Systemic Inflammation Response Index and weight loss as prognostic factors in metastatic pancreatic cancer: A concept study from the PANTHEIA-SEOM trial

BACKGROUND The prognostic value of the Systemic Inflammation Response Index(SIRI)in advanced pancreatic cancer is recognized,but its correlation with patients´nutritional status and outcomes remains unexplored.AIM To study the prognostic significance of SIRI and weight loss in metastatic pancreatic cancer.METHODS The PANTHEIA-Spanish Society of Medical Oncology(SEOM)study is a multicentric(16 Spanish hospitals),observational,longitudinal,non-interventional initiative,promoted by the SEOM Real World-Evidence work group.This pilot study sought to analyze the association between weight loss and inflammatory status as defined by SIRI.The cohort stems from a proof-of-concept pilot study conducted at one of the coordinating centers.Patients with pathologically confirmed metastatic pancreatic adenocarcinoma,treated from January 2020 to January 2023,were included.The index was calculated using the product of neutrophil and monocyte counts,divided by lymphocyte counts,obtained within 15 days before initiation chemotherapy.This study evaluated associations between overall survival(OS),SIRI and weight loss.RESULTS A total of 50 patients were included.66%of these patients were male and the median age was 66 years.Metastasis sites:36%liver,12%peritoneal carcinomatosis,10%lung,and 42%multiple locations.Regarding the first line palliative chemotherapy treatments:50%received gemcitabine plus nab-paclitaxel;28%,modified fluorouracil,leucovorin,irinotecan and oxaliplatin,and 16%were administered gemcitabine.42%had a weight loss>5%in the three months(mo)preceding diagnosis.21 patients with a SIRI≥2.3×10^(3)/L exhibited a trend towards a lower median OS compared to those with a SIRI<2.3×10^(3)/L(4 vs 18 mo;P<0.000).Among 21 patients with>5%weight loss before diagnosis,the median OS was 6 mo,in contrast to 19 mo for those who did not experience such weight loss(P=0.003).Patients with a weight loss>5%showed higher SIRI levels.This difference was statistically significant(P<0.000).For patients with a SIRI<2.3×10^(3)/L,those who did not lose>5%of their weight had an OS of 20 mo,compared to 11 mo for those who did(P<0.001).No association was found between carbohydrate antigen 19-9 levels≥1000 U/mL and weight loss.CONCLUSION A higher SIRI was correlated with decreased survival rates in patients with metastatic pancreatic cancer and associated with weight loss.An elevated SIRI is suggested as a predictor of survival,emphasizing the need for prospective validation in the upcoming PANTHEIA-SEOM study.

Weight regain after intragastric balloon for pre-surgical weight loss

BACKGROUND Over one-third of Americans carry the diagnosis of obesity,many also with obesity-related comorbidities.This can place patients at increased risk of operative and postoperative complications.The intragastric balloon has been shown to aid in minor weight loss,however its weight recidivism in patients requiring short interval weight loss has not been well studied.AIM To evaluate weight loss,ability to undergo successful elective surgery after intragastric balloon placement,and weight management after balloon removal.METHODS This study is a retrospective review of patients in a single academic institution undergoing intragastric balloon placement from 2019-2023 to aid in weight loss prior to undergoing elective surgery.Clinical outcomes including weight loss,duration of balloon placement,successful elective surgery,weight regain postballoon and post-procedure complications were assessed.Exclusion criteria included those with balloon in place at time of study.RESULTS Thirty-three patients completed intragastric balloon therapy from 2019-2023 as a bridge to elective surgery.All patients were required to participate in a 12-month weight management program to be eligible for balloon therapy.Elective surgeries included incisional hernia repair,umbilical hernia repair,inguinal hernia repair,and knee and hip replacements.The average age at placement was 53 years±11 years,majority(91%)were male.The average duration of intragastric balloon therapy was 186 days±41 days.The average weight loss was 14.0 kg±7.4 kg and with an average percent excess body weight loss of 30.0%(7.9%-73.6%).Over half of the patients(52.0%)achieved the goal of 30-50 lbs(14-22 kg)weight loss.Twenty-one patients(64%)underwent their intended elective surgery,2 patients(6%)deferred surgery due to symptom relief with weight loss alone.Twenty-one of the patients(64%)have documented weights in 3 months after balloon removal,in these patients the majority(76%)gained weight after balloon removed.In patients with weight regain at 3 months,they averaged 5.8 kg after balloon removal in the first 3 months,this averaged 58.4%weight regain of the initial weight lost.CONCLUSION Intragastric balloon placement is an option for short-term weight management,as a bridge to elective surgery in patients with body mass index(BMI)>35.Patients lost an average of 14 kg with the balloon,allowing two-thirds of patients to undergo elective surgery at a healthy BMI.However,most patients regained an average of 58%of the original weight lost after balloon removal.The intragastric balloon successfully serves as a tool for rapid weight loss,though patients must be educated on the risks including weight regain.

