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1. Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI studyResearch in context

Author

Kausik K. Ray, Inaam Haq, Aikaterini Bilitou, Marius C. Manu, Annie Burden, Carlos Aguiar, Marcello Arca, Derek L. Connolly, Mats Eriksson, Jean Ferrières, Ulrich Laufs, Jose M. Mostaza, David Nanchen, Ernst Rietzschel, Timo Strandberg, Hermann Toplak, Frank L.J. Visseren, and Alberico L. Catapano

Subjects
Cardiovascular disease, LDL cholesterol, High cardiovascular risk, Lipid-lowering therapy, Real-world evidence, Cohort study, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: European data pre-2019 suggest statin monotherapy is the most common approach to lipid management for preventing cardiovascular (CV) events, resulting in only one-fifth of high- and very high-risk patients achieving the 2019 ESC/EAS recommended low-density lipoprotein cholesterol (LDL-C) goals. Whether the treatment landscape has evolved, or gaps persist remains of interest. Methods: Baseline data are presented from SANTORINI, an observational, prospective study that documents the use of lipid-lowering therapies (LLTs) in patients ≥18 years at high or very high CV risk between 2020 and 2021 across primary and secondary care settings in 14 European countries. Findings: Of 9602 enrolled patients, 9044 with complete data were included (mean age: 65.3 ± 10.9 years; 72.6% male). Physicians reported using 2019 ESC/EAS guidelines as a basis for CV risk classification in 52.0% (4706/9044) of patients (overall: high risk 29.2%; very high risk 70.8%). However, centrally re-assessed CV risk based on 2019 ESC/EAS guidelines suggested 6.5% (308/4706) and 91.0% (4284/4706) were high- and very high-risk patients, respectively. Overall, 21.8% of patients had no documented LLTs, 54.2% were receiving monotherapy and 24.0% combination LLT. Median (interquartile range [IQR]) LDL-C was 2.1 (1.6, 3.0) mmol/L (82 [60, 117] mg/dL), with 20.1% of patients achieving risk-based LDL-C goals as per the 2019 ESC/EAS guidelines. Interpretation: At the time of study enrolment, 80% of high- and very high-risk patients failed to achieve 2019 ESC/EAS guidelines LDL-C goals. Contributory factors may include CV risk underestimation and underutilization of combination therapies. Further efforts are needed to achieve current guideline-recommended LDL-C goals. Trial registration: ClinicalTrials.gov Identifier: NCT04271280. Funding: This study is funded by Daiichi Sankyo Europe GmbH, Munich, Germany.

Published
2023
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2. Association of branched-chain amino acids with mortality-the Ludwigshafen Risk and Cardiovascular Health (LURIC) study

Author

Angela P. Moissl, Stefan Lorkowski, Andreas Meinitzer, Stefan Pilz, Hubert Scharnagl, Graciela E. Delgado, Marcus E. Kleber, Bernhard K. Krämer, Burkert Pieske, Martin R. Grübler, Helmut Brussee, Dirk von Lewinski, Hermann Toplak, Astrid Fahrleitner-Pammer, Winfried März, and Andreas Tomaschitz

Subjects
Health sciences, Cardiovascular medicine, Association analysis, Science
Abstract

Summary: Branched-chain amino acids (BCAAs) are effectors of metabolic diseases, but their impact on mortality is largely unknown. We investigated the association of BCAA with risk factors and mortality in 2,236 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study using linear and Cox regression. Adiponectin, hemoglobin, C-peptide, hemoglobin A1c, and homoarginine showed the strongest association with BCAA concentration (all p

Published
2023
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3. Measuring subcutaneous fat thickness using skinfold calipers vs. high-resolution B-scan ultrasonography in healthy volunteers: A pilot study

Author

Hannes Nösslinger, Ewald Mair, Hermann Toplak, and Marlies Hörmann-Wallner

Subjects
Skinfold thickness, Ultrasonography, Subcutaneous fat, Adipose tissue, Adult, Nutrition. Foods and food supply, TX341-641
Abstract

Summary: Background & Aims: Measuring the thickness of skinfolds using calipers is a frequently used method for determining body fat in clinical practice. It is inexpensive and time saving compared to other methods and can be learned quickly. The aim of this study is to compare skinfold measurements made using calipers against measurements obtained using high-resolution ultrasonography (USG). Methods: A monocentric cross-sectional observational pilot study with 69 normal-weight volunteer participants aged between 18 and 80 years (women: n = 36, men: n = 33). Subcutaneous fat thickness was measured at five different sites (chest, abdomen, thighs, triceps, and back) using calipers and via USG.The mean values from the calipers and the USG measurements were examined for statistical significance using the paired t-test, and the Bland–Altman plot was used to compare the two methods. We then performed an agreement analysis by calculating the percentage of the differences less than or equal to 1 mm between the measurements made using calipers and those obtained via USG. Results: From the Bland–Altman analysis, the best matches among measurements for the female subjects were the skinfolds on the triceps (ULoA: 4.6 mm, mean: −0.1 mm, LLoA: −4.8 mm), the back (ULoA: 3.9 mm, mean: −0.2 mm, LLoA: −4.4 mm), and on the chest (ULoA: 5.9 mm, mean: 0.6 mm, LLoA: −4.6 mm). In contrast, for the male subjects, the best matches were the skinfolds on the triceps (ULoA: 3.3 mm, mean: −0.3 mm, LLoA −4.0 mm), the back (ULoA 3.5 mm, mean −0.3 mm, LLoA −4.0 mm), and the thigh (ULoA 2.2 mm, mean −0.5 mm, LLoA −3.2 mm).The best agreement for women was obtained with the measurements of the chest fold (47.2%), followed by the measurements of the back fold (38.9%). For men, it was the measurements of the thigh fold (63.6%), followed by the measurements of the triceps (51.5%) and back fold (51.5%). Conclusion: The agreement between skinfold measurements made using calipers and ultrasonography depends on the skinfold thickness and the localization of the measurement, with gender-based differences.

Published
2022
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4. Evaluation of contemporary treatment of high- and very high-risk patients for the prevention of cardiovascular events in Europe – Methodology and rationale for the multinational observational SANTORINI study

Author

Kausik K. Ray, Inaam Haq, Aikaterini Bilitou, Carlos Aguiar, Marcello Arca, Derek L. Connolly, Mats Eriksson, Jean Ferrières, Per Hildebrandt, Ulrich Laufs, Jose M. Mostaza, David Nanchen, Ernst Rietzschel, Timo Strandberg, Hermann Toplak, Frank L.J. Visseren, and Alberico L. Catapano

Subjects
Cardiovascular disease, LDL cholesterol, High cardiovascular risk, Lipid-lowering therapy, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background and aims: Clinical practice before 2019 suggests a substantial proportion of high and very high CV risk patients taking lipid-lowering therapy (LLT) would not achieve the new LDL-C goals recommended in the 2019 ESC/EAS guidelines (

Published
2021
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5. Underestimation of resting metabolic rate using equations compared to indirect calorimetry in normal-weight subjects: Consideration of resting metabolic rate as a function of body composition

Author

Hannes Nösslinger, Ewald Mair, Hermann Toplak, and Marlies Hörmann-Wallner

Subjects
Basal metabolism, Energy metabolism, Body composition, Calorimetry, Indirect, Adult, Nutrition. Foods and food supply, TX341-641
Abstract

