Team Metabolic Health

Health services in Kent are teaming up to deliver an action plan to tackle obesity and support those who want to lose weight.

The “majority” of the county’s districts have more overweight and obese adults than the England average, according to a report looking at the issue.

The Kent Weight Management Strategic Action Plan was jointly developed by Kent County Council and NHS Kent and Medway Integrated Care Board.

Meeting documents for Tuesday’s health reform and public health cabinet committee said in 2021-22, 65.8% of adults in Kent were overweight or obese, compared to 63.8% in England.

The report said this was an increase from 63.1% in 2020-2021 and that while the percentage of adults classified as obese increased from 26% in 2020-2021 to 27.3% in 2021-2022, this increase was “statistically significant”.

The districts with the highest overweight and obesity prevalence were Folkestone and Hythe (72.8%), Thanet (72%), Dover (69.4%) and Gravesham (68.3%), according to the report.

Obesity is a significant risk factor for physical and mental health conditions including type 2 diabetes, cardiovascular disease, liver disease, depression and low self-esteem, the report said.

“As a result, there is an increased risk of disability and premature death” for individuals who are overweight or obese, the report continued.

Meanwhile, one programme which has helped people in Kent lose weight is Man v Fat football, where weekly weight loss progress counts towards team goals.

Dan Church, regional manager at Man v Fat, said across Kent participants had lost more than 10,000 kg of weight.

Mr Church said different reasons brought people to Man v Fat, whether people were looking to lose weight, better their mental health or were looking for a social activity.

“Every single guy that we can support to make a lifestyle change and improve their wellbeing is a positive thing,” he said.

Credit: BBC News

Team Metabolic Health

New study links iron deficiency to sleep disorders in children with ADHD and autism: exploring the critical role of iron in sleep regulation.

A recent Nutrients study examines the relationship iron deficiency (ID) and sleep-related disorders.

Iron and sleep/wake disorders

Iron is a trace element present in neurons, astrocytes, oligodendrocytes, and microglia. Iron is also an essential component for both the synthesis of neurotransmitters that regulate the sleep/wake cycle, as well as the dopamine synthesis pathway.

These observations indicate that ID could significantly influence sleep and wake patterns; however, iron levels are rarely considered in the clinical management of sleep/wake disorders.

The most frequent causes of sleep/wake disorders are hyper-arousability, restless leg syndrome (RLS), hyper-motor restlessness, restless sleep disorder (RSD), and periodic limb movements in sleep (PLMS).

Deficiency and Restless Sleep/Wake Behaviors in Neurodevelopmental Disorders and Mental Health Conditions. Image Credit: Dragana Gordic/Shutterstock.com

About the study

Prospective data were obtained between 2021 and 2023 through clinical assessments and structured intake forms. Subsequently, a retrospective analysis was conducted.

Data on the most recent iron status and parental ID history, as well as covariate factors, including comorbidities, demographics, and medications, were recorded. Patients with hematologic comorbidities were excluded. The mean patient age was about 11 years.

Study findings

Of the 250 patients referred to the Sleep/Wake-Behavior clinic in Vancouver, British Columbia, 80% met the inclusion criteria, 188 of whom fulfilled the criteria for non-anemic or anemic ID. A family history of ID was reported in several participants, many of whom indicated that their mothers experienced some form of ID in their teenage years and/or during pregnancy.

Approximately half of the study cohort reported disruptive behaviors, with attention deficit hyperactivity disorder (ADHD) being the most common diagnosis. Anxiety disorder was the most frequently reported internalizing disorder among 84 participants.

Autism spectrum disorder (ASD), global developmental delay/intellectual disability, neurologic conditions, and genetic conditions were the most commonly reported neurodevelopmental presentations.

About 74% of patients exhibited RLS, 52% reported a family history of RLS, and 11% had painful RLS. In 30% of patients, PLMS/restless sleep was noted.

A total of 92 patients had ADHD, among whom the risk of having familial RLS, insomnia, and RLS was significantly increased with a family history of ID. No evidence of an increased risk of painful RLS was observed.

A family history of ID significantly increased the likelihood of having RLS/PLMS/restlessness, insomnia/DIMS, RLS, and familial RLS in a subsample of patients with ASD.

As compared to patients without ID, a family history of ID was associated with a significantly higher risk of RLS. ADHD patients were almost twice as likely to have RLS as compared to patients without ADHD. No association was observed between RLS and ASD, nor bedtime resistance or restlessness, in multivariate logistic regression analyses.

Familial RLS analysis indicated that a family history of ID was associated with a four-fold increased risk of familial RLS as compared to those without a family history of ID. RLS and ADHD were not associated; however, a 70% increased risk of familial RLS was observed in ASD patients. No association was reported between bedtime resistance and restlessness and familial RLS.

Insignificant results were obtained regarding the association between a family history of ID and probable painful RLS. Bedtime resistance or restlessness, ADHD, and ASD were not associated with probable painful RLS.

These findings highlight the need to integrate comprehensive blood work and family history to capture ID in children and adolescents with restless behaviors.”

Strengths and limitations

The high prevalence and family history of ID, coupled with a possible association between ID and self-injurious behaviors, are key strengths of the present study. Nevertheless, there remained a lack of information on the possible causes of ID. Thus, future studies are needed to elucidate the mechanisms involved ID, as this nutrient deficit could be due to multiple factors, such as inflammation or inadequate nutrition.