Comparative Efficacy of Lifestyle Modifications versus Pharmacotherapy on Weight Loss and Metabolic Health Outcomes: A Comprehensive Review

Background: Obesity has become a serious global public health challenge, given that it leads to various adverse health outcomes that include cardiovascular illnesses, diabetes, and certain types of cancer. The World Health Organization (WHO) has estimated that, at the end of 2022, 1 out of every 8 individuals were obese, and that the global adult obesity rates have over doubled since 1990, even as the adolescent obesity rates have quadrupled. Thus, as of 2022, nearly 2.5 billion adults, aged 18 years and above, were overweight, with 890 million being obese. Obesity and overweight incidence rate has been gradually increasing over the years, presenting significant challenges to the healthcare systems throughout the globe. In this regard, the objective of this systematic review was to evaluate the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. Methodology: To attain the above stated study objective, a systematic evaluation of previous studies was carried out, particularly studies that assessed the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. The authors have used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the selection of eligible studies for inclusion in the study. Results: The findings indicate that lifestyle interventions resulted in 5% - 10% weight reduction and significant improvements in metabolic indicators, while pharmacotherapy (GLP-1 receptor agonists) achieved up to 15% weight reduction and considerable metabolic health benefits. Further, comparative studies show lifestyle modifications provide overall health benefits, while medication is necessary for non-responders. Conclusion: Individualized treatment strategies are crucial, and further research is needed on long-term consequences and combination therapies.

Atypical Weight Loss in Two Patients with Schizophrenia Treated with Clozapine: A Case Report

Clozapine is widely recognized as an effective antipsychotic medication for treatment-resistant schizophrenia, but it is typically associated with significant weight gain. This case report presents two unusual cases of patients with schizophrenia who experienced substantial weight loss while on long-term clozapine therapy. The first case involves a 35-year-old male who lost 21.3% of his initial body weight, and the second case describes a 54-year-old female who lost 30.2% of her initial weight, despite having comorbid hypothyroidism. Both patients showed improvement in psychiatric symptoms concurrent with the weight loss. Comprehensive investigations did not reveal other clear etiologies for the weight reduction. These cases challenge the conventional understanding of clozapine’s metabolic effects and highlight the potential for atypical responses in some individuals. The report discusses possible mechanisms for this unusual phenomenon, including genetic factors and altered pharmacokinetics. It also emphasizes the need for individualized monitoring and management strategies in clozapine therapy. These findings contribute to the growing body of evidence suggesting that metabolic responses to clozapine may be more complex and varied than previously thought, underscoring the importance of personalized approaches in schizophrenia treatment.

Liver decompensation after rapid weight loss from semaglutide in a patient with non-alcoholic steatohepatitis -associated cirrhosis

There is rapidly increasing uptake of GLP-1 (glucagon-like peptide-1) agonistssuch as semaglutide worldwide for weight loss and management of non-alcoholicsteatohepatitis (NASH). remains a paucity of safety data in the vulnerable NASHcirrhotic population. We report herein the first documented case of liver decompensationand need for liver transplant waitlisting in a patient with NASHcirrhosistreated with semaglutide. Rapid weight loss led to the development ofascites and hepatic encephalopathy and an increase in the patients Model forEndstage Liver Disease-Na (MELD-Na) score from 11 to 22. Aggressive nutritionalsupplementation was commenced and the semaglutide was stopped. Overthe following months she regained her weight and her liver recompensated andher MELD-Na decreased to 13, allowing her to be delisted from the transplantwaitlist. This case serves as a cautionary tale to clinicians using semaglutide in thecirrhotic population and highlights the need for more safety data in this patientgroup.