Summary: Background & aims: Resting metabolic rate (RMR) can either be estimated using specific equations or measured with indirect calorimetry (iCal). The calculation formulas usually exclude body composition. In addition to age, height, weight, sex and disease, fat-free mass (FFM) and fat mass (FM), in particular, influence energy expenditure. The aim of the present study was to compare the difference between calculated RMR using various predictive formulas reported in the literature and the values from measured iCal. Additionally, differing muscle mass and FM were considered in the calculations. Our hypothesis was that the accuracy of the calculation formulas depends on body constitution. Methods: This monocentric exploratory pilot study with an observational cross-sectional design included 69 healthy normal-weight adults. Participants were assigned to groups depending on constitution (slender, athletic, full slender). RMR was estimated with a set of 12 clinically relevant predictive equations. Results: The comparison of the calculated and measured values showed that the prevalent equations under-rather than overestimated the RMR. The equation from the World Health Organization (WHO) had the most accurate prediction range, from 90% to 110% of the RMR measured by iCal, followed by the Harris–Benedict formula and its modifications according to Roza–Shizgal and Mifflin. The agreement between predicting formulas and measured RMR improved in the group with higher fat mass. Conclusions: Body composition has a significant influence on RMR, mainly through muscle mass. The equations used correlated well with iCal in only 40%–60% of the studied population. Measurements and calculations varied considerably for subjects with greater muscle mass, whereas they were more consistent for subjects with greater FM. Increased emphasis should be placed on the measurement of RMR using iCal.

Published
2021
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6. The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications

Author

Gema Frühbeck, Luca Busetto, Dror Dicker, Volkan Yumuk, Gijs H. Goossens, Johannes Hebebrand, Jason G.C. Halford, Nathalie J. Farpour-Lambert, Ellen E. Blaak, Euan Woodward, and Hermann Toplak

Subjects
Adiposity, Dysfunctional adipose tissue, Noncommunicable diseases, Comorbidities, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO’s proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage.

Published
2019
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7. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care

Author

Dominique Durrer Schutz, Luca Busetto, Dror Dicker, Nathalie Farpour-Lambert, Rachel Pryke, Hermann Toplak, Daniel Widmer, Volkan Yumuk, and Yves Schutz

Subjects
Obesity, Overweight, Primary care, GPs, Management, Behavioural therapy, Motivational interviewing, Conservative treatment, Bariatric/metabolic surgery, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs’ education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5–10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).

Published
2019
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8. Short-Term Treatment with Alirocumab, Flow-Dependent Dilatation of the Brachial Artery and Use of Magnetic Resonance Diffusion Tensor Imaging to Evaluate Vascular Structure: An Exploratory Pilot Study

Author

Thomas Metzner, Deborah R. Leitner, Gudrun Dimsity, Felix Gunzer, Peter Opriessnig, Karin Mellitzer, Andrea Beck, Harald Sourij, Tatjana Stojakovic, Hannes Deutschmann, Winfried März, Ulf Landmesser, Marianne Brodmann, Gernot Reishofer, Hubert Scharnagl, Hermann Toplak, and Günther Silbernagel

Subjects
alirocumab, PCSK9, lipids, magnetic resonance, endothelial function, ultrasound, Biology (General), QH301-705.5
Abstract

Background: Short-term effects of alirocumab on vascular function have hardly been investigated. Moreover, there is a scarce of reliable non-invasive methods to evaluate atherosclerotic changes of the vasculature. The ALIROCKS trial was performed to address these issues using standard ultrasound-based procedures and a completely novel magnetic resonance-based imaging technique. Methods: A total of 24 patients with an indication for treatment with PCSK9 antibodies were recruited. There were 2 visits to the study site, the first before initiation of treatment with alirocumab and the second after 10 weeks of treatment. The key outcome measures included the change of carotid vessel wall fractional anisotropy, a novel magnetic resonance-based measure of vascular integrity, and the changes of carotid intima-media thickness and flow-dependent dilatation of the brachial artery measured with ultrasound. Results: A total of 19 patients completed the trial, 2 patients stopped treatment, 3 patients did not undergo the second visit due to the COVID pandemic. All of them had atherosclerotic vascular disease. Their mean (standard deviation) LDL-cholesterol concentration was 154 (85) mg/dL at baseline and was reduced by 76 (44) mg/dL in response to alirocumab treatment (p < 0.001, n = 19). P-selectin and vascular endothelial growth factors remained unchanged. Flow-dependent dilatation of the brachial artery (+41%, p = 0.241, n = 18), carotid intima-media thickness (p = 0.914, n = 18), and fractional anisotropy of the carotid artery (p = 0.358, n = 13) also did not significantly change. Conclusion: Despite a nominal amelioration for flow-dependent dilatation, significant effects of short-term treatment with alirocumab on vascular function were not detectable. More work would be needed to evaluate, whether fractional anisotropy may be useful in clinical atherosclerosis research.

Published
2022
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9. Effects of Alirocumab on Triglyceride Metabolism: A Fat-Tolerance Test and Nuclear Magnetic Resonance Spectroscopy Study

Author

Thomas Metzner, Deborah R. Leitner, Karin Mellitzer, Andrea Beck, Harald Sourij, Tatjana Stojakovic, Gernot Reishofer, Winfried März, Ulf Landmesser, Hubert Scharnagl, Hermann Toplak, and Günther Silbernagel

Subjects
alirocumab, PCSK9, lipids, nuclear magnetic resonance spectroscopy, fat-tolerance test, Biology (General), QH301-705.5
Abstract

Background: PCSK9 antibodies strongly reduce LDL cholesterol. The effects of PCSK9 antibodies on triglyceride metabolism are less pronounced. The present study aimed to investigate in detail the effects of alirocumab on triglycerides, triglyceride-rich lipoproteins, and lipase regulators. Methods: A total of 24 patients with an indication for treatment with PCSK9 antibodies were recruited. There were two visits at the study site: the first before initiation of treatment with alirocumab and the second after 10 weeks of treatment. Fat-tolerance tests, nuclear magnetic resonance spectroscopy, and enzyme-linked immunosorbent assays were performed to analyze lipid metabolism. Results: A total of 21 participants underwent the first and second investigation. Among these, two participants only received alirocumab twice and 19 patients completed the trial per protocol. All of them had atherosclerotic vascular disease. There was no significant effect of alirocumab treatment on fasting triglycerides, post-prandial triglycerides, or lipoprotein-lipase regulating proteins. Total, large, and small LDL particle concentrations decreased, while the HDL particle concentration increased (all p < 0.001). Mean total circulating PCSK9 markedly increased in response to alirocumab treatment (p < 0.001). Whereas PCSK9 increased more than three-fold in all 19 compliant patients, it remained unchanged in those two patients with two injections only. Conclusion: Significant effects of alirocumab on triglyceride metabolism were not detectable in the ALIROCKS trial. The total circulating PCSK9 concentration might be a useful biomarker to differentiate non-adherence from non-response to PCSK9 antibodies.

Published
2022
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10. Sarcopenic Obesity: Time to Meet the Challenge

Author

Rocco Barazzoni, Stephan Bischoff, Yves Boirie, Luca Busetto, Tommy Cederholm, Dror Dicker, Hermann Toplak, Andre Van Gossum, Volkan Yumuk, and Roberto Vettor

Subjects
Obesity, Sarcopenia, Skeletal muscle, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social, and multidisciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures, and cancer as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability, and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term ‘sarcopenic obesity' has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification, and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria, and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has a strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.

