Liraglutida comparada a terapia padrão para o tratamento da obesidade: revisão rápida de evidências / Liraglutide compared to standard therapy for the treatment of obesity: rapid response review of evidence

Liraglutida e terapia padrão (modificação no estilo de vida, com dieta e prática regular de exercícios), como opção disponível no Sistema Único de Saúde. Indicação: Tratamento da obesidade. Pergunta: Liraglutida, comparada à terapia padrão, é mais eficaz e segura para promover redução do peso em pessoas adultas com obesidade? Métodos: Revisão rápida de evidências, revisão de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews version 2). Resultados: Foi selecionada uma revisão sistemática que atendeu aos critérios de inclusão. Conclusão: Liraglutida em dose ≤ 1,8 mg e em dose > 1,8 mg, comparadas a placebo (com terapia padrão) promoveram redução estatisticamente significativa de peso (-2,99 kg e -4,55 kg, respectivamente) e maior risco relativo de descontinuação do tratamento devido a efeitos adversos, com alta certeza de evidência para esses desfechos, além de maior risco relativo de náusea e de vômitos

Liraglutide and standard therapy (lifestyle modification, diet and regular exercise), as a option available in the Brazilian Public Health System. Indication: Treatment of obesity. Question: Is Liraglutide, compared to standard therapy, more effective and safer for weight reduction in obese adults? Methods: Rapid review of evidence, overview of systematic reviews, with a bibliographic search in the PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews version 2). Results: A unique systematic review that met the inclusion criteria was selected. Conclusion: Liraglutide at a dose ≤ 1.8 mg and at a dose > 1.8 mg, compared to placebo (and standard therapy) induced statistically significant weight reduction (-2.99 kg and -4.55 kg, respectively) and greater relative risk of treatment discontinuation due to adverse effects, with high certainty of evidence, and greater relative risk of nausea and vomiting

Medición del gasto energético real por usar un producto comercial para ejercitarse en el hogar / Measurement of actual energy expenditure when using a commercial device for exercising at home

Resumen Montoya Arroyo, J.A., Ramírez Cambronero, J y Aragón Vargas, L.F. (2021). Medición del gasto energético real por usar un producto comercial para ejercitarse en el hogar. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-11. La evidencia sobre la importancia de ejercitarse regularmente es abrumadora. Muchas personas, conscientes de ello, recurren a las soluciones simples y atractivas que se les venden por televisión. Lamentablemente, muchos países no tienen reglamentación estricta para valorar las afirmaciones que hacen los productos comerciales; más aún, los requisitos para la evaluación científica de los productos relacionados con el ejercicio parecieran no existir. Cada vez que una persona compra un equipo para ejercitarse y poco después decide renunciar al ejercicio por la falta de resultados positivos, se da un paso hacia atrás en la salud pública. El propósito de este estudio fue medir el gasto energético inducido por utilizar un artículo comercialmente disponible para ejercitarse en casa y contrastarla con su publicidad. Se utilizaron distintos métodos de campo y laboratorio para medir el gasto energético de 27 estudiantes jóvenes, aparentemente saludables (15F, 12M; 19.1 ± 1.0 años; 1.647 ± .073 m; 63.09 ± 10.13 kg; M ± DT) mientras descansaban en posición decúbito supino durante diez minutos y mientras utilizaban la máquina para ejercitarse 10 minutos a intensidad intermedia. Ninguno de los métodos utilizados registró un gasto energético bruto superior a 272 kJ (65 kcal) en 10 min de actividad; el consumo de oxígeno durante el esfuerzo fue equivalente a 1.54 ± .23 MET, que corresponden a 23.4 ± 9.2 kJ (5.6 ± 2.2 kcal) de gasto neto o 70.3 ± 11.7 kJ (16.8 ± 2.8 kcal) de gasto bruto. En contraste, el gasto energético bruto reportado en el comercial del producto es de 277 kcal (1159 kJ) para 10 min. En conclusión, el gasto energético neto real es 1/50 (dos centésimas) del gasto energético presentado en la publicidad.

Abstract Montoya Arroyo, J.A., Ramírez Cambronero, J & Aragón Vargas, L.F. (2021). Measurement of actual energy expenditure when using a commercial device for exercising at home. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-11. The evidence on the importance of regular exercise is overwhelming. Awareness of this fact leads many people to resort to simple, attractive solutions marketed through TV. Many countries, unfortunately, lack strict regulations to assess the claims made by commercial items. Moreover, it would seem that requirements for scientific evaluation of exercise-related products do not exist at all. Every time someone purchases exercising equipment and shortly afterwards decides to give up working out because no positive results can be seen, one step backwards is taken in public health. The purpose of this study was to measure the actual energy expenditure induced by using a commercially available device for exercising at home and compare it to the claims made about it in advertising. Various field and laboratory methods were used to measure the energy expenditure of 27 young, apparently healthy students (15F, 12 M; 19.1 ± 1.0 years old; 1.647 ± .073 m; 63.09 ± 10.13 kg; mean ± SD) while they were resting for 10 minutes in supine position, and then while working out on the equipment at medium speed for 10 minutes. None of the methods used showed a gross energy expenditure above 272 kJ (65 kcal) in 10 min activity. Oxygen consumption during stress was equivalent to 1.54 ± .23 MET, corresponding to 23.4 ± 9.2 kJ (5.6 ± 2.2 kcal) net expenditure, or 70.3 ± 11.7 kJ (16.8 ± 2.8 kcal) gross expenditure. In contrast, the gross energy expenditure reported in the equipment's commercial is 277 kcal (1159 kJ) for 10 min. In conclusion, the actual net energy expenditure is 1/50 (two hundredths) the energy expenditure being claimed in the advertisements.