Semaglutide’s Trail of Success in Weight Loss Management and HbA1c Reduction: A Systematic Review

Introduction: Obesity is a preventable health condition, yet it remains a complex relapsing global health conundrum, triggering an array of comorbidities, including diabetes, dyslipidemia, hypertension, and mental health decline. This review intends to highlight the success of semaglutide for its therapeutic intervention for weight loss management in diabetics and non-diabetics and HbA1c reduction in type 2 diabetics. Methods: We searched and systematically reviewed the literature from within the past ten years on semaglutide utilization for weight loss and HbA1c reduction. Databases investigated included PMC, JAMA, Nature Medicine, and The Lancet, resulting in four original research articles that were systematically reviewed. Web consultations with WHO, CDC, and Healthy People 2030 were conducted to ascertain epidemiological obesity and diabetes data. AAFP and USPSTF references were included for obesity management and preventive care guidelines. Results: Based on results from systematically reviewing four original research studies, semaglutide can effectively reduce elevated weight and HbA1c, using the once-weekly subcutaneous injection formulation. A composite average percent weight loss of 8.27% (16 - 20 pounds) and an average HbA1c percent reduction rate of 1.07% (3 - 4 points) were attained. There were no major adverse events reported from any of the four original research studies related to the drug. Discussion: With evidence from several studies after its FDA approval, semaglutide delivers a promise for weight loss management and HbA1c reduction for appropriate patient populations. Clinician and patient education on its proper use should be continuously revisited.

Weight Loss and Improved Metabolic Health Measures Using a One-Week Active Nutrition Jumpstart Program in Overweight and Obese Men and Women

Background: The prevalence of individuals who are obese or overweight is an increasing global epidemic that is associated with a multitude of adverse health conditions. Multiple strategies are available to promote weight loss in these populations, including the use of caloric restriction and/or liquid diets. We determined the impact of a low-calorie, nutrient-dense, primarily liquid diet on body weight and associated measures of metabolic health in overweight and obese men and women. Methods: Twenty-six men and women (age: 42.6 ± 10.8) completed a seven-day intervention using the USANA Active Nutrition Jumpstart program, which consisted of consuming three meal replacement shakes and three to four servings of fruits and vegetables, along with a probiotic, three metabolism supplements, and two vitamin packs each day. Pre-post measurements included body composition—determined (via DXA), fasting levels of lipids and glucose in heparinized whole blood, weight, waist circumference, hip circumference, heart rate, and blood pressure. Subjective mood and hunger were also assessed. Results: The dietary program was well-tolerated, and the intervention resulted in a mean weight loss of approximately 4.5 pounds. Clinically relevant reductions were noted in systolic and diastolic blood pressure, cholesterol (total and LDL), and glucose. In addition, there were favorable changes in self-esteem, energy, motivation, and physical appearance. Conclusion: A one-week period of adherence to the Active Nutrition Jumpstart program positively impacted subjective feelings, while resulting in significant weight loss and other health benefits that may have clinical relevance. Longer-term interventions are needed to sustain these initial results.

Umbilicoplasty: An Important Step in Abdominoplasty Surgery for Massive Weight Loss Cases