The current study is a retrospective analysis, which lacks a structured categorization for certain data. For example, no distinction was made between anemic and nonanemic ID in the electronic intake forms, whereas data on mother and father ID was not separated. The statistical power in logistic regression analyses was also reduced due to relatively small sample sizes.

Credit: news-medical.net

Team Metabolic Health

Cancer cachexia can cause muscle deterioration, weakness

Patients on highest dose of drug regained 5.6% of body weight

Pfizer Inc.’s experimental drug for cancer weight loss was shown to help patients regain weight in a mid-stage study, offering fresh promise for treating the dangerous muscle-wasting condition.

In cancer patients, a syndrome called cachexia causes changes in metabolism and appetite. It can lead to the loss of critical skeletal muscle and fat that weakens the body and, in some cases, can make cancer treatments less effective. Studies suggest that as much as 30% of all cancer deaths are caused by cachexia and about 80% of patients with advanced stage cancers are affected by the condition. There are currently no drugs approved to treat it.

Credit: Bloomberg

Team Metabolic Health

Nutri-Score hints at foods that increase CVD risk

Cardiovascular diseases are the leading cause of mortality in Western Europe, accounting for 1/3 of deaths in 2019. Diet is thought to be responsible for around 30% of such deaths. Nutrition-related prevention policies therefore constitute a major public health challenge for these diseases.

In an article published in Lancet Regional Health – Europe, researchers from the Nutritional Epidemiology Research Team (CRESS-EREN), with members from Inserm, Inrae, Cnam, Université Sorbonne Paris Nord and Université Paris Cité, in collaboration with researchers from the International Agency for Research on Cancer (WHO-IARC), report an increased risk of cardiovascular diseases associated with the consumption of foods that rank less favourably on the Nutri-Score scale (new 2024 version) within the European cohort EPIC. A total of 345,533 participants from the cohort, spread across 7 European countries and followed for 12 years, were included in the analyses.

These findings confirm the relevance of Nutri-Score as a public health tool to guide consumers in their food choices with the goal of preventing chronic diseases

Mélanie Deschasaux-Tanguy

Officially adopted in France in 2017 (and in 6 other European countries since), the Nutri-Score aims to provide rapid information on the nutritional quality of foods and drinks to help and encourage consumers to compare them and choose those that offer a better nutritional quality. In parallel, it encourages manufacturers to improve the nutritional quality of their products. The Nutri-Score has 5 categories, ranging from A (dark green – higher nutritional quality) to E (dark orange – lower nutritional quality). An algorithm ranks each product according to its levels – per 100 g – of energy, sugars, saturated fatty acids and salt (to limit) and proteins, fruits, vegetables and pulses (to favour). 

A number of studies published in international scientific journals have shown the validity of Nutri-Score in characterising the nutritional quality of foods and its efficacy in guiding consumers towards more nutritious choices (over 140 publications). In particular, links between the consumption of foods with a less favourable Nutri-Score (lower nutritional quality) and an increased risk of cardiovascular diseases have so far been observed in French studies (SU.VI.MAX and NutriNet-Santé cohorts). Studies in France, UK, Spain and Italy have also seen similar associations with an increased risk of various chronic diseases as well as higher mortality.

In this new study, the researchers focused on the latest version of the Nutri-Score algorithm, linked to the risk of cardiovascular diseases, in a large population spread across 7 European countries, with the aim of providing new scientific evidence for validating the Nutri-Score on a European scale. It follows two studies on cancer risk published in 2018 and on cancer mortaility published in 2020 in the same population. 

A total of 345 533 participants from the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort were included in the analyses. During the follow-up (12 years, between 1992 and 2010), 16 214 participants developed a cardiovascular disease (6 565 of whom had myocardial infarction and 6 245 stroke). The findings show that the participants consuming on average more foods with less favourable Nutri-Score, reflecting lower nutritional quality, were at increased risk of cardiovascular diseases, particularly myocardial infarction and stroke. These associations were significant after a large number of sociodemographic and lifestyle factors were taken into account. 

‘These findings confirm the relevance of Nutri-Score as a public health tool to guide consumers in their food choices with the goal of preventing chronic diseases’, emphasises Inserm researcher Mélanie Deschasaux-Tanguy. ‘They also provide key elements to support the adoption of Nutri-Score as a mandatory nutritional logo in Europe’, explains Mathilde Touvier, Inserm research director. 

Source: Inserm

Credit: healthcare-in-europe.com

Team Metabolic Health

Pregnancy brain really does exist, according to one of the first detailed maps of human-brain changes before, during and after those crucial nine months.

Based on 26 scans of one healthy 38-year-old woman’s brain, scientists found “remarkable things” including changes to regions linked to socialising and emotional processing – some of which were still obvious two years after giving birth.

Further studies in many more women are now needed to determine the potential impact of these brain changes, they say.

And those insights could improve understanding of the earliest signs of conditions such as postnatal depression and pre-eclampsia.

“It’s the first detailed map of the human brain across gestation,” Emily Jacobs, study author and neuroscientist, from the University of California, Santa Barbara, says.

“We’ve never witnessed the brain in a process of metamorphosis like this.

“We are finally able to observe changes to the brain in real time.”

The massive physical changes to the body during pregnancy are well known but much less is understood about how and why the brain changes.

Many women talk about having “pregnancy brain” or “baby brain”, to describe feeling forgetful, absent-minded or having brain fog.

