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1.
Pharmacotherapy for Weight Loss in Cirrhosis and Liver Transplantation: Translating the Data and Underused Potential.
Brown, SA, Izzy, M, Watt, KD
Hepatology (Baltimore, Md.). 2021;(5):2051-2062
Abstract
BACKGROUND AND AIMS Thirty percent of patients with cirrhosis are obese and the prevalence of obesity increases after transplant to >40% post-transplant. There are currently four weight loss medications approved by the FDA for treatment of obesity (orlistat, phentermine-topiramate, naltrexone-bupropion, and liraglutide). The aim of this review was to investigate the data on the use of these weight loss medications and alternative medicines in patients with cirrhosis and in liver transplant recipients (LTRs). APPROACH AND RESULTS While there is paucity of data for these medications in patients with cirrhosis and LTRs, Liraglutide appears to be generally safe in view of its pharmacokinetic properties. Phentermine-topiramate seems to have the highest weight loss potential but special consideration should be given to neuropsychiatric disorders, cardiovascular comorbidities, and drug interactions. There are emerging data on use of alternative medicines for weight loss but more data are needed. CONCLUSIONS The use of weight loss medications is feasible in this patient population but the decision of which medication to prescribe should be individualized based on the degree of renal and hepatic impairment, other co-morbidities, and concomitant medications.
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2.
Plants used against obesity in Turkish folk medicine: A review.
Sargin, SA
Journal of ethnopharmacology. 2021;:113841
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Obesity is one of the growing public health problems in Turkey, as well as all over the world, threatening people of almost all ages. Turkey has a large potential for research on this topic due to owning broad ethnomedicinal experience and the richest flora (34% endemic) of Europe and the Middle East. Herbs that they have utilized for centuries to treat and prevent obesity can provide useful options to overcome this issue. AIM OF THE STUDY This survey was carried out to disclose the inventory of plant taxa that the people of Turkey have been using for a few centuries in treating obesity without any side effects or complications, and to compare them with experimental studies in the literature. MATERIALS AND METHODS The research was achieved in two phases on the matter above by using electronic databases, such as Web of Science, ScienceDirect, Scopus, ProQuest, Medline, Cochrane Library, EBSCO, HighWire Press, PubMed and Google Scholar. Both results were shown in separate tables as well as the regional comparative analysis. RESULTS 117 herbal taxa belonging to 45 families were identified among the selected 74 studies conducted in the seven regions of Turkey. However, only 49 (41.9%) of them were found to be subjected to worldwide in vitro and in vivo research conducted on anti-obesity activity. Quercetin (9.1%), gallic acid (6.1%) and ferulic acid and epigallocatechin gallate (4.5%) have been recorded as the most common active ingredients among the 66 active substances identified. Prunus avium (32.4%) and Rosmarinus officinalis (25.7%) were identified as the most common plants used in Turkey. Also, Portulaca oleracea and Brassica oleracea emerged as the most investigated taxa in the literature. CONCLUSION This is the first country-wide ethnomedical review conducted on obesity treatment with plants in Turkey. Evaluating the results of the experimental anti-obesity research conducted in the recent years in the literature, it was determined that forty-nine plants were verified. This clearly shows that these herbs have a high potential to be a pharmacological resource. Moreover, 68 (41.9%) taxa, which haven't been investigated yet, are likely to be a promising resource for national and international pharmacological researchers in terms of new natural medicine searches.
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3.
Lesser Investigated Natural Ingredients for the Management of Obesity.
Majeed, M, Majeed, S, Nagabhushanam, K, Gnanamani, M, Mundkur, L
Nutrients. 2021;(2)
Abstract
Obesity, an epidemiological disorder, is related to various complications in both the developed and developing world. It epitomizes a crucial risk factor for health, decreasing productivity and life expectancy while increasing health care costs worldwide. Conventional therapies with synthetic drugs or bariatric surgery, associated with numerous side effects, recurrence, and surgical complexity, have been restricted in their use. Lifestyle changes and dietary restrictions are the proven methods for successful weight loss, although maintaining a strict lifestyle is a challenge. Multiple natural products have been explored for weight management with varied efficacy. The current review explores less explored natural herbs, their active constituents, and their mechanisms of action against obesity.
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4.
The Role of Resveratrol Administration in Human Obesity.