Published
2018
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11. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Author

Luca Busetto, Dror Dicker, Carmil Azran, Rachel L. Batterham, Nathalie Farpour-Lambert, Martin Fried, Jøran Hjelmesæth, Johann Kinzl, Deborah R. Leitner, Janine M. Makaronidis, Karin Schindler, Hermann Toplak, and Volkan Yumuk

Subjects
European guidelines, Obesity management, Bariatric surgery, Nutrition, Diabetes mellitus, Sleep apnoea, Hypertension, Pregnancy, Psychological aspects, Weight maintenance, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

Published
2017
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12. Obesity and Type 2 Diabetes: Two Diseases with a Need for Combined Treatment Strategies - EASO Can Lead the Way

Author

Deborah R. Leitner, Gema Frühbeck, Volkan Yumuk, Karin Schindler, Dragan Micic, Euan Woodward, and Hermann Toplak

Subjects
Obesity, Diabetes, Diabesity, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Obesity is a chronic metabolic disease affecting adults and children worldwide. It has become one of the leading causes of death, as obesity is known to be the main risk factor for a number of non-communicable diseases, in particular type 2 diabetes. This close relationship led to the connotation ‘diabesity', highlighting the fact that the majority of individuals with diabetes are overweight or obese. Until today the BMI is still used to classify overweight and obesity. Since reduced muscle mass is highly prevalent throughout the BMI range, the measurement of body composition is strongly recommended. Moreover, it is essential for monitoring the course of weight reduction, which is part of every effective anti-obesity treatment. Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention (diet and exercise), pharmacotherapy, or bariatric surgery. However, not all of these strategies are suitable for all patients, and any further needs should be considered. Besides, attention should also be drawn to concomitant therapies. These therapies may promote additional weight gain and further trigger the deterioration of blood glucose control. Thus, therapeutic strategies are warranted, which can be easily used for the management of obese patients with type 2 diabetes to achieve their glycemic and weight loss goals.

Published
2017
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13. A Proposal of the European Association for the Study of Obesity to Improve the ICD-11 Diagnostic Criteria for Obesity Based on the Three Dimensions Etiology, Degree of Adiposity and Health Risk

Author

Johannes Hebebrand, Jens-Christian Holm, Euan Woodward, Jennifer Lyn Baker, Ellen Blaak, Dominique Durrer Schutz, Nathalie J. Farpour-Lambert, Gema Frühbeck, Jason G.C. Halford, Lauren Lissner, Dragan Micic, Dana Mullerova, Gabriela Roman, Karin Schindler, Hermann Toplak, Tommy L.S. Visscher, and Volkan Yumuk

Subjects
ICD-10, ICD-11, Obesity class, Overweight, Pre-obesity, Diagnostic classification, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Diagnostic criteria for complex medical conditions caused by a multitude of both genetic and environmental factors should be descriptive and avoid any attribution of causality. Furthermore, the wording used to describe a disorder should be evidence-based and avoid stigmatization of the affected individuals. Both terminology and categorizations should be readily comprehensible for healthcare professionals and guide clinical decision making. Uncertainties with respect to diagnostic issues and their implications may be addressed to direct future clinical research. In this context, the European Association of the Study of Obesity (EASO) considers it an important endeavor to review the current ICD-11 Beta Draft for the definition of overweight and obesity and to propose a substantial revision. We aim to provide an overview of the key issues that we deem relevant for the discussion of the diagnostic criteria. We first discuss the current ICD-10 criteria and those proposed in the ICD 11 Beta Draft. We conclude with our own proposal for diagnostic criteria, which we believe will improve the assessment of patients with obesity in a clinically meaningful way.

Published
2017
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15. European Guidelines for Obesity Management in Adults

Author

Volkan Yumuk, Constantine Tsigos, Martin Fried, Karin Schindler, Luca Busetto, Dragan Micic, Hermann Toplak, and for the Obesity Management Task Force of the European Association for the Study of Obesity

Subjects
European guidelines, Obesity management, Multidisciplinary, Primary care, OMTF, COMs, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.

Published
2015
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19. An EASO Position Statement on Multidisciplinary Obesity Management in Adults

Author

Volkan Yumuk, Gema Frühbeck, Jean Michel Oppert, Euan Woodward, and Hermann Toplak

Subjects
Statement, Obesity management, OMTF, Weight loss, Multidisciplinary, Treatment, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Obesity has proven to be a gateway to ill health. It has already reached epidemic proportions becoming one of the leading causes of death and disability in Europe and world-wide. Obesity plays a central role in the development of a number of risk factors and chronic diseases like hypertension, dyslipidaemia and type 2 diabetes mellitus inducing cardiovascular morbidity and mortality. Therefore weight management plays a central role in controlling the respective risk factors and their consequences. Obesity is a complex condition of multifactorial origin. Biological but also psychological and social factors interfere to lead to excess body weight and its deleterious outcomes. Obesity management cannot focus any more only on weight (and BMI) reduction. More attention is to be paid to waist circumference (or waist-to-hip ratio, especially in females), the improvement in body composition (measured with body composition tracking systems like BOD POD, dual energy X-ray absorptiometry or bioelectrical impedance analysis) which is focusing on ameliorating or maintaining fat-free mass and decreasing fat mass. Management of co-morbidities, improving quality of life and well-being of obese patients are also included in treatment aims. This statement emphasises the importance of a comprehensive approach to obesity management.

Published
2014
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21. Diabetes mellitus and co-morbid depression: treatment with milnacipran results in significant improvement of both diseases (results from the Austrian MDDM study group)

Author

Heidemarie Abrahamian, Peter Hofmann, Rudolf Prager, and Hermann Toplak

Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Neurology. Diseases of the nervous system, RC346-429
Abstract

Heidemarie Abrahamian1, Peter Hofmann2, Rudolf Prager1, Hermann Toplak313rd Medical Department, General Hospital Hietzing with Neurological Center Rosenhuegel and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Vienna, Austria; 2Department of Psychiatry, University Hospital, Graz, Austria; 3Department of Internal Medicine, University Hospital, Graz, AustriaAbstract: Co-morbid depression is common in patients with diabetes mellitus and has a negative impact on diabetes self-care, adherence to treatment and the development of complications. Effective treatment of depression has been associated with improvement in metabolic parameters. We evaluated the feasibility of a two question screen for co-morbid depression in diabetic patients and studied the effect of the serotonin norepinephrine reuptake inhibitor antidepressant, milnacipran, on metabolic and psychological parameters in 64 type 2 diabetic patients with co-morbid depression. The severity of depression was evaluated using the Beck Depression Inventory (BDI). Patients received milnacipran, and diabetes was treated according to the guidelines of the Austrian Diabetes Association in a 6-month open label study. Metabolic parameters and BDI were measured at baseline and after 1, 3 and 6 months. 46 patients satisfied the criteria for an antidepressant response (reduction of baseline BDI score of at least 50%). Hemoglobin A1c, fasting blood glucose, body mass index, total and LDL-cholesterol and serum triglyceride levels were all significantly decreased in these patients at the end of the study whereas in antidepressant non-responders these parameters were not significantly changed. Diagnosis and treatment of depression is an important factor for the improvement of metabolic control in patients with type 2 diabetes and co-morbid depression. Keywords: depression, diabetes, milnacipran, metabolic control, metformin