Previous studies have focused on brain scans before and soon after pregnancy, rather than throughout.

The brain studied in the research, published in Nature Neuroscience, is that of scientist Elizabeth Chrastil, from University of California, Irvine’s Center for the Neurobiology of Learning and Memory.

She was planning an IVF (in-vitro fertilisation) pregnancy when the research was being discussed and now has a four-year-old son.

It is “cool” to study her own brain in detail and compare it with those of women who were not pregnant, Dr Chrastil says.

“It certainly is a little strange to see your own brain changing like this – but I also know that to start this line of research needed a neuroscientist to do it,” she says.

In nearly 80% of the regions of Dr Chrastil’s brain, the volume of grey matter – tissue that controls movement, emotions and memory – decreased by about 4%, with only a small rebound after pregnancy.

But there were increases in white-matter integrity – a measure of the health and quality of connections between brain regions – in the first and second trimesters, which returned to normal levels soon after birth.

The changes are similar to those during puberty, the researchers say.

Studies in rodents suggest they could make mothers-to-be more sensitive to smells and prone to grooming and nesting, or homemaking.

“But humans are way more complicated,” Dr Chrastil says.

She did not personally experience any “mommy brain” during her pregnancy but was certainly more tired and emotional in the third trimester, she says.

The next step is to collect detailed brain images from 10 to 20 women and data from a much larger sample at particular timepoints, to capture a wide range of different experiences.

In this way, Dr Chrastil says, “we can determine whether any of these changes could help predict things like postpartum depression or understand how something like pre-eclampsia could affect the brain”.

Credit: BBC News

Team Metabolic Health

A coordinated, multidisciplinary health care team to address the specific physical, psychological and developmental needs of children with Trisomy 21, or Down syndrome, and congenital heart disease may help children with these conditions lead longer and more productive lives, according to a new scientific statement from the American Heart Association.

The scientific statement, “Trisomy 21 and Congenital Heart Disease: Impact on Health and Functional Outcomes from Birth Through Adolescence,” published today in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the Association.

Statement highlights include:

• Trisomy 21, also known as Down syndrome, is a genetic condition that occurs when a person has an extra copy of chromosome 21. According to the American Heart Association’s 2018 scientific statement on the genetic basis for congenital heart disease, Down syndrome is the most common chromosome abnormality, with approximately 5,300 infants born with Down syndrome in the U.S. each year. About 35-50% of children with Down syndrome are also affected by congenital heart disease.
• Around 70% of congenital heart disease conditions in children with Down syndrome present as some type of atrial septal defect or ventricular septal defect of the heart, often referred to as “a hole in the heart.”
• Pulmonary hypertension and single ventricle heart disease are two known cardiovascular conditions that may reduce life expectancy in individuals with Down syndrome.
• Conditions affecting other body systems, including respiratory, endocrine, gastrointestinal, hematological, neurological and sensory systems, may interact with cardiovascular health concerns and lead to adverse effects for children with congenital heart disease and Down syndrome.
• Improvements in diagnostic, medical and surgical interventions for cardiovascular disease over the past several decades have resulted in greatly improved survival for infants and children with congenital heart disease including those with Down syndrome. Current research on survival in children with congenital heart disease indicates that more than 97% of children with congenital heart disease can be expected to reach adulthood, highlighting the need for multidisciplinary care throughout their lifetime.
• Neurodevelopmental and functional challenges may affect quality of life for children with Down syndrome and congenital heart disease. About 75% of children with these conditions experience feeding and swallowing problems as infants, increasing the risk of malnutrition and failure to thrive, which would affect physical and neurologic development. They also often face lifelong respiratory problems and hypothyroidism (an underactive thyroid; the thyroid produces important hormones that help regulate many functions in the body).
• Vision and hearing impairments (sensory processing disorders) are also common among children with Down syndrome and may impact development of language and communication, as well as cognitive and social behavior skills.
• Psychological conditions, including autism spectrum disorder, attention deficit/hyperactivity disorder, anxiety and depression, are also common in children with Down syndrome as well as children with congenital heart disease.
• Social determinants of health may affect outcomes in children with Down syndrome and congenital heart disease because intellectual limitations and chronic health conditions often contribute to discrimination, bias, inequity, education and socioeconomic status.
• Physical, occupational, speech and behavioral therapies are integral in health care plans for children with Down syndrome and congenital heart disease. Early speech intervention is important to improve communication and autonomy, while physical and occupational therapy are focused on strengthening gross and fine motor skills, increasing independence in activities of daily living, and supporting social skills and sensory integration.
• A comprehensive “medical home” with primary and specialty care that includes a multidisciplinary team of professionals is advised to support care continuity, family-centered care and advocacy. Effective care coordination improves health care access and reduces delays in care, hospitalizations and health care costs. It can also result in enhanced care satisfaction and improvements in overall health outcomes.
• With appropriate support and resources from the multidisciplinary care team, community, school and family, children with Down syndrome and congenital heart disease have opportunities to live fulfilling and productive lives with independence. It is important that the transition to adulthood includes assessment of their needs, skills and decision-making capacity.
• Future research focused on reducing the burden of these conditions is needed to improve functional outcomes and quality of life for children with Down syndrome and congenital heart disease.

The statement was written on behalf of the American Heart Association’s Pediatric Cardiovascular Nursing Committee of the Council on Cardiovascular and Stroke Nursing, the Council on Clinical Cardiology, the Council on Genomic and Precision Medicine, and the Council on Cardiovascular Radiology and Intervention. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations.