Resumo Montoya Arroyo, J.A., Ramírez Cambronero, J e Aragón Vargas, L.F. (2021). Medição do gasto energético real ao usar um produto comercial para exercitar-se em casa. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-11. A evidência sobre a importância da prática contínua do exercício físico é indiscutível. Muitas pessoas, conscientes disso, recorrem a soluções simples e atraentes vendidas pela televisão. Infelizmente, muitos países não têm regulamentações estritas para validar as afirmações que os produtos comerciais fazem; mais ainda, as exigências para a avaliação científica dos produtos relacionados com o exercício parecem não existir. Toda vez que uma pessoa compra um equipamento para se exercitar e pouco depois decide renunciar ao exercício pela falta de resultados positivos é um retrocesso para a saúde pública. Este estudo teve como propósito medir o gasto energético provocado pelo uso de um item comercialmente disponível para fazer exercício em casa e contrastá-lo com sua publicidade. Foram utilizados distintos métodos de campo e laboratório para medir o gasto energético de 27 estudantes jovens, aparentemente saudáveis (15F, 12M; 19,1 ± 1,0 anos; 1,647 ± 0,073 m; 63,09 ± 10,13 kg; M ± DT) enquanto descansavam na posição decúbito dorsal durante dez minutos e enquanto utilizavam a máquina para se exercitar por 10 minutos na intensidade média. Nenhum dos métodos utilizados registrou um gasto energético bruto superior a 272 kJ (65 kcal) em 10 min de atividade; o consumo de oxigênio durante o esforço foi equivalente a 1,54 ± 0,23 MET, correspondente a 23,4 ± 9,2 kJ (5,6 ± 2,2 kcal) de gasto líquido ou 70,3 ± 11,7 kJ (16,8 ± 2,8 kcal) de gasto bruto. Em contraste, o gasto energético bruto informado no comercial do produto é de 277 kcal (1159 kJ) para 10 min. Para concluir, o gasto energético líquido real é 1/50 (dois centésimos) do gasto energético apresentado na publicidade.

Aislamiento e identificación de compuestos con actividad antiobesidad y antiadipogénica de Thevetia peruviana / Isolation and identification of anti-obesity and anti-adipogenic compounds from Thevetia peruviana

Thevetia peruviana ha sido utilizada en la medicina tradicional mexicana por sus efectos adelgazantes. Para la identificación de las fracciones y los compuestos activos de T. peruviana se utilizó cromatografía en columna abierta y las fracciones obtenidas se evaluaron en ratones con obesidad inducida con glutamato monosódico. Como control positivo se utilizó Orlistat y los tratamientos se administraron oralmente una vez al día durante 8 semanas. La fracción con mayor actividad fue sub-fraccionada y, con la intención de evitar el uso de más ratones, los productos fueron seleccionados por su capacidad para inhibir la adipogénesis en la línea celular 3T3-L1. Los animales tratados con la fracción F-B mostraron un aumento de peso significativamente menor y mantuvieron la sensibilidad a la insulina, así como, niveles significativamente más bajos de colesterol y triglicéridos. El análisis de GC-MS indicó que esta fracción activa está compuesta principalmente por los ácidos palmítico (1), oleico (2) y octadacanoico (3), 2-palmitoil glicerol (4), 2-oleoil glicerol (5) así como la estigmastenona (6).

Thevetia peruviana has been used in Mexican traditional medicine for its slimming effects. Active fractions and compounds from T. peruviana were isolated and identified by means of gravitational open-column chromatography, and the fractions were evaluated on mice with MonoSodium Glutamate-induced obesity. Orlistat was used as positive control, and treatments were administered, orally, once a day for 8 weeks. The fraction with higher activity was sub-fractioned and, with the intention of avoiding using more mice, the fractions were analyzed by evaluating their capability to inhibit adipogenesis in the 3T3-L1 cell line. Animals treated with the F-B fraction revealed a significantly smaller weight increase and maintained adequate insulin sensitivity, and significantly lower blood levels of cholesterol and triglycerides. The active compounds that demonstrated greatest adipogenesis inhibition were palmitic acid (1), oleic acid (2), octadecanoic acid (3), 2-palmitoyl glycerol (4), 2-oleoyl glycerol (5) and stigmastenone (6).

Lupine as a potential agent against diet-induced obesity through adenosine monophosphate-activated protein kinase pathway: crude oil versus nanoemulsion formulations

Obesity represents a major challenge to the pharmaceutical community due to the minimal availability of anti-obesity drugs and the drawbacks of current weight-loss agents. The study described herein presents lupine oil, in two pharmaceutical formulations, as a potential anti-obesity agent via its effect on different physiological, biochemical, and hormonal parameters. Rats were divided into two groups; one group was continued on a standard commercial rodent diet and served as the non-obese control. The other group was fed a high-fat diet for 7 weeks to prepare an obese rat model. Then, the obese rats were divided into groups to receive 100 mg/kg of the crude lupine oil or nanoemulsion for 10 or 20 days. Lupine oil showed a potent body weight-reducing effect and improved insulin resistance. The oil altered obesity-induced hyperlipidemia and it enhanced the leptin/adiponectin/AMPK hormonal system in epididymal fat, serum, and liver, to which all the above physiological activities could be attributed. The nanoemulsion formulation of lupine oil significantly amplified the activity for all the above physiological and hormonal parameters when compared to the crude oil formulation. Lupine oil nanoemulsion could be used as a potential drug against diet-induced obesity.