Published
2009

23. Antihyperglykämische Therapie bei Diabetes mellitus Typ 2 (Update 2023)

Author

Martin Clodi, Heidemarie Abrahamian, Helmut Brath, Guntram Schernthaner, Johann Brix, Bernhard Ludvik, Heinz Drexel, Christoph H. Saely, Peter Fasching, Gersina Rega-Kaun, Bernhard Föger, Claudia Francesconi, Elke Fröhlich-Reiterer, Alexandra Kautzky-Willer, Jürgen Harreiter, Anton Luger, Michael Resl, Michaela Riedl, Yvonne Winhofer, Sabine E. Hofer, Friedrich Hoppichler, Joakim Huber, Susanne Kaser, Claudia Ress, Monika Lechleitner, Felix Aberer, Julia K. Mader, Harald Sourij, Hermann Toplak, Bernhard Paulweber, Lars Stechemesser, Thomas Pieber, Rudolf Prager, Harald Stingl, Thomas Stulnig, Birgit Rami-Merhar, Michael Roden, Christian Schelkshorn, Thomas C. Wascher, Raimund Weitgasser, and Sandra Zlamal-Fortunat

Subjects
General Medicine
Abstract

ZusammenfassungDie Hyperglykämie ist wesentlich an der Entstehung der Spätkomplikationen bei an Diabetes mellitus Typ 2 erkrankten Patienten/Patientinnen beteiligt. Während Lebensstilmaßnahmen die Eckpfeiler jeder Diabetestherapie bleiben, benötigen im Verlauf die meisten Patienten/Patientinnen mit Typ 2 Diabetes eine medikamentöse Therapie. Bei der Definition individueller Behandlungsziele stellen die Therapiesicherheit, die Effektivität sowie substanzspezifische, kardiovaskuläre Effekte der Therapie die wichtigsten Faktoren dar. In dieser Leitlinie haben wir die rezenten evidenzbasierten Daten für die klinische Praxis zusammengestellt.

Published
2023

24. Psychische und neurokognitive Erkrankungen und Diabetes mellitus (Update 2023)

Author

Heidemarie Abrahamian, Alexandra Kautzky-Willer, Angelika Rießland-Seifert, Diana Lebherz-Eichinger, Peter Fasching, Christoph Ebenbichler, Alexander Kautzky, and Hermann Toplak

Subjects
General Medicine
Abstract

ZusammenfassungDiabetes mellitus ist häufig mit psychischen Erkrankungen assoziiert. Depressive Störungen kommen bei diabetischen Patient:innen doppelt so häufig vor wie in der nicht-diabetischen Population. Andere psychische Erkrankungen, die gehäuft mit Prädiabetes und Diabetes mellitus vorkommen, sind kognitive Dysfunktionen bis zur Demenz, auffälliges Essverhalten, Angststörungen, Schizophrenie, bipolare Störungen und Borderline-Persönlichkeitsstörungen. Die ungünstigen Auswirkungen dieser Koinzidenz auf den Stoffwechsel sind nachhaltig und manifestieren als schlechtere metabolische Kontrolle und vermehrte mikro- und makroangiopathische Komplikationen. Ziel dieses Positionspapieres ist die Sensibilisierung aller involvierten medizinischen Fachkolleg:innen sowie aller anderen mit dem Thema Diabetes befassten Berufsgruppen und Organisationen, um eine Intensivierung der komplexen therapeutischen Interventionen bei Patient:innen zu erreichen.Positive Auswirkungen wären die Verringerung der Inzidenz von Diabetes mellitus bei Patient:innen mit psychischen Erkrankungen, sowie die Reduktion von Spätfolgen des Diabetes mellitus, insbesondere der kardiovaskulären Morbidität und Mortalität und eine verbesserte Lebensqualität der Betroffenen.

Published
2023

25. Nutrition for diabetic patients (Update 2023)

Author

Carmen Klammer, Karin Schindler, Rita Bugl, Dagmar Plazek, Miriam Vötter, Tanja Kirchner, Claudia Martino, Jasmin Klammer-Martin, Johanna Brix, Sabine Dämon, Friedrich Hoppichler, Alexandra Kautzky-Willer, Renate Kruschitz, Hermann Toplak, Martin Clodi, and Bernhard Ludvik

Subjects
General Medicine
Abstract

ZusammenfassungJe nach Diabetesform und -therapie sollen alle Menschen mit Diabetes eine individuelle ernährungsmedizinische Beratung und Schulung durch Fachpersonal erhalten. Im Vordergrund sollte eine patientinnen- und patientenzentrierte, individualisierte Beratung stehen, angepasst an die jeweiligen Bedürfnisse und Lebensumstände der Menschen mit Diabetes. Neben der Unterstützung zur Umsetzung einer ausgewogenen Ernährung gilt es, gemeinsam mit Patient:innen individuelle Stoffwechselziele und Gewichtsziele zu definieren, um mithilfe der Ernährung den Krankheitsverlauf positiv zu beeinflussen und mögliche Spätfolgen zu vermeiden. Dabei sollten vor allem praxisbezogene Empfehlungen unter Berücksichtigung der persönlichen Nahrungsmittel-Präferenzen ausgesprochen werden und Hilfsmittel zur Planung von geeigneten Portionsgrößen und der geeigneten Mahlzeitenzusammenstellung zum Einsatz kommen. Entsprechend aktueller internationaler und nationaler Standards sollen Menschen mit Diabetes im Diabetes-Selbstmanagement unterstützt werden (DSMES) und erlernen, die postprandiale Reaktion auf Speisen und Getränke besser einschätzen und durch die geeignete Lebensmittel- und Getränkeauswahl positiv beeinflussen zu können. Alle Menschen mit Diabetes sollten regelmäßig, je nach individuellem Bedarf, die Möglichkeit haben, eine ernährungstherapeutische Beratung oder Schulung in Anspruch nehmen zu können.Diese Praxisempfehlung stellt eine Zusammenfassung der aktuellen Literatur zu ernährungsrelevanten Aspekten bei Diabetes dar.

Published
2023

26. Obesity and type 2 diabetes (Update 2023)

Author

Martin Clodi, Hermann Toplak, Michael Resl, Johanna Brix, Deborah Raphaela Leitner, Jürgen Harreiter, Friedrich Hoppichler, Thomas C. Wascher, Karin Schindler, and Bernhard Ludvik

Subjects
General Medicine
Abstract

ZusammenfassungDer Body-Mass-Index (BMI) ist individuell betrachtet ein sehr grobes Maß für den Anteil des Körperfetts am Körpergewicht. Sogar Normalgewichtige können bei Muskelmangel zu viel Körperfett aufweisen (Sarkopenie), weswegen zusätzlich Messungen der Körperzusammensetzung (z. B. Bioimpedanzanalyse [BIA]) empfohlen werden. Lebensstilmanagement mit Ernährungsumstellung und Bewegung ist eine der wichtigsten Maßnahmen in der Diabetesprävention und -therapie. In der Therapie des Typ-2-Diabetes hat das Gewicht als sekundärer Zielparameter zunehmende Bedeutung erlangt. Auch die Wahl der antidiabetischen Therapie, aber auch der Begleittherapien nimmt immer mehr darauf Rücksicht. Die modernen GLP‑1 Analoga als auch der kombinierte GLP-1–GIP-Agonist Tirzepatid nehmen einen wichtigen Stellenwert in der gemeinsamen Behandlung von Adipositas und Diabetes mellitus Typ 2 ein. Die bariatrische Chirurgie ist derzeit bei an Diabetes mellitus Typ 2 erkrankten Menschen mit BMI > 35 kg/m2 indiziert und kann zumindest teilweise zur Diabetesremission beitragen, sie muss aber in ein entsprechendes lebenslanges Betreuungskonzept eingebunden sein.