Credit: news-medical.net

Team Metabolic Health

Ozempic maker Novo Nordisk on Wednesday said data showed its hotly anticipated weight loss pill prompts greater and more rapid weight loss than its blockbuster treatment Wegovy, amid competition from Mounjaro maker Eli Lilly, pharma titans like Pfizer and biotech upstarts.

Novo Nordisk is developing a weight loss pill. (GETTY)

Key Facts

Participants taking Novo Nordisk’s experimental weight loss treatment amycretin lost up to 13% of their body weight over 12 weeks in an early stage Phase 1 clinical trial, according to an abstract of data to be presented at the annual meeting of the European Association for the Study of Diabetes in Madrid on Wednesday.

In the early stage trial, Novo evaluated how patients fared when taking one or two 50 mg amycretin pills a day or an inert placebo.

Patients taking two pills a day lost up to 13% of their body weight after 12 weeks and patients taking one amycretin pill a day had weight loss of more than 10%, according to the abstract data, while those on the placebo had 1.1% weight loss.

While the study does not compare amycretin directly against existing obesity treatments and has not been subjected to external scientific scrutiny by publication in a peer reviewed journal, the results hint at the potential for greater and more rapid weight loss than Novo’s blockbuster injection Wegovy, which was around 6% at 12 weeks.

Novo said the trial suggests the drug is safe and has a similar side effect profile to Wegovy and Ozempic, which commonly includes mild or moderately severe gastrointestinal complaints like nausea, vomiting and diarrhea.

Amycretin targets the same GLP-1 hormone as other weight loss and diabetes drugs like Novo’s Ozempic and Wegovy and Lilly’s Mounjaro and Zepbound, as well as stimulating receptors for another hormone, amylin, which regulates hunger.

When Will Weight Loss Pills Be Available?

The best weight loss drugs on the market at the moment, Lilly’s tirzepatide and Novo’s semaglutide, are only available as injections, which many people find off putting and can be challenging and expensive to produce. Pharma titans like Pfizer, Roche and Novo, are all racing to crack into this lucrative sector with alternatives like weight loss pills and early data suggests they could be as, or even more, effective than current treatments. However, obesity pills are unlikely to replace injections completely. Experts told Forbes oral medications can often come with restrictive dietary practices, like taking it on an empty stomach, that many users find unappetizing, and need to be taken daily rather than less frequent weekly injections. It can also be challenging to find a formulation that works well and is tolerated by patients and the less direct method of delivery means pills often require more of the active ingredient to produce the same effect, a major supply issue given chronic shortages for injections already on the market.

What To Watch For

Though the trial is small, Novo’s head of development Martin Lange Holst said the results are promising and justify further clinical research into the pill. Novo is also testing a subcutaneous form of amycretin that, like Wegovy, would be delivered by regular injection. The early stage trial is ongoing and data is expected to be released in 2025. Novo will decide whether to accelerate development of amycretin and proceed directly to a large-scale Phase 3 trial—skipping an intermediate stage of testing to what is often the last stage of testing before a company seeks regulatory approval—in a pill or subcutaneous form once this data is available, Holst reportedly said.

Credit: Forbes

Team Metabolic Health

Pfizer (PFE.N), opens new tab is trying to increase doctor awareness of and testing for a rare lung cancer mutation to help boost use of its drug Braftovi, which the pharmaceutical maker anticipates could grow to become the standard of care.

The company presented three-year follow-up data from a Phase 2 study on Saturday looking at patients with BRAF V600E-mutant metastatic non-small cell lung cancer who received Braftovi and another Pfizer drug, Mektovi, as a first treatment. The study showed they had a median of over two-and-a-half years of progression-free survival, a measure of how long treated patients live before their cancer gets worse.

Pfizer company logo is seen at a Pfizer office in Puurs, Belgium, December 2, 2022. REUTERS/Johanna Geron/File Photo 

Chris Boshoff, Pfizer’s Chief Oncology Officer, said the new data supports the use of the drug as standard of care for that group and said it expects to get market penetration of up to 60% in lung cancer patients with the mutation.

He said approximately 2% to 3% of lung cancers have the mutation in question.

Standard of care for such patients is currently an immunotherapy paired with chemotherapy, Boshoff said. The combination of Braftovi and Mektovi has been approved for patients with non-small cell lung cancer with the mutation since last year.

“All patients with lung cancer should be tested for BRAF mutations, and that could be done with a simple blood test,” he said. “It’s a relatively easy test to identify these patients who clearly would benefit significantly from having a targeted therapy.”

He said that fewer than 50% of lung cancer patients in the U.S. are currently tested for the mutation. That number is even lower globally.

“This is a space where Pfizer is particularly well equipped, not just in the US, but globally, to encourage testing and to help educate physicians, pathologists, patients, and patient advocate groups,” Boshoff said. He said the test is covered by insurance in the U.S.

What if robots had artificial muscles?

Pfizer sold close to $400 million of Braftovi and Mektovi last year, but analysts are not currently forecasting significant growth for the drugs, according to LSEG data.

One area where Boshoff said Braftovi could expand its market is in colorectal cancer, where BRAF-mutated cancers make up 10% of the cancers. Data from the company’s late-stage study in colorectal cancer is expected to be announced by the end of the year, he said.

