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Author: Medical team doctors report NMT NMT ENDO finishing compiler, please do not reprint without authorization.
Introduction: The 2021 American Endocrine Society Annual Meeting (ENDO) announced a number of research progress related to obesity.
Yimaitong compiled and compiled some of the contents and shared them with teachers.
The content of this article includes "The latest progress in the treatment of obesity in children with hypothalamus", "Assessment of renal function status in patients after metabolic bariatric surgery", "Evaluation of the efficacy of liraglutide in hereditary obesity" and "Cancer risk prediction model for obese patients.
"
1.
Dextroamphetamine treats children with hypothalamic obesity, which has a more significant effect on acquired obesity.
Hypothalamic obesity (HO) is a disease caused by a patient's overeating and/or a reduction in resting energy expenditure (REE).
Divided into two categories: hereditary and acquired, patients and their families have a heavy burden, and there is currently no effective treatment drug.
Dextroamphetamine is a drug commonly used to treat attention deficit hyperactivity disorder.
It has a strong stimulating effect on REE and can suppress appetite.
Jiska van Schaik and others shared their experience in the treatment of children and adolescents with dextroamphetamine (used beyond the instructions).
A retrospective cohort study included 18 children and adolescents with HO (13 acquired HO and 5 hereditary HO).
All patients received dexamphetamine treatment with an initial dose of 5 mg qd or 5 mg bid.
According to the patient's overall health and side effects, the dose is increased by 5 mg/d every week, and the maximum dose is increased to 0.
5 mg/kg/d.
The average treatment duration was 18.
3±14.
7 months, and 10/18 (55.
6%) patients had clinically relevant weight loss.
Thirteen/18 (72.
2%) patients reported overfeeding, REE levels, and/or behavioral improvement. No serious adverse reactions occurred during the treatment.
Among the 13 acquired HO patients, 10 patients lost weight (mean ΔBMI SDS -1.
09 ± 1.
00), 1 patient maintained stable BMI (ΔBMI SDS +0.
03), and 2 patients increased BMI SDS (mean ΔBMI SDS +0.
32 ± 0.
05) ).
Nine patients with acquired HO evaluated the REE before and after treatment, and the REE increased by 15.
3% ± 10.
5 on average.
Among the 5 cases of hereditary HO, 3 patients maintained stable BMI (mean ΔBMI SDS -0.
08 ± 0.
19).
There was no significant difference in REE before and after treatment in these patients; BMI SDS increased in 2 patients (mean ΔBMI SDS +0.
29 ± 0.
25).
It can be seen that for children and adolescents with acquired HO, dexamphetamine can significantly reduce BMI, reduce overfeeding, and improve activity levels.
For patients with hereditary HO, these effects are not obvious.
2.
One year after metabolic bariatric surgery, the patient's renal function improved significantly.
Obesity is one of the strongest risk factors for new-onset chronic kidney disease (CKD).
Studies have shown that weight loss can reduce renal ultrafiltration and proteinuria levels, and metabolic weight loss Surgery (MBS) is currently an effective method for the treatment of obesity and metabolic-related complications.
However, the current research on the long-term effects of MBS on renal function is still very limited.
An observational retrospective study from Singapore included 557 patients treated with MBS from 2008 to 2019 for analysis (mean age 41.
7 years, female accounted for 65.
4%).
The collected data included baseline and postoperative data The estimated glomerular filtration rate (eGFR) and proteinuria [defined as urine albumin/creatinine ratio (uACR)>3.
5 mg/mmol] level of the patient at 1 year. One year after the operation, the patient’s average BMI decreased significantly (-11.
3 ±4.
2 kg/m^2), systolic BP (-3.
24 ±19.
3 mmHg) and diastolic BP decreased (-5.
23 ±13.
8 mmHg), and fasting blood glucose decreased (-1.
95 ± 2.
89 mmol/L), HDL level increased (0.
29 ± 0.
26 mmol/L).
The proportion of patients using antihypertensive drugs (from 48.
8% to 14.
4%), hypoglycemic drugs (from 34.
1% to 12.
7%) and lipid-lowering drugs (from 37.
8% to 20.
4%) decreased.
In particular, the use of ACEi and/or ARB (from 32.
9% to 9.
2%, p<0.
