Culturally Sensitive Education Can Decrease Hispanic Workers' Risk of Metabolic Syndrome.

Our friend and colleague Wayne Fenton asked to write this article for the Journal because of his desire to educate other psychiatrists about the treatment of schizophrenia, including what he recognized to be a growing problem with the metabolic syndrome. This lifelong passion, which he pursued from his psychiatry residency at Yale, through his directorship of Chestnut Lodge, to his position at NIMH as Director of the Division of Adult Translational Research and Associate Director for Clinical Affairs, ended tragically with his killing during an evaluation of a psychotic young man. Wayne had worked tirelessly to secure support for new drug discovery in the NIMH programs that he directed. The Journal will be initiating in 2007 a series of articles on the discovery of new mental illness treatments. We will dedicate this series to Wayne's memory and include with it a memorial of his life and contributions to the treatment of mental illness.

Background: Laparoscopic Sleeve Gastrectomy (LSG) is an approved procedure for weight reduction in obese patients. This outcome of weight loss is essential to achieve optimal control in patients with type 2 diabetes mellitus (T2DM).Objectives: This study was designed to evaluate the effect of LSG on glycemic control among a sample of obese patients in Al-Madinah Al-Munawwarah, Saudi Arabia, through assessment of reduction in hemoglobin A1c (HbA1c) associated with weight loss following LSG.Methods: In this cross-sectional study, we studied 102 patients with a body mass index (BMI) of ≥30 kg/m2 and aged ≥18 years who underwent LSG between January 2017 and December 2019. Patient age, characteristics, preoperative and postoperative records of BMI and HbA1c were collected. The data of BMI and HbA1c were analyzed based on baseline and mean postoperative readings with variable postoperative visits after LSG.Results: There was a 30% reduction in BMI and a 26.4% reduction in HbA1c following LSG from baseline in all patients. We noted 44 patients achieved BMI <40kg/m2 with HbA1c <6.5% and 32 patients achieved BMI <40kg/m2 with HbA1c <5.7% within a mean follow-up time of 10 months.Conclusions: Laparoscopic Sleeve Gastrectomy (LSG) has a positive effect on glycemic control in obese patients in short term, evidenced by the significant reduction of weight and HbA1c. Larger longitudinal studies are needed to assess the long-term impact of LSG glycemic control and the related factors associated with maintaining weight reduction and optimal glycemic control in Saudi Arabia for patients with obesity.

Type 1 diabetes is known to be associated with increased cardiovascular disease in the presence of nephropathy and hypertension. It was the aim of the present study to elucidate whether or not clinical findings of metabolic syndrome (MS) are further increasing cardiovascular morbidity among type 1 diabetics. In the present cross-sectional study, 1,241 type 1 diabetics were included. These patients attended the Diabetes Clinic Karlsburg, Germany, from February 1, 2002 to December 31, 2003. The presence of the following findings was taken into consideration as clinical features of MS in type 1 diabetes: fasting triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), daily insulin requirement/kg body weight (b.w.), increased blood pressure > 130/85 mmHg, including overt arterial hypertension. In each of the five categories the highest quintile in each sample was assessed: TG 2.9 +/- 3.6 mmol/l, HDL-C 1.48 +/- 0.46 mmol/l, BMI 29.1 +/- 4.98 kg/m(2) height, insulin requirement 0.71 +/- 0.23 IU/kg b.w., systolic blood pressure 130 +/- 12.3 mmHg. MS was defined as the presence of at least three categories. Among 1,241 type 1 diabetics (651 men, 590 women), 226 patients (129 men, 97 women) fulfilled the criteria of MS. The risk of MS was assessed by multiple regression analysis. Risk variables were: age, diabetes duration, sex, glycated hemoglobin (HbA(1c)), actual smoking, neuropathy, albumin excretion rate (AER), regular alcohol consumption, retinopathy, peripheral vascular disease (PVD), coronary heart disease (CHD), TGs, HDL-C, low-density lipoprotein cholesterol (LDL-C), cholesterol, blood pressure increase, BMI, increased insulin requirement, and foot syndrome. After adjusting for age, the variables were separately included into the mathematical model. The risk of MS was assessed after excluding the variables defining MS. Type 1 diabetics with MS were characterized by higher age (46 vs. 36 years; p < 0.01), and longer diabetes duration (19 vs. 16 years; p < 0.01). The risk of MS was independently associated (odds ratios) with higher age (40-59 years; 4.21; p < 0.01), increased HbA(1c) (1.41; p < 0.01), PVD (2.28; p < 0.01), CHD (2.19; p < 0.01), and the foot syndrome (4.17; p < 0.01). There were no significant associations of MS with type 2 diabetes heredity (first and second degree). Patients with type 1 diabetes and the presence of findings of MS are suffering from increased cardiovascular morbidity. The risk of MS increases with the age and HbA(1c). Life style factors such as weight gain and muscular inactivity seem to have an influence on the pathogenesis of MS in type 1 diabetes, thereby increasing cardiovascular morbidity.

