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Journal of Neuroendocrinology Jun 2024The polycystic ovary syndrome (PCOS) imparts health risks including dyslipidaemia, diabetes and cardiovascular disease that are amenable to lifestyle adjustment and/or...
The polycystic ovary syndrome (PCOS) imparts health risks including dyslipidaemia, diabetes and cardiovascular disease that are amenable to lifestyle adjustment and/or medication. We describe dyslipidaemia in women referred to a gynaecological endocrine clinic. Clinical data and endocrine and lipoprotein investigations comprising fasting triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and calculated low density lipoprotein cholesterol (LDLC) were studied along with electrophoresis patterns of apolipoprotein B-containing lipoproteins. The 1721 participants comprised black, mixed ancestry, white and Indian individuals (9.8%, 83.2%, 5.8% and 1.2%, respectively). The mean ± standard deviation of the age, body mass index (BMI) and waist/hip ratio were 26.0 ± 5.9 years, 32.3 ± 8.3 kg/m and waist/hip ratio 0.88 ± 0.11, respectively. Overweight status (BMI 26-30 kg/m) and obesity (BMI >30 kg/m) involved 272 (15.8%) and 1010 (58.7%) individuals, respectively. Morbid obesity (BMI >40 kg/m) was present in 309 (17.9%) individuals. The TG, TC, HDLC and LDLC concentrations were 1.22 ± 0.86, 4.77 ± 1.02, 1.3 ± 0.36, 2.94 ± 0.94 mmol/L, respectively. LDL hypercholesterolaemia occurred in 753 (43.7%) and exceeded 5 mmol/L in 39 (2.3%) women. Low HDLC (<0.9 mmol/L) affected 122 (7%), hypertriglyceridaemia (>1.7 mmol/L) affected 265 (15.4%) and exceeded 2.5 mmol/L in 91 (5.3%) women. Mixed hyperlipidaemia (TG >1.7, TC >5.0 mmol/L) occurred in 176 (10.2%). Electrophoresis revealed small LDL particles in 79 (4.6%) and dysbetalipoproteinaemia in 13 (0.76%) of the cohort. Small LDL associated with obesity, blood pressure, TG and glucose concentration and higher androgenic state. Many women with PCOS had unfavourable lipoprotein results: mostly moderate changes in TG, HDLC and LDLC. Small LDL is not rare, may aid risk assessment and is best determined directly. Incidental monogenic disorders of lipoprotein metabolism included dysbetalipoproteinaemia, familial hypercholesterolaemia and severe hypertriglyceridaemia. Dyslipidaemia in PCOS requires more careful diagnosis, individualised management and research.
PubMed: 38858175
DOI: 10.1111/jne.13414 -
American Journal of Perinatology Jun 2024We aimed to examine rates of induction of labor at 39 weeks and cesarean delivery before and after the ARRIVE (A Randomized Trial of Induction Versus Expectant...
OBJECTIVE
We aimed to examine rates of induction of labor at 39 weeks and cesarean delivery before and after the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial stratified by body mass index (BMI; kg/m) category.
STUDY DESIGN
This was a repeated cross-sectional analysis of publicly available U.S. birth certificate data from 2015 to 2021. We limited analyses to nulliparous individuals with a singleton pregnancy, cephalic presentation, without chronic hypertension, diabetes (gestational or pregestational), and fetal anomaly who delivered between 39 and 42 weeks' gestation. The pre-ARRIVE period spanned from August 2016 to July 2018 and the post-ARRIVE period spanned from January 2019 to December 2020. The dissemination period of the ARRIVE trial was from August 2018 to December 2018. Our co-primary outcomes were induction at 39 weeks and cesarean delivery. Our secondary outcomes were overall induction of labor and preeclampsia. We conducted an interrupted time series analysis after stratifying by prepregnancy BMI (<40 or ≥40). Negative binomial regression was used to calculate adjusted incident rate ratios with 95% confidence intervals.