Published
2023

27. Evaluation of lipoprotein(a) in the prevention and management of atherosclerotic cardiovascular disease: A survey among the Lipid Clinics Network

Author

Catapano, Alberico L, Tokgözoğlu, Lale, Banach, Maciej, Gazzotti, Marta, Olmastroni, Elena, Casula, Manuela, Ray, Kausik K, the Lipid Clinics Network, Alaa ABDELRAZIK (University Hospital of North Midland, United Kingdom), Alberto MELLO E SILVA (Sociedade Portuguesa de Aterosclerose, Portugal), Alexander VONBANK (VIVIT Institute, Austria), Alexandros, D TSELEPIS (Dept of Chemistry, Atherothrombosis Research Center, University of Ioannina, Greece), Alper SONMEZ (Department of Endocrinology and Metabolism, Ankara Guven Hospital, Turkey), Angelina PASSARO (Department of Translational Medicine, University of Ferrara &amp, Center for the Study and Treatment of Metabolic Diseases, Atherosclerosis, and Clinical Nutrition, University Hospital of Ferrara Arcispedale Sant’Anna, Italy), Anja VOGT (Medizinische Klinik und Poliklinik IV, Klinikum der Universit¨at München, Germany), Ann MERTENS (Clinical and Experimental Endocrinology, Leuven, Ku, Leuven, Belgium), Ann VERHAEGEN (Antwerp University Hospital, Belgium), Arman, S POSTADZHIYAN (Medical University of Sofia, Saint Anna University Hospital, Departement of Cardiology, Bulgaria), BAHADIR KIRILMAZ (Canakkale Onsekiz Mart University, Medical Faculty Cardiology Dept, Baris GUNGOR (University of Health Sciences Dr. Siyami Ersek Hospital, Turkey), Berit S HEDEGAARD (Aalborg University, Denmark), Bertrand CARIOU (Nantes Universit´e, Chu, Nantes, Cnrs, Inserm, l’institut du thorax, Nantes, France), Britta OTTE (Universit¨atsklinikum Münster, Lipidambulanz, Germany), Bu˘gra ¨OZKAN (Mersin University, Turkey), of cardiology, Christ BERGE (Dept., Unversity Hopsital, Haukeland., Norway), F EBENBICHLER (Department for Internal Medicine I, Christoph, Medical University Innsbruck, Austria), Christoph J BINDER (Medical University of Vienna, Austria), Christoph OLIVIER (Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Conrad AZZOPARDI (Mater Dei Hospital, Malta), Cristina SOLER (Lipid Unit, Hospital de Sta Caterina, Spain), Dan GAITA (Universitatea de Medicina si Farmacie Victor Babes din Timisoara &amp, Clinica de Cardiologie, Institutul de Boli Cardiovasculare Timisoara, Romania), Daniel WEGHUBER (Department of Pediatrics, Paracelsus Medical University, Dilek URAL (Koç University School of Medicine Department of Cardiology, Turkey), Diogo CRUZ (Hospital de Cascais - Dr. Jos´e de Almeida, Portugal), Dragos VINEREANU (University of Medicine and Pharmacy, University and Emergency Hospital, Bucharest, Romania), Elena D PENCU (Grand Hˆopital de Charleroi GHDC, Belgium), Emil HAGSTR¨OM (Dept of medical sciences, Uppsala, University, Sweden), Erik B SCHMIDT (Aalborg University, Denmark), Erik, S STROES (Dept of vascular medicine, Amsterdamumc, The, Netherlands), Evangelos LIBEROPOULOS (1st Department of Propedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, General Hospital of Athens Laiko, Fabian DEMEURE (CHU UCL Namur - Site Godinne, Belgium), Fabio FIMIANI (Azienda Ospedaliera di Rilievo Nazionale AORN Dei Colli, Monaldi', 'V., Unit of Inherited and Rare Cardiovascular Diseases, Italy, ), Fabio PELLEGATTA (Center for the Study of Atherosclerosis. Bassini Hospital. Cinisello Balsamo, Italy), Fahri BAYRAM (Erciyes University, Turkey), Finn L HENRIKSEN (Department of Cardiology Odense University Hospital, Denmark), Florian H¨OLLERL (1st Medical Department, Landstrasse, Clinic, Vienna Health Association, Francesco CIPOLLONE (Clinica Medica Institute of, Department of Medicine and Aging Sciences, d’Annunzio' University, 'G., Francisco ARAÚJO (Hospital Lusíadas, Portugal), Franck BOCCARA (Sorbonne Universit´e, Groupe de Recherche Clinique number 22, C2MV—Complications Cardiovasculaires et M´etaboliques chez les Patients Vivant avec le Virus de l’Immunod´eficience Humaine, Institut National de la Sant´e et de la Recherche M´edicale Unit´e Mixte de Recherche, S 938, Centre de Recherche Saint-Antoine, Institut Hospital Universitaire de Cardiom ´etabolisme et Nutrition Cardiologie, Hˆopital Saint Antoine Assistance Publique–Hˆopitaux de Paris, Paris, France), François PAILLARD (Cardiologie et Centre Clinico-Biologique des Lipides et Ath´eroscl´erose, Chu, Rennes, France), Imre University Teaching Hospital, Gabor SIMONYI (DBC St., Metabolic, Center, Lipid, Center, Hungary), Gabriella IANNUZZO (Department of Clinical Medicine and Surgery. University of Naples Federico II, Italy), Giuseppe MANDRAFFINO (Department of Clinical and Experimental Medicine, - Lipid Center, University of Messina, Graham BAYLY (Dept Clinical Biochemistry, University Hospitals Bristol, United, Kingdom), Gustavs LATKOVSKIS (Institute of Cardiology and Regenerative Medicine, University of Latvia &amp, Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital &amp, University of Latvia, Latvia), Gy¨orgy PARAGH (Division of Metabolic Disorders, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary), Hana ROSOLOVA (Charles University Prague Medical Hospital in Pilsen, Czech Republic), Handrean SORAN (Central Manchester University Hospital NHS Foundation Trust, United Kingdom), Helle KANSTRUP (Department of cardiology, Aarhus University hospital, Denmark), Hermann TOPLAK (Department of Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Hülya ÇIÇEKÇIO ˘GLU (ankara bilkent city hospital, Turkey), Inanc ARTAC (Department of Cardiology, Kafkas University Hospital, Ioanna GOUNI-BERTHOLD (Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Irfan, V DUZEN (Gaziantep University, Cardiology, Department, Isabel M PALMA (CHUPORTO - Centro Hospitalar Universit ´ario do Porto, Portugal), Istvan REIBER (Szent Gyorgy University Teaching Hospital of Fejer County, Hungary), Iveta DZIVITE-KRISANE (Children’s University Hospital, Latvia), Jeanine, E ROETERS VAN LENNEP (Department of Internal medicine, Erasmus MC University Medical Center, Jean-Luc, J BALLIGAND (Institut de Recherche Exp´erimentale et Clinique, Universite catholique de Louvain, Bruxelles), Joao C PORTO (CHUC, Portugal), Jo˜ao, S DUARTE (Hospital Egas Moniz, Lisboa, Portugal), Johan DE SUTTER (AZ Maria Middelares Hospital Gent, Belgium), Jos´e L´OPEZ-MIRANDA (Lipid and Arteriosclerosis Unit. Department of Internal Medicine. Hospital Universitario Reina Sofia. IMIBIC. University of Cordoba. CiberOBN, Spain), Jose M MOSTAZA (Hospital La Paz-Carlos III, Spain), Jurgita PLISIENE (Lithuanian University of Health sciences, Lithuania), Kadir, U MERT (Eskis ¸ehir Osmangazi University, Department of Cardiology, Kirsten, B HOLVEN (Department of Nutrition, University of Oslo and National Advisory unit on FH, Oslo University Hospital, Kjetil RETTERSTØL (The Lipid Clinic, Oslo University Hospital and Department of Nutrition, University