Aim: Excessive increase of weight followed by massive weight loss distorts the shape of the umbilicus as part of the affected skin of the abdomen. There is usually discrepancy between the elongated umbilicus at the time the patient was gaining excessive weight and the thinned abdominal wall after the massive weight loss. This study discusses a procedure that aims at restoring the shape of the umbilicus to its original shape as much as possible. Patients and Methods: In 4 years retrospective study from the 1st of March 2016 till the end of February 2020, the files of the patients who underwent abdominoplasty after massive weight loss with umbilicoplasty performed, as part of the procedure, were reviewed. In these patients the caudal part of the umbilicus at 6 o’clock site was excised in an oblique direction with slanting cut going to both 3 and 9 o’clock directions to shorten the elongated umbilicus keeping the cephalic part at 12 o’clock intact. This residual elongated cephalic part was utilized to make the shape of the hood of the umbilicus. A bolster suture was used at 12 o’clock to add a small depression above the hood. This technique gave the umbilicus the vertical “T” triangular shape with hooding. A questionnaire to assess patients’ satisfaction regarding the shape, depth, location, size, scarring and overall result of the umbilicoplasty procedure was conducted. The questionnaire used a five-point Likert-type scale as follows: 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). Results were collected and evaluated. Results: 197 patients underwent full abdominoplasty surgery during this 4 years study. Those who underwent umbilicoplasty during the abdominoplasty procedure were 34 patients. The results of the questionnaire could be obtained from 23 patients of them. Each patient gave a number from 1 - 5 for each aspect of the questionnaire of the umbilicus shape, depth, location, size, scarring and overall result. This resulted in total number of points of 115 for each aspect (23 patients × 5 points). The patients’ satisfaction with the shape of the umbilicus was 78.3% (90 out of the 115 points), 80.9% satisfaction rate with the depth (93 out of 115), 98.3% with the location (113 out of 115), 89.6% with the size (103 out of 115), 82.6% with the scar (95 out of 115) and 86.1% as an overall result (99 out of 115). Conclusion: Shortening of the elongated umbilicus at its caudal part with slanting incision directing to its cephalic part gives it the preferred vertical triangular “T” shape. Utilizing the length of the cephalic part in making the hood of the umbilicus and using a bolster suture to make a depression above the hood adds a shape near to the original natural one. The patients’ satisfaction ranged from “very good” to “excellent” according to the five-point Likert-type scale.

Impact of weight Loss on the progression of cancer cachexia and the patient prognosis:insights from a retrospective study

Background:Cachexia is a metabolic state with weight and muscle mass loss as its basic characteristics.This study aims to reveal the influ-ence of weight loss on the progression of cancer cachexia,and to determine its impact on the patient prognosis.Methods:A total of 2990 cancer patients were enrolled in this retrospective study.Demographic information,clinical materials,and follow-up data were collected for all patients.A receiver operating characteristic curve was used to determine threshold values for weight loss within the past six months(WL).Kaplan-Meier curves and Cox proportional hazard regression models were adopted for survival analyses.Results:After excluding ineligible patients,2480 patients were included in the analysis,705(28.4%)of whom were considered to be ca-chexic.A WL of 10%was determined to be the optimal threshold for diagnosing malnutrition according to the Patient-Generated Subjective Global Assessment.Notably,WL>10%was a predictor of survival outcomes only in the general population(HR=1.218,95%Cl=1.002-1.481,P=0.048),but not in the cachexic population,based on the multivariable Cox regression model.A larger proportion of cachexic pa-tients with WL>10%had a nutritional risk screening 2002 score≥3(25.7%vs 13.7%,P<0.001)and a modified Glasgow Prognosis Score=2(12.8%vs 7.8%,P=0.032).No significant difference was observed in the degree of decreased muscle strength or quality of life(P>0.05).Conclusions:Weight loss is a predictor of impaired survival in the general population,but not in the cachexic population.The present study shows that cachexic patients with severe weight loss had a higher risk of malnutrition,a worse systemic inflammation status,and more severe malnutrition,but that the weight loss itself was not associated with the prognosis of these patients or the progression of their cachexia.

Analysis of the Weight Loss of High Temperature Cement Slurry

The weight loss of cement slurry is the main cause of early annular air channeling and accurate experimental evaluation of the law of loss change is the key to achieve compression stability and prevent this undesired phenomenon.Typically,tests on the pressure loss of cement slurry are carried out for temperature smaller than 120°C,and this condition cannot simulate effectively the situation occurring in high temperature wells.For this reason,in this study a series of experimental tests have been conducted considering a larger range of temperatures,different retarders and fluid loss additives.The results show that with an increase in the temperature,the weight loss curve of cement slurry changes from a“two-stage”to a“three-stage”behavior,and the risk of channeling increases accordingly.On increasing the amount of retarder and fluid loss additive,the transition time of cement slurry displays a non-monotonic behavior(it decreases first and then increases).It is found that the optimized retarder and fluid loss additive dosage are 0.2%and 2.5%,respectively.

