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Pre- and postnatal calorie restriction is associated with postnatal growth restriction, reduced circulating leptin concentrations, and perturbed energy balance. Hypothalamic regulation of energy balance demonstrates enhanced orexigenic (NPY, AgRP) and diminished anorexigenic (POMC, CART) neuropeptide expression (PN21), setting the stage for subsequent development of obesity in female Sprague-Dawley rats. Leptin replenishment during the early postnatal period (PN2-PN8) led to reversal of the hypothalamic orexigenic:anorexigenic neuropeptide ratio at PN21 by reducing only the orexigenic (NPY, AgRP), without affecting the anorexigenic (POMC, CART) neuropeptide expression. This hypothalamic effect was mediated via enhanced leptin receptor (ObRb) signaling that involved increased pSTAT3/STAT3 but reduced PTP1B. This was further confirmed by an increase in body weight at PN21 in response to intracerebroventricular administration of antisense ObRb oligonucleotides (PN2-PN8). The change in the hypothalamic neuropeptide balance in response to leptin administration was associated with increased oxygen consumption, carbon dioxide production, and physical activity, which resulted in increased milk intake (PN14) with no change in body weight. This is in contrast to the reduction in milk intake with no effect on energy expenditure and physical activity observed in controls. We conclude that pre- and postnatal calorie restriction perturbs hypothalamic neuropeptide regulation of energy balance, setting the stage for hyperphagia and reduced energy expenditure, hallmarks of obesity. Leptin in turn reverses this phenotype by increasing hypothalamic ObRb signaling (sensitivity) and affecting only the orexigenic arm of the neuropeptide balance.

Background: Little is known of the efficacy of telemedicine on the clinical outcomes of the high-risk group of non-alcoholic fatty liver disease (NAFLD) patients, such as those with obesity. This study aimed to determine the effects of telemedicine vs. usual care for the management of obese patients with NAFLD.Methods: Literature searches were performed from inception to 1st June 2021 in the following databases: Cochrane CENTRAL, ScienceDirect, PubMed, and Scopus. Prospective trials assessed the effects of telemedicine on obese patients with NAFLD were included. The outcomes of interest were alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride, high-density lipoprotein cholesterol levels, and body mass index, which were reported as weighted mean difference (WMD) with 95% confidence interval (CI).Results: Four studies were examined in the systematic review, one was excluded from the meta-analysis due to an inappropriate group-comparison. In all, 285 obese patients with NAFLD were included in the meta-analysis (70% of those received telemedicine intervention). The mean ages of the patients in the telemedicine and usual-care groups were 51.78 ± 5.91 and 47.30 ± 8.14 years, respectively. Telemedicine significantly decreased ALT levels compared with usual care (WMD = −18.93 U/L [95%CI: −25.97, −11.90]; I2 = 53.8%), and it significantly decreased AST levels (WMD = −10.24 U/L [95%CI: −13.43, −7.05]; I2 = 0.0%). However, telemedicine did not show significant benefits for the remaining outcomes.Conclusion: Compared with usual care, telemedicine significantly reduced the AST and ALT levels of obese patients with NAFLD. Further long-term studies with clinical endpoints are needed to determine the best characteristics of telemedicine and to confirm the benefits.Systematic Review Registration: PROSPERO [CRD42020207451].

Objective: Surgical resection is the mainstay treatment for colorectal liver metastasis. In unresectable cases, chemotherapy is used to transform the tumor into resectable lesions, with related concerns about toxicity to nontumoral liver parenchyma. Liver toxicity, including steatosis, steatohepatitis, and sinusoidal dilation, has been reported. However, these changes are difficult to histologically distinguish from non-alcoholic fatty liver disease, which is commonly found in populations and attributed mainly to metabolic syndrome. The aim of this study was to investigate the factors associated with liver injury in patients with colorectal liver metastasis. Methods: This retrospective study included patients who underwent hepatic resection for colorectal liver metastasis at Siriraj Hospital during the 2006 to 2013 study period. Patient demographic data, clinical characteristics, and histologic changes related to liver injury were collected and analyzed. Results: Ninety-two patients (50 men, 42 women) were included, with a mean age of 59.4 years (range: 48.5-70.3). Forty-four patients (47.8%) received preoperative chemotherapy (CMT). Incidence of liver injury was not significantly different between the CMT and non-CMT groups (65.9% vs. 62.5%; p=0.902). However, incidence of liver injury was significantly higher in obese patients than in non-obese patients (82.8% vs. 55.6%; p=0.022, odds ratio=3.95). In multivariate analysis, obesity (BMI ≥25 kg/m2) was the only factor significantly associated with liver injury in patients with colorectal liver metastasis. Conclusion: Of the ten factors evaluated for association in this study, including preoperative chemotherapy, obesity was the only factor found to be significantly associated with liver injury in patients with colorectal liver metastasis.