of Oslo, Kristian, K THOMSEN (University Hospital of South Denmark, Esbjerg, Denmark), Lale TOKGOZOGLU (Hacettepe University, Turkey), Laszlo BAJNOK (1st Department of Medicine, Medical, School, University of Pecs, Lia E BANG (Copenhagen University Hospital, Denmark), Liliana GRIGORE (IRCCS Multimedica, Italy), Lluís MASANA (Hospital Universitari Sant Joan. Universitat Rovira i Virgili. CIBERDEM. Reus, Spain), Loukianos S RALLIDIS (University General Hospital Attikon, Greece), Maciej BANACH (Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Poland), Małgorzata WALU´S-MIARKA (Jagiellonian University Medical College, Of Metabolic Diseases and Diabetology, Dept., Manuel CASTRO CABEZAS (Franciscus Gasthuis &amp, Vlietland Rotterdam, The Netherlands), Marcello ARCA (Sapienza University of Rome, Italy), Margus VIIGIMAA (North Estonia Medical Centre, Tallinn University of Technology, Estonia), Martin, P BOGSRUD (Unit for Cardiac and Cardiovascular Genetics, Matej MLINARIˇC (Department of Endocrinology, Diabetes and Metabolism, University Children’s Hospital, University Medical Centre Ljubljana, Slovenia), Matteo PIRRO (Section of Internal Medicine, Angiology and Arteriosclerosis Diseases, Maurizio AVERNA (Department PROMISE-University of Palermo &amp, Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Palermo, Italy), Meral KAYIKCIOGLU (Ege University Medical School Department of Cardiology, Turkey), Merete HEITMANN (Bispebjerg-Frederiksberg University Hospital, Denmark), Mette MOURIDSEN (Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Michal VRABLIK (3rd Department of Internal Medicine, General University Hospital and 1st Medical Faculty, Charles, University, Prague, Czech, Republic), Michel FARNIER (PEC2, University of Bourgogne Franche-Comt´e, Laboratory Medicine, Michel R LANGLOIS (Dept., Jan Hospital, AZ St., Belgium), Milad KHEDR (Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Muge ILDIZLI DEMIRBAS (Kartal Kosuyolu Research and Training Hospital, Turkey), Myra TILNEY (Lipid Clinic, Mater Dei Hospital &amp, Dept of Medicine, University of Malta Medical School, Malta), Nadia CITRONI (Internal Medicine, APSS Trento Hospital, Of Internal Medicine, Niels P RIKSEN (Dept., Radboud university medical center, Nikolay M RUNEV (UMHAT Alexandrovska, Bulgaria), Nora KUPSTYTEKRISTAPONE (Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Lithuania), Olena MITCHENKO (NSC, Clinical and Regenerative Medicine of the NAMS of Ukraine, Ukraine), Oliver WEING¨ARTNER (Universit¨atsklinikum Jena, Department of Internal Medicine, I, Oner OZDOGAN (University of Health Sciences, Izmir Faculty of Medicine, Tepecik Training and Research Hospital, Ovidio MU˜NIZGRIJALVO (Hospital Virgen del Rocío, Spain), Ozcan BASARAN (Mugla Sitki Kocman University, Pankaj GUPTA (University Hospitals of Leicester, United Kingdom), Paolo PARINI (Cardio Metabolic Unit, Karolinska, Institutet, and Theme Inflammation and Ageing, Karolinska University Hospital Huddinge, Patrizia SUPPRESSA (Department of Internal Medicine and rare disease Centre, Bari, Italy), Paul DOWNIE (Salisbury NHS Foundation trust, United Kingdom), Pavel JESINA (Metabolic Center General University Hospital, Czech Republic), of Internal Medicine, Pavel KRAML (Dept., Third Faculty of Medicine, Charles University and Kr´alovsk´e Vinohrady University Hospital Prague, Pawel BURCHARDT (Department of Cardiology, Cardiovascular, Unit, Hospital, J. Stru´s., Pozna´n, &amp, Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Pozna´n, Poland), Pedro VALDIVIELSO (Hospital VIRGEN DE LA VICTORIA, Spain), Pedro VON HAFE (Instituto Cuf, Portugal), Dept, Peter FASCHING (5th Med., Clinic, Ottakring, Philippe MOULIN (Hospices civils de Lyon/INSERM/Universit ´e Lyon1, Hˆopital Louis Pradel, F´ed´eration, D’Endocrinologie, Quit´eria RATO (Sociedade Portuguesa de Aterosclerose, Portugal), Reinhold INNERHOFER (Medical University Vienna, Austria), Renata C´IFKOV´A (Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital, Rene VALERO (Aix Marseille Univ, Aphm, Inserm, Inrae, C2vn, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, Scicali, Roberto, Robin URB´ANEK (Internal medicine, Obezita-Ormiga, s. r. o., Roma KAVALIAUSKIENE (Klaip˙ eda Seamen’s Hospital, Lituania), Roman CIBULKA (Department of paramedic science, medical diagnostics studies and public health, Faculty of Health Care Studies, University of West Bohemia, Sabina ZAMBON (Department of Medicine, - DIMED, University of Padova, Sergio D’ADDATO (University of Bologna. IRCCS S. Orsola Bologna, Italy), Stanislav ZEMEK (Lipidova ambulance, Czech Republic), Stefano ROMEO (Gothenburg University, Sweden), Stephanie K¨ONEMANN (Department of Internal Medicine, B, University Medicine Greifswald, DZHK (German Centre for Cardiovascular Research), Susanne GREBER-PLATZER (Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Thomas STULNIG (Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna &amp, Third Medical Department and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic, Hietzing, Vienna, Austria), Thomas MUHR (Dept of Cardiology, Link¨oping University Hospital, Tina, Z KHAN (Consultant Cardiologist, Royal Brompton and Harefield Hospitals Part of Guy’s and St Thomas’ NHS Foundation Trust, Tomas FREIBERGER (Centre of Cardiovascular Surgery and Transplantation, Brno &amp, Medical, Faculty, Masaryk, University, Brno, Tom´aˇs ˇS´ALEK (Metabolic Clinic, Tomas Bata Hospital, Zlín, Tomas VASYLIUS (Republican Panevezys hospital, Of Cardiology, Dep., Lithuania), Ulrich LAUFS (Klinik und Poliklinik für Kardiologie, Universit ¨atsklinikum Leipzig, Ulrike SCHATZ (University Hospital Carl Gustav Carus Dresden at the Technical University Dresden, Department of Internal Medicine III, Urh GROSELJ (UMC, - University Children’s Hospital Ljubljana, University of Ljubljana, Victoria MARCO-BENEDI (Hospital Universitario Miguel Servet, Iisa, Cibercv, Vincent MAHER (Advanced Lipid Management and Research ALMAR centre, Tallaght University Hospital, Ireland), Vladimír BLAHA (University Hospital Hradec Kr´alov´e and Charles University, Faculty of Medicine in Hradec Kr´alov´e, 3rd Department of Internal Medicine, - Metabolism and Gerontology, Vladimir SOSKA (Department of Clinical Biochemistry, St. Anne’s University Hospital Brno, 2nd Clinic of Internal Medicine, Masaryk University Brno, Volker JJ SCHETTLER (Centre of Nephrology G¨ottingen, Germany), Wolfgang REINHARDT (SUS Malmoe, Sweden), Xavier PINT´O (Hospital Universitari de Bellvitge-Idibell-UB-CiberObn, Spain), Yoto YOTOV (Second Cardiology Clinic, Marina, University Hospital Sv., Medical University of Varna, Zaneta PETRULIONIENE (Vilnius University Medical Faculty, Vilnius University Hospital Santaros klinikos, Lithuania), ˇZeljko REINER (Department for Metabolic Diseases, University Hospital Center Zagreb, and Croatia, ).