Hydroxycut hepatotoxicity:A case series and review of liver toxicity from herbal weight loss supplements

Dietary supplements represent an increasingly common source of drug-induced liver injury. Hydroxycut is a popular weight loss supplement which has previously been linked to hepatotoxicity, although the individual chemical components underlying liver injury remain poorly understood. We report two cases of acute hepatitis in the setting of Hydroxycut exposure and describe possible mechanisms of liver injury. We also comprehensively review and summarize the existing literature on commonly used weight loss supplements, and their individual components which have demon-strated potential for liver toxicity. An increased effort to screen for and educate patients and physicians about supplement-associated hepatotoxicity is warranted.

Effects of novel vaccines on weight loss in diet-induced-obese(DIO) mice

The purpose of the study was to test the therapeutic effects of novel vaccines for reducing weight gain and increasing weight loss in diet induced obesity （DIO） model. Male C57BL/6 J mice, fed a 60% Kcal fat diet for 8 weeks prior to the start of the study, were vaccinated via the intraperitoneal route with two formulations （JH17 ＆ JH]8） of chimeric-somatostatin vaccines at 1 and 22 days of the study. Control mice were injected with PBS. All mice continued to be feed the 60% Kcal fat diet for the week and food intake was measured weekly. At week 6 6 week study. Body weights were measured two times a mice were euthanized and a terminal bleed was made and antibody levels to somatostatin and levels of insulin-like growth factor 1 （IGF-1） were determined. Vaccination with both vaccine formulations induced a statistically significant body weight change over the study period, as compared with PBS controls. Percentage of baseline body weight was also significantly affected by vaccination during the study period. Vaccinates finished the study at 104% and 107% of baseline weight, JHI7 ＆ JH18 respectively, while untreated controls reached 115% of baseline weight. Food intake per mouse was similar in all mouse groups during the entire study. Control mice did not demonstrate any antibody titers to somatostatin, while all vaccinated mice had measurable antibody responses （〉 1：500,000 titer）. IGF-1 levels were not statistically significant among the groups, but were elevated in the JH18 vaccinates （mean 440.4 ng/mL） when compared with PBS controls （mean 365.6 ng/mL）. Vaccination with either JH17 or JH18 chimeric -somatostatin vaccines produced a statistically significant weight loss as compared with PBS controls （P 〈 0.0001）, even though the DIO mice with continually fed a 60% Kcal fat diet. The weight loss/lower weight gain observations were even more significant, as all mice consumed similar amounts of food for the entire study. The presence of high levels of anti-somatostatin antibodies at 6 weeks was correlative with the weight observations and confirmed the success of vaccination.

Weight loss interventions in living donor liver transplantation as a tool in expanding the donor pool: A systematic review and metaanalysis

BACKGROUND With increasing rates of liver transplantation and a stagnant donor pool,the annual wait list removals have remained high.Living donor liver transplantation(LDLT)is an established modality in expanding the donor pool and is the primary method of liver donation in large parts of the world.Marginal living donors,including those with hepatic steatosis,have been used to expand the donor pool.However,due to negative effects of steatosis on graft and recipient outcomes,current practice excludes overweight or obese donors with more than 10%macro vesicular steatosis.This has limited a potentially important source to help expand the donor pool.Weight loss is known to improve or resolve steatosis and rapid weight loss with short-term interventions have been used to convert marginal donors to low-risk donors in a small series of studies.There is,however,a lack of a consensus driven standardized approach to such interventions.AIM To assess the available data on using weight loss interventions in potential living liver donors with steatotic livers and investigated the feasibility,efficacy,and safety of using such donors on the donor,graft and recipient outcomes.The principal objective was to assess if using such treated donor livers,could help expand the donor pool.METHODS We performed a comprehensive literature review and meta-analysis on studies examining the role of short-term weight loss interventions in potential living liver donors with hepatic steatosis with the aim of increasing liver donation rates and improving donor,graft,and recipient outcomes.RESULTS A total of 6 studies with 102 potential donors were included.Most subjects were males(71).All studies showed a significant reduction in body mass index postintervention with a mean difference of-2.08(-3.06,1.10,I2=78%).A significant reduction or resolution of hepatic steatosis was seen in 93 of the 102(91.2%).Comparison of pre-and post-intervention liver biopsies showed a significant reduction in steatosis with a mean difference of-21.22(-27.02,-15.43,I2=56%).The liver donation rates post-intervention was 88.5(74.5,95.3,I2=42%).All donors who did not undergo LDLT had either recipient reasons or had fibrosis/steatohepatitis on post intervention biopsies.Post-operative biliary complications in the intervention group were not significantly different compared to controls with an odds ratio of 0.96[(0.14,6.69),I2=0].The overall post-operative donor,graft,and recipient outcomes in treated donors were not significantly different compared to donors with no steatosis.CONCLUSION Use of appropriate short term weight loss interventions in living liver donors is an effective tool in turning marginal donors to low-risk donors and therefore in expanding the donor pool.It is feasible and safe,with comparable donor,graft,and recipient outcomes,to non-obese donors.Larger future prospective studies are needed.

