scholarly journals Effects of Behavioral Weight Loss and Metformin on Insulin-like Growth Factors in Cancer Survivors: A Randomized Trial

2021 ◽  
Author(s):  
Hsin-Chieh Yeh ◽  
Nisa M Maruthur ◽  
Nae-Yuh Wang ◽  
Gerald J Jerome ◽  
Arlene T Dalcin ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cancer Survivors ◽  
Mean Difference ◽  
Molar Ratio ◽  
Controlled Clinical Trial ◽  
Behavioral Weight Loss ◽  
Weight Changes ◽  
Trial Duration ◽  
Directed Group ◽  
Increased Risk

Abstract Context Higher levels of insulin-like growth factor-1 (IGF-1) are associated with increased risk of cancers and higher mortality. Therapies that reduce IGF-1 have considerable appeal as means to prevent recurrence. Design Randomized, 3-parallel-arm controlled clinical trial. Interventions and Outcomes Cancer survivors with overweight or obesity were randomized to 1) self-directed weight loss (comparison), 2) coach-directed weight loss, or 3) metformin treatment. Main outcomes were changes in IGF-1 and IGF-1:IGFBP3 molar ratio at six months. The trial duration was 12 months. Results Of the 121 randomized participants, 79% were women, 46% were African Americans, and the mean age was 60 years. At baseline, the average BMI was 35 kg/m 2; mean IGF-1 was 72.9 (SD, 21.7) ng/ml; and mean IGF1:IGFBP3 molar ratio was 0.17 (SD, 0.05). At 6 months, weight changes were -1.0% (p=0.07), −4.2% (p<0.0001), and -2.8% (p<0.0001) in self-directed, coach-directed, and metformin groups, respectively. Compared to the self-directed group, participants in metformin had significant decreases on IGF-1 (mean difference in change: -5.50 ng/ml, p=0.02) and IGF1:IGFBP3 molar ratio (mean difference in change: -0.0119, p=0.011) at 3 months. The significant decrease of IGF-1 remained in participants with obesity at 6 months (mean difference in change: -7.2 ng/ml; 95% CI: -13.3 to -1.1), but not in participants with overweight (p-for interaction=0.045). There were no significant differences in changes between the coach-directed and self-directed groups. There were no differences in outcomes at 12 months. Conclusions In cancer survivors with obesity, metformin may have a short-term effect on IGF-1 reduction that wanes over time.

scholarly journals Changes in Dietary Intake After Metformin Treatment and Behavioral Weight Loss Intervention in Overweight or Obese Cancer Survivors: Results from a Randomized Clinical Trial (P05-029-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Zhongyu Li ◽  
Noel Mueller ◽  
Juraschek Stephen ◽  
Hsin-Chieh Yeh ◽  
Lawrence Appel ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cancer Survivors ◽  
Dietary Fiber ◽  
Food Consumption ◽  
Metformin Treatment ◽  
Weight Loss Intervention ◽  
Behavioral Weight Loss ◽  
Directed Group ◽  
Behavioral Weight Loss Intervention ◽  
Risk Of Cancer

Abstract Objectives Metformin and behavioral weight loss are postulated to lower the risk of cancer development and recurrence in overweight/obese individuals. Few studies have compared dietary changes longitudinally associated with these interventions. This study aimed to investigate the effects of metformin treatment and coach-directed behavioral weight loss intervention on overweight/obese cancer survivors’ food consumption, with an emphasis on fruits, vegetables, fiber, and fat intakes. Methods Overweight and obese cancer survivors enrolled in the SPIRIT trial (n = 121) were randomized into three arms consisting of self-directed weight loss (control), coach-directed weight loss and metformin treatment. Fruit, vegetable and fat screeners were used to assess the diet of the participants at baseline, 3-month, 6-month, and 12-month visit. Linear regression models and Generalized Estimated Equations were performed in STATA 15.1 to analyze the associations between interventions and food consumption throughout the study. Results Groups did not differ by sex (79% female), race (45% black) or age (mean 60 years). Metformin treatment was associated with decreased dietary fiber intake versus self-directed group (difference in slope β = −0.13, 95%CI: −0.01, −0.25; P = 0.04) and versus coach-directed group (−0.130, 95%CI: −0.02, −0.24; P = 0.02). After adjusting for baseline intake, participants assigned to metformin treatment consumed less dietary fiber daily than did participants in the self-directed (−2.0 grams, 95%CI: −0.47, −3.53; P = 0.01) and coach directed groups (−1.54 grams, 95%CI: −0.12, −2.95; P = 0.03) at the 12-month visit. Fruit and vegetable servings also decreased among participants in the metformin group versus non-metformin groups (difference at 12 months = −0.47 servings, 95%CI: 0.00, −0.94; P = 0.05). Coach-directed weight loss reduced % calories from fat compared to self-directed (−1.5% P = 0.03). Conclusions Metformin treatment in overweight/obese cancer survivors was associated with reduced intake of fruits, vegetables, and dietary fiber. The unintended and negative changes of diet that could result in negative impacts on health in metformin users should be noticed in clinical practices and deserve further research. Funding Sources Maryland Cigarette Restitution Funds and SKCCC. Supporting Tables, Images and/or Graphs