Mongioì, LM, La Vignera, S, Cannarella, R, Cimino, L, Compagnone, M, Condorelli, RA, Calogero, AE
International journal of molecular sciences. 2021;(9)
Abstract
Obesity is a widespread disease that is associated with numerous and serious comorbidities. These include metabolic syndrome, diabetes mellitus, cardiovascular-cerebrovascular disease, hypertension, obstructive sleep apnea syndrome, cancer, and sexual and hormonal disorders. The treatment of obesity has therefore become a goal of great clinical and social relevance. Among the therapeutic strategies against obesity, resveratrol has aroused great interest. This polyphenol has anticancer and antioxidant properties and cytoprotective and anti-inflammatory effects. Other favorable effects attributed to resveratrol are anti-lipid, anti-aging, anti-bacterial, anti-viral, and neuroprotective actions. Administration of resveratrol appears to improve the metabolic profile in obese and/or insulin-resistant patients. This article aims to review the main results of clinical studies evaluating the effects of administering resveratrol alone in overweight/obese patients.
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5.
Hypertension in Obesity: Novel Insights.
Natsis, M, Antza, C, Doundoulakis, I, Stabouli, S, Kotsis, V
Current hypertension reviews. 2020;(1):30-36
Abstract
BACKGROUND The relationship between obesity and hypertension has been established in both adults and children. The combination of obesity, hypertension and other cardiovascular risk factors significantly increases the likelihood of adverse cardiovascular effects and raises concerns about aggressive treatment strategies. OBJECTIVE Despite the impressive elements which indicate an important role for excessive weight gain in increasing blood pressure, not all obese patients are hypertensive. A subgroup of obese people may not develop hypertension. Furthermore, masked hypertension occurs more common among obese patients, and body fat distribution has a major role in the development of hypertension. METHOD We conducted a research of the relevant literature regarding obesity-induced hypertension and possible treatment strategies. RESULTS Successful weight loss is correlated with blood pressure reduction and requires a multidisciplinary approach that includes personalized dietary interventions combined with regular exercise and cognitive behavioral therapy. CONCLUSION Pharmacological therapy may be considered as part of a comprehensive obesity management strategy. More research and new treatment therapies are required in this field.
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6.
Targeting obesity with plant-derived pancreatic lipase inhibitors: A comprehensive review.
Rajan, L, Palaniswamy, D, Mohankumar, SK
Pharmacological research. 2020;:104681
Abstract
The prevalence of obesity is alarmingly increasing in the last few decades and leading to many serious public health concerns worldwide. The dysregulated lipid homeostasis due to various genetic, environmental and lifestyle factors is considered one of the critical putative pathways mediating obesity. Nonetheless, the scientific advancements unleashing the molecular dynamics of lipid metabolism have provided deeper insights on the emerging roles of lipid hydrolysing enzymes, including pancreatic lipase. It is hypothesized that inhibiting pancreatic lipase would prevent the breakdown of triglyceride and delays the absorption of fatty acids into the systemic circulation and adipocytes. Whilst, orlistat is the only conventional pancreatic lipase enzyme inhibitor available in clinics, identifying the safe clinical alternatives from plants to inhibit pancreatic lipase has been considered a significant advancement. Consequently, plants which have shown significant potential to combat obesity are now revisited for its abilities to inhibit pancreatic lipase. In this regard, our review surveyed the potential of medicinal plants and its phytoconstituents to inhibit pancreatic lipase and to elicit anti-obesity effects. Thus, the review collate and critically appraise the potential of medicinal plants and phyto-molecules inhibiting pancreatic lipase enzyme and consequently modulating triglyceride absorption in gut, and discuss its implications in the development of novel therapeutic strategies to combat obesity.
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7.
Obesity: The New Global Epidemic Pharmacological Treatment, Opportunities and Limits for Personalized Therapy.
Milano, W, De Biasio, V, Di Munzio, W, Foggia, G, Capasso, A
Endocrine, metabolic & immune disorders drug targets. 2020;(8):1232-1243
Abstract
BACKGROUND The increase in global obesity rates over the past three decades has been remarkable, a true epidemic, both in developed and in developing countries. The projections, based on current trends, suggest an increase in the prevalence of obesity at 60% in adult men, 40% in adult women and 25% in children in 2050. Given the limitations of lifestyle and surgery interventions bariatric, drug therapy approaches for the treatment of obesity, therefore become important options. AIM: The purpose of this review is a review of the literature, based on research on MEDLINE until 2019, on the possible pharmacological options in the treatment of obesity. RESULTS Currently, the FDA has approved several molecules for the treatment of obesity, both in monotherapy and in combination. Pharmacological monotherapies focus mainly on a single protein target and include orlistat, lorcaserin and liraglutide while the combination molecules propose a multitarget approach and include phentermine/topiramate and naltrexone/bupropion. All the approved drugs showed, in the different studies, a weight reduction of at least 5%, compared to placebo, in 52 weeks of observation. Phentermine-topiramate and liraglutide have been associated with the highest probability of at least 5% weight loss. Liraglutide and naltrexone-bupropion had the lowest rates of therapy discontinuation due to adverse events. CONCLUSION The drugs, associated with the standard diet and/or exercise protocols, represent a good therapeutic opportunity to allow not only weight loss but also to reduce the risk of developing diseases caused by obesity, particularly cardiovascular diseases, and to maintain the set objectives over time. However, future research on the pharmacological treatment of obesity should encourage greater personalization of therapy, given the differences in safety, efficacy and response to therapy, in the different subpopulations of patients with obesity.