Behavioral programs may improve outcomes for individuals with type 2 diabetes mellitus, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs. To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes. 6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists. Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs. One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias. Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥ 11 contact hours) led to clinically important improvements in glycemic control (≥ 0.4% reduction in hemoglobin A1c [HbA1c]), whereas most diabetes self-management education programs without added support-especially those offering 10 or fewer contact hours-provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥ 75% nonwhite participants). All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions. Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control. Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515).

The purpose of this study was to evaluate costs associated with the primary intervention of the Mediterranean Lifestyle Program (MLP), which targeted postmenopausal women with type 2 diabetes at risk for coronary heart disease. Using retrospective data collected during MLP development and implementation, the authors estimated costs for the first 6 months relative to the usual care condition and incremental costs per behavioral, biologic, and quality-of-life change. Sensitivity analyses were conducted using variations in inflation rates, implementation settings, labor and nonlabor inputs, and market wage rates. Of the sample of 279 study participants, 163 were randomized into the MLP condition. Total intervention costs were estimated at $211 061 ($148 022 direct costs) or $1295 per MLP participant relative to usual care ($908 direct costs). This translates to $3808 per average change in coronary heart disease risk as measured by an average 1-point reduction in hemoglobin A1C. Relative to other measured improvements, this corresponds to $2345 per unit reduction in body mass index and $644 per unit improvement in Problem Areas in Diabetes Quality-of-Life Self-care Summary score, and a $196 per-gram reduction in intake of saturated fatty acids as noted by the Food Frequency Questionnaire. A significant portion of the direct costs were related to the resources used during the recruitment phase. Providing a relatively intensive lifestyle self-management program for this high-risk group is associated with modest incremental costs compared with usual care, making the program potentially appealing to policy makers.

Objective To assess the impact of a group medical clinic designed for patient with type 2 diabetes mellitus and hypertension on body mass index. Methods Using data from a randomized trial of 239 veterans with type 2 diabetes mellitus, we performed a secondary analysis using analysis of covariance mixed models to explore the effect of a 12-month group medical clinic intervention on change in body mass index vs. usual care. In an exploratory subgroup analysis, we compared change in body mass index between treatment arms stratified by whether patients had &gt;0.5% reduction in hemoglobin A1c at 12 months. Results Baseline body mass index was 33.5 kg/m2. At 12 months, there was no significant difference in change in body mass index between treatment arms (estimate=−0.02, 95% CI −0.51 to 5.05; P = 0.94); body mass index increased by approximately 0.20 points in both groups. There was also no significant difference in change in body mass index between treatment arms by whether or not patients had &gt;0.5% reduction in hemoglobin A1c (estimate=−0.14, 95% CI −1.21 to −0.92; P = 0.79). Discussion Improved glycemic control was not associated with improved body mass index in the group medical clinic intervention. Given their positive effects on other outcomes, group medical clinics for patients with type 2 diabetes mellitus may be more beneficial if focus is shifted towards weight loss.

