scholarly journals Changes in alanine aminotransferase in adults with severe and complicated obesity during a milk-based meal replacement programme

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Razk Abdalgwad ◽  
Mohammed Faraz Rafey ◽  
Conor Murphy ◽  
Iulia Ioana ◽  
Paula Mary O’Shea ◽  
...  
Keyword(s):  
Weight Loss ◽  
Alanine Aminotransferase ◽  
Rank Test ◽  
Rapid Weight Loss ◽  
Meal Replacement ◽  
Spectrophotometric Detection ◽  
Excess Adiposity ◽  
Weight Loss Programme ◽  
Bariatric Patients ◽  
Changes Over Time

Abstract Introduction Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity. Methods We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each 8 weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test. Results Of 105 patients, 56 were female, mean age was 51.2 ± 11.2 (range 18.0–71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/L at baseline to 40.0 [26.0, 55.0] iu/L after 2 weeks (p < 0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/L by 24 weeks (p < 0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2 ± 28.0 kg at baseline to 121.6 ± 25.4 kg at 24 weeks (p < 0.0005) and body mass index (BMI) decreased from 50.7 ± 8.1 kg m−2 at baseline to 43.0 ± 7.6 kg m−2 by 24 weeks (p < 0.0005). Conclusion In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first 2 weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.

scholarly journals Changes in Alanine Aminotransferase in Adults with Severe and Complicated Obesity during a Milk-Based Meal Replacement Programme

2020 ◽  
Author(s):  
Razk Abdalgwad ◽  
Mohammed Faraz Rafey ◽  
Conor Murphy ◽  
Iulia Ioana ◽  
Paula Marie O'Shea ◽  
...  
Keyword(s):  
Weight Loss ◽  
Alanine Aminotransferase ◽  
Rank Test ◽  
Rapid Weight Loss ◽  
Meal Replacement ◽  
Spectrophotometric Detection ◽  
Excess Adiposity ◽  
Weight Loss Programme ◽  
Bariatric Patients ◽  
Changes Over Time

Abstract Introduction: Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity.Methods: We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each eight weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test.Results: Of 105 patients, 56 were female, mean age was 51.2±11.2 (range 18.0-71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/l at baseline to 40.0 [26.0, 55.0] iu/l after two weeks (p<0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/l by 24 weeks (p<0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2±28.0 kg at baseline to 121.6±25.4 kg at 24 weeks (p<0.0005) and body mass index (BMI) decreased from 50.7±8.1 kg m-2 at baseline to 43.0±7.6 kg m-2 by 24 weeks (p<0.0005).Conclusion: In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first two weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.

scholarly journals Changes in Alanine Aminotransferase in Adults with Severe and Complicated Obesity during a Milk-Based Meal Replacement Programme

2020 ◽  
Author(s):  
Razk Abdalgwad ◽  
Mohammed Faraz Rafey ◽  
Conor Murphy ◽  
Iulia Ioana ◽  
Paula Marie O'Shea ◽  
...  
Keyword(s):  
Weight Loss ◽  
Alanine Aminotransferase ◽  
Rank Test ◽  
Rapid Weight Loss ◽  
Test Results ◽  
Meal Replacement ◽  
Spectrophotometric Detection ◽  
Weight Loss Programme ◽  
Bariatric Patients ◽  
Changes Over Time

Abstract Introduction: Excess adiposity is associated with fat accumulation within the liver, and non-alcoholic steatohepatitis (NASH) is highly prevalent in bariatric patients. Elevated alanine aminotransferase (ALT) is associated with prevalent NASH. We sought to determine the influence of a milk-based meal replacement weight-loss programme on ALT levels in adults with severe and complicated obesity. Methods We conducted a retrospective cohort study of patients who completed a 24-week meal replacement programme, comprised of a weight loss phase followed by weight stabilisation and maintenance phases, each eight weeks long. ALT was quantified using an enzymatic assay with spectrophotometric detection. We examined changes over time in ALT using the non-parametric Wilcoxon singed-rank test and the Friedman test. Results Of 105 patients, 56 were female, mean age was 51.2 ± 11.2 (range 18.0-71.6) years. There was an unanticipated but transient increase in ALT from 28.0 [20.0, 40.5] iu/l at baseline to 40.0 [26.0, 55.0] iu/l after two weeks (p < 0.0005), followed by a gradual reduction to 21.0 [17.0, 28.3] iu/l by 24 weeks (p < 0.0005). The overall reductions in ALT were more pronounced in patients who had elevated levels at baseline. Body weight decreased from 144.2 ± 28.0 kg at baseline to 121.6 ± 25.4 kg at 24 weeks (p < 0.0005) and body mass index (BMI) decreased from 50.7 ± 8.1 kg m− 2 at baseline to 43.0 ± 7.6 kg m− 2 by 24 weeks (p < 0.0005). Conclusion In adults with severe and complicated obesity undergoing a milk-based meal replacement programme, there was an initial unanticipated rise in ALT in the first two weeks, followed by a gradual overall reduction by 24 weeks. These findings suggest that rapid weight loss secondary to significant caloric restriction might induce a transient deterioration in hepatic steatosis prior to an ultimate overall improvement.

scholarly journals O-B01 Role of Ursodeoxycholic acid in prevention of gallstones formation in bariatric patients: need to amend recent BOMSS guidelines

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Amit Sharma ◽  
Hari Nageswaran ◽  
Ahmed Saad ◽  
Ameet Patel ◽  
Lawrence Best
Keyword(s):  
Weight Loss ◽  
Placebo Group ◽  
Ursodeoxycholic Acid ◽  
Meta Analysis ◽  
Gallstone Formation ◽  
Controlled Trials ◽  
Number Needed To Treat ◽  
Cochrane Central Register ◽  
Rapid Weight Loss ◽  
Bariatric Patients