Sericin as treatment of obesity: morphophysiological effects in obese mice fed with high-fat diet / Sericina como tratamento da obesidade: efeitos morfofisiológicos de camundongos obesos por dieta hiperlipídica

ABSTRACT Objective To investigate the effects of sericin extracted from silkworm Bombyx mori cocoon on morphophysiological parameters in mice with obesity induced by high-fat diet. Methods Male C57Bl6 mice aged 9 weeks were allocated to one of two groups - Control and Obese, and fed a standard or high-fat diet for 10 weeks, respectively. Mice were then further subdivided into four groups with seven mice each, as follows: Control, Control-Sericin, Obese, and Obese-Sericin. The standard or high fat diet was given for 4 more weeks; sericin (1,000mg/kg body weight) was given orally to mice in the Control-Sericin and Obese-Sericin Groups during this period. Weight gain, food intake, fecal weight, fecal lipid content, gut motility and glucose tolerance were monitored. At the end of experimental period, plasma was collected for biochemical analysis. Samples of white adipose tissue, liver and jejunum were collected and processed for light microscopy analysis; liver fragments were used for lipid content determination. Results Obese mice experienced significantly greater weight gain and fat accumulation and had higher total cholesterol and glucose levels compared to controls. Retroperitoneal and periepididymal adipocyte hypertrophy, development of hepatic steatosis, increased cholesterol and triglyceride levels and morphometric changes in the jejunal wall were observed. Conclusion Physiological changes induced by obesity were not fully reverted by sericin; however, sericin treatment restored jejunal morphometry and increased lipid excretion in feces in obese mice, suggesting potential anti-obesity effects.

RESUMO Objetivo Investigar os efeitos da sericina extraída de casulos de Bombyx mori na morfofisiologia de camundongos com obesidade induzida por dieta hiperlipídica. Métodos Camundongos machos C57Bl6, com 9 semanas de idade, foram distribuídos em Grupos Controle e Obeso, que receberam ração padrão para roedores ou dieta hiperlipídica por 10 semanas, respectivamente. Posteriormente, os animais foram redistribuídos em quatro grupos, com sete animais cada: Controle, Controle-Sericina, Obeso e Obeso-Sericina. Os animais permaneceram recebendo ração padrão ou hiperlipídica por 4 semanas, período no qual a sericina foi administrada oralmente na dose de 1.000mg/kg de massa corporal aos Grupos Controle-Sericina e Obeso-Sericina. Parâmetros fisiológicos, como ganho de peso, consumo alimentar, peso das fezes em análise de lipídios fecais, motilidade intestinal e tolerância à glicose foram monitorados. Ao término do experimento, o plasma foi coletado para dosagens bioquímicas e fragmentos de tecido adiposo branco; fígado e jejuno foram processados para análises histológicas, e amostras hepáticas foram usadas para determinação lipídica. Resultados Camundongos obesos apresentaram ganho de peso e acúmulo de gordura significativamente maior que os controles, aumento do colesterol total e glicemia. Houve hipertrofia dos adipócitos retroperitoneais e periepididimais, instalação de esteatose e aumento do colesterol e triglicerídeos hepáticos, bem como alteração morfométrica da parede jejunal. Conclusão O tratamento com sericina não reverteu todas as alterações fisiológicas promovidas pela obesidade, mas restaurou a morfometria jejunal e aumentou a quantidade de lipídios eliminados nas fezes dos camundongos obesos, apresentando-se como potencial tratamento para a obesidade.

Understanding the Mechanism of Action and Clinical Implications of Anti-Obesity Drugs Recently Approved in Korea / 가정의학회지

The Korean Ministry of Food and Drug Safety has approved three anti-obesity drugs for long-term management in the past decade. In addition, since 2019, bariatric surgery has been financially supported by National Health Insurance Service in Korea. In this review, the mechanisms of action and the clinical implications of the recently approved anti-obesity drugs, lorcaserin, naltrexone/bupropion, and liraglutide are explained. Lorcaserin stimulates proopiomelanocortin (POMC)/cocaine- and amphetamine-regulated transcript (CART) neurons and inhibits neuropeptide Y (NPY)/agouti-related peptide (AgRP) neurons, which results in the activation of melanocortin 3/4 receptors. Naltrexone/bupropion stimulates POMC neurons through bupropion; this stimulation is augmented by blocking the autoinhibitory mechanism of POMC with naltrexone. The hypophagic effect of liraglutide is mediated through the direct activation of POMC/CART neurons and the indirect suppression of NPY/AgRP neurons through γ-aminobutyric acid-dependent signaling, with adjunctive suppression of the mesolimbic dopamine reward system. In addition to liraglutide, another glucagon-like peptide-1 receptor agonist, semaglutide, is expected to be added to the list of anti-obesity drugs in the near future. In patients with obesity and high cardiovascular risk, lorcaserin was considered neutral and liraglutide was considered favorable, whereas inconclusive results were obtained for naltrexone/bupropion.