Credit: Reuters

Team Metabolic Health

A popular prescription drug that is used to treat type 2 diabetes or to manage weight in adults seems to be both safe and effective for weight loss in children – at least in the short term, according to new results.

Liraglutide (brand name Victoza or Saxenda) belongs to the same class of medicine as semaglutide, which is the drug behind Ozempic and Wegovy.

The subcutaneous injection was first approved in the US as an adjunct therapy for type 2 diabetes in 2010. Four years later, it was approved for weight management in adults who are considered overweight or obese.

Despite its surging popularity, the long-term effects of liraglutide and similar drugs are still being investigated, even among adults. Their use among children remains controversial.

While some scientists have warned that liraglutide may be dangerous or have unintended consequences for kids in the long run, in 2019, the US Food and Drug Administration approved liraglutide for use in patients with type 2 diabetes who are 10 years or older.

To date, no medications are currently approved for the treatment of obesity in children younger than 12.

A phase 3 clinical trial among 82 participants has now provided initial results that liraglutide, combined with other lifestyle interventions, is both safe and effective as a weight loss drug for children as young as six years old.

Roughly a year after starting the trial, which was funded by liraglutide maker Novo Nordisk, participants between the ages of 6 and 12 who were given the liraglutide reduced their body mass index by 5.8 percent. Those given a placebo over the same period showed increased BMIs by about 1.6 percent.

Children at this age are still growing, so it is expected that some weight gain would occur without drug treatment over the course of a year.

All participating children were counseled by qualified health care professionals and encouraged to eat healthily and exercise for an hour or so a day.

“In our study, diastolic blood pressure and… a measure of blood sugar control improved more in children receiving liraglutide than in those receiving the placebo,” explains lead researcher and pediatrician Claudia Fox from the University of Minnesota Twin Cities. Fox has received grant and contact support from Novo Nordisk and another pharmaceutical company, Eli Lilly.

The prevalence of negative side effects was about the same among both groups, although transient gastrointestinal issues, like nausea and vomiting, were nearly 30 percent more common in the liraglutide group.

“To date, children have had virtually no options for treating obesity,” argues Fox.

“They have been told to ‘try harder’ with diet and exercise. Now with the possibility of a medication that addresses the underlying physiology of obesity, there is hope that children living with obesity can live healthier, more productive lives.”

In an accompanying editorial, pediatricians Julian Hamilton-Shield and Timothy Barrett argue that Fox and her colleagues have provided “much-needed evidence” for the effects of liraglutide on young children with obesity.

But body composition was not measured in the trial, and BMI is a poor surrogate for fat mass, they note.

After treatment was ceased, children in the liraglutide group of the trial showed increased BMI scores, “which is worrisome because it implies the ongoing need for pharmacotherapy to prevent BMI rebound,” explain Hamilton-Shield and Barrett.

The same concerns also apply to adults taking these medications. Once the injections are stopped, studies have found the average patient typically regains about two-thirds of their lost weight within a year.

Significant fluctuations in weight during childhood could be a serious risk for ongoing development.

In a commentary published last year, some scientists (with no conflicts of interest to declare) warned that “little attention has been paid to the possible unintended consequences or adverse impact of these medications on children and adolescents during their critical period of growth and development.”

Given that the long-term side effects of incretin mimetics are still being realized in adults, there’s every reason to tread cautiously.

The study was published in the New England Journal of Medicine.

Credit: sciencealert.com

Team Metabolic Health

Reducing fat accumulation may help mitigate risk, per new study

A higher volume of epicardial adipose tissue (EAT) — meaning more fat accumulated near the heart muscle and arteries that supply the heart — significantly increases the risk for early heart disease in people with Cushing’s syndrome.

That’s according to a study from China that assessed risk factors for left ventricular diastolic dysfunction, or LVDD, a condition that affects the ability of the heart’s left ventricle, or chamber, to fill with blood before contraction.

“These results suggested that reducing EAT accumulation may be promising to mitigate the risk of LVDD development in patients with [Cushing’s syndrome],” the researchers wrote.

The study, “Epicardial adipose tissue volume highly correlates with left ventricular diastolic dysfunction in endogenous Cushing’s syndrome,” was published in Annals of Medicine.

Higher risk of heart disease seen for patients vs. healthy people

Cushing’s syndrome comprises a group of conditions characterized by high levels of the stress hormone cortisol, produced by the adrenal glands, located atop the kidneys.

Cushing’s disease, the most common form of the syndrome, is caused by a tumor in the brain’s pituitary gland, which produces excessive levels of ACTH, a hormone that triggers cortisol production.

The syndrome is associated with several risk factors of cardiovascular disease, including diabetes, marked by high levels of blood sugar, high blood pressure, also known as hypertension, and dysregulation of the levels of fatty molecules in the blood. Cardiovascular complications are the main cause of death in this patient population.

Additionally, evidence suggests that exposure to excessive levels of cortisol may cause changes in the heart’s structure and function, and increase the risk of heart failure.

Now, a team of researchers from Tongji Medical College at Huazhong University of Science and Technology set out to evaluate the potential impact of high cortisol levels on certain types of body fat, including EAT. The team also sought to identify risk factors for LVDD, an underlying mechanism associated with heart failure, in people with Cushing’s syndrome.

The researchers retrospectively analyzed data from 86 adults with endogenous Cushing’s, and 86 healthy people matched for age, sex, and body mass index (BMI), a ratio of height and weight (used as the control group).