Abstract Background During rapid weight-loss phase following bariatric procedures, biliary cholesterol homeostasis is altered leading to increased propensity to gallstone formation. Incidence of gallstone formation following bariatric procedures is shown to be 10-38%. There is no consensus regarding its prevention and current BOMSS guidelines do not address this issue. This meta-analysis aims to pool high level evidence (RCTs) to assess efficacy of Ursodeoxycholic acid (UDCA) in reducing risk of gallstone formation in this cohort of patients and the need for revision of current guidelines. Methods A systematic literature search was performed using electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, PROSPERO and Google Scholar) in line with PRISMA guidelines. Only randomised controlled trials were included without restrictions on study language, year, status of publication and patient’s age. Meta-analysis was performed using Review Manager Software to calculate pooled risk ratios (RR) using random-effects model. Results Fifteen trials were included (3952 patients analysed, 2487 in UDCA and 1465 in placebo group). The overall rate of gallstone formation was 16.0% (6.4% in UDCA vs 31.4% in placebo group). Trials included various bariatric procedures (SG/RYGB/OAGB/AGB/Gastroplasty). UDCA dose ranged from 300 to 1200mg per day. UDCA significantly reduced the risk of post-operative gallstone formation (3952 patients, RR 0.24, 95% CI 0.16-0.37, p &lt; 0.0001). The absolute risk reduction and number needed to treat (NNT) were 25% and 4 respectively. Conclusions Oral Ursodeoxycholic acid treatment following restrictive bariatric surgical procedures significantly reduces the risks of gallstone formation. As such, its regular use in first 6 months (rapid weight-loss phase) can significantly reduce the risk of complications associated with gallstones. Such treatment would be cost effective and benefit 1 in 4 patients. There is significant evidence available on benefits of using UDCA in post-operative bariatric patients and that this should be added to the recent BOMSS guidelines.

The efficacy of meal replacement programs for weight loss

2020 ◽  
Vol 179 (1-2) ◽  
Author(s):  
Mohanad O. Alkhamash ◽  
Ruwayd A. Attar ◽  
Abdulaziz Y. Wafi ◽  
Hamed A. Almalki ◽  
Azza H. Gaafer ◽  
...  
Keyword(s):  
Weight Loss ◽  
Meal Replacement

scholarly journals Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT)

Diabetologia ◽  
2021 ◽  
Author(s):  
Wilma S. Leslie ◽  
Eman Ali ◽  
Leanne Harris ◽  
C. Martina Messow ◽  
Naomi T. Brosnahan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Weight Loss ◽  
Antihypertensive Medication ◽  
Intervention Group ◽  
Pressure Control ◽  
Negative Energy ◽  
Diabetes Remission ◽  
Rapid Weight Loss ◽  
Antihypertensive Medications ◽  
Total Diet

Abstract Aims/hypothesis Our aim was to evaluate the safety and efficacy of a planned therapeutic withdrawal of all antihypertensive and diuretic medications, on commencing a formula low-energy diet replacement, targeting remission of type 2 diabetes. Methods Post hoc analysis of changes in BP, antihypertensive medication prescriptions and symptoms during the initial total diet replacement phase was performed in the intervention arm of the Diabetes Remission Clinical Trial (n = 143) and in the subset (n = 69) who discontinued antihypertensive medications at the start of total diet replacement. The Counterweight-Plus total diet replacement provided about 3470 kJ/day (830 kcal) with automatic reductions in all nutrients, including sodium, to achieve marked negative energy balance and rapid weight loss over 12–20 weeks, with regular BP monitoring and an antihypertensive reintroduction protocol based on current clinical guidelines. Results Of 143 intervention group participants who commenced total diet replacement, 78 (55%) were on treatment for hypertension at baseline. The overall mean BP fell significantly from the start of total diet replacement (week 1) and was significantly lower at week 20, after total diet replacement finished, and also at 12 and 24 months. Of the 78 participants previously on treatment for hypertension, 65 (83%) stopped all antihypertensive and diuretic medications as per protocol, and four (5%) stopped some drugs. These 69 participants experienced no immediate (within the first week) change in BP, but their mean BP fell significantly from 9 weeks. No excessive rises in BP were recorded in individuals, but antihypertensive medications were reintroduced during total diet replacement to manage raised BP for 19/69 (27.5%) participants, mostly within the first 3–7 weeks, despite some weight loss. Reintroduction of antihypertensive medications was necessary for 5/19 participants previously on one drug, and for 14/19 previously on two or more drugs. Of the 69 who stopped antihypertensives, 19 (28%) remained off medications at 24 months. Among the 53 participants who achieved sustained remissions of diabetes at 24 months (with a mean weight loss of 11.4 kg), 31 had been previously treated for hypertension. Twenty-seven stopped medication at baseline, and 15/27 required reintroduction of antihypertensive medications. Mild to moderate dizziness, suggesting some postural hypotension, was reported during total diet replacement by 51 participants, 15 of whom had recorded dizziness at baseline prior to starting total diet replacement, with nine of these on antihypertensive or diuretic medications. Conclusions/interpretation Replacing antihypertensive medications with a 3470 kJ/day (830 kcal) diet to induce weight loss reduces BP substantially and may increase mild dizziness. It is safe to stop antihypertensives, but BP should be monitored regularly, particularly for those taking two or more antihypertensives, as over two-thirds will require reintroduction of some medications. Long-term support to maintain weight loss is vital. Trial registration ISRCTN registry, number 03267836. Graphical abstract

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