Mechanisms of action and clinical applications of anti-obesity drugs currently available in Korea

Over the last 5 years, the Korean Ministry of Food and Drug Safety has approved four anti-obesity drugs for long-term weight management. In this review, the mechanisms of action and clinical applications of lorcaserin, naltrexone/bupropion, liraglutide, and phentermine/topiramate have been clarified. Lorcaserin stimulates proopiomelanocortin/cocaine- and amphetamine-regulated transcript neurons in the arcuate nucleus. Naltrexone/bupropion reduces body weight by controlling the hedonic reward system of food intake. The hypophagic effect of liraglutide depends on the direct activation of the proopiomelanocortin/cocaine- and amphetamine-regulated transcript neurons and indirect suppression of neuropeptide Y/agouti-related peptide neurons through gammaaminobutyric acid-dependent signaling, with an additional thermogenic effect. Phentermine/topiramate induces weight loss by elevating the norepinephrine levels in the hypothalamus, reducing energy deposition in the adipose tissue and skeletal muscle, and elevating the corticotropin-releasing hormone in the hypothalamus. In patients with high cardiovascular risks or type 2 diabetes mellitus, lorcaserin and liraglutide are appropriate. In patients with mood disorders, naltrexone/bupropion could be considered as the first choice of therapy. Notably, lorcaserin and liraglutide are neutral in the aspect of sleep disorder. In case of obese individuals with obstructive sleep apnea, liraglutide or phentermine/topiramate would be selected as the treatment option. These four drugs should be used after considering the patients' co-morbidities of obesity.

Supplementation of Fermented Barley Extracts with Lactobacillus Plantarum dy-1 Inhibits Obesity via a UCP1-dependent Mechanism / 生物医学与环境科学（英文）

OBJECTIVE@#We aimed to explore how fermented barley extracts with Lactobacillus plantarum dy-1 (LFBE) affected the browning in adipocytes and obese rats.@*METHODS@#In vitro, 3T3-L1 cells were induced by LFBE, raw barley extraction (RBE) and polyphenol compounds (PC) from LFBE to evaluate the adipocyte differentiation. In vivo, obese SD rats induced by high fat diet (HFD) were randomly divided into three groups treated with oral gavage: (a) normal control diet with distilled water, (b) HFD with distilled water, (c) HFD with 800 mg LFBE/kg body weight (bw).@*RESULTS@#In vitro, LFBE and the PC in the extraction significantly inhibited adipogenesis and potentiated browning of 3T3-L1 preadipocytes, rather than RBE. In vivo, we observed remarkable decreases in the body weight, serum lipid levels, white adipose tissue (WAT) weights and cell sizes of brown adipose tissues (BAT) in the LFBE group after 10 weeks. LFBE group could gain more mass of interscapular BAT (IBAT) and promote the dehydrogenase activity in the mitochondria. And LFBE may potentiate process of the IBAT thermogenesis and epididymis adipose tissue (EAT) browning via activating the uncoupling protein 1 (UCP1)-dependent mechanism to suppress the obesity.@*CONCLUSION@#These results demonstrated that LFBE decreased obesity partly by increasing the BAT mass and the energy expenditure by activating BAT thermogenesis and WAT browning in a UCP1-dependent mechanism.

Current Treatments on Obesity

Recently, the number of obesity and diabetes mellitus have increased rapidly not only in Korea but also around the world. It is even called the new pandemic of the 21st century. In Korea, the diabetes growth rate, which exceeds the obesity growth rate, is a bigger problem. Accordingly, the simultaneous treatment of diabetes and obesity has become a global issue. In this article, we will review various obesity treatments to help diabetes remission and take a look at meaningful previous study about dietary methods for obesity. This overview includes the update of medications for obesity and the practical method for clinicians in field of obesity treatment in Korea.

Suplementos termogênicos reduzem o peso ou prejudicam a saúde? / Thermogenic supplements reduce weight or harmful health?

Introdução: os recursos ergogênicos nutricionais (RENs) são substâncias utilizadas por praticantes de exercício físico e atletas para melhora do desempenho. Dentre os diversos tipos destes Ren´s, os suplementos termogênicos e emagrecedores vêm sendo amplamente utilizados devido aos seus efeitos no aumento da oxidação de metabolismo de lipídios que impactam na redução da composição corporal, entretanto contêm substancias que agem no sistema nervoso central e podem causar efeitos colaterais e estão sendo amplamente utilizadas de forma indiscriminada e sem orientação. Objetivo: descrever em síntese os principais efeitos dos recursos ergogênicos emagrecedores identificando suas principais consequências à saúde humana. Metodologia: foi realizado revisão narrativa de literatura acessando artigos científicos encontrados nas bases de dados Scielo, Google Acadêmico e Pubmed, pesquisando pelos seguintes descritores: suplementação, emagrecimento, efeitos ergogênicos, efeitos colaterais. Desenvolvimento: Os suplementos termogênicos emagrecedores que agem no sistema nervoso central; efedrina, 1,3-dimetilamilamina promovem muitos efeitos colaterais e risco cardíaco. A cafeína quando bem administrada apresenta efeitos desejáveis, entretanto tem variações individuais e L-Carnitina, demonstrou efeitos metabólicos na oxidação de lipídios, entretanto não estão totalmente esclarecidos. Conclusão: Sugere-se não consumir estes suplementos termogênicos e emagrecedores com ação no sistema nervoso, pois podem causar morte. Por outro lado, a adoção de estilo de vida saudável pode contribuir para o emagrecimento.

Introduction: ergogenic nutritional resources (REN's) are substances used by physical exercise practitioners and athletes to improve performance. Among the various types of Ren's, thermogenic and weight loss supplements have been widely used due to their effects on the increase of oxidation of lipid metabolism that impact on the reduction of body composition, but it contains substances that act on the central nervous system and can cause effects collaterals and are being widely used indiscriminately and without guidance. Objective: to describe in brief the main effects of the ergogenic resources, identifying the main consequences in human health. Methodology: a literature review was carried out by accessing scientific articles found in the Scielo, Google Academic and Pubmed databases, the following descriptors were used: supplementation, weight loss, ergogenic effects, side effects. Development: Thermogenic weight loss supplements that act on the central nervous system; ephedrine, 1,3-dimethylamylamine promote many side effects and heart risk. While well-administered caffeine has desirable effects, however, it has individual variations and L-Carnitine has demonstrated metabolic effects on lipid oxidation, but they are not fully understood. Conclusion: However, it is suggested not to consume these thermogenic and weight loss supplements with action in the nervous system because they are at risk of death. On the other hand, adopting a healthy lifestyle can contribute to weight loss.

Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia / Attempts to lose weight in an overweight and obese population referred to an endocrinology center in Colombia / Tentativas de perda de peso de uma população com sobrepeso e obesidade encaminhada para um centro de endocrinologia na Colômbia

Introducción. El exceso de peso es una condición prevalente en Colombia. Esto conlleva a realizar múltiples intentos para perder peso, muchos autodirigidos y con riesgos, siendo un motivo de consulta frecuente en atención médica primaria y especializada. Metodología. Estudio de corte transversal con datos secundarios de la consulta de endocrinología de pacientes que consultaron por percepción de aumento de peso. Se indagó por 18 métodos convencionales y populares para perder peso, su duración, peso perdido y posterior re ganancia. Resultados. Se incluyeron 100 personas, 79% mujeres, con un promedio de edad de 41.1 años, índice de masa corporal de 32.9 ± 4.6 kg/m2 y perímetro abdominal de 102.7 ± 12.5 cm. En promedio se registraron entre 4 y 5 intentos para perder peso por persona antes de consultar al endocrinólogo, con una mediana de historia de exceso de peso de 10 años. Todos los intentos lograron alguna pérdida con posterior reganancia del total del peso perdido, excepto liraglutida. No se encontró asociación significativa entre variables antropométricas y el número de intentos para perder peso. Discusión. Los intentos de pérdida de peso más empleados por la población evaluadas son los que no están aprobados o carecen de evidencia científica robusta. Conclusiones. Los pacientes con sobrepeso y obesidad realizan múltiples intentos fallidos para perder peso antes de consultar al médico especialista. La reganancia es muy frecuente, independientemente del tipo de intento. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Introduction. Excess weight is a prevailing condition in Colombia. This leads to many weight loss attempts, many self-managed and with risks, being a frequent reason for consulting primary and specialized healthcare. Methodology. Cross-sectional study with secondary data from the endocrinology consultation of patients who made the appointment due to a perceived increase in weight. Eighteen conventional and popular ways of losing weight, their duration, the weight lost and the subsequent regained weight were investigated. Results. One hundred people were included, 79% women with an average age of 41.1 years, a body mass index of 32.9 ± 4.6 kg/m2 and a waist circumference of 102.7 ± 12.5 cm. Each person reported an average of four to five attempts to lose weight before consulting the endocrinologist, with a median history of being overweight of ten years. All of the attempts achieved some weight loss with subsequent regain of the total weight lost, except when using liraglutide. A significant association was not found between the anthropometric variables and the number of weight loss attempts. Discussion. The weight loss methods most used by the assessed population are ones that are not approved or that lack strong scientific evidence. Conclusions. Overweight or obese patients make multiple failed attempts to lose weight before consulting a specialist physician. Regain of the lost weight is frequent, regardless of the method used. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Introdução. Excesso de peso é uma condição prevalecente na Colômbia. Isso leva a várias tentativas de perda de peso, muitas auto-dirigidas e de risco, sendo motivo de consultas frequentes em atendimento médico primário e especializado. Metodologia. Estudo transversal com dados secundários da consulta de endocrinología de pacientes que consultaram para percepção do ganho de peso. Foram investigados 18 métodos convencionais e populares para perder peso, sua duração, peso perdido e subsequente reganho. Resultados. Foram incluídas 100 pessoas, 79% mulheres, com idade média de 41,1 anos, índice de massa corporal de 32,9 ± 4,6 kg / m2 e perímetro abdominal de 102,7 ± 12,5 cm. Em média, foram registradas entre quatro e cinco tentativas de perda de peso por pessoa antes de consultar o endocrinologista, com uma mediana de história de excesso de peso de 10 anos. Todas as tentativas alcançaram alguma perda com subsequente re-ganancia do peso total perdido, exceto o liraglutida. Não foi encontrada associação significativa entre as variáveis antropométricas e o número de tentativas de perda de peso. Discussão. As tentativas de perda de peso mais utilizadas pela população avaliada são aquelas que não são aprovadas ou não possuem evidências científicas robustas. Conclusões. Pacientes com sobrepeso e obesos fazem várias tentativas fracassadas de perder peso antes de consultar o especialista. A re-ganancia de peso é frequente, independentemente do tipo de tentativa. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Quality of evidence of anti-obesity pharmacotherapy: an overview of systematic reviews

The safety and effectiveness of main anti-obesity drugs are controversial, and there is no consensus among regulatory agencies regarding anti-obesity drugs. We undertook an overview of systematic reviews (SR) of randomized controlled trials (RCT) to summarize the quality of evidence related to anti-obesity drugs. Data sources included Medline, Scopus, The Cochrane Library and PROSPERO. Twenty-one SR (564 RCT; average of 2,356 participants per review) satisfied the inclusion criteria. Ten SR presented a high level of heterogeneity, and only five SR included sensitivity analyses. The most important limitations reported by the SR were a high level of attrition, a small sample size, and a short follow-up. Eight different outcomes for efficacy were used, 15 different outcomes for biomarkers were used, and nine different outcomes for safety were used. Conclusions: In conclusion, the quality of SR pertaining to anti-obesity drugs is low, and these reviews have a high level of heterogeneity. Future SR should present more detailed population inclusion criteria, larger sample sizes, and focus variables reported in a predefined anti-obesity core outcome set.(AU)