001) decreased significantly.
In terms of renal function, the median eGFR of patients increased by 1.
66mL/min/1.
73m^2 (p<0.
001), and the GFR of non-diabetic and pre-diabetic patients increased significantly; the median uACR decreased significantly by 0.
30 mg/mmol ( p=0.
001) (Figure 1).
In patients with diabetes and prediabetes, the result is still statistically significant.
12.
9% of patients had improved CKD staging, and the proportion of patients with proteinuria decreased from 24.
8% at baseline to 1.
89% (p<0.
001).
Figure 1 One year after MBS, the patient's eGFR was significantly increased (left), and uACR was significantly decreased (right).
Studies have confirmed that metabolic bariatric surgery can improve the patient's renal function.
One year after surgery, eGFR in non-diabetic patients improved, and proteinuria levels in pre-diabetic and diabetic patients decreased.
In the future, more long-term data will be needed to confirm this conclusion.
3.
The effect of glucagon-like peptide 1 analogues in the treatment of genetic obesity.
Obesity is a common chronic disease, which increases the health burden of patients and is difficult to treat, especially for genetic obesity.
Genetic obesity has limited efficacy after intensive lifestyle therapy, and may develop into refractory obesity.
Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist or GLP-1 analogue, which can induce metabolic parameters, satiety and weight loss in obese patients through lifestyle.
Has a good effect.
Mila W et al.
conducted a study that included 4 overweight or severely obese patients with hereditary obesity.
All patients were treated with liraglutide 3 mg qd.
At the same time, supportive treatment with intensive lifestyle was performed to evaluate the patient’s human parameters and metabolism.
Parameters, resting energy expenditure (REE), adverse reactions, and subjectively reported outcomes such as satiety and quality of life.
The study aims to evaluate the efficacy of GLP-1 analogs in the treatment of patients with genetic obesity.
Figure 2 The length of follow-up of a patient participating in the study ranged from 33 weeks to 12 years.
The patient's BMI decreased by an average of 5.
7 ± 3.
8 kg/m2, and the waist circumference decreased by an average of 15.
2 ± 21.
1 cm.
All patients reported an improvement in their quality of life, and 3 of them also reported increased satiety.
In addition, the patient's metabolic parameters improved, and no significant improvement in REE was observed.
Two patients had mild adverse reactions (such as nausea and stomach pain), but the duration was short.
Studies have confirmed that GLP-1 analogs have a good effect on the weight, metabolic parameters and quality of life of patients with genetic obesity.
All patients had a 5%-10% weight loss, and 3 patients felt fuller.
It can be seen that for genetically obese patients, in addition to a healthy lifestyle, GLP-1 analogs may be an effective treatment option.
4.
Cancer risk prediction model for obese patients Obesity is a common chronic disease.
This type of population has a higher risk of cancer, but its risk factors can often be intervened in advance.
Therefore, it is of great significance to identify obese patients with high risk of cancer in advance, and can guide treatment and intervention strategies appropriately.
Alexander T et al.
carried out an observational study and constructed a predictive model that included the electronic medical record data of 394,161 adult patients (18-80 years old) with a BMI ≥25kg/m^2 from 2000 to 2019.
All patients There was no history of cancer at baseline, and the researchers assessed the risk of cancer and related risk factors in obese and overweight patients.
The average age of the patients was 46.
7 (SD=15.
5) years old, the average BMI was 30.
5 kg/m^2 (SD=5.
4), and the proportion of women was 51.
9%.
With an average follow-up of 7.
5 years, a total of 34,679 (8.
8%) subjects suffered from cancer.
Ranking of cancer risk factors: 1.
HIV infection: cancer risk increased by 122%; 2.
Older age: every 15.
5 years old, cancer risk increased by 105%; 3.
Hepatitis C virus infection: cancer risk increased by 48%; 4.
Cancer family history: Cancer risk increased by 44%; 5.
Proteinuria: cancer risk increased by 23%; 6.
Smoking history: cancer risk increased by 20%; 7.
Obesity: For every increase in BMI of 5.
4kg/m^2, the patient's cancer risk increased by 6%.
Studies have confirmed that it is feasible to use predictive models (risk factors) to identify those who are at higher risk of cancer among overweight and obese patients.