Subjects
Clinicians, Clinical evaluation, Cardiology and Cardiovascular Medicine, Cardiovascular risk, Lipoprotein(a)
Published
2023

28. Reproductive outcomes after bariatric surgery in women

Author

Dragan D. Micic, Hermann Toplak, Dusan D. Micic, and Snezana P. Polovina

Subjects
Pregnancy, Bariatric Surgery, Humans, Female, Obesity, General Medicine, Infertility, Female, Polycystic Ovary Syndrome
Abstract

SummaryThe presence of obesity may significantly influence female fertility through various mechanisms. Impairment of the hypothalamic-pituitary-ovarian axis in obese women may induce anovulation and infertility. Obesity may have an effect on women’s spontaneous and assisted conception rates, increased miscarriage rates, premature labor, stillbirth and perinatal risks, and menstrual irregularity. It has been suggested that weight loss improves reproductive outcomes due to fertility amelioration and an improvement in menstrual irregularity and ovulation. It is still not known which weight reduction procedures (changes in lifestyle, pharmacological management or bariatric intervention) result in optimal outcome on infertility. Currently, bariatric surgery is defined as the best available method for the management of obesity and its associated diseases.We have analyzed literature facts about effects of bariatric surgery on the function of the hypothalamic-pituitary-ovarian axis, polycystic ovary syndrome (PCOS), anti-Mullerian hormone (AMH) and sexual dysfunction in obesity and pregnancy in obesity. Immediate positive effects of bariatric surgery are evident at the moment, while for long-term outcomes more prolonged follow-up investigations should be done.

Published
2021

29. Evaluation of contemporary treatment of high- and very high-risk patients for the prevention of cardiovascular events in Europe – Methodology and rationale for the multinational observational SANTORINI study

Author

Derek L. Connolly, Marcello Arca, Kausik K. Ray, Hermann Toplak, Per Hildebrandt, Ernst Rietzschel, Carlos Aguiar, Inaam Haq, David Nanchen, Jean Ferrières, Frank L.J. Visseren, Timo E. Strandberg, Ulrich Laufs, Aikaterini Bilitou, Jose M. Mostaza, Mats Eriksson, Alberico L. Catapano, HUS Internal Medicine and Rehabilitation, Timo Strandberg / Principal Investigator, Department of Medicine, and Clinicum

Subjects
medicine.medical_specialty, High cardiovascular risk, Lipid-lowering therapy, 030204 cardiovascular system & hematology, achievement, adult, article, cardiovascular risk, controlled study, coronary artery atherosclerosis, Europe, female, follow up, health economics, high risk patient, human, human tissue, lipid blood level, major clinical study, male, multicenter study, patient care, patient coding, practice guideline, prevention, prospective study, risk assessment, C reactive protein, endogenous compound, low density lipoprotein cholesterol, Cardiovascular disease, LDL cholesterol, 03 medical and health sciences, 0302 clinical medicine, Plasma lipids, Medicine and Health Sciences, Internal Medicine, Diseases of the circulatory (Cardiovascular) system, Goal achievement, Medicine, 030212 general & internal medicine, Intensive care medicine, Health economics, business.industry, Plasma levels, Patient data, 3. Good health, Multinational corporation, RC666-701, 3121 General medicine, internal medicine and other clinical medicine, Observational study, Cardiology and Cardiovascular Medicine, business, Very high risk
Abstract

Background and aims: Clinical practice before 2019 suggests a substantial proportion of high and very high CV risk patients taking lipid-lowering therapy (LLT) would not achieve the new LDL-C goals recommended in the 2019 ESC/EAS guidelines (18 years of age with high and very high CV risk (as assigned by the investigators) requiring LLT, with no formal patient or comparator groups. The primary objective is to document, in the real-world setting, the effectiveness of current treatment modalities in managing plasma levels of LDL-C in high-and very high-risk patients requiring LLT. Key secondary effectiveness objectives include documenting the relationship between LLT and levels of other plasma lipids, high sensitivity C-reactive protein (hsCRP) and overall predicted CV risk over one year. Health economics and patient-relevant parameters will also be assessed. Conclusions: The SANTORINI study, which commenced after the 2019 ESC/EAS guidelines were published, is ideally placed to provide important contemporary insights into the evolving management of LLT in Europe and highlight factors contributing to the low levels of LDL-C goal achievement among high and very high CV risk patients. It is hoped the findings will help enhance patient management and reduce the burden of ASCVD in Europe. ' (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Published
2021

30. High-Protein, Low-Glycaemic Meal Replacement Improves Physical Health-Related Quality of Life in High-Risk Persons for Metabolic Syndrome—A Subanalysis of the Randomised-Controlled ACOORH Trial

Author

Kerstin, Kempf, Martin, Röhling, Winfried, Banzer, Klaus Michael, Braumann, Martin, Halle, Nina, Schaller, David, McCarthy, Hans Georg, Predel, Isabelle, Schenkenberger, Susanne, Tan, Hermann, Toplak, Stephan, Martin, Aloys, Berg, and On Behalf Of The Acoorh Study Group

Subjects
Metabolic Syndrome, Nutrition and Dietetics, dewey610, Medizin, Overweight, Article, health-related quality of life, protein-rich, low-glycaemic meal replacement, weight reduction, multicenter study, RCT, Hypoglycemia, ddc, Weight Loss, Quality of Life, Humans, Obesity, Exercise, Life Style, Food Science
Abstract

While obesity impairs health-related quality of life (HRQOL), lifestyle interventions targeting weight reduction have been effective in improving HRQOL. Therefore, we hypothesised that a meal replacement-based lifestyle intervention, which has been shown to successfully reduce weight, would also improve HRQOL more effectively than a lifestyle intervention alone. In the international, multicenter, randomised-controlled ACOORH-trial (Almased-Concept-against- Overweight-and-Obesity-and-Related-Health-Risk), overweight or obese participants with elevated risk for metabolic syndrome (n = 463) were randomised into two groups. Both groups received telemonitoring devices and nutritional advice. The intervention group additionally used a protein-rich, low-glycaemic meal replacement for 6 months. HRQOL was estimated at baseline, after 3 and 12 months, using the SF-36 questionnaire, and all datasets providing HRQOL data (n = 263) were included in this predefined subanalysis. Stronger improvements in the physical component summary (PCS) were observed in the intervention compared to the control group, peaking after 3 months (estimated treatment difference 2.7 [1.2; 4.2]; p < 0.0001), but also in the long-term. Multiple regression analysis demonstrated that insulin levels and the achieved weight loss were associated with the mental component summary (MCS) after 12 months (p < 0.05). Thus, meal replacement-based lifestyle intervention is not only effective in weight reduction but, concomitantly, in enhancing HRQOL.