scholarly journals Effects of a Behavioral Weight Loss Intervention and Metformin Treatment on Serum Urate: Results from a Randomized Clinical Trial

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2673
Author(s):  
Jiun-Ruey Hu ◽  
Hsin-Chieh Yeh ◽  
Noel T. Mueller ◽  
Lawrence J. Appel ◽  
Edgar R. Miller ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cancer Survivors ◽  
Randomized Trial ◽  
Controlled Trial ◽  
Serum Urate ◽  
The Self ◽  
Metformin Treatment ◽  
Behavioral Weight Loss ◽  
Directed Group ◽  
Adult Cancer Survivors

Background: Lower body mass index (BMI) has been associated with lower serum urate (SU), but only in observational studies. We sought to determine the effects of behavioral weight loss and metformin treatment on SU in a randomized trial. Methods and Findings: The Survivorship Promotion In Reducing IGF-1 Trial (SPIRIT) was a parallel three-arm randomized controlled trial of overweight/obese adult cancer survivors without gout at a single center in Maryland, United States. Participants were randomized to: (1) coach-directed weight loss (behavioral telephonic coaching), (2) metformin (up to 2000 mg daily), or (3) self-directed weight loss (informational brochures; reference group). SU and BMI were assessed at baseline and at 3, 6, and 12 months post-randomization. The 121 participants had a mean ± standard deviation (SD) age of 60 ± 9 years, 79% were female, and 45% were Black. At baseline, BMI was 35 ± 5 kg/m2, and SU was 5.6 ± 1.3 mg/dL. Compared to the self-directed group, at 12 months, the coach-directed group reduced BMI by 0.9 kg/m2 (95% confidence interval (CI): −1.5, −0.4) and metformin reduced BMI by 0.6 kg/m2 (95% CI: −1.1, −0.1). However, compared to the self-directed group, the coach-directed group unexpectedly increased SU by 0.3 mg/dL (95% CI: 0.05, 0.6), and metformin non-significantly increased SU by 0.2 mg/dL (95% CI: −0.04, 0.5); these effects were attenuated when analyses included change in estimated glomerular filtration rate (eGFR). Conclusions: In this randomized trial of cancer survivors without gout, reductions in BMI either increased or did not change SU, potentially due to effects on eGFR. These results do not support a focus on BMI reduction for SU reduction; however, long-term studies are needed. ClinicalTrials.gov Registration: NCT02431676.

scholarly journals Association of gene polymorphisms with body weight changes in prediabetic patients

2021 ◽  
Author(s):  
Farida V. Valeeva ◽  
Mariya S. Medvedeva ◽  
Kamilya B. Khasanova ◽  
Elena V. Valeeva ◽  
Tatyana A. Kiseleva ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Carbohydrate Metabolism ◽  
Dietary Intervention ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Diet Therapy ◽  
Weight Changes ◽  
Body Weight Changes ◽  
Increased Risk