Cushing’s disease was the most common form of the syndrome, accounting for the diagnosis of 48 patients (55.8%).

Compared with the control group, the individuals with Cushing’s had significantly higher cardiovascular risk factors, including higher blood pressure, higher blood sugar levels, and more severe problems with fat metabolism. Also, a significantly higher proportion of these patients had hypertension (74.42% vs. 6.98%) and diabetes (48.84% vs. 2.33%) relative to the controls.

Moreover, Cushing’s patients had significantly higher EAT volume (150.3 vs. 90.6 cubic centimeters) and area of visceral fat, or the fat that accumulates around abdominal organs (166.81 vs. 80.28 cubic centimeters). There also were significant differences regarding heart structure and function parameters between the two groups.

More study needed into impact of excess corisol on fat deposits

A total of 50 patients (58.1%) had LVDD, while the remaining 36 (41.9%) did not. Those with LVDD were significantly older, had significantly higher EAT volume (175.28 vs. 142.16 cm3) and visceral fat area (194.06 vs 152.14 cm2), and a significantly lower E/A ratio, a measure of left ventricle function.

Moreover, EAT volume was significantly higher in patients with ACTH-dependent Cushing’s (173.6 vs. 129.91 cm3), as well as visceral fat (188.7 vs. 145.2 cm2), compared with those with ACTH-independent Cushing’s.

Statistical analyses adjusted for potential influencing factors showed that a higher EAT volume was significantly and independently associated with an increased risk for LVDD.

In turn, higher blood levels of HDL-C — known as so-called good cholesterol — and higher estimated glomerular filtration rate, indicating better kidney function, were protective factors against LVDD.

Using a cutoff value of 139.252 cubic centimeters, EAT volume was able to discriminate Cushing’s patients with LVDD with a sensitivity of 84% sensitivity and a specificity of 55.6%. A test’s sensitivity is its ability to correctly identify those with a given disease, while specificity refers to correctly identifying those without it.

Overall, “these results underscored the potentially pivotal role of excessive cortisol-induced EAT deposition in the development of LVDD in [Cushing’s syndrome] patients,” the researchers wrote.

“Future studies with larger sample sizes are required to validate our results and explore the impact of excess cortisol on EAT deposition, as well as identify additional risk factors for the development of LVDD in [Cushing’s],” the team concluded.

Credit: cushingsdiseasenews.com

Team Metabolic Health

The market for weight-loss treatments is expected to see 16 new drugs vying for a slice of the lucrative business currently dominated by Novo Nordisk (NOVOb.CO), opens new tab and Eli Lilly (LLY.N), opens new tab, according to estimates from analysts at Morningstar and Pitchbook.

In a joint report published on Monday, analysts estimated the market for obesity treatments could expand to $200 billion by 2031. The 16 drugs could launch by 2029, with roughly $70 billion of the GLP-1 market coming from these new challengers.

Boxes of Wegovy made by Novo Nordisk are seen at a pharmacy in London, Britain March 8, 2024. REUTERS/Hollie Adams/File Photo

The market for weight-loss treatments is expected to see 16 new drugs vying for a slice of the lucrative business currently dominated by Novo Nordisk (NOVOb.CO), opens new tab and Eli Lilly (LLY.N), opens new tab, according to estimates from analysts at Morningstar and Pitchbook.

In a joint report published on Monday, analysts estimated the market for obesity treatments could expand to $200 billion by 2031. The 16 drugs could launch by 2029, with roughly $70 billion of the GLP-1 market coming from these new challengers.

WHY IT’S IMPORTANT

Surging demand for Novo’s Wegovy and Lilly’s Zepbound has sparked interest among competitors to test their own weight-loss treatments. Companies such as Amgen (AMGN.O), opens new tab and Pfizer (PFE.N), opens new tab are currently testing their drug candidates in clinical trials.

These developments come amid criticism from lawmakers over the high costs associated with these medications. The new entrants, however, are expected to drive down prices as they vie for market share, according to the report.

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CONTEXT

The potential new treatments include those from Boehringer Ingelheim and Zealand Pharma (ZELA.CO), opens new tab, along with competitors from Roche (ROG.S), opens new tab, Amgen (AMGN.O), opens new tab and Pfizer (PFE.N), opens new tab, according to the report, provided that the drugs clear clinical trials.

Other entrants include those by Structure Therapeutics (GPCR.O), opens new tab, Viking Therapeutics (VKTX.O), opens new tab and Altimmune (ALT.O), opens new tab, along with next-generation drugs by Novo and Lilly.

Analysts, last year, had forecast the obesity market would be $170 billion by 2031, but have recently raised their estimates, partly due to anticipated higher diabetes market penetration.

The report projects 41% individuals with diabetes and nearly one-quarter of nondiabetic obesity patients will be on a GLP-1 drug by 2031.

WHAT’S NEXT

Analysts expect significant acquisitions by major pharmaceutical companies in the obesity sector over the next 18 months, targeting smaller companies specializing in obesity drug development.

Potential acquisition targets include firms such as Structure, Viking and Altimmune.

Private companies such as NodThera, Corteria and Diasome have a higher-than-50% chance of being acquired, according to PitchBook data.

Credit: Reuters

Team Metabolic Health

Liraglutide is an older version of the popular GLP-1 drugs, which include Ozempic. But questions remain about starting kids on a lifelong drug so young.