Physical activity support or weight loss counseling for nonalcoholic fatty liver disease?

AIM: To determine the clinical effectiveness of intense psychological support to physical activity (PA) in nonalcoholic fatty liver disease (NAFLD), compared with cognitive-behavioral treatment (CBT).

Predictive factors for body weight loss and its impact on quality of life following gastrectomy

To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life (QOL). METHODSWe applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure (TGRY) or distal gastrectomy with Billroth-I (DGBI) or Roux-en-Y (DGRY) procedures. RESULTSA total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss (P < 0.001) among groups stratified according to preoperative body mass index (< 18.5, 18.5-25 and > 25 kg/m2). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL (P < 0.0001) after gastrectomy, but the influence of both such factors on QOL was relatively small (R2, 0.028-0.080). CONCLUSIONWhile it is certainly important to maintain adequate body weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.

Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity:A systematic review and meta-analysis

Background:Weight-loss-induced fat loss improves cardiometabolic health in individuals with overweight and obesity;however,weight loss can also result in bone loss and increased fracture risk.Weight-loss-induced bone loss may be attenuated with exercise.Our aim was to compare changes in bone mineral density(BMD)in adults with overweight and obesity who undertook diet-induced weight loss alone or in combination with exercise.Methods:We included randomized controlled trials(RCTs)in adults with overweight or obesity(aged-18 years;body mass index-25 kg/m^(2))that prescribed diet-induced weight loss alone or in combination with supervised exercise,and measured any bone structural parameters.Risk of bias was assessed using the Cochrane Risk of Bias tool.Random-effects meta-analyses determined mean changes and net mean differences(95%confidence intervals(95%CIs))in the percentage of areal BMD(aBMD)change between groups.Results:We included 9 RCTs.Diet-induced weight loss led to significant losses in femoral neck aBMD(mean change:-1.73%(95%CI:-2.39%to-1.07%),p<0.001)and total hip aBMD(-2.19%(95%CI:-3.84%to-0.54%),p=0.009).Femoral neck aBMD losses were significantly greater in the diet-induced weight loss group compared to the exercise plus diet-induced weight loss group(net difference:-0.88%(95%CI:-1.73%to-0.03%));however,there were no differences in aBMD changes at any other skeletal site:total hip(-1.96%(95%CI:-4.59%to 0.68%))and lumbar spine(-0.48%(95%CI:-1.81%to 0.86%)).aBMD changes did not differ significantly according to exercise modality(resistance exercise,aerobic exercise,or a combination of the two)during diet-induced weight loss.Conclusion:Diet-induced weight loss led to greater femoral neck bone loss compared to diet-induced weight loss plus exercise.Bone loss at the total hip and lumbar spine was not attenuated by exercise during diet-induced weight loss.The lack of consistent skeletal benefits may be due to the insufficient duration and/or training intensities of most exercise interventions.Additional RCTs with appropriate,targeted exercise interventions should be conducted.

Science of weight loss supplements:Compromised by conflicts of interest?

Weight loss supplements often contain powerful pharmacoactive ingredients with the potential to cause harm. Trials used to determine product safety and effectiveness, meanwhile,tend to be small, of short duration, and frequently lack financial conflict of interest disclosures. These factors could conspire to place consumers at risk, especially when published research cited in advertising cloaks products with the suggestion that their safety and effectiveness have been proven by science. Examples of current and former weight loss products backed by potentially con? icted or low quality research include Metabolife-356, Hydroxycut, Xenadrine and LeptiCore. Published research, especially in the field of weight loss supplements, needs better conflict of interest disclosure, and regulators should consider how research f indings are used in marketing claims.