This method can be used to guide crowd management and treatment decision making.
Introduction: The 2021 American Endocrine Society Annual Meeting (ENDO) announced a number of research progress related to obesity.
Yimaitong compiled and compiled some of the contents and shared them with teachers.
The content of this article includes "The latest progress in the treatment of obesity in children with hypothalamus", "Assessment of renal function status in patients after metabolic bariatric surgery", "Evaluation of the efficacy of liraglutide in hereditary obesity" and "Cancer risk prediction model for obese patients.
"
1.
Dextroamphetamine treats children with hypothalamic obesity, which has a more significant effect on acquired obesity.
Hypothalamic obesity (HO) is a disease caused by a patient's overeating and/or a reduction in resting energy expenditure (REE).
Divided into two categories: hereditary and acquired, patients and their families have a heavy burden, and there is currently no effective treatment drug.
Dextroamphetamine is a drug commonly used to treat attention deficit hyperactivity disorder.
It has a strong stimulating effect on REE and can suppress appetite.
Jiska van Schaik and others shared their experience in the treatment of children and adolescents with dextroamphetamine (used beyond the instructions).
A retrospective cohort study included 18 children and adolescents with HO (13 acquired HO and 5 hereditary HO).
All patients received dexamphetamine treatment with an initial dose of 5 mg qd or 5 mg bid.
According to the patient's overall health and side effects, the dose is increased by 5 mg/d every week, and the maximum dose is increased to 0.
5 mg/kg/d.
The average treatment duration was 18.
3±14.
7 months, and 10/18 (55.
6%) patients had clinically relevant weight loss.
Thirteen/18 (72.
2%) patients reported overfeeding, REE levels, and/or behavioral improvement. No serious adverse reactions occurred during the treatment.
Among the 13 acquired HO patients, 10 patients lost weight (mean ΔBMI SDS -1.
09 ± 1.
00), 1 patient maintained stable BMI (ΔBMI SDS +0.
03), and 2 patients increased BMI SDS (mean ΔBMI SDS +0.
32 ± 0.
05) ).
Nine patients with acquired HO evaluated the REE before and after treatment, and the REE increased by 15.
3% ± 10.
5 on average.
Among the 5 cases of hereditary HO, 3 patients maintained stable BMI (mean ΔBMI SDS -0.
08 ± 0.
19).
There was no significant difference in REE before and after treatment in these patients; BMI SDS increased in 2 patients (mean ΔBMI SDS +0.
29 ± 0.
25).
It can be seen that for children and adolescents with acquired HO, dexamphetamine can significantly reduce BMI, reduce overfeeding, and improve activity levels.
For patients with hereditary HO, these effects are not obvious.
2.
One year after metabolic bariatric surgery, the patient's renal function improved significantly.
Obesity is one of the strongest risk factors for new-onset chronic kidney disease (CKD).
Studies have shown that weight loss can reduce renal ultrafiltration and proteinuria levels, and metabolic weight loss Surgery (MBS) is currently an effective method for the treatment of obesity and metabolic-related complications.
However, the current research on the long-term effects of MBS on renal function is still very limited.
An observational retrospective study from Singapore included 557 patients treated with MBS from 2008 to 2019 for analysis (mean age 41.
7 years, female accounted for 65.
4%).
The collected data included baseline and postoperative data The estimated glomerular filtration rate (eGFR) and proteinuria [defined as urine albumin/creatinine ratio (uACR)>3.
5 mg/mmol] level of the patient at 1 year. One year after the operation, the patient’s average BMI decreased significantly (-11.
3 ±4.
2 kg/m^2), systolic BP (-3.
24 ±19.
3 mmHg) and diastolic BP decreased (-5.
23 ±13.
8 mmHg), and fasting blood glucose decreased (-1.
95 ± 2.
89 mmol/L), HDL level increased (0.
29 ± 0.
26 mmol/L).
The proportion of patients using antihypertensive drugs (from 48.
8% to 14.
4%), hypoglycemic drugs (from 34.
1% to 12.
7%) and lipid-lowering drugs (from 37.
8% to 20.
4%) decreased.
In particular, the use of ACEi and/or ARB (from 32.
9% to 9.
2%, p<0.
001) decreased significantly.
In terms of renal function, the median eGFR of patients increased by 1.
66mL/min/1.
73m^2 (p<0.
001), and the GFR of non-diabetic and pre-diabetic patients increased significantly; the median uACR decreased significantly by 0.
30 mg/mmol ( p=0.
001) (Figure 1).
In patients with diabetes and prediabetes, the result is still statistically significant.
12.
9% of patients had improved CKD staging, and the proportion of patients with proteinuria decreased from 24.
8% at baseline to 1.
89% (p<0.
001).
Figure 1 One year after MBS, the patient's eGFR was significantly increased (left), and uACR was significantly decreased (right).
Studies have confirmed that metabolic bariatric surgery can improve the patient's renal function.
One year after surgery, eGFR in non-diabetic patients improved, and proteinuria levels in pre-diabetic and diabetic patients decreased.
In the future, more long-term data will be needed to confirm this conclusion.
3.
The effect of glucagon-like peptide 1 analogues in the treatment of genetic obesity.
Obesity is a common chronic disease, which increases the health burden of patients and is difficult to treat, especially for genetic obesity.
Genetic obesity has limited efficacy after intensive lifestyle therapy, and may develop into refractory obesity.
Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist or GLP-1 analogue, which can induce metabolic parameters, satiety and weight loss in obese patients through lifestyle.
Has a good effect.
Mila W et al.
conducted a study that included 4 overweight or severely obese patients with hereditary obesity.
All patients were treated with liraglutide 3 mg qd.
At the same time, supportive treatment with intensive lifestyle was performed to evaluate the patient’s human parameters and metabolism.
Parameters, resting energy expenditure (REE), adverse reactions, and subjectively reported outcomes such as satiety and quality of life.
The study aims to evaluate the efficacy of GLP-1 analogs in the treatment of patients with genetic obesity.
Figure 2 The length of follow-up of a patient participating in the study ranged from 33 weeks to 12 years.
The patient's BMI decreased by an average of 5.
7 ± 3.
8 kg/m2, and the waist circumference decreased by an average of 15.
2 ± 21.
1 cm.
All patients reported an improvement in their quality of life, and 3 of them also reported increased satiety.
In addition, the patient's metabolic parameters improved, and no significant improvement in REE was observed.
Two patients had mild adverse reactions (such as nausea and stomach pain), but the duration was short.
Studies have confirmed that GLP-1 analogs have a good effect on the weight, metabolic parameters and quality of life of patients with genetic obesity.
All patients had a 5%-10% weight loss, and 3 patients felt fuller.
It can be seen that for genetically obese patients, in addition to a healthy lifestyle, GLP-1 analogs may be an effective treatment option.
4.
Cancer risk prediction model for obese patients Obesity is a common chronic disease.
This type of population has a higher risk of cancer, but its risk factors can often be intervened in advance.
Therefore, it is of great significance to identify obese patients with high risk of cancer in advance, and can guide treatment and intervention strategies appropriately.
Alexander T et al.
carried out an observational study and constructed a predictive model that included the electronic medical record data of 394,161 adult patients (18-80 years old) with a BMI ≥25kg/m^2 from 2000 to 2019.
All patients There was no history of cancer at baseline, and the researchers assessed the risk of cancer and related risk factors in obese and overweight patients.
The average age of the patients was 46.
7 (SD=15.
5) years old, the average BMI was 30.
5 kg/m^2 (SD=5.
4), and the proportion of women was 51.
9%.
With an average follow-up of 7.
5 years, a total of 34,679 (8.
8%) subjects suffered from cancer.
Ranking of cancer risk factors: 1.
HIV infection: cancer risk increased by 122%; 2.
Older age: every 15.
5 years old, cancer risk increased by 105%; 3.
Hepatitis C virus infection: cancer risk increased by 48%; 4.
Cancer family history: Cancer risk increased by 44%; 5.
Proteinuria: cancer risk increased by 23%; 6.
Smoking history: cancer risk increased by 20%; 7.
Obesity: For every increase in BMI of 5.
4kg/m^2, the patient's cancer risk increased by 6%.
Studies have confirmed that it is feasible to use predictive models (risk factors) to identify those who are at higher risk of cancer among overweight and obese patients.
This method can be used to guide crowd management and treatment decision making.