Recent Advances in Anti-Obesity Agents / 대한내과학회지

Obesity is a chronic disorder that is a significant risk factor for diabetes, cardiovascular diseases, malignancy, and other chronic diseases. Lifestyle modifications form the basis of most treatments for obesity, but it has become clear that such modifications alone are not enough for many obese patients. When a behavioral approach is insufficient, pharmacological treatment may be recommended. In recent years, the US Food and Drug Administration (FDA) has withdrawn several therapeutic options for obesity due to their side effects, but has approved four novel anti-obesity agents. Until recently, orlistat was the only drug approved for the management of long-term obesity, but the US FDA approved the novel anti-obesity drugs lorcaserin and phentermine/topiramate in 2012, and naltrexone/bupropion and liraglutide in 2014. The present review discusses the different pharmacotherapeutic options for the treatment of obesity.

The effects of Brassica juncea L. leaf extract on obesity and lipid profiles of rats fed a high-fat/high-cholesterol diet

BACKGROUND/OBJECTIVES: Obesity is a global health problem of significant importance which increases mortality. In place of anti-obesity drugs, natural products are being developed as alternative therapeutic materials. In this study, we investigated the effect of Brassica juncea L. leaf extract (BLE) on fat deposition and lipid profiles in high-fat, high-cholesterol diet (HFC)-induced obese rats. MATERIALS/METHODS: Male Sprague-Dawley rats were divided into four groups (n = 8 per group) according to diet: normal diet group (ND), high-fat/high-cholesterol diet group (HFC), HFC with 3% BLE diet group (HFC-A1), and HFC with 5% BLE diet group (HFC-A2). Each group was fed for 6 weeks. Rat body and adipose tissue weights, serum biochemical parameters, and tissue lipid contents were determined. The expression levels of mRNA and proteins involved in lipid and cholesterol metabolism were determined by reverse transcription polymerase chain reaction and western blot analysis, respectively. RESULTS: The HFC-A2 group showed significantly lower body weight gain and food efficiency ratio than the HFC group. BLE supplementation caused mesenteric, epididymal, and total adipose tissue weights to decrease. The serum levels of triglyceride, total cholesterol, and low-density lipoprotein cholesterol were significantly reduced, and high-density lipoprotein cholesterol was significantly increased in rats fed BLE. These results were related to lower glucose-6-phosphate dehydrogenase, acetyl-coA carboxylase, and fatty acid synthase mRNA expression, and to higher expression of the cholesterol 7α-hydroxylase and low density lipoprotein-receptor, as well as increased protein levels of peroxisome proliferator-activated receptor α. Histological analysis of the liver revealed decreased lipid droplets in HFC rats treated with BLE. CONCLUSIONS: Supplementation of HFC with 3% or 5% BLE inhibited body fat accumulation, improved lipid profiles, and modulated lipogenesis- and cholesterol metabolism-related gene and protein expression.

Anti-obesity and LDL-cholesterol lowering effects of silkworm hemolymph in C57BL/6N mice fed high fat diet / 한국영양학회지

PURPOSE: Obesity, a worldwide epidemic, is associated with insulin resistance, hyperlipidemia, hypertension, cardiovascular disease, and certain cancers. Many strategies, including natural alternative anti-obesity agents, are used widely to prevent obesity. This study examined the effects of silkworm hemolymph on the weight control of C57BL/6N mice fed with a high-fat diet. METHODS: The mice were divided into five groups: normal group (N), high-fat diet group (HFC), high-fat diet and silkworm hemolymph (at dose of 1 mL/kg BW (HFS-1), 5 mL/kg BW (HFS-5) and 10 mL/kg (HFS-10) for 12 weeks. RESULTS: After 12 weeks treatment, the administration of silkworm hemolymph decreased the final body weight significantly along with a decrease in the weights of epididymal fat and total fat. The plasma LDL-cholesterol concentration was significantly lower in the HFS-1, HFS-5, and HFS-10 groups than in the HFC group. In addition, the leptin level of the HFS groups was significantly lower than those of the HFC group without a change in the plasma insulin concentration. CONCLUSION: These findings suggest that the silkworm hemolymph may have the potential to prevent obesity.

Características demográficas, clínicas y reacciones adversas de personas con sobrepeso y obesidad: consumidores de orlistat atendidos por centro de atención telefónica (2009 ­ 2017) / Demographic and clinical characteristics, and adverse reactions of people with overweight and obesity consumers of orlistat, attended by a call center (2009 ­ 2017)