In a late-stage clinical trial, a drug similar to Ozempic was shown to reduce body mass index in kids ages 6 to 11 with obesity, according to results published Tuesday in the New England Journal of Medicine.

The findings bring the phenomenon — and the controversy — of the latest new and powerful weight loss drugs to the youngest age group yet. With the exception of drugs for rare genetic disorders that cause obesity, there are no pharmaceutical options for obesity in children under 12.

The new trial looked at liraglutide, the active ingredient used in two of Novo Nordisk’s older GLP-1 drugs: Saxenda, a weight loss drug, and Victoza, a diabetes drug. Semaglutide, another GLP-1 also from Novo Nordisk, is the drug in Ozempic and Wegovy. 

All are intended for lifelong use.

Given that 6 to 11 are crucial ages for a child’s development, there are concerns about how the medications might impact their growth, said Dr. Roy Kim, a pediatric endocrinologist at Cleveland Clinic Children’s in Ohio.

“We do not know the long-term effectiveness and safety of these medicines in children,” Kim said. “While the medicine was well tolerated, there are concerns about this category of medicines and possible pancreas problems, thyroid cancer risk and bone health over the lifetime.”

A growing number of kids in the U.S. have obesity, including 1 in 5 kids ages 6 to 11, according to the Centers for Disease Control and Prevention. 

How well the drug works

The trial included 82 children with an average BMI of 31 who either got a once-daily injection of liraglutide or a placebo for 56 weeks. 

Every child and their parents in the study also met regularly with a lifestyle coach to discuss healthy eating and exercise before starting the injections, said lead study author Dr. Claudia Fox, an associate professor of pediatrics at the University of Minnesota. Fox serves as a principal investigator for clinical trials sponsored by both Novo Nordisk and Eli Lilly.

Once the kids began taking the medication, they met less often with the coaches — about once every one to two months, Fox said. 

Figuring out how well the drug worked wasn’t as simple as measuring weight loss because the kids are still growing, and each child grows at different rates, Fox said. So instead of looking at overall weight loss like in adult studies, they decided to focus more on BMI, which takes into account both weight and height.

“A five-pound change for a 6-year-old is very different from a five-pound change for a 10-year-old,” she said.  

After 56 weeks, kids who got liraglutide saw an average BMI reduction of 5.8%, while the kids who got a placebo saw a 1.6% increase. Nearly half of the kids on liraglutide saw their BMI go down by at least 5%, compared to just 9% in the placebo group.

“To me, this sort of suggests that perhaps it is better to intervene earlier rather than wait until a kid is an adolescent,” Fox said.

The medication was well tolerated — similar to the findings in the adult trials — although gastrointestinal side effects were more common in the kids who got liraglutide, she said. The most common side effect was vomiting, followed by nausea and diarrhea. Older kids, she added, were able to give themselves the injections, while younger kids needed their parents to do it.

A spokesperson for Novo Nordisk said that it has submitted an application to the Food and Drug Administration to expand the approval of liraglutide for weight loss in children ages 6 to 11. 

Is 6 too young for a weight loss drug? 

As childhood obesity rates rise, some doctors have advocated for more aggressive approaches and earlier treatments. 

In 2023, the American Academy of Pediatrics released new guidelines for treating childhood obesity, recommending for the first time weight loss drugs and, in some cases, surgery for children ages 12 and up. For kids under 12, the guidelines endorsed working closely with pediatricians and other health care providers to focus on lifestyle changes.

Dr. Sarah Armstrong, a professor of pediatrics at Duke University and a co-author of the American Academy of Pediatrics guidelines, said that medication will probably be necessary for children with severe obesity; that is, a BMI of at least 35.

“It is pretty clear that without effective treatment, this does tend to get worse, not better, over time,” Armstrong said. “If a child has severe obesity and maybe has developed some early life comorbidities, it’s probably the right thing to do.”

Still, she has some concerns about use of medications in young kids because of the long-term nature of treatment.

“What happens to kids if you put them on medication that makes them less hungry while they’re still growing?” Armstrong said. “Are they going to have delayed puberty? Are they going to have delayed growth? Will it somehow affect their bone density? Will it create disordered eating patterns that are going to cause other problems later in life?” 

Kim, of Cleveland Clinic Children’s, said the weight loss in the trial was “relatively small” but promising. He also noted shortcomings of the trial, including that the study group and duration was small, with only 82 children taking the drug or a placebo for 56 weeks.

He also noted that the ethnic and racial makeup of the children in the trial “does not reflect the populations most seriously impacted by the obesity epidemic.” More than two-thirds of the kids in the trial were white. 

Despite the shortcomings, “it is exciting because it is a taste of what’s to come,” Kim said. “We know there are more potent medicines, given once a week, that are on the market and approved for adults and adolescents.”

Wegovy, approved for people ages 12 and up, is a weekly injection, as is Zepbound, from Eli Lilly. Zepbound is only approved for adults.

Dr. Shauna Levy, a specialist in obesity medicine and the medical director of the Tulane Bariatric Center in New Orleans, said that while diet and exercise must continue to be mainstays for treating children with obesity, some kids would benefit from the drug.

“In my practice, I have seen 18 year olds with BMI of 60+ that are already suffering from their disease,” Levy wrote in an email. “We have long thought that weight is something that kids grow out of as they age; now that we understand obesity better we know that not only do not grow out of obesity, but it needs to be actively treated.”

Credit: NBC News

Team Metabolic Health

A daily weight loss pill from Novo Nordisk was shown to lower body weight by up to 13% after three months in a Phase 1 clinical trial, according to findings presented Tuesday at the European Association for the Study of Diabetes annual meeting in Spain.

The rate of weight loss with the experimental pill, called amycretin, appears to be more rapid than what’s seen for other drugs.

“It’s roughly double the weight loss rate seen with current GLP-1 agonists and approaching procedural or surgical-level outcomes,” said Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in North Carolina. “It shows potential promise.”

Dr. Susan Spratt, an endocrinologist and the senior medical director for the Population Health Management Office at Duke Health, said the results looked impressive.

“How could they achieve weight loss that quickly?” Spratt asked. “It’s almost like a miracle pill.”

The findings are early — more research is needed, particularly over a longer period of time — and the drug can’t be directly compared to existing weight loss drugs because they weren’t tested in a head-to-head trial. The results also haven’t been published in a peer-reviewed journal.

Credit: NBC News

Team Metabolic Health

A healthy Indian plate should have fruits and veggies in one half, and pulses, millets and eggs in another half.

A balanced diet consists of all the important nutrients required for the body to generate energy for proper functioning. The bodily functions carried out at all times require energy that we get from the food choices that we make. From plant-based diet to animal protein, the diet we consume should have all the essential nutrients. From protein, to carbohydrates, to healthy fats to vitamins to minerals, the body requires each of these nutrients.

According to the guidelines, a healthy plate of food should consist of fruits and vegetables as the half. The other half should consist of cereals, millets, pulses, flesh foods, eggs, nuts, oilseeds, milk and curd. (Unsplash)

Dietary guidelines for Indians:

According to the Dietary guidelines for Indians 2024, developed by Indian Council for Medical Research (ICMR) and National institute for Nutrition, for a 2000 Kcal Indian diet per day, certain portions are recommended for healthy eating. According to the guidelines, a healthy plate of food should consist of fruits and vegetables as the half. The other half should consist of cereals, millets, pulses, flesh foods, eggs, nuts, oilseeds, milk and curd.

However, according to the dietary patterns observed in Indians, people tend to consume less micro-nutrient rich food items such as whole grains, pulses and fresh produce. People also have the chronic habit of overconsuming cereals. The guidelines further stated that cereals can be consumed for 45 percent of the daily energy needs – for the rest of energy, we should focus more on less carbohydrate-rich nutrients.

The ICMR and NIN guidelines further observed the chronic unhealthy dietary patterns in Indians – ultra processed foods high in sugars, salt and fats can contribute to health conditions. This unhealthy eating habit combined with a sedentary lifestyle further contributes to micronutrient deficiencies and obesity rates. The study further observed the role of aggressive marketing in influencing people to make dietary preferences – this had steered people away from nutritious choices on their plate. In foods and beverages, high content of sugar, sodium and saturated fats can harm health.

Disclaimer: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Credit: Hindustan Times

Team Metabolic Health

An epilepsy drug could help people with a common breathing problem that causes them to snore and gasp loudly at night, it has been claimed.

Sulthiame, a drug sold under the brand name Ospolot, appeared to reduce symptoms of obstructive sleep apnoea in a recent international clinical trial of 298 patients.

Lead author Jan Hedner, professor of respiratory medicine at Sahlgrenska University Hospital in Gothenburg, Sweden, found improvements in those on the highest doses of the drug.

Bhik Kotecha, consultant ear, nose and throat surgeon at Nuffield Health Brentwood Hospital, Essex, said lifestyle changes such as weight loss and reduced alcohol intake could also help with sleep apnoea.

Professor Kotecha described sleep apnoea as a condition in which a patient stops breathing momentarily, but repeatedly, during sleep.

He said: “The main symptoms of sleep apnoea include snoring, poor and fragmented sleep, periodic gasping for breath, morning headaches and daytime sleepiness.”

Ms Hedner found after 12 weeks, those taking Sulthiame had up to 50% fewer occasions where their breathing stopped and higher levels of oxygen in their blood during sleep.

A common misconception is that snoring and sleep apnoea are the same thing.

What causes general snoring?

“Snoring occurs as a result of a turbulent airflow and can affect both children and adults,” explained Mr Kotecha.

“If the airway becomes constantly obstructed, then the patient could develop sleep apnoea.”

Children often snore due to enlarged tonsils and adenoids.

“There is a plethora of evidence that demonstrates that the removal of tonsils and adenoids in these children dramatically improves their quality of sleep as well as their cognitive function,” said Mr Kotecha.

“In adults, the problem could be due to an obstruction in the nose as a result of a deviated nasal septum or nasal polyps.

“More commonly, it is the redundant, floppy soft palate in the throat that is the culprit.”

But, because the majority of symptoms happen when asleep, it can be hard to detect.

How can it be treated?

As the effects of Sulthiame need to be investigated further, Mr Kotecha said there were other ways to treat the condition.

Options included nasal CPAP (continuous positive airway pressure), oral appliances, nasal sprays, antihistamines and lifestyle changes like weight loss and reduced alcohol intake.

Surgeries such as minimally invasive radiofrequency surgery, tonsillectomy and laser or robotic surgery can also be offered to select patients.

“Minimally invasive radiofrequency surgery can improve the upper airway by shortening and stiffening the soft palate, reducing the bulkiness of the tongue and improving nasal patency,” added Mr Kotecha.

Credit: BBC News