Low predictability of anthropometric indicators of obesity in metabolic syndrome (MS) risks among elderly women

Prevalance of morbid obesity and metabolic syndrome in U.S. adolescents and very young adults

Effects of GLP-1 receptor agonists on cardiometabolic outcomes in heart transplant recipients: A systematic review and meta-analysis of observational studies.

Exenatide is a glucagon-like peptide-1 receptor agonist that can reduce body weight. This study aimed to determine the efficacy of exenatide on body mass index (BMI) reduction in patients with type 2 diabetes mellitus (T2DM) with differing baseline body weight, blood glucose, and atherosclerotic status and to determine if there is a correlation between BMI reduction and cardiometabolic indices in these patients. This retrospective cohort study used data from our randomized controlled trial. A total of 27 T2DM patients treated with combination therapy of exenatide twice daily and metformin for 52 weeks were included. The primary endpoint was a change in the BMI from the baseline to week 52. The secondary endpoint was a correlation between BMI reduction and cardiometabolic indices. Findings. The BMIs of overweight and obesity patients and those with glycated hemoglobin (HbA1c) ≥ 9% significantly decreased -1.42 ± 1.48 kg/m2(P=0.015) and -0.87 ± 0.93 kg/m2(P=0.003), respectively, at the baseline after 52 weeks of treatment. There was no reduction in BMI in patients with normal weight, HbA1c <9%, the nonatherosclerosis group, and the atherosclerosis group. The decrease in BMI was positively correlated with changes in blood glucose, high-sensitivity C-reactive protein (hsCRP), and systolic blood pressure (SBP). BMI scores improved after exenatide treatment for 52 weeks in T2DM patients. Weight loss was affected by baseline body weight and blood glucose level. In addition, BMI reduction from the baseline to 52 weeks was positively correlated with baseline HbA1c, hsCRP, and SBP. Trial Registration. Chinese Clinical Trial Registry (ChiCTR-1800015658).

The evidence for effective non-pharmacological management of type 2 diabetes in children and young adults is scarce. This systematic review aims to identify the available evidence for non-pharmacological interventions in managing type 2 diabetes in children and young adults. A systematic search of OVID MEDLINE, Ovid Emcare, EMBASE, CINAHL, Cochrane, APA PsycINFO, Joanna Briggs, ACP Journal Club, Global Health, Scopus databases, INFORMIT, Circumpolar Health, Native Health Database, Indigenous Studies Portal, OpenGrey and Clinicaltrials.gov was performed up to March 2024. Information on author, year, study design, setting and population, intervention characteristics, and results were extracted by three reviewers independently. Seven studies met criteria for inclusion. Very low-energy diet (VLED) was associated with reduction in hemoglobin A1c (HbA1c), weight, and body mass index (BMI). No other interventions (intensive group-based lifestyle program, occupational-therapist conducted support program or peer support program) improved HbA1c. Interventions positively impacted well-being, mental health and cardiometabolic outcomes. Evidence for non-pharmacological management of youth onset type 2 diabetes is scarce. Available evidence demonstrated that VLED is associated with improved glycemia and weight loss. The role of social support from peers, family, and health professionals shows mixed results.