Resumen Introducción Las enfermedades crónicas van en ascenso y están asociadas al incremento ponderal. Se requieren estrategias multidisciplinarias para su control. Métodos El diseño es descriptivo, observacional y retrospectivo. Los objetivos de esta comunicación son describir las características demográficas, clínicas y reacciones adversas de personas con sobrepeso y obesidad consumidores de orlistat, atendidos por un centro de atención telefónica durante el periodo 2009 a 2017; e identificar al profesional de la salud más consultado por ellos. La información se obtuvo desde una base de datos existente de un programa de atención a personas con sobrepeso u obesidad, interesadas en usar orlistat (prospectos) o usuarios (pacientes). El estudio se llevó a cabo en México y duró siete años. Las variables estudiadas fueron demográficas, clínicas y reacciones adversas. Resultados Se reunieron 311 913 solicitudes de 126 607 sujetos (104 711 prospectos interesados en consumir orlistat y 21 896 pacientes que ya lo tomaban). Las principales actividades fueron llamadas al sujeto (35,9%). Hubo 104 711 solicitudes: 82 810 (79,1%) prospectos y 21 896 (20,9%) pacientes. El 79,9% fue de sexo femenino. El intervalo de edad predominante fue de 32 a 45 años. Se detectaron 43 reacciones adversas (0,02%); las más comunes fueron dolor abdominal (0,05%) y cefalea (0,03%). Conclusiones La población más interesada en el control ponderal en este estudio es la femenina (79,9%) y el grupo etario de 32 a 45 años. El profesional más consultado fue el nutriólogo. Solo se obtuvo el índice de masa corporal (29,2 kilogramos por metro cuadrado) de los sujetos que desarrollaron 43 reacciones adversas, las más comunes fueron dolor abdominal y cefalea.

Introduction Chronic diseases are on the rise and are associated with weight gain. Multidisciplinary strategies are required for its control. Methods The design was descriptive, observational and retrospective. The objectives of this communication were to describe the demographic and clinical characteristics and adverse reactions of overweight and obese people who were consumers of orlistat, attended by a call center during the period 2009 to 2017; and to identify the healthcare professional most consulted by them. The information was obtained from an existing database of a program of attention to people with overweight or obesity, interested in using orlistat (prospects) or users (patients). The study was carried out in Mexico and lasted seven years. The variables studied were demographic, clinical and adverse reactions. Results A total of 311,913 requests were collected from 126 607 subjects (104 711 prospects interested in consuming orlistat and 21 896 patients who already took it). The main activities were phone calls to the subject (35.9%). There were 104 711 requests: 82 810 (79.1%) prospects and 21 896 (20.9%) patients. 79.9% of all were female. The predominant age interval was 32 to 45 years. 43 adverse reactions (0.02%) were detected; the most common were abdominal pain (0.05%) and headache (0.03%). Conclusions The population most interested in weight control in this study was the female population (79.9%) and the age group from 32 to 45 years. The most consulted healthcare professional was the nutritionist. Only the body mass index (29.2 kilograms per square meter) of the subjects who developed 43 adverse reactions was obtained. There were 43 adverse reactions, the most common being abdominal pain and headache.

O discurso do risco na controvérsia dos emagrecedores: uma análise da cobertura de imprensa nos anos de 2011 e 2014 / The discourse of risk in diet pills controversy: an analysis of the presscoverage in 2011 and in 2014 / El discurso del riesgo en la controversia de las píldoras de dieta: unanálisis de la cobertura de prensa en los años 2011 y 2014

Os inibidores de apetite são comercializados no Brasil há mais de 30 anos. Em 2010, a Agência Nacional de Vigilância Sanitária (Anvisa) iniciou um processo de revisão da avaliação de risco desses fármacos e cancelou, em 2011, o registro dos três emagrecedores à base de anfetamina (anfepramona, femproporex,mazindol), permitindo que apenas a sibutramina fosse comercializada. A decisão foi revogada em 2014 pelo Congresso Nacional, que autorizou a volta ao mercado brasileiro dos anorexígenos derivados da anfetamina. Este artigo analisa a construção dos sentidos sobre risco por jornais diários durante a cobertura noticiosa da controvérsia relativa aos emagrecedores, nesses dois momentos antagônicos. Com base na semiologia dos discursos sociais, foram analisadas 25 notícias de 2011 e 2014 que demonstraram que o discurso do risco,embora presente na maioria dos textos, foi minimizado pela cobertura política que privilegia os conflitos de interesses, os embates travados com a autoridade sanitária e as contradições do processo.(AU)

Appetite suppressants are sold in Brazil over 30 years. In 2010, the Agência Nacional de Vigilância Sanitária- Anvisa (National Health Surveillance Agency) began a process to review the risk assessment of these drugs and in 2011 cancelled the register of the three amphetamine-based anorexigenics (anfepramone,fenproporex, mazindol), only allowing to be marketed in Brazil the sibutramine. In 2014, the Congressrevoked the decison-making by Anvisa and authorized the sale of the amphetamine derivatives. This paper analyzes how the meanings of risk were built by daily newspapers during the coverage of the appetite suppressants controversy, considering these two antagonistic moments. Based on the social semiotics, weanalyzed 25 newspaper articles published in 2011 and in 2014, which showed that the discourse of risk doesnot assume the center of the discursive scene, resulting in a political coverage that favours the conflicts ofinterests, as well as the disputes with the Anvisa and the contradictions of the process

Los inhibidores del apetito se venden en Brasil hace más de 30 años. En 2010, la Agência Nacional deVigilância Sanitária ­ Anvisa (Agencia Nacional de Vigilancia Sanitaria) inició un proceso de revisión dela evaluación de riesgos de estos fármacos y ha cancelado, en 2011, la inscripción en el registro de los tresinhibidores del apetito de la familia de las anfetaminas (dietilpropión, fenproporex, mazindol), permitiendoque sólo la sibutramina fuese mantenida en el mercado. La decisión ha sido revocada en 2014 por el Congreso Nacional, que autorizó la comercialización de los inhibidores del apetito derivados de la anfetamina.En este artículo se analiza la construcción del sentido del riesgo en periódicos diarios durante la coberturade la controversia relativa a esos fármacos, en los dos momentos antagónicos. Basado en la teoría de losdiscursos sociales, se analizaron 25 noticias de los años 2011 y 2014, que mostraron que el discurso delriesgo ha sido infravalorado por la cobertura política que privilegia los conflictos de intereses, así como lasdisputas con la autoridad sanitaria, y las contradicciones del proceso.