Abstract Background: Recent research has demonstrated that Type 2 Diabetes (T2D) risk is influenced by a number of common polymorphisms, including rs17782313 MC4R, rs1801282 PPARG, and rs7903146 TCF7L2. Knowledge of the association between these SNPs (single nucleotide polymorphism) and body weight changes in different forms of prediabetes treatment is still limited. The aim of this study was to investigate the association of polymorphisms within the MC4R, PPARG, TCF7L2 genes on the risk of carbohydrate metabolism disorders and body composition changes in overweight or obese patients with early carbohydrate metabolism disorders. Methods and Results: From 327 patients, a subgroup of 81 prediabetic female patients (48.7±14.8 years) of Eastern European descent participated in a 3-month study comprised of diet therapy or diet therapy accompanied with metformin treatment. Bioelectrical impedance analysis and genotyping of rs17782313 MC4R, rs7903146 TCF7L2, rs1801282 PPARG were performed. The MC4R CC and TCF7L2 TT genotypes were associated with increased risk of T2D (OR=1.46, p=0.05 and OR=2.47, p=0.006, respectively). PPARG СС homozygotes experienced increased weight loss; however, no additional improvements were experienced with the addition of metformin. MC4R ТТ homozygotes who took metformin alongside dietary intervention experienced increased weight loss and reductions in fat mass (p<0.05).Conclusions: We confirmed the previous association of the MC4R C and TCF7L2 T alleles with T2D risk. The obesity-protective alleles (MC4R T and PPARG C) were positively associated with weight loss efficiency.

Abstract MP16: A Behavioral Weight-loss Intervention, But Not Metformin, Decreases A Marker Of Gut Barrier Permeability In Adult Cancer Survivors With Overweight Or Obesity

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Curtis Tilves ◽  
Hsin-Chieh Yeh ◽  
Nisa Maruthur ◽  
Stephen Juraschek ◽  
Edgar R Miller ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cancer Survivors ◽  
Weight Loss Intervention ◽  
Fiber Intake ◽  
Behavioral Weight Loss ◽  
Gut Permeability ◽  
Gut Barrier ◽  
Adult Cancer Survivors ◽  
Behavioral Weight Loss Intervention ◽  
Overweight Or Obesity

Background: Serum lipopolysaccharide-binding protein (LBP), a surrogate biomarker for gut barrier permeability, is higher in adults with obesity and type 2 diabetes and may trigger inflammation. It is unknown whether a behavioral weight loss intervention or metformin — current first-line treatments for obesity or diabetes — can reduce gut permeability. Objective: To determine the effects of behavioral weight loss intervention or metformin, compared to self-directed weight loss, on serum LBP. Methods: SPIRIT was a parallel-arm, randomized trial of adult cancer survivors with overweight or obesity. Participants were randomized to a self-directed weight loss (control), metformin, or coach-directed (healthy diet/physical activity) weight loss arm. Of 121 randomized participants, a random subset (n=88) had LBP measured at baseline, 6-months, and 12-months post intervention. The effects of interventions on LBP over time were assessed using generalized estimating equations (GEE). Models were further adjusted for absolute change in fiber intake to investigate potential mediation. Results: Arms were balanced by sex (83% female), race (48% black), and age (mean 60 years). There were no between-group differences in LBP at baseline (median 42.3 μg/dL). Over the 12-month period, only the coach-directed and metformin arms showed weight loss (both mean -3% from baseline). Similar increases in LBP were seen in the self-directed and metformin arms, while a decrease in LBP was seen in the coach-directed arm ( figure ). In GEE models, the difference in slopes between the coach vs. self-directed arms was statistically significant (β=-1.67, p=0.037), but not between the metformin and self-directed arms (β=0.003, p=0.997). The effect of coach-directed weight loss on LBP was similar by sex and race and was not mediated by changes in fiber intake. Conclusion: The manner of weight loss can differentially impact gut permeability and thus subsequent exposure to proinflammatory microbial products.

Abstract P373: Changes in Adipokines with Weight Loss and Regain in a 24-Month Behavioral Weight Loss Study: The SMART Trial

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Lora E Burke ◽  
Erica Ambeba ◽  
Lei Ye ◽  
Mindi Styn ◽  
Sushama Acharya ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Fat ◽  
Behavioral Treatment ◽  
Weight Regain ◽  
Percent Body Fat ◽  
Behavioral Weight Loss ◽  
Healthy Behaviors ◽  
Increased Risk ◽  
Tnf Α ◽  
Over Time