Published
2022
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31. A High‐Protein and Low‐Glycemic Formula Diet Improves Blood Pressure and Other Hemodynamic Parameters in High‐Risk Individuals

Author

Martin, Röhling, Kerstin, Kempf, Winfried, Banzer, Klaus Michael, Braumann, Dagmar, Führer-Sakel, Martin, Halle, David, McCarthy, Stephan, Martin, Jürgen, Scholze, Hermann, Toplak, Aloys, Berg, Hans-Georg, Predel, and Acoorh Study Group

Subjects
Nutrition and Dietetics, dewey610, Medizin, Blood Pressure, Fasting, Overweight, Pulse Wave Analysis, Article, blood pressure, insulin, lifestyle intervention, formula diet, cardiac autonomic regulation, pulse wave velocity, heart rate, Hypoglycemia, ddc, Diabetes Mellitus, Type 2, Hypertension, Humans, Obesity, Food Science
Abstract

Low-caloric formula diets can improve hemodynamic parameters of patients with type 2 diabetes. We, therefore, hypothesized that persons with overweight or obesity can benefit from a high-protein, low-glycemic but moderate-caloric formula diet. This post-hoc analysis of the Almased Concept against Overweight and Obesity and Related Health Risk- (ACOORH) trial investigated the impact of a lifestyle intervention combined with a formula diet (INT, n = 308) compared to a control group with lifestyle intervention alone (CON, n = 155) on hemodynamic parameters (systolic and diastolic blood pressure (SBP, DBP), resting heart rate (HR), and pulse wave velocity (PWV)) in high-risk individuals with prehypertension or hypertension. INT replaced meals during the first 6 months (1 week: 3 meals/day; 2–4 weeks: 2 meals/day; 5–26 weeks: 1 meal/day). Study duration was 12 months. From the starting cohort, 304 (68.3%, INT: n = 216; CON: n = 101) participants had a complete dataset. Compared to CON, INT significantly reduced more SBP (−7.3 mmHg 95% CI [−9.2; −5.3] vs. −3.3 mmHg [−5.9; −0.8], p < 0.049) and DBP (−3.7 mmHg [−4.9; −2.5] vs. −1.4 mmHg [−3.1; 0.2], p < 0.028) after 12 months. Compared to CON, INT showed a pronounced reduction in resting HR and PWV after 6 months but both lost significance after 12 months. Changes in SBP, DBP, and PWV were significantly associated positively with changes in body weight and fat mass (all p < 0.05) and resting HR correlated positively with fasting insulin (p < 0.001) after 12 months. Combining a lifestyle intervention with a high-protein and low-glycemic formula diet improves hemodynamic parameters to a greater extent than lifestyle intervention alone in high-risk individuals with overweight and obesity.

Published
2022

32. Contemporary Treatment Gaps in the Implementation of Ldl Cholesterol Control Among High- And Very High-Risk Patients in Europe between 2020–2021 – The Multinational Santorini Study

Author

Kausik K. Ray, Inaam Haq, Aikaterini Bilitou, Marius Constantin Manu, Annie Burden, Carlos Aguiar, Marcello Arca, Derek L. Connolly, Mats Eriksson, Jean Ferrières, Per Hildebrandt, Ulrich Laufs, Jose María Mostaza, David Nanchen, Ernst Rietzschel, Timo Strandberg, Hermann Toplak, Frank LJ Visseren, Alberico Catapano, and SANTORINI Study Investigators

Subjects
History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published
2022

34. Antihyperglykämische Therapie bei Diabetes mellitus Typ 2 (Update 2019)

Author

Birgit Rami-Merhar, Michaela Riedl, Sandra Zlamal-Fortunat, Harald Sourij, Julia K. Mader, Joakim Huber, Peter Fasching, Sabine E. Hofer, Helmut Brath, Hermann Toplak, Johanna Brix, Michael Resl, Bernhard Föger, Michael Roden, Raimund Weitgasser, Yvonne Winhofer-Stöckl, G. Schernthaner, Harald Stingl, Susanne Kaser, Christoph H. Saely, Lars Stechemesser, Friedrich Hoppichler, Thomas C. Wascher, Christian Schelkshorn, Jürgen Harreiter, Alexandra Kautzky-Willer, Bernhard Ludvik, Thomas R. Pieber, Heidemarie Abrahamian, Monika Lechleitner, R. Prager, Martin Clodi, Anton Luger, Elke Fröhlich-Reiterer, Claudia Francesconi, Heinz Drexel, and Bernhard Paulweber

Subjects
medicine.medical_specialty, Health professionals, business.industry, General Medicine, Guideline, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, Diabetes mellitus, Lifestyle intervention, medicine, In patient, Disease prevention, 030212 general & internal medicine, Intensive care medicine, business, Glycemic
Abstract

Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.

Published
2019

35. Psychische Erkrankungen und Diabetes mellitus (Update 2019)

Author

Christoph Ebenbichler, Heidemarie Abrahamian, Alexander Kautzky, Hermann Toplak, Angelika Rießland-Seifert, Alexandra Kautzky-Willer, Peter Hofmann, and Peter Fasching

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Diabetes mellitus, Medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, Cognitive impairment, business, medicine.disease
Abstract

Diabetes mellitus ist haufig mit psychischen Erkrankungen assoziiert. Depressive Storungen kommen bei diabetischen PatientInnen doppelt so haufig vor wie in der nicht-diabetischen Population. Andere psychische Erkrankungen, die gehauft mit Pradiabetes und Diabetes mellitus vorkommen, sind kognitive Dysfunktionen bis zur Demenz, auffalliges Essverhalten, Angststorungen, Schizophrenie, bipolare Storungen und Borderline-Personlichkeitsstorungen. Die ungunstigen Auswirkungen dieser Koinzidenz auf den Stoffwechsel sind nachhaltig und manifestieren als schlechtere metabolische Kontrolle und vermehrte mikro- und makroangiopathische Komplikationen. Ziel dieses Positionspapieres ist sowohl die Sensibilisierung aller involvierten medizinischen FachkollegInnen sowie sonstiger mit dem Thema befasster Berufsgruppen und Organisationen als auch die Intensivierung der komplexen therapeutischen Interventionen bei PatientInnen. Positive Auswirkungen waren die Verringerung der Inzidenz von Diabetes mellitus bei PatientInnen mit psychischen Erkrankungen, die konsekutive Reduktion von Spatfolgen, insbesondere der kardiovaskularen Morbiditat und Mortalitat sowie eine verbesserte Lebensqualitat der Betroffenen.

Published
2019

36. Ernährungsempfehlungen bei Diabetes mellitus (Update 2019)

Author

Hermann Toplak, Renate Kruschitz, Bernhard Ludvik, Alexandra Kautzky-Willer, Johanna Brix, Friedrich Hoppichler, Karin Schindler, and Sabine Dämon

Subjects
Gynecology, medicine.medical_specialty, business.industry, Physical activity, General Medicine, Weight control, 030204 cardiovascular system & hematology, Body weight, 03 medical and health sciences, 0302 clinical medicine, Dietary protein, Medicine, 030212 general & internal medicine, business
Abstract

Es besteht breiter Konsens, dass eine effiziente Diabetes-Therapie in den meisten Fallen auch von einer Modifikation des Lebensstils begleitet sein muss. Das bedeutet fur die Patienten in der Regel eine Normalisierung des Korpergewichts (Gewichtsreduