en los fenotipos e incluyó diferentes intervenciones según la causa subyacente predominante de la obesidad en la persona. Una dieta basada en fenotipos tiene en cuenta las características genéticas y fenotípicas de una persona para crear un plan de alimentación personalizado destinado a optimizar la salud y el bienestar.

    Los investigadores compararon si las intervenciones en la dieta y el estilo de vida adaptadas a los fenotipos de la obesidad funcionarían mejor que las intervenciones estándar en el estilo de vida en la pérdida de peso, los factores de riesgo cardiometabólicos y las variables físicas que contribuyen a la obesidad. La salud cardiometabólica describe la conexión entre el corazón y los vasos sanguíneos con la energía y los procesos químicos del cuerpo. Cubre una amplia gama de trastornos y factores de riesgo que contribuyen a la enfermedad cardíaca y al síndrome metabólico.

    En los adultos con obesidad, las intervenciones en el estilo de vida adaptadas al fenotipo llevaron a una mayor pérdida de peso que las intervenciones estándar en el estilo de vida de una dieta baja en calorías, ejercicio y terapia conductual.

    Los hallazgos después de 12 semanas incluyeron lo siguiente:

    • Los pacientes que usaron intervenciones en el estilo de vida adaptadas al fenotipo obtuvieron mejores resultados en el tratamiento de su obesidad que los que usaron intervenciones estándar en el estilo de vida.
    • El grupo de pacientes centrado en el fenotipo tuvo una pérdida de peso más considerable, una disminución de la circunferencia de la cintura, una disminución de los triglicéridos, una disminución de la ingesta calórica diaria y menos ansiedad.
    • Tuvieron un aumento importante en el porcentaje de masa corporal magra.
    • También tuvieron una menor disminución en la cantidad de calorías que el cuerpo requiere durante las condiciones de reposo.

    “Los resultados destacan la importancia de identificar la causa subyacente de la obesidad como una enfermedad compleja con muchos factores”, afirma el Dr. en Ciencias Andrés Acosta, investigador de la obesidad de Mayo Clinic y último autor del estudio.

    ¿Qué es una intervención adaptada al fenotipo?

    Los fenotipos de la obesidad se basan en la causa de la enfermedad y los componentes conductuales, e incluyen las siguientes tres áreas principales:

    • Alimentación homeostática: comer en respuesta a una necesidad de energía percibida por el cerebro.
    • Conducta alimentaria hedónica: consumir alimentos por placer, no por sensación física de hambre o necesidades de energía.
    • Gasto anormal de energía: la cantidad de calorías quemadas en 24 horas en comparación con una persona promedio.

    Cuatro fenotipos aplicables de estas áreas incluyen la saciedad anormal, medida por las calorías ingeridas hasta experimentar una saciedad desagradable; la duración anormal de la saciedad; la conducta alimentaria emocional; y el gasto anormal de energía en reposo.

    Los investigadores informaron que las personas que utilizaron las intervenciones en el estilo de vida adaptadas al fenotipo mostraron una mejora considerable en algunas áreas específicas, como la saciedad anormal y la alimentación emocional.

    “Los resultados de este estudio respaldan la necesidad de una clasificación aplicable basada en el fenotipo [de los pacientes en el tratamiento de la obesidad] en lugar de depender únicamente del número en la balanza, las medidas corporales o las enfermedades relacionadas con la obesidad [si tienen], como enfermedad cardíaca, presión arterial alta y ciertos tipos de cáncer”, afirma el Dr. Acosta.

    Oportunidades para futuras investigaciones

    El Dr. Acosta afirma que es necesario contar con más investigación para evaluar el efecto a largo plazo de un enfoque basado en el fenotipo. En particular, es posible que otros estudios deban analizar otras variables físicas y metabólicas para comprender a las personas sin un fenotipo identificado.

    El Dr. Acosta también indica que los efectos del tratamiento en los dos enfoques deben examinarse de forma independiente. Las personas con un componente de alimentación emocional recibieron una intervención más intensa, con 24 sesiones de modificación de la conducta, para abordar este rasgo subyacente que puede tener un rol principal en el desarrollo de la obesidad.

    “Con más investigación, se mejorará el enfoque personalizado propuesto a partir de los datos”, afirma el Dr. Acosta. “Seguiremos trabajando en el tratamiento individualizado de la obesidad dirigido a rasgos específicos para identificar el tratamiento correcto para el paciente adecuado”.

    Declaración de intereses:
    El Dr. Acosta es accionista de Gila Therapeutics y Phenomix Sciences; fue médico especialista de Rhythm Pharmaceuticals, General Mills, Amgen, Bausch Health y RareStone; tiene contratos con Vivus Inc, Satiogen Pharmaceutical y Rhythm pharmaceutical; y ha presentado una patente para biomarcadores de una dieta adaptada al fenotipo.

    ###

    Información sobre Mayo Clinic
    Mayo Clinic es una organización sin fines de lucro, dedicada a innovar la práctica clínica, la educación y la investigación, así como a ofrecer pericia, compasión y respuestas a todos los que necesitan recobrar la salud. Visite la Red Informativa de Mayo Clinic para leer más noticias sobre Mayo Clinic.

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  • يُمهد باحثو مايو كلينك الطريق لعلاج السُمنة بصورة فردية، وتخصيص التدخلات وفقًا لاحتياجات الشخص

    يُمهد باحثو مايو كلينك الطريق لعلاج السُمنة بصورة فردية، وتخصيص التدخلات وفقًا لاحتياجات الشخص

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    روتشستر، مينيسوتا — فيدراسة  تجريبية شملت 165 شخصًا، درس باحثو مايو كلينك فعّالية طريقتين مختلفتين لفقدان الوزن: تدخُّل قياسي في نمط الحياة وعلاج فردي. يضمن التدخل القياسي في نمط الحياة اتباع نظام غذائي منخفض السعرات وممارسة الرياضة والعلاج السلوكي. وقام النهج الفردي على الأنماط الظاهرية وشمل تدخلات مختلفة اعتمادًا على السبب الكامن السائد للسُمنة لدى الشخص. يأخذ النظام الغذائي القائم على الأنماط الظاهرية في الاعتبار الخصائص الوراثية والمظهرية للشخص لوضع خطة تناول طعام مخصصة تهدف إلى تحسين الصحة والعافية.

    قارن الباحثون ما إذا كانت التدخلات في النظام الغذائي ونمط الحياة المصممة خصيصًا للأنماط الظاهرية للسُمنة ستعمل بشكل أفضل من التدخلات القياسية في نمط الحياة فيما يتعلق بفقدان الوزن وعوامل خطر مشكلات القلب والأوعية الدموية والمتغيرات الجسدية التي تساهم في السُمنة. تصف صحة القلب والأوعية الدموية العلاقة بين القلب والأوعية الدموية وطاقة الجسم والعمليات الكيميائية. وتشمل مجموعة واسعة من الاضطرابات وعوامل الخطر التي تُساهم في مرض القلب و متلازمة التمثيل الغذائي.

    في البالغين المصابين بالسُمنة، أدت التدخلات في نمط الحياة المصممة خصيصًا حسب النمط الظاهري إلى فقدان الوزن أكثر من التدخلات القياسية في نمط الحياة لنظام غذائي منخفض السعرات الحرارية وممارسة الرياضة والعلاج السلوكي.

    تضمنت النتائج بعد 12 أسبوعًا ما يلي:

    • عالج المرضى الذين استخدموا التدخلات في نمط الحياة المصممة خصيصًا للنمط الظاهري السُمنة بشكل أفضل من أولئك الذين استخدموا التدخلات القياسية في نمط الحياة.
    • حظيت مجموعة المرضى التي ينصَّب تركيزها على النمط الظاهري بفقدان وزن أكبر، ومحيط خصر أقل، وانخفاض الدهون الثلاثية، وانخفاض السعرات الحرارية اليومية وقلق أقل.
    • كان لديهم زيادة كبيرة في النسبة المئوية لكتلة الجسم الخالية من الدهون.
    • كان لديهم أيضًا انخفاض أقل في عدد السعرات الحرارية التي يحتاجها الجسم أثناء فترات الراحة.

    “تؤكد النتائج على أهمية تحديد السبب الكامن وراء السُمنة كمرض معقد له العديد من العوامل”، كما يقول أندريه أكوستا، دكتور في الطب والأبحاث الطبية، باحث في السُمنة في مايو كلينك والمؤلف الأخير للدراسة.

    ما هو التدخل المصمم خصيصًا حسب النمط الظاهري؟

    تعتمد الأنماط الظاهرية للسُمنة على سبب المرض والمكونات السلوكية وتشمل ثلاثة مجالات رئيسية:

    • تناول الطعام في حالة التوازن – الأكل استجابة للحاجة المتصورة للطاقة من الدماغ.
    • سلوك تناول الطعام للحصول على لذّة – تناول الأطعمة من أجل المتعة، وليس من أجل الجوع الجسدي أو احتياجات الطاقة.
    • استهلاك غير طبيعي للطاقة – عدد السعرات الحرارية التي حُرِقَت في 24 ساعة مقارنة بشخص عادي.

    أربعة أنماط ظاهرية عملية في هذه المجالات تشمل الامتلاء غير الطبيعي، يُقاس بالسعرات الحرارية التي يتم تناولها لتجربة الامتلاء المزعج، مدة الامتلاء غير الطبيعية، سلوك تناول الطعام لدوافع عاطفية واستهلاك غير طبيعي للطاقة أثناء الراحة.

    ذكر الباحثون أن الأشخاص الذين استخدموا التدخلات في نمط الحياة المصممة خصيصًا حسب النمط الظاهري أظهروا تحسنًا ملحوظًا في بعض المجالات الاستهدافيّة، مثل الامتلاء غير الطبيعي وتناول الطعام لدوافع عاطفية.

    “تدعم نتائج هذه الدراسة الحاجة إلى تصنيف عملي قائم على النمط الظاهري [للمرضى الخاضعين لعلاج السُمنة] بدلاً من الاعتماد فقط على الرقم على المقياس أو قياسات الجسم أو [إذا كان لديهم] أمراض مرتبطة بالسُمنة، مثل أمراض القلب وارتفاع ضغط الدم وبعض أنواع السرطان”، كما يقول الدكتور أكوستا.

    فرص لإجراء المزيد من الأبحاث

    يقول الدكتور أكوستا إن هناك حاجة إلى إجراء المزيد من الأبحاث لتقييم تأثير النهج القائم على النمط الظاهري على المدى الطويل. على وجه الخصوص، قد توجد حاجة إلى أن يبحث المزيد من الدراسات في المتغيرات الفيزيائية ومتغيرات التمثيل الغذائي الأخرى لفهم الأشخاص الذين ليس لديهم نمط ظاهري محدد.

    ويُشير الدكتور أكوستا أيضًا إلى أنه يجب فحص تأثيرات العلاج على الطريقتين بشكل مستقل. تلقى الأشخاص الذين يعانون فيما يتعلق بتناول الطعام لدوافع عاطفية تدخلاً أكثر كثافة، من خلال 24 جلسة لتعديل السلوك، لمعالجة هذه السمة الأساسية التي قد يكون لها دور رئيسي في اكتساب السُمنة.

    يقول الدكتور أكوستا: “ستعمل المزيد من الأبحاث على تعزيز النهج المصمم خصيصًا المقترح من البيانات”. “سنواصل العمل على علاج السُمنة الفردي الموجه إلى سمات معينة لتحديد العلاج المناسب لكل مريض.”

    إعلان المصالح

    الدكتور أكوستا هو أحد المساهمين في Gila Therapeutics وPhenomix Sciences. وكان مستشارًا لشركات Rhythm Pharmaceuticals وGeneral Mills وAmgen وBausch Health وRareStone؛ لديه عقود مع Vivus Inc وSatiogen Pharmaceutical وRhythm Pharmaceutical؛ ولديه براءة اختراع مقدمة للمؤشرات الحيوية لنظام غذائي مصمم خصيصًا للنمط الظاهري.

    ###

    نبذة عن مايو كلينك
    مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.

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    Mayo Clinic

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  • New factor in excess body weight discovered

    New factor in excess body weight discovered

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    Newswise — What determines whether we become overweight? Aside from lifestyle, predisposition plays a role, but genes cannot fully explain the inherited propensity to accumulate excess weight. A new study by Charité – Universitätsmedizin Berlin in Science Translational Medicine* shows that a kind of formatting of the DNA code in one gene that is associated with satiety is implicated in a slightly elevated risk of excess body weight – at least in women. This “epigenetic marking” is established early on during the embryonic stage.

    People who are overweight, especially those who are severely overweight, are at increased risk of a number of serious diseases such as cardiovascular disease, diabetes, and cancer. It is a growing health issue. All over the world, the number of overweight people is increasing. In the European Region, two out of three adults (59 percent) are overweight or obese, according to the World Health Organization.

    But what determines whether people will become overweight? Genetic predisposition plays a major role, alongside lifestyle. The similarity of the body mass index (BMI) in identical twins ranges from 40 to 70 percent. Even identical twins raised in different families still show the same significant similarity. Scientists have identified several genetic variants that influence a person’s body weight – and with it, the risk of developing obesity. But even taken all together, they cannot explain the heritability that has been observed. Researchers began to suspect there must be additional non-genetic factors that affect a person’s propensity to gain excess weight.

    Satiety gene is not altered, but formatted

    Researchers led by Prof. Peter Kühnen, Director of the Department of Pediatric Endocrinology at Charité, have now identified one such factor in their recent study. According to their findings, women’s risk of being overweight increases by about 44 percent if there are an especially large number of methyl groups adhering to the POMC (pro-opiomelanocortin) gene, which is responsible for the feeling of satiety. Methyl groups are tiny chemical units the body uses to mark the letters in the DNA code to activate or deactivate genes without modifying the sequence of letters in the DNA. In other words, the effect is much like highlighting a section of a text without rewriting the text itself. This type of “DNA formatting” is known as epigenetic marking.

    For their study, the team of researchers analyzed the “formatting” of the POMC gene in more than 1,100 people. They found more methyl groups attached to the satiety gene in obese women with a BMI of over 35 than in women with normal body weight. “A 44 percent increase in the risk of obesity is about the same as the effect that has been observed for individual gene variants as well,” says Kühnen. “By comparison, socioeconomic factors have a much stronger effect. They can increase the risk by a factor of two to three. As for why the methylation effect only shows up in women, we don’t know yet.”

    The POMC gene is “formatted” very early on during embryonic development, as the researchers showed by comparing methylation patterns in more than 15 sets each of identical and fraternal twins. While the “formatting” of the satiety gene was the same in most of the identical twins, there was hardly any correlation in the fraternal twins. “This indicates that the epigenetic marking of the POMC gene is established shortly after the egg and sperm cells merge, before the fertilized egg divides into two twin embryos,” explains Lara Lechner, the study’s first author, who works at the Department of Pediatric Endocrinology. This means the very early stage of pregnancy is crucial.

    What influences formatting?

    But what influences how much methylation the satiety gene undergoes – and thus, the risk that a person will become overweight? Past studies indicated that the presence or absence of certain nutrients that supply methyl groups could have an effect on epigenetic processes. These nutrients include betaine, methionine, and folic acid, all of which are typically absorbed through a person’s diet. A newly developed method involving individual human stem cells allowed the Charité researchers to simulate in the lab how the methylation pattern is determined during embryonic development and how nutrients affect it.

    “On the one hand, our studies and others as well show that folic acid, betaine, and other nutrients have a limited effect on the extent of methylation,” Kühnen notes. “We’ve observed that the ‘DNA formatting system’ is very stable on the whole, with cells compensating for minor fluctuations in the nutrient supply. On the other hand, there are indications that the variability of this ‘formatting’ develops at random. That means that it is not possible – not yet, at any rate – to externally influence whether a person has more or less methylation in the POMC region.”

    Medications may help

    At least in theory, women who are at elevated risk of developing obesity due to methylation of the POMC gene could receive medications to help them lose weight, as initial studies of four severely obese women and one man with this exact type of “formatting” of the satiety gene suggest. The subjects were given a specific drug that curbs the feeling of hunger and has already been approved to treat obese patients with a mutation of the POMC gene. Within three months after starting treatment, all five patients experienced less hunger. They lost an average of seven kilograms, or about five percent of their body weight. Some of them continued the treatment and continued to lose weight.

    “These findings show, for a start, that a POMC gene that has undergone epigenetic changes can in fact potentially be addressed through medication,” Kühnen says. “Further large controlled studies will be needed to show whether treatment with this drug would also be effective over a longer period, and if so, how effective and how safe this type of treatment is. Overall, though, a medication like this would still need to be just one piece of a holistic treatment strategy.”

     

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    Charite – Universitatsmedizin Berlin

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  • متلازمة الفم الحارق: لماذا يُعالج الأطباء ألم الحرق بالمزيد من الحرارة

    متلازمة الفم الحارق: لماذا يُعالج الأطباء ألم الحرق بالمزيد من الحرارة

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    Newswise — لندن – تشيع هَبَّات الحرارة وتقلبات المزاج ومشكلات النوم مع اقتراب المرأة من سن نقطاع الطمث وتجاوزه. حالة أخرى أقل شيوعًا ولكنها مؤلمة يمكن أن تصيب النساء في فترة ما قبل انقطاع الطمث وبعد انقطاع الطمث هي: متلازمة الفم الحارق. يصف الدكتور سرمد سامي، بكالوريوس الطب والجراحة،، طبيب الجهاز الهضمي في مايو كلينك للرعاية الصحية في لندن، الحالة المؤلمة وكيف يتم تشخيصها ولماذا يعالج الأطباء الألم الحارق بحرارة المذاق الحارّ أحيانًا.

    يقول الدكتور سامي “يمكن أن تؤثر متلازمة الفم الحارق على البلع والأكل والكلام والنوم”. “هناك أكثر من مجرد شعور غير مريح في فمك. وبالإضافة إلى تأثيرها على جودة حياتك، يمكن أن تؤثر على جوانب مختلفة من صحتك.”

    يمكن أن تشمل متلازمة الفم الحارق الفم شعورًا حارقًا في اللسان أو الشفتين أو اللثة أو الحلق أو سقف الفم. توجد أعراض أخرى قد تشمل الشعور بالعطش وجفاف الفم أو الإحساس بطعم مرارة أو مذاق معدني في الفم أو فقدان حاسة التذوق والشعور بالتنميل أو اللسع أو الخَدَر في الفم. يمكن أن يختلف تكرار الأعراض على نطاق واسع، من يوميًا طوال اليوم إلى متقطع. 

    يقول الدكتور سامي إن العلاج يتضمن معالجة الأعراض والسبب. فعلى سبيل المثال، إذا كان من المحتمل أن تكون متلازمة الفم الحارق مرتبطة بانقطاع الطمث، فقد يُساعد العلاج بالهرمونات البديلة. تشمل الحالات الكامنة المحتملة الأخرى الارتجاع المعدي المريئي، ومشكلات الغدة الدرقية، ونقص الفيتامينات، والتهيج الناجم عن معجون الأسنان وغسول الفم الحمضي أو الأطعمة والمشروبات الحمضية. وليس دومًا يمكن تحديد السبب.

    يقول الدكتور سامي: “نستخدم الأدوية بشكل أساسي لتهدئة الأعصاب والمستشعرات في الفم، لأننا نعتقد أن هناك حساسية مفرطة”. “يمكن أن يسببها التوتر أيضًا، لذلك قد نستخدم علاجات تكميلية مثل الوخز بالإبر.”

    قد تشمل العلاجات الأخرى الصلصة الحارة، والمعروفة أيضًا باسم صلصة الفلفل: “توجد بها مواد كيميائية معينة تساعد في تقليل الحساسية. قد تبدو الصلصة الحارة غير منطقية، لكنها تحتوي على مادة الكابسيسين، والتي يمكن أن تساعد في تخفيف الألم الحارق في الأعصاب،” كما يقول الدكتور سامي.

    تشمل العوامل التي تضع الأشخاص في أعلى خطورة للإصابة بالفم الحارق أن تكون أنثى، أو في فترة ما قبل انقطاع الطمث أو بعد انقطاع الطمث، أو أكبر من 50 عامًا، والتدخين. تشمل العوامل الثانوية التي يمكن أن تزيد من المخاطر المرض الحديث، الحالات الطبية مثل الألم الليفي العضلي، وداء باركنسون، ومرض في المناعة الذاتية والاعتلال العصبي، والخضوع لإجراءات في الأسنان وتفاعلات تحسُّسية من الطعام، أدوية معينة، والتوتر والقلق والاكتئاب وأحداث حياتية صادمة.

    بالإضافة إلى العلاج الطبي، يمكن تخفيف أعراض الفم الحارق عن طريق تغيير نمط الحياة وإجراءات أخرى للمساعدة الذاتية. وهي تشمل شرب الكثير من السوائل، وامتصاص رقائق الثلج، وتجنب الأطعمة والسوائل الحمضية مثل الطماطم وعصير البرتقال والمشروبات الغازية والقهوة، وتجنب الكحول وتجنب الأطعمة الغنية بالتوابل، والامتناع عن استهلاك منتجات التبغ، وتجنب المنتجات التي تحتوي على القرفة أو النعناع، واستخدام معاجين أسنان خفيفة أو خالية من النكهات. ويمكن للاسترخاء وتقليل التوتر المساعدة أيضًا في تخفيف الأعراض. 

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    نبذة عن مايو كلينك للرعاية الصحية
    مايو كلينك للرعاية الصحية، الموجودة في لندن، هي شركة فرعية مملوكة بالكامل لـ مايو كلينك، وهي مركز طبي أكاديمي غير هادف للربح. تُصنَّف مايو كلينك في الولايات المتحدة في المرتبة الأولى في تخصصات كثيرة أكثر من أي مستشفى آخر وفقًا لتقرير يو إس نيوز آند وورد ريبورت بسبب: جودة الرعاية. مايو كلينك للرعاية الصحية هي المدخل في المملكة المتحدة لتلك التجربة التي لا مثيل لها. تفضل بزيارة مايو كلينك للرعاية الصحية لمزيد من المعلومات.

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  • Ozempic and other weight-loss drugs boost pharmacy sales at Rite Aid

    Ozempic and other weight-loss drugs boost pharmacy sales at Rite Aid

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    Rite Aid Corp. said Thursday that its fiscal first-quarter pharmacy sales got a boost from a new class of drug.

    Pharmacy sales, which rose 3.4% from a year ago, were boosted by higher sales of Ozempic and other GLP-1 receptor agonists, which are used to treat Type 2 diabetes and obesity.

    The higher sales did not translate into profit, however.

    “As the cost of these drugs is also high, the impact of the increase in volume of these drugs on our gross profit dollars is minimal,” Rite Aid Chief Financial Officer Matthew Schroeder told analysts on the company’s earnings call, according to a FactSet transcript.

    Still, the company
    RAD,
    +2.96%
    cheered investors by raising its full-year revenue guidance due to the sales bump from Ozempic and other high-dollar GLP-1 drugs. It now expects revenue of $22.6 billion to $23 billion, ahead of the FactSet consensus of $22.3 billion.

    Ozempic, Wegovy and Rybelsus, which are made by Novo Nordisk
    NOVO.B,
    +0.17%

    NOVO.B,
    +0.17%    ,
    and Mounjaro, which is made by Eli Lilly & Co.
    LLY,
    +1.34%    ,
    have become so popular in the U.S. that supplies have at times run short and the U.S. Food and Drug Administration has been forced to warn patients against using knockoff versions.

    The drugs are administered by injection and mimic the effects of GLP-1, a gut hormone that can help control blood-sugar levels and reduce appetite. GLP stands for glucagon-like peptide.

    Ozempic, Rybelsus and Mounjaro have been approved by the Food and Drug Administration for treatment of Type 2 diabetes, while Wegovy is approved for people with obesity and for certain people with excess weight combined with weight-related medical problems. 

    Last year, more than 5 million prescriptions for Ozempic, Mounjaro, Rybelsus or Wegovy were written for weight management, up from 230,000 in 2019, according to data and analytics firm Komodo Health.

    Obesity drugs could be a $54 billion market by 2030, up from $2.4 billion in 2022, Morgan Stanley said in a report last year. Reports of people who take GLP-1 drugs seeing improvements in addictive behaviors such as smoking and drinking have lately amplified interest in the medications.  

    For more, read: The dark side of the weight-loss-drug craze: eating disorders, medication shortages, dangerous knockoffs

    Drug companies, including Lilly and Pfizer Inc.
    PFE,
    -0.32%    ,
    are now working to develop treatments in the form of pills that could be more convenient alternatives to the injectables.

    See now: Weight-loss drugs in development aim to replace injections with pills

    Rite Aid’s overall numbers surprised on the upside, as its loss was narrower than expected and revenue beat the consensus estimate.

    For more, see: Rite Aid’s stock soars 7.5% after company surprises with earnings that are less bad than feared

    Eleanor Laise contributed.

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  • توصلت أبحاث Mayo Clinic أن من يعانون من السُمنة المفرطة وأحد المتغيرات الجينية، عرضة أكثر للإصابة بارتفاع ضغط الدم

    توصلت أبحاث Mayo Clinic أن من يعانون من السُمنة المفرطة وأحد المتغيرات الجينية، عرضة أكثر للإصابة بارتفاع ضغط الدم

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    Newswise — روتشستر ، مينيسوتا – تعتبر السمنة وما يرتبط بها من مشاكل في القلب والأوعية الدموية مصدر قلق كبير في جميع أنحاء العالم. وجدت دراسة أجرتها Mayo Clinic أن الأشخاص الذين يعانون من السمنة ولديهم متغير جيني معين معرضون بشكل متزايد لخطر الإصابة بارتفاع ضغط الدم. 

    مع السمنة ، يزداد خطر الإصابة بأمراض القلب والأوعية الدموية ، والتي تشمل السكتة الدماغية وفشل القلب الاحتقاني واحتشاء عضلة القلب. السمنة مرض متعدد العوامل ينتج عن اختلال توازن الطاقة. السمنة عامل خطر قابل للتعديل لأمراض القلب والأوعية الدموية. 

    وضحت ليزيث سيفينتس، دكتور في الطب “الباحثة في علم الجهاز الهضمي في Mayo Clinic “يتم التحكم في وزن الجسم من خلال مجموعة معقدة ومتعددة من التفاعلات بين العوامل الوراثية والعوامل البيئية. “تتراوح احتمالية الإصابة بالسُمنة الوراثية بين 40% إلى 70%، ولكن فقط 10% من حالات السُمنة المفرطة المبكرة تحدث بسبب جيني.” 

    تلك المتغيرات هي نتيجة لحدوث طفرات متنحية في الجينات المسؤولة عن مسار الليبتين والميلانوكورتين، وهو المسار المسؤول عن تنظيم تناول الطعام ووزن الجسم. وتعد هذه التغيرات الجينية الأكثر انتشارًا، حيث لوحظ وجودها في 6% من الأطفال و2.5% من البالغين الذي يعانون من السُمنة المفرطة المبكرة. 

    وفي برنامج الطب الدقيق للسُمنة التابع لـ Mayo Clinic، أرادت د. سيفينتس وزملاؤها دراسة الاختلافات بين عوامل الخطر للمرض القلبي الوعائي وبين الأمراض التي تصيب من يعانون من السُمنة المفرطة، سواءً كان لديهم المتغير الجيني أو لم يكن. ووضحت “بفهم تأثير هذه المتغيرات على صحة القلب والأوعية الدموية يمكننا مساعدة الأطباء لعلاج عوامل الخطر القابلة للتعديل في مرضى السُمنة المفرطة.” 

    لتحقيق ذلك، قام الباحثون بعمل دراسة مستعرضة على المشاركين في البنك الحيوي التابع لـ Mayo Clinic ممن يعانون من سمنة مفرطة. تم تعريف السمنة المفرطة على أنها زيادة مؤشر كتلة الجسم عن 40، أو الحاجة إلى إجراء جراحة علاج السُمنة بعد ثبوت وجود متغير جيني في مسار الليبتين والميلانوكورتين للمريض. يتكون الينك الحيوي التابع لـ Mayo Clinic من مجموعة من العينات الطبية والتي تشمل عينات الدم ومشتقاته، والمعلومات الطبية التي تبرع بها مرضى Mayo Clinic لاستخدامها في الأبحاث الطبية المستمرة. 

    تم تحديد 168 حامل للمتغير الجيني MC4R. ووجد الباحثون في مايو كلينك أن الحاملين لهذا المتغير كانوا أكثر عرضة للإصابة بارتفاع ضغط الدم، كما كان لديهم عدد أكبر من عوامل الخطر لأمراض القلب والأوعية الدموية مقارنة بغير الحاملين للمتغير الجيني وعددهم 2039. ووضح د. أندريس أكوستا، دكتور في الطب، الباحث الرئيسي في معمل الطب الدقيق للسُمنة “لم يؤثر العمر أو الجنس أو مؤشر كتلة الجسم -وكلها عوامل خطر لأمراض القلب والأوعية الدموية- على النتائج، وتوصلنا في النهاية إلى أن الحاملين للمتغير الجيني أكثر عرضة للإصابة بارتفاع ضغط الدم”. 

    مع ذلك، وتبعًا للنتائج، فالحاملين للمتغير الجيني MC4R ليسو أكثر عرضة للإصابة بالمرض القلبي الوعائي أو للوفاة، تبعًا للنتائج التي عُرضت في إحدى أبحاث مجلة “مايو كلينيك بروسيدنجز – Mayo Clinic Proceedings”. استكمل د. أكوستا، كبير الباحثين، قائلًا: “توقعنا وجود زيادة أكبر في ارتفاع ضغط الدم، لأن زيادة الوزن تنبئ بالإصابة بارتفاع ضغط الدم”. 

    وأعربت د. سيفينتس عن تفاجؤ الباحثين من عدم وجود علاقة ثابتة مع المرض القلبي الوعائي. ووضحت ” نظرًا لمدى تعقيد مسببات المرض القلبي الوعائي، فببساطة قد يكون هناك قدر ضخم من البيانات التي لم يتم قياسها في تحليلاتنا”. 

    تكمن أهمية هذا البحث بالنسبة للأطباء في إدراك أن مرضى السُمنة الذين أظهر تنميطهم الوراثي وجود متغيرات متباينة الزيجوت في مسار اللبتين والميلانوكورتين قد لا يكونون محميين من ارتفاع ضغط الدم كما كان يعتقد سابقًا. ووضحت د. سيفينتس “يحتاج هؤلاء المرضى إلى مزيد من الاهتمام بعوامل الخطر القابلة للتعديل لارتفاع ضغط الدم، بما فيها أنواع العلاج الفردية للسُمنة”. 

    قد يصاب الأفراد الحاملين للمتغير الجيني بالسُمنة منذ الطفولة، لكن لم يتم توثيق الفترة الزمنية في الورقة التي قدمها الباحثون في Mayo Clinic. نحتاج إلى أبحاث أخرى لتحديد مخاطر الإصابة طويلة المدى للسمنة وللمرض القلبي الوعائي في الحاملين للمتغير الجيني. 

    من بين قيود هذا البحث أن 90% من المشاركين في بنك الحيوي لـ Mayo Clinic من البيض، لذا لا يمكننا تعميم نتائج هذا البحث على الأعراق الأخرى. 

    تلقى بحث د. أكوستا الدعم من المعاهد الوطنية للصحة، ومن البنك الحيوي التابع لـ Mayo Clinic، وشركة Rhythm لدراسة الأنماط الجينية. لم يتم الإعلان عن أي تضارب في المصالح. يقدم مركز Mayo Clinic للطب الفردي الدعم للبنك الحيوي لـ Mayo Clinic. 

    يمكنكم الرجوع إلى الورقة البحثية للتعرف على القائمة الكاملة للمؤلفين، والتمويل وتضارب المصالح، والإفصاحات. 

    لمزيد من المعلومات، يمكنك الرجوع إلى مدونة مركز Mayo Clinic للطب الفردي.  

    ###   

     نبذة عن مايو كلينك للرعاية الصحية   مايو كلينك للرعاية الصحية، الموجودة في لندن، هي شركة فرعية مملوكة بالكامل لمؤسسة مايو كلينك، وهو مركز طبي أكاديمي غير هادف للربح. تُصنَّف مايو كلينك في المرتبة الأولى بين المستشفيات وفقًا لتقرير يو إس نيوز آند وورد ريبورت بسبب: جودة الرعاية. مايو كلينك للرعاية الصحية هي المدخل الرئيسي في المملكة المتحدة لتلك التجربة التي لا مثيل لها. تفضل بزيارة مايو كلينك للرعاية الصحية لمزيد من المعلومات.   

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  • No more needles? A daily pill may work as well as Wegovy shots to treat obesity

    No more needles? A daily pill may work as well as Wegovy shots to treat obesity

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    What if treating obesity could be as easy as popping an effective pill?

    That’s a notion that has long fueled hope for many of the more than 40% of Americans who are considered obese — and fueled criticism by those who advocate for wider weight acceptance. Soon, it may be a reality.

    High-dose oral versions of the medication in the weight-loss drug Wegovy may work as well as the popular injections when it comes to paring pounds and improving health, according to final results of two studies released Sunday night. The potent tablets also appear to work for people with diabetes, who notoriously struggle to lose weight.

    Drugmaker Novo Nordisk plans to ask the U.S. Food and Drug Administration to approve the pills later this year.

    “If you ask people a random question, ‘Would you rather take a pill or an injection?’ People overwhelmingly prefer a pill,” said Dr. Daniel Bessesen, chief of endocrinology at Denver Health, who treats patients with obesity but was not involved in the new research.

    That’s assuming, Bessesen said, that both ways to take the medications are equally effective, available and affordable. “Those are the most important factors for people,” he said.

    There have been other weight-loss pills on the market, but none that achieve the substantial reductions seen with injected drugs like Wegovy. People with obesity will be “thrilled” to have an oral option that’s as effective, said Dr. Katherine Saunders, clinical professor of medicine at Weill Cornell Health and co-founder of Intellihealth, a weight-loss center.

    Novo Nordisk already sells Rybelsus, which is approved to treat diabetes and is an oral version of semaglutide, the same medication used in the diabetes drug Ozempic and Wegovy. It comes in doses up to 14 milligrams.

    But results of two gold-standard trials released at the American Diabetes Association’s annual meeting looked at how doses of oral semaglutide as high as 25 milligrams and 50 milligrams worked to reduce weight and improve blood sugar and other health markers.

    A 16-month study of about 1,600 people who were overweight or obese and already being treated for Type 2 diabetes found the high-dose daily pills lowered blood sugar significantly better than the standard dose of Rybelsus. From a baseline weight of 212 pounds, the higher doses also resulted in weight loss of between 15 and 20 pounds, compared to about 10 pounds on the lower dose.

    Another 16-month study of more than 660 adults who had obesity or were overweight with at least one related disease — but not diabetes — found the 50-milligram daily pill helped people lose an average of about 15% of their body weight, or about 35 pounds, versus about 6 pounds with a dummy pill, or placebo.

    That’s “notably consistent” with the weight loss spurred by weekly shots of the highest dose of Wegovy, the study authors said.

    But there were side effects. About 80% of participants receiving any size dose of oral semaglutide experienced things like mild to moderate intestinal problems, such as nausea, constipation and diarrhea.

    In the 50-milligram obesity trial, there was evidence of higher rates of benign tumors in people who took the drug versus a placebo. In addition, about 13% of those who took the drug had “altered skin sensation” such as tingling or extra sensitivity.

    Medical experts predict the pills will be popular, especially among people who want to lose weight but are fearful of needles. Plus, tablets would be more portable than injection pens and they don’t have to be stored in the refrigerator.

    But the pills aren’t necessarily a better option for the hundreds of thousands of people already taking injectable versions such as Ozempic or Wegovy, said Dr. Fatima Cody Stanford, an obesity medicine expert at Massachusetts General Hospital.

    “I don’t find significant hesitancy surrounding receiving an injection,” she said. “A lot of people like the ease of taking a medication once a week.”

    In addition, she said, some patients may actually prefer shots to the new pills, which have to be taken 30 minutes before eating or drinking in the morning.

    Paul Morer, 56, who works for a New Jersey hospital system, lost 85 pounds using Wegovy and hopes to lose 30 more. He said he would probably stick with the weekly injections, even if pills were available.

    “I do it on Saturday morning. It’s part of my routine,” he said. “I don’t even feel the needle. It’s a non-issue.”

    Some critics also worry that a pill will also put pressure on people who are obese to use it, fueling social stigma against people who can’t — or don’t want to — lose weight, said Tigress Osborn, chair of the National Association to Advance Fat Acceptance.

    “There is no escape from the narrative that your body is wrong and it should change,” Osborn said.

    Still, Novo Nordisk is banking on the popularity of a higher-dose pill to treat both diabetes and obesity. Sales of Rybelsus reached about $1.63 billion last year, more than double the 2021 figure.

    Other companies are working on oral versions of drugs that work as well as Eli Lilly and Co.’s Mounjaro — an injectable diabetes drug expected to be approved for weight-loss soon. Lilly researchers reported promising mid-stage trial results for an oral pill called orforglipron to treat patients who are obese or overweight with and without diabetes.

    Pfizer, too, has released mid-stage results for dangulgipron, an oral drug for diabetes taken twice daily with food.

    Novo Nordisk officials said it’s too early to say what the cost of the firm’s high-dose oral pills would be or how the company plans to guarantee adequate manufacturing capacity to meet to demand. Despite surging popularity, injectable doses of Wegovy will be in short supply until at least September, company officials said.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • No more needles? A daily pill may work as well as Wegovy shots to treat obesity

    No more needles? A daily pill may work as well as Wegovy shots to treat obesity

    [ad_1]

    That’s a notion that has long fueled hope for many of the more than 40% of Americans who are considered obese — and fueled criticism by those who advocate for wider weight acceptance. Soon, it may be a reality.

    High-dose oral versions of the medication in the weight-loss drug Wegovy may work as well as the popular injections when it comes to paring pounds and improving health, according to final results of two studies released Sunday night. The potent tablets also appear to work for people with diabetes, who notoriously struggle to lose weight.

    Drugmaker Novo Nordisk
    NOVO.B,
    +0.22%
    plans to ask the U.S. Food and Drug Administration to approve the pills later this year.

    “If you ask people a random question, ‘Would you rather take a pill or an injection?’ People overwhelmingly prefer a pill,” said Dr. Daniel Bessesen, chief of endocrinology at Denver Health, who treats patients with obesity but was not involved in the new research.

    That’s assuming, Bessesen said, that both ways to take the medications are equally effective, available and affordable. “Those are the most important factors for people,” he said.

    There have been other weight-loss pills on the market, but none that achieve the substantial reductions seen with injected drugs like Wegovy. People with obesity will be “thrilled” to have an oral option that’s as effective, said Dr. Katherine Saunders, clinical professor of medicine at Weill Cornell Health and co-founder of Intellihealth, a weight-loss center.

    Novo Nordisk already sells Rybelsus, which is approved to treat diabetes and is an oral version of semaglutide, the same medication used in the diabetes drug Ozempic and Wegovy. It comes in doses up to 14 milligrams.

    But results of two gold-standard trials released at the American Diabetes Association’s annual meeting looked at how doses of oral semaglutide as high as 25 milligrams and 50 milligrams worked to reduce weight and improve blood sugar and other health markers.

    A 16-month study of about 1,600 people who were overweight or obese and already being treated for Type 2 diabetes found the high-dose daily pills lowered blood sugar significantly better than the standard dose of Rybelsus. From a baseline weight of 212 pounds, the higher doses also resulted in weight loss of between 15 and 20 pounds, compared to about 10 pounds on the lower dose.

    Another 16-month study of more than 660 adults who had obesity or were overweight with at least one related disease — but not diabetes — found the 50-milligram daily pill helped people lose an average of about 15% of their body weight, or about 35 pounds, versus about 6 pounds with a dummy pill, or placebo.

    That’s “notably consistent” with the weight loss spurred by weekly shots of the highest dose of Wegovy, the study authors said.

    But there were side effects. About 80% of participants receiving any size dose of oral semaglutide experienced things like mild to moderate intestinal problems, such as nausea, constipation and diarrhea.

    In the 50-milligram obesity trial, there was evidence of higher rates of benign tumors in people who took the drug versus a placebo. In addition, about 13% of those who took the drug had “altered skin sensation” such as tingling or extra sensitivity.

    Medical experts predict the pills will be popular, especially among people who want to lose weight but are fearful of needles. Plus, tablets would be more portable than injection pens and they don’t have to be stored in the refrigerator.

    But the pills aren’t necessarily a better option for the hundreds of thousands of people already taking injectable versions such as Ozempic or Wegovy, said Dr. Fatima Cody Stanford, an obesity medicine expert at Massachusetts General Hospital.

    “I don’t find significant hesitancy surrounding receiving an injection,” she said. “A lot of people like the ease of taking a medication once a week.”

    In addition, she said, some patients may actually prefer shots to the new pills, which have to be taken 30 minutes before eating or drinking in the morning.

    Paul Morer, 56, who works for a New Jersey hospital system, lost 85 pounds using Wegovy and hopes to lose 30 more. He said he would probably stick with the weekly injections, even if pills were available.

    “I do it on Saturday morning. It’s part of my routine,” he said. “I don’t even feel the needle. It’s a non-issue.”

    Some critics also worry that a pill will also put pressure on people who are obese to use it, fueling social stigma against people who can’t — or don’t want to — lose weight, said Tigress Osborn, chair of the National Association to Advance Fat Acceptance.

    “There is no escape from the narrative that your body is wrong and it should change,” Osborn said.

    Still, Novo Nordisk is banking on the popularity of a higher-dose pill to treat both diabetes and obesity. Sales of Rybelsus reached about $1.63 billion last year, more than double the 2021 figure.

    Other companies are working on oral versions of drugs that work as well as Eli Lilly and Co.’s
    LLY,
    +0.25%
    Mounjaro — an injectable diabetes drug expected to be approved for weight-loss soon. Lilly researchers reported promising mid-stage trial results for an oral pill called orforglipron to treat patients who are obese or overweight with and without diabetes.

    Pfizer
    PFE,
    -1.11%    ,
    too, has released mid-stage results for dangulgipron, an oral drug for diabetes taken twice daily with food.

    Novo Nordisk officials said it’s too early to say what the cost of the firm’s high-dose oral pills would be or how the company plans to guarantee adequate manufacturing capacity to meet to demand. Despite surging popularity, injectable doses of Wegovy will be in short supply until at least September, company officials said.

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