Advances in endoscopic balloon therapy for weight loss and its limitations

The field of medical and surgical weight loss is undergoing an explosion of new techniques and devices. A lot of these are geared towards endoscopic approaches rather than the conventional and more invasive laparoscopic or open approach. One such recent advance is the introduction of intrgastric balloons. In this article, we discuss the recently Food and Drug Administration approved following balloons for weight loss: the Orbera? Intragastric Balloon System(Apollo Endosurgery Inc, Austin, TX, United States), the Re Shape? Integrated Dual Balloon System(Re Shape Medical, Inc., San Clemente, CA, United States), and the Obalon(Obalon? Therapeutics, Inc.). The individual features of each of these balloons, the method of introduction and removal, and the expected weight loss and possible complications are discussed. This review of the various balloons highlights the innovation in the field of weight loss.

Effect of exercise training intensity on adipose tissue hormone sensitive lipase gene expression in obese women under weight loss

Background:Hormone sensitive lipase(HSL) is an enzyme that regulates adipose tissue lipolysis and plays an important role in chronic exerciseinduced changes in adipose tissue metabolism.The purpose of this study was to determine whether aerobic exercise intensity influences abdominal adipose tissue HSL gene expression in obese women under weight loss. Methods:Thirty women(body mass index(BMI) = 33.0±0.7 kg/m^2,age = 58±1 years) completed one of three 20-week interventions: caloric restriction alone(CR only,n = 8),CR plus moderate-intensity exercise(CR + moderate-intensity,45%—50%heart rate reserve(HRR). 3 day/week,n = 9),or CR plus vigorous-intensity exercise(CR + vigorous-intensity,70%—75%HRR,3 day/week,n = 13).Each group had a similar prescribed energy deficit comprised of underfeeding alone(2800 kcal/week for CR only) or underfeeding(2400 kcal/week) plus exercise(400 kcal/week).Body composition and maximal aerobic capacity(VO_2max) were measured,and subcutaneous abdominal adipose tissue samples were collected before and after the interventions.Adipose tissue HSL gene expression was measured by real time reversetranscriptase polymerase chain reaction. Results:All three interventions reduced body weight,fat mass,percent fat.and waist to a similar degree(all p < 0.01).In addition,all interventions did not change absolute VO_2 max,but increased relative VO_2 max(p < 0.05 to P < 0.01).Compared to pre-intervention.neither CR only nor CR + moderate-intensity changed adipose tissue HSL gene expression,but CR + vigorous-intensity significantly increased adipose tissue HSL gene expression(p < 0.01).The changes of HSL gene expression levels in the CR + vigorous-intensity group were significantly different from those in the CR only(p < 0.05) and CR + moderate-intensity(p < 0.01) groups.In the whole cohort,changes in adipose tissue HSL gene expression correlated positively to changes in absolute(r = 0.55,p < 0.01) and relative(r = 0.32,p = 0.09) VO_2 max. Conclusion:These results support a potential effect of aerobic exercise training intensity on hormone sensitive lipase pathway in adipose tissue metabolism in obese women under weight loss.

Apatite formation and weight loss study in EDMed perforated AZ31 Mg-alloy

Porous structures are highly preferred for bone regeneration and high tissue in-growth.In present work,electrical discharge drilling(EDD),a thermal erosion process was used to produce through holes in Mg-alloys to fabricate perforated structure similar to open cell porous structure in extruded AZ31.Apatite formation and weight loss study was conducted for 7 days,14 days and 21 days after immersion tests in SBF solution.The perforated structure in AZ31 with 26 through micro-holes provides 72%increase in surface area but with marginally 4%higher weight loss as compare to non-perforated structure.Comparing perforated and non-perforated samples of Mg-alloy,it was well observed that perforated structure forms high volume of apatite as compared to non-perforated structure.Scanning electron microscopic(SEM)study revealed that in perforated structure,drilled holes retain their circularity after 21 days of immersion test and distinct corrosion phenomenon occur at localized sites.