Key challenges of post-liver transplant weight management

Liver transplantation serves as a life-saving intervention for patients with endstage liver disease,yet long-term survival remains a challenge.Post-liver transplant obesity seems to have a significant contribution to this challenge and it emerges as a significant risk factor for graft steatosis,metabolic syndrome and denovo malignancy development.This review synthesizes current literature on prevalence,risk factors and management strategies for post-liver transplant obesity,emphasizing its impact on graft and patient survival.Literature review consultation was conducted in Medline/PubMed,SciELO and EMBASE,with the combination of the following keywords:Weight management,liver transplantation,immunosuppressive therapy,lifestyle interventions,bariatric surgery.Immunosuppressive therapy has a significant influence on long-term survival of liver transplant patients,yet it seems to have lesser effect on post-transplant obesity development than previously thought.However,it significantly contributes to the development of other components of metabolic syndrome.Key predisposing factors for post-transplant obesity development encompass elevated recipient and donor body mass index,a history of alcoholic liver disease,hepatocellular carcinoma,male gender,the absence of cellular rejection and the marital status of the recipient.Tailored immunosuppressive regimens,pharmacotherapy,lifestyle interventions and bariatric surgery represent key components in mitigating post-transplant obesity and improving long-term survival and quality of life in this group of patients.Timely identification and intervention thus hold paramount importance.Further research is warranted to refine optimal management strategies and enhance outcomes in this patient population.

Influence of weight management on the prognosis of steatohepatitis in chronic hepatitis B patients during antiviral treatment

Background:Although concomitant nonalcoholic steatohepatitis(NASH)is common in chronic hepatitis B(CHB),the impact of viral factors on NASH and the outcome of CHB patients concomitant with NASH remain unclear.We aimed to investigate the outcomes of NASH in CHB patients receiving antiviral treatment.Methods:In the post-hoc analysis of a multicenter trial,na?ve CHB patients receiving 72-week entecavir treatment were enrolled.We evaluated the biochemical,viral and histopathological responses of these patients.The histopathological features of NASH were also evaluated,using paired liver biopsies at baseline and week 72.Results:A total of 1000 CHB patients were finally enrolled for analysis,with 18.2%of whom fulfilling the criteria of NASH.A total of 727 patients completed entecavir antiviral treatment and received the second biopsy.Serum HBe Ag loss,HBe Ag seroconversion and HBV-DNA undetectable rates were similar between patients with or without NASH(P>0.05).Among patients with NASH,the hepatic steatosis,ballooning,lobular inflammation scores and fibrosis stages all improved during follow-up(all P<0.001),46%(63/136)achieved NASH resolution.Patients with baseline body mass index(BMI)≥23 kg/m2(Asian criteria)[odds ratio(OR):0.414;95%confidence interval(95%CI):0.190-0.899;P=0.012]and weight gain(OR:0.187;95%CI:0.050-0.693;P=0.026)were less likely to have NASH resolution.Among patients without NASH at baseline,22(3.7%)developed NASH.Baseline BMI≥23 kg/m2(OR:12.506;95%CI:2.813-55.606;P=0.001)and weight gain(OR:5.126;95%CI:1.674-15.694;P=0.005)were predictors of incident NASH.Conclusions:Lower BMI and weight reduction but not virologic factors determine NASH resolution in CHB.The value of weight management in CHB patients during antiviral treatment deserves further evaluation.

A Pilot Clinical Trial on L-Carnitine Supplementation in Combination with Motivation Training: Effects on Weight Management in Healthy Volunteers

A 4-week low dosage (500 mg/day) L-carnitine supplementation in combination with motivation training was carried out in 24 overweight (BMI 25.8 - 26.6 kg/m2) Japanese males in the course of a double-blind randomized placebo-controlled study. L-carnitine motivated group showed significant body weight loss and a decrement of serum triglyceride level vs. the non-motivated placebo group. Serum adiponectin levels increased in both L-carnitine supplemented groups. The beneficial effects of L-carnitine were amplified by motivation training. For clinical evaluation of supplements, whose efficacy is potentially affected by inter-individual life style variability, supportive motivation training might be advisable for future clinical trials.

The Danger within:Covid-19 Affinity for ACE2 Receptors in Adipose Tissue and Testes.The Protective Effects of Estradiol,Fitness,and Weight Management

The imminent danger of the Covid-19 pandemic has accelerated research in pharmaceuticals that either target the viral Spike proteins fusion with ACE2 receptors,or the infectious RNA replication that often overwhelms immune defences.The scope of this review was to elucidate the main human vulnerabilities to Covid-19,including the accumulation of ACE2 receptors in testes,adipose tissue,thyroid,heart and kidneys that escalate viral affinity in males,the aged,and certain medical conditions,including diabetes,CVD,and pulmonary diseases.Pre-existing inflammation inherent in obesity may exacerbate the“cytokine storm,”a rampaging immune reaction during the course of Covid-19 that is deleterious to the host.We examined the molecular dynamics illustrating the action of new therapeutics necessary for Covid-19 patients;the estradiol advantage hypothesis;alternative therapies including hormone replacement procedures and mesenchymal stem cells;plus preventive and protective interventions.The current perspective also explored the primary components of dysregulated health predisposing individuals to Covid-19,including hormonal imbalance,increased lipids and lipoproteins,thyroid dysfunction,degraded fitness,and age-related testosterone decline accompanied by cortisol increase that provokes stress eating behaviours and weight accumulation.Obesity increases the probability of Covid-19 infection due to its abundance of ACE2 receptors;while physical activity may decrease Covid-19 vulnerability,by reducing fat and increasing muscle mass that manifests a relatively inhibited ACE2 expression.Several weight management solutions feature lasers and radiofrequency which diminish subcutaneous adiposity but do not enhance fitness.A data metanalysis of seven recently published clinical studies on 95 obese individuals,73 males and 22 females with an average BMI of 30.9,demonstrated visceral fat reduction combined with increased skeletal muscle mass.It also revealed a statistically significant decrease in BMI,lipids,lipoproteins,inflammation and toxicity as measured by CRP,Creatinine and Bilirubin respectively,juxtaposed by optimally healthier levels of Cortisol,Testosterone,Free T3,IGF-1,Insulin,and the appetite controlling hormones Leptin and Ghrelin.

Weight Management of Young Women with Down Syndrome: <i>C-ICAN</i>Meal Plan

Primary care physicians are in a unique position to provide a holistic and individualized care to their patients with Down Syndrome. These patients share common medical problems with general population;however, they often are medically complex and present with cardiac, orthopedic, and endocrine challenges such as overweight-obesity and related comorbidities that occur with more frequency in this unique population. The prevention of overweight-obesity is an important public health issue for both the general population and for the population of individuals with Down Syndrome. If abnormal weight gain is treated early and effectively many secondary comorbidities can be prevented or ameliorated. This case report discusses the impact of implementing a Consistent Individualized Carbohydrate controlled Anti-inflammatory Nutrition plan (C-ICAN) as part of the treatment plan for a young woman with Down Syndrome (DS). The C-ICAN meal plan is a low glycemic load meal plan with 30% to 35% calories from fat, 20% to 25% calories from protein, 40% to 45% calories from carbohydrate, and goal of 25 gm fiber per day. The C-ICAN meal plan combines the Mediterranean diet because of its well-established anti-inflammatory, and cardiovascular benefits, with a high protein and low glycemic-load meal plan to improve satiety and glycemic control. In this case the patient and her caregivers adjusted to a structured meal pattern well, weight balance resulted, and mealtime stress was reduced.

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.

Obesity and weight management:What can we do as gastroenterologists?

Obesity is a chronic,relapsing,multifactorial pandemic defined as the excessive or abnormal accu・mulation of body fat due to genetic,biological,microbial,and environmental factors that promote a positive energy balance mainly associated with increased intake and reduced consumption.1-3 Obesity is the consequence of enormous multisystem disorders,in eluding cardiovascular disease,4 type 2 diabetes,5 tumors,&sleep apnea,7-10 etc.,significantly increases mortality rate,11-13 and accounts for substantial elevation in health expenditures.14 Compared with Western countries.

Prevalence and Associated Factors of Eating Disorders in Weight Management Centers in Tanta, Egypt

Background： Eating disorders （EDs） are serious illnesses associated with medical complications and have been increased, especially among societies with an excessive concern about weight, shape, or appearance. This study aimed to investigate the prevalence of EDs among the individuals attending weight management centers and its associated factors. Methods： A cross-sectional study was carried out among individuals attending four weight management centers in Tanta, Gharbia Governorate, Egypt during the period from July to December 2016. Precoded interview questionnaires were used to identify the following data： sociodemographic characteristics and medical history of depression or psychological disorders and the Eating Attitude Test （EAT-40） was used to assess the attitudes, behavior, and traits associated with the EDs. Results： A total of 400 participants （I 12 males and 288 females） were included in the study. According to EAT-40 questionnaires, the prevalence of positive and negative EDs was 65.0% （n = 260） and 35.0% （n = 140）, respectively. EDs were more likely reported by females, married singles, rural residents, those with higher education, and nonworking or part-time working patients, those who were overweight or obese, and who were suffering from depression or any psychological problems. Logistic regression analysis revealed that the independent predictors of EDs were age （adjusted odds ratio [OR]： 1.06）, nonworking （adjusted OR： 2.32） or part-time working （adjusted OR： 2,18）, increased body weight （adjusted OR： 2.66 for overweight and adjusted OR： 1.24 for obese）, and having a history of depression or any psychological problem （adjusted OR： 2.76）. Factor analysis of EAT-40 revealed four factors （eating behavior, diet-related lifestyle, weight concern, and food preoccupation） that were responsible for 33.2% of the total variance. Conclusions： EDs are prevalent among individuals attending the weight management centers in a northern city in Egypt. Specific management strategies are warranted to address this commonly prevalent disease.

Remission of type 2 diabetes mellitus

The surge in type 2 diabetes mellitus(T2DM)is tightly linked to obesity,leading to ectopic fat accumulation in internal organs.Weight management has become a cornerstone of T2DM treatment,with evidence suggesting that significant weight loss can induce remission.Remission,defined as sustained hemoglobin(HbA1c)below 6.5% for at least 3 months without medication,can be achieved through various approaches,including lifestyle,medical,and surgical interventions.Metabolic bariatric surgery offers significant remission rates,particularly for patients with severe obesity.Intensive lifestyle modifications,including lowcalorie diets and exercise,have also demonstrated significant potential.Medications like incretin-based agents show robust results in improving beta-cell function,achieving glycemic control,and promoting weight loss.While complete remission without medication may not be attainable for everyone,especially those with severe insulin resistance or deficiency,early and aggressive glycemic control remains a crucial strategy.Maintaining HbA1c below 6.5%from the time of diagnosis reduces the risk of long-term complications and mortality.Moreover,considering a broader definition of remission,encompassing individuals with sustained control on medication,could offer a more comprehensive and inclusive approach to managing this chronic disease.

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.

Less Aggressive Weight Making Practices in Combat Sport When Recovery Time is Limited:Weight Loss Practices of Pencak Silat Athletes in Singapore

Abstract Weight making behaviours and best practice recommendations for various combat sports have been well documented,how-ever this is not true for Silat athletes.Pre-and post-weigh-in recommendations for other combat sports may not be suitable for Silat due to differences in weigh-in rules.Using a well-established questionnaire,this questionnaire-based cross sectional study examined weight making practices of Silat match athletes(n=102)competing at a national Pencak Silat championship.The 24.5%of athletes engaged in pre-competition weight loss,and the overall Rapid Weight Loss Score(RWLS)was 27.7±8.7,considerably lower than other combat sports.The median age when weight loss began was 17 years,with 32%(n=8)starting such practices under 17 years.Risky weight management practices such as the use of laxatives,diet pills and vomiting were less common than in other combat sports.Coaches and fellow athletes are key influencers of weight making practices,and dietitians were found be an underutilised resource.Appropriate measures to empower coaches and athletes with the knowledge and ability to guide and execute less detrimental weight making practice with the involvement of dietitians are suggested.The study findings provide information to establish Silat-specific dietary strategies to improve health and performance.