Background: Weight regain commonly occurs in many adults who intentionally lose weight. Failure to maintain weight loss can lead to an increased risk for chronic diseases, such as type 2 diabetes and atherosclerosis. A potential mechanism behind the increased risk includes the increased secretion of pro-inflammatory adipokines (TNF-α and IL-6) and the decreased secretion of anti-inflammatory adipokines (adiponectin and IL-10). Objectives: We conducted an ancillary study to a 24-month behavioral weight loss trial. The purpose of the study was to examine the association between weight loss and regain and changes in body fat from baseline to 24 months and changes in TNF-α, IL-6, IL-10, and adiponectin. Methods: The analysis included a subsample of participants (n=67) from the SMART Trial who lost and regained at least 10 lbs during the 24-month trial. All participants received standard behavioral treatment for weight loss in group sessions during the first 18 months beginning with weekly sessions, which decreased in frequency over time. Linear mixed modeling was used to examine the association of percent changes in weight and body fat with percent changes in adipokines. Results: The sample was 81% female and 87% White with a mean (±SD) age of 48.4±7.34 years. At entry into study the mean weight was 96.4±15.6 kg and mean BMI was 34.5±4.35 kg/m 2 . Percent body fat was on average 42.1±6.13%. Mean weight change from baseline to six months was -10.7±5.19% and from baseline to 24 months was -3.34±6.66% while mean change in percent body fat was -8.07±11.6% from baseline to six months and -3.03±9.57% from baseline to 24 months. Weight loss over time was significantly associated with an increase in adiponectin [b(se)=-1.7(0.34), p<.0001] and a decrease in IL-6 [b(se)=1.26(0.49), p=0.01]. A similar pattern of associations was observed for reduction in body fat over time with an increase for adiponectin [b(se)=-0.76(0.19), p<.0001] and a decrease for IL-6 [b(se)=0.68(0.25), p=.006]. There were no significant associations found for either weight loss or change in percent body fat with change in IL-10 [weight: b(se)=0.51(0.54), p=.35; body fat: b(se)=0.43(0.28), p=.12] and TNF-alpha [weight: b(se)=0.35(0.44), p=.43; body fat: b(se)=0.19(0.24), p=.43] over 24-months. Conclusion: Weight loss and reduction in body fat were significantly associated with improvements in two of the adipokines. However, by 24 months, when weight regain occurred, those changes were attenuated. Implementing strategies that support healthy behaviors and sustained weight loss can help prevent a state of chronic systemic inflammation and prevent adverse health outcomes.

Anthropometric change among breast cancer survivors provided a behaviorally based weight loss intervention.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9591-9591
Author(s):  
Kim Dittus ◽  
Janice Bunn ◽  
Zachary Paul ◽  
Jean Harvey-Berino
Keyword(s):  
Breast Cancer ◽  
Weight Loss ◽  
Resistance Training ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Fat Free Mass ◽  
Weight Loss Intervention ◽  
Online Chat ◽  
Supervised Exercise ◽  
Increased Risk

9591 Background: A majority of women with breast cancer are overweight or obese. Weight gain and loss of lean body mass often accompany chemotherapy. Excess weight is associated with increased risk of recurrence and decreased overall survival. Our aim was to determine the feasibility of a behavioral based weight loss intervention for breast cancer survivors who did and did not receive chemotherapy and to determine if additional resistance training enhances weight loss. Methods: Women with a BMI of 26-50 and stage I-III breast cancer were recruited for a 6 mo weight loss program which included individualized calorie reduction, 300 min of weekly exercise and a weekly online “chat”. Resistance training consisted of 2x/wk 30 min resistance exercises. Anthropometric measures; kcal measured by 24-hr recalls; and physical activity measured by accelerometer were assessed. Results: Seventy-four women were recruited and 52 completed post testing. The average age was 54 and average time since diagnosis was 33 mos. The average BMI at study initiation was 33 kg/m2. Overall the survivors lost 5.9 kg (6.7 % of baseline weight). Based on paired t-test evaluation weight, BMI and % body fat were all significantly lower after the intervention for completers and when using intent to treat analysis. There were no differences between groups for anthropometric change. The kcal deficit was significant for the chemo + wt loss + resistance (274kcal) and the no chemo (327kcal) groups but not the chemo+ wt loss group (196kcal). Exercise did not significantly increase between the baseline and post testing. Conclusions: Breast cancer survivors lose significant amounts of weight with a standard behaviorally based weight loss intervention. Receipt of chemotherapy did not influence ability to lose weight. Resistance training may increase weight loss while decreasing amount of fat free mass lost. Supervised exercise may be needed to achieve increases in exercise. Clinical trial information: NCT01482702. [Table: see text]

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