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8.
Comprehensive Review of Current and Upcoming Anti-Obesity Drugs.
Son, JW, Kim, S
Diabetes & metabolism journal. 2020;(6):802-818
Abstract
Obesity is among the leading causes of morbidity and mortality worldwide and its prevalence continues to increase globally. Because obesity is a chronic, complex, and heterogeneous disease influenced by genetic, developmental, biological, and environmental factors, it is necessary to approach obesity with an integrated and comprehensive treatment strategy. As it is difficult to achieve and sustain successful long-term weight loss in most patients with obesity through lifestyle modifications (e.g., diet, exercise, and behavioral therapy), pharmacological approaches to the treatment of obesity should be considered as an adjunct therapy. Currently, four drugs (orlistat, naltrexone extended-release [ER]/bupropion ER, phentermine/topiramate controlled-release, and liraglutide) can be used long-term (>12 weeks) to promote weight loss by suppressing appetite or decreasing fat absorption. Pharmacotherapy for obesity should be conducted according to a proper assessment of the clinical evidence and customized to individual patients considering the characteristics of each drug and comorbidities associated with obesity. In this review, we discuss the mechanisms of action, efficacy, and safety of these available long-term anti-obesity drugs and introduce other potential agents under investigation. Furthermore, we discuss the need for research on personalized obesity medicine.
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9.
[Effectiveness of hydroxycinamates and beta-glucans as dietary tools against obesity and its associated dysfunctions, and their application as nutraceuticals].
García Cordero, J, Sarria Ruiz, B, González Rámila, S, Bravo Clemente, L, Mateos Briz, R
Nutricion hospitalaria. 2020;(5):1061-1071
Abstract
Over the last few years the prevalence of overweight and obesity has increased, affecting in certain parts of the world more than half of the adult population. Obesity has been related to disorders such as type-2 diabetes, non-alcoholic fatty liver disease, and cardiovascular diseases, among others, which has made of obesity the second cause of preventable death, only behind smoking. Bearing this in mind, it is necessary to find new strategies to overcome overweight/obesity and its associated pathologies. In this context, nutraceuticals and dietary supplements have become interesting tools thanks to their composition, rich in bioactive compounds beneficial to health. Among bioactive compounds, this study will focus on β-glucans, a type of soluble dietary fiber, and hydroxycinnamic acids, a group of phenols. Both types of compounds show complex and multifactorial effects, acting as hypolipemic, hypoglycemic, antioxidant, prebiotic and satiating agents. They act by modulating different metabolic pathways, affecting the absorption and metabolism of lipids and carbohydrates, reducing oxidative damage, promoting the proliferation of beneficial bacterial species, and reducing dietary intake. It may be concluded that both beta-glucans and hydroxycinnamates have potential as a nutritional tool for the management of obesity and its associated metabolic dysfunctions.
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10.
Medical and surgical management of obesity and diabetes: what's new?
Ammori, BJ, Skarulis, MC, Soran, H, Syed, AA, Eledrisi, M, Malik, RA
Diabetic medicine : a journal of the British Diabetic Association. 2020;(2):203-210
Abstract
We conducted a narrative review of the medical and surgical management of people with obesity and diabetes. Results of this review showed that a 5-10% loss in body weight can be achieved with a change in lifestyle, diet and behaviour and with approved pharmacological therapies in people with obesity and diabetes. New targeted therapies are now available for patients with previously untreatable genetic causes of obesity. Compared to medical treatment, metabolic and bariatric surgery is associated with significantly higher rates of remission from type 2 diabetes and lower rates of incident macrovascular and microvascular complications and mortality. The National Institute for Health and Care Excellence and the American Diabetes Association endorse metabolic and bariatric surgery in obese adults with type 2 diabetes and there may also be a role for this in obese individuals with type 1 diabetes. The paediatric committee of the American Society for Metabolic and Bariatric Surgery have recommended metabolic and bariatric surgery in obese adolescents with type 2 diabetes. Earlier and more aggressive treatment with metabolic and bariatric surgery in obese or overweight people with diabetes can improve morbidity and mortality.