Impact of roux-en-y gastric bypass surgery (rygb) on metabolic syndrome components and on the use of associated drugs in obese patients / Impacto do bypass gástrico em Y de Roux (RYGB) nos componentes da síndrome metabólica e sobre o uso de drogas associadas em pacientes obesos

ABSTRACT BACKGROUND The prevalence of obesity and metabolic syndrome is increasing worldwide and both behavior modification and drug therapy have low adherence. Gastric bypass has shown effective results in both reducing weight and improving comorbidities. OBJECTIVE To evaluate the impact of Roux-en-Y Gastric Bypass Surgery (RYGB) on both metabolic syndrome components and the use of associated drugs in obese patients. METHODS Historical cohort of patients subjected to Roux-en-Y Gastric Bypass Surgery (RYGB) between January 2007 and March 2014 in a private clinic. The sample consisted of 273 obese class II and III individuals, 86.4% of whom were female, with age ≥20 years, followed up for 2 months after surgery. Sociodemographic, anthropometric, biochemical, clinical, and drug-use data were collected from patients’ medical records. RESULTS Significant differences were found in weight, body mass index and waist circumference, after 60 postoperative days. Components for metabolic syndrome diagnosis (hypertension P=0.001; hyperglycemia P<0.001; hypertriglyceridemia P=0.006) were reduced after 60 days of postoperative, with the exception HDL-c (P=0.083). There was a significant reduction in the use of antihypertensive (P<0.001), hypoglycemic (P=0.013), lipid lowering (P<0.001), and antiobesity (P=0.010) drugs and increased use of gastroprotective drugs, vitamins, and minerals (P<0.001) after 60 postoperative days. CONCLUSION Patients subjected to Roux-en-Y Gastric Bypass Surgery exhibited both weight loss and significant improvement not only in metabolic syndrome components (except for HDL-c) but in the use of drugs associated with obesity and metabolic syndrome.

RESUMO CONTEXTO A prevalência de obesidade e síndrome metabólica é crescente no mundo e tanto a terapia de modificação de estilo de vida quanto a medicamentosa têm baixa adesão. O bypass gástrico tem apresentado resultados eficazes na redução de peso e comorbidades. OBJETIVO Avaliar o impacto do bypass gástrico em Y de Roux nos componentes da síndrome metabólica e sobre o uso de drogas associadas em pacientes obesos. MÉTODOS Coorte histórica de pacientes submetidos ao bypass gástrico em Y de Roux entre janeiro de 2007 e março de 2014, em clínica privada. A amostra foi composta por 273 indivíduos obesos classe II e III, 86,4% dos quais eram do sexo feminino, idade ≥20 anos, acompanhados por 2 meses após a cirurgia. Dados sociodemográficos, antropométricos, bioquímicos, clínicos e de uso de medicamentos foram coletados nos prontuários dos pacientes. RESULTADOS Foram encontradas diferenças significativas no peso, índice de massa corporal e circunferência da cintura, após 60 dias de pós-operatório. Os componentes para diagnóstico da síndrome metabólica (hipertensão P=0,001; hiperglicemia P<0,001; hipertrigliceridemia P=0,006) foram reduzidos no pós-operatório, com exceção do HDL-c (P=0,083). Houve uma redução significativa no uso de medicamentos anti-hipertensivos (P<0,001), hipoglicêmicos (P=0,013), hipolipemiantes (P<0,001), antiobesidade (P=0,010) e uma maior utilização de gastroprotectores, vitaminas e minerais (P<0,001) após 60 dias de pós-operatório. CONCLUSÃO Os pacientes submetidos ao bypass gástrico em Y de Roux exibiram perda de peso e uma melhora significativa, não só em componentes da síndrome metabólica (exceto para o HDL-c), mas também no uso de medicamentos associados à obesidade e à síndrome metabólica.

Ferulic acid lowers body weight and visceral fat accumulation via modulation of enzymatic, hormonal and inflammatory changes in a mouse model of high-fat diet-induced obesity

Previous studies have reported on the glucose and lipid-lowering effects of ferulic acid (FA) but its anti-obesity potential has not yet been firmly established. This study investigated the possible anti-obesitogenic effects of FA in mice fed a high-fat diet (HFD) for 15 weeks. To assess the antiobesity potential of FA, 32 male Swiss mice, weighing 20–25 g (n=6–8 per group) were fed a normal diet (ND) or HFD, treated orally or not with either FA (10 mg/kg) or sibutramine (10 mg/kg) for 15 weeks and at the end of this period, the body weights of animals, visceral fat accumulation, plasma levels of glucose and insulin hormone, amylase and lipase activities, the satiety hormones ghrelin and leptin, and tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCH-1) were analyzed. Results revealed that FA could effectively suppress the HFD-associated increase in visceral fat accumulation, adipocyte size and body weight gain, similar to sibutramine, the positive control. FA also significantly (P<0.05) decreased the HFD-induced elevations in serum lipid profiles, amylase and lipase activities, and the levels of blood glucose and insulin hormone. The markedly elevated leptin and decreased ghrelin levels seen in HFD-fed control mice were significantly (P<0.05) reversed by FA treatment, almost reaching the values seen in ND-fed mice. Furthermore, FA demonstrated significant (P<0.05) inhibition of serum levels of inflammatory mediators TNF-α, and MCH-1. These results suggest that FA could be beneficial in lowering the risk of HFD-induced obesity via modulation of enzymatic, hormonal and inflammatory responses.