To the Editor: Recent data from Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) have recently reported that pharmacological treatment with a fibrate (gemfibrozil) significantly reduced coronary heart disease (CHD) risk among men with a history of CHD who had low HDL-cholesterol and LDL-cholesterol levels at baseline evaluation.1 Moreover, this study also demonstrated that changes in the lipoprotein-lipid profile only partially explained the beneficial effect of gemfibrozil on CHD risk, suggesting that other factors may be responsible for the reduction in the risk of CHD observed among patients undergoing fibrate therapy.2 On the other hand, the contribution of inflammation to the development of atherosclerosis and CHD is increasingly recognized, and recent studies have identified some inflammatory markers, such as plasma C-reactive protein (CRP) and cytokines, as CHD risk factors.3,4 ⇓ Recent data have suggested that statins and fibrates may favorably decrease markers of inflammation.5–8 ⇓ ⇓ ⇓ However, the effect of fibrates among abdominally obese men with the atherogenic dyslipidemia of the metabolic syndrome (a condition associated with markedly elevated inflammatory markers) has, to the best of our knowledge, never been reported. Thus, the aim of the present study was to examine the effect of a 6-month fibrate treatment on plasma CRP concentrations and cytokine levels such as interleukin …

Studies have demonstrated that interventions targeting weight loss and body mass index (BMI) reduction can be successful, although the specific factors that influence their effectiveness are still unclear. Behavior change support systems (BCSS) are an approach that aims to help users in their efforts to modify their behavior. A useful tool for assessing BCSS is the Persuasive Systems Design model (PSD), where different features and postulates can be employed. However, it is unknown whether the grouping of software features and design principles, along with behavioral traits, provide a better combination to achieve effective BMI reduction. This study investigates the impact of PSD features, postulates behind the design, and behavioral traits on BMI reduction after six months of utilizing a mobile health behavior change support system (mHBCSS). We examined a subset of 96 individuals from a randomized controlled trial using a mHBCSS for a period of six months. Data was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). We found that 15.3% in the variance of BMI reduction was explained by the ability of setting goals. Furthermore, users who perceive a system as highly persuasive are more likely to establish goals (R2=0.207). Among PSD features, Dialogue Support and Primary Task Support explained 54.9% of the variance in Perceived Persuasiveness. In addition, both Dialogue Support and Credibility Support have a mutual effect on Primary Task Support (R2=0.685). Finally, the system's unobtrusiveness explained 41.1% of the variance in Dialogue Support. PSD framework and behavior change theories provide significant influence on BMI reduction. Setting a clear and organized objective assists individuals in successfully pursuing their intended results. The findings of this study can help developers and health professionals decide which PSD features and postulates to include to make mHBCSS interventions targeting BMI reduction more effective.

ObjectivesThe study aim was to analyze the regional differences in dietary protein intake and protein sources of Korean older adults and their association with metabolic syndrome.MethodsStudy participants were 1,721 older adults aged 65 and over who participated in 2016–2019 Korea National Health and Nutrition Examination Survey. Using 24-hour recall dietary intake data, protein intake and their food sources were examined. The association between protein intake and metabolic syndrome, obesity, and abdominal obesity were analyzed by multiple logistic regression.ResultsTotal protein and animal protein intakes were higher in urban area (60.0 g, 24.4 g, respectively) than in rural area (54.6 g, 19.6 g, respectively). With increase of protein intake level, animal to total protein proportion was increased in both areas. Total protein and plant protein intake was negatively associated with the risk of obesity, abdominal obesity in both areas. Animal protein intake was negatively associated with the risk of obesity in both areas, and with abdominal obesity only in urban area. In urban area, plant protein intake was also negatively associated with the risks of metabolic syndrome, elevated triglyceride, and reduced high density lipoprotein-cholesterol. In urban area, the risk of metabolic syndrome was decreased when their protein intake was more than 0.91 g/kg and was lowest when their protein intake was more than 1.5 g/kg (P for trend < 0.001).ConclusionsKorean older adults showed inadequate protein intake and those in rural area showed lower animal protein intake than in urban area. The risk of obesity and metabolic syndrome was decreased with the increase of protein intake level. These findings may help develop effective nutrition support strategy for older adults to reduce regional health disparity.

Increased Gut Microbiota-Dependent Trimethylamine-N-Oxide and Body Mass Index Associated With Metabolic Syndrome Risk in a Community-Dwelling Elders