RESULTS
Of 2,122,267 individuals that were included, 2,051,050 had BMI <40 and 71,217 had BMI ≥40. In individuals with BMI <40, the post-ARRIVE period compared to the pre-ARRIVE period was associated with an increased rate of induction of labor at 39 weeks, a decreased rate of cesarean delivery, and an increased rate of overall induction of labor. In individuals with BMI ≥40, the post-ARRIVE period compared to the pre-ARRIVE period was associated with an increased rate of induction of labor at 39 weeks, an increased rate of overall induction of labor and a decreased rate of preeclampsia; however, the decrease in the rate of cesarean delivery was not significant.
CONCLUSION
An increase in induction of labor at 39 weeks' gestation in individuals with BMI ≥40 was not associated with a decrease in the cesarean delivery rate.
KEY POINTS
· The ARRIVE trial increased 39-week labor inductions in BMI <40 and ≥40.. · BMI <40 had fewer cesareans; BMI ≥40 showed no significant decrease.. · Offering labor induction is reasonable as cesarean rates didn't increase..
PubMed: 38857621
DOI: 10.1055/s-0044-1787542 -
Obesity Surgery Jul 2024The purpose of this study is to assess the impact of pre-surgery exercise training on cardiopulmonary fitness. Ten articles (six RCTs and four non-RCTs) involving 281... (Meta-Analysis)
Meta-Analysis
Evaluation of the Effect of the Pre-Operative Exercise Training on Weight Loss, Quality of Life, and Cardiopulmonary Parameter in Bariatric Metabolic Surgery: A Systematic Review and Meta-Analysis.
The purpose of this study is to assess the impact of pre-surgery exercise training on cardiopulmonary fitness. Ten articles (six RCTs and four non-RCTs) involving 281 individuals were finally included in the synthesis. Regarding the effect on VO2 peak, overall standardized mean differences were 0.71 (95% CI, 0.31 to 1.11, n = 103) with heterogeneity (I = 0%, P = 0.49). For 6MWT, overall weighted mean differences (distance in meters) were 31.87 (95% CI, 27.84 to 35.89, n = 100) with heterogeneity (I = 0%, P = 0.96). Engaging in pre-bariatric metabolic surgery exercise training might improve anthropometric parameters and cardiopulmonary fitness with no significant changes in components of quality of life. However, considering high levels of heterogeneity, the results should be generalized cautiously.
Topics: Adult; Female; Humans; Male; Middle Aged; Bariatric Surgery; Cardiorespiratory Fitness; Exercise Therapy; Obesity, Morbid; Preoperative Exercise; Quality of Life; Treatment Outcome; Weight Loss
PubMed: 38856886
DOI: 10.1007/s11695-024-07333-y -
Cureus May 2024Although repairing ventral hernias in individuals who have undergone bariatric surgery is a common practice, persistent technical intricacies and controversies surround...
Innovative Approaches to Address the Technical Challenge of Hernial Sac Distension Due to Pneumoperitoneum in the Synchronous Management of Complex Hernias in Individuals With Morbid Obesity.
Although repairing ventral hernias in individuals who have undergone bariatric surgery is a common practice, persistent technical intricacies and controversies surround their management. Concurrently, addressing ventral hernias in morbidly obese patients undergoing bariatric surgery presents a significant surgical challenge, amplified by the larger intraperitoneal cavities and the presence of large hernial sacs. This technical report introduces two innovative techniques to alleviate the challenge of hernia sac distension due to pneumoperitoneum associated with simultaneous bariatric surgery and ventral hernia repair using laparoscopic technique. The methods are designed to address the complexities of the procedures, making their simultaneous execution feasible and safe. The goal is to eliminate the need for two separate interventions while ensuring the outcomes of each procedure remain uncompromised. The larger intraperitoneal cavities and the presence of large hernial sacs are managed successfully, demonstrating the feasibility and safety of the introduced methods. Importantly, the simultaneous execution of both procedures does not compromise the outcomes of either intervention. Concurrently managing ventral hernias in morbidly obese patients undergoing bariatric surgery requires innovative solutions to overcome technical challenges. The introduction of these two novel techniques proves to be a valuable approach, making simultaneous execution feasible and safe. Eliminating the need for two separate interventions streamlines the surgical process without compromising the outcomes of either bariatric surgery or ventral hernia repair.
PubMed: 38854311
DOI: 10.7759/cureus.59897 -
Obesity Surgery Jul 2024
Topics: Humans; Laparoscopy; Obesity, Morbid; Biomarkers; Treatment Outcome; Gastrectomy; Female; Male; Weight Loss; Adult
PubMed: 38851647
DOI: 10.1007/s11695-024-07347-6 -
Obesity Surgery Jul 2024This study aimed to evaluate the impact of achieving < 37.7% excess body-weight loss (EBWL) within 3 months of postlaparoscopic sleeve gastrectomy (LSG) on clinical...
Three-Month Excessive Body Weight Loss < 37.7% as a Predictor of Mid-term Suboptimal Outcomes Postlaparoscopic Sleeve Gastrectomy: Risk Factors and the Impact of Neutrophil-to-Lymphocyte Ratio on Adipocyte Function.
INTRODUCTION
This study aimed to evaluate the impact of achieving < 37.7% excess body-weight loss (EBWL) within 3 months of postlaparoscopic sleeve gastrectomy (LSG) on clinical outcomes and its correlation with adipocyte function.
METHODS
Patients (n = 176) who underwent LSG between January 2019 and January 2023 were included. Weight loss and status of health markers were monitored postoperatively. The cohort was stratified based on EBWL < 37.7% at 3 months or not. Variables including neutrophil-to-lymphocyte ratio (NLR), insulin resistance, and comorbidities were analyzed. Omental visceral and subcutaneous adipose tissue samples were used to analyze the differences in adipocyte function by western blot.
RESULTS
Patients with EBWL < 37.7% at 3 months post-LSG (suboptimal group) comprised less likelihood of achieving ≥ 50% EBWL than those who achieved ≥ 37.7% EBWL (optimal group) at 6 months (42.55% vs. 95.52% in optimal group, p < 0.001), 12 months (85.11% vs. 99.25% in optimal group, p < 0.001) and 24 months (77.14% vs. 94.74% in optimal group, p = 0.009) post-LSG. High BMI (OR = 1.222, 95% CI 1.138-1.312, p < 0.001), NLR ≥ 2.36 (OR = 2.915, 95% CI 1.257-6.670, p = 0.013), and female sex (OR = 3.243, 95% CI 1.306-8.051, p = 0.011) significantly predicted EBWL < 37.7% at 3 months post-LSG. Patients with NLR ≥ 2.36 had significantly lower adipose triglyceride lipase in omental fat (p = 0.025).
CONCLUSION
EBWL < 37.7% at 3 months post-LSG is a strong predictor of subsequent suboptimal weight loss. High BMI, NLR ≥ 2.36, and female sex are risk factors in predicting EBWL < 37.7% at 3 months post-LSG. These findings may offer a reference to apply adjuvant weight loss medications to patients who are predisposed to suboptimal outcomes.
Topics: Humans; Female; Male; Neutrophils; Weight Loss; Adult; Gastrectomy; Laparoscopy; Risk Factors; Lymphocytes; Obesity, Morbid; Middle Aged; Adipocytes; Treatment Outcome; Retrospective Studies
PubMed: 38851646
DOI: 10.1007/s11695-024-07315-0 -
Biomedicine & Pharmacotherapy =... Jul 2024Cancer and cardiovascular diseases are major contributors to global morbidity and mortality, and their seemingly separate pathologies are intricately intertwined. In the... (Review)
Review
Cancer and cardiovascular diseases are major contributors to global morbidity and mortality, and their seemingly separate pathologies are intricately intertwined. In the context of cancer, the cardiovascular disease encompasses not only the side effects arising from anti-tumor treatments but also the metabolic shifts induced by oncological conditions. A growing body of research indicates that lipid metabolic reprogramming serves as a distinctive hallmark of tumors. Furthermore, anomalies in lipid metabolism play a significant role in the development of cardiovascular disease. This study delves into the cardiac implications of lipid metabolic reprogramming within the cancer context, closely examining abnormalities in lipid metabolism present in tumors, cardiac tissue, and immune cells within the microenvironment. Additionally, we examined risk factors such as obesity and anti-tumor therapy. Despite progress, a gap remains in the availability of drugs targeting lipid metabolism modulation for treating tumors and mitigating cardiac risk, with limited advancement seen in prior studies. Here, we present a review of previous research on natural drugs that exhibit both shared and distinct therapeutic effects on tumors and cardiac health by modulating lipid metabolism. Our aim is to provide insights for potential drug development.
Topics: Humans; Neoplasms; Lipid Metabolism; Cardiovascular Diseases; Animals; Biological Products; Antineoplastic Agents; Comorbidity; Tumor Microenvironment
PubMed: 38850662
DOI: 10.1016/j.biopha.2024.116875 -
Clinical Nutrition ESPEN Aug 2024Obesity is a chronic disease that increases the risk of cardiovascular diseases (CVD), including systemic arterial hypertension (SAH), underestimated in this population....
BACKGROUND
Obesity is a chronic disease that increases the risk of cardiovascular diseases (CVD), including systemic arterial hypertension (SAH), underestimated in this population. The high mortality related to CVD reveals the need for early screening. One of the training tools is the waist-to-hip ratio (WHR). However, few studies evaluate its relationship with metabolic changes in severe obesity, making necessary a new cut-off point.
METHOD
Cross-sectional study with 75 Brazilian women with severe obesity (mean age: 37,6 years; weight of 122 kg and body mass index (BMI) of 47,8 kg/m). Height, weight, neck circumference (NC), hip (HC), waist (WC) and waist-to-hip ratio (WHR) were obtained. Blood samples were collected for lipid/glucose profile. The Receiver Operating Characteristic (ROC) was explored to define cut-off points for WHR based on SAH. Women were compared using the t-Student/Mann Whitney test. Pearson/Spearman correlations were performed, and the significance level was set at 5%.
RESULTS
The ROC curve indicated that WHR ≥0.92 best predicted SAH. The group with WHR ≥0.92 had higher Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (p = 0.037), insulin (p = 0.037), NC (p = 0.004), and Atherogenic Index of Plasma (AIP) (p = 0.038). WHR correlated with NC (p = 0.002; r = 0.358), glucose (p = 0.026; r = 0.270); insulin (p = 0.05; r = 0.238); HOMA-IR (p = 0.01; r = 0.3238), triglycerides (p = 0.006; r = 329) and AIP (p = 0.02; r = 0.370).
CONCLUSIONS
A new cut-off point for WHR related to SAH in severe obesity is suggested.
Topics: Humans; Female; Cross-Sectional Studies; Waist-Hip Ratio; Adult; Obesity, Morbid; Brazil; Body Mass Index; Middle Aged; ROC Curve; Insulin Resistance; Blood Glucose; Waist Circumference; Hypertension; Cardiovascular Diseases; Risk Factors
PubMed: 38850528
DOI: 10.1016/j.clnesp.2024.05.019 -
Obesity Surgery Jul 2024
Topics: Humans; Bariatric Surgery; Obesity, Morbid
PubMed: 38850436
DOI: 10.1007/s11695-024-07351-w -
Obesity Surgery Jul 2024
Topics: Humans; Bariatric Surgery; Obesity, Morbid
PubMed: 38850435
DOI: 10.1007/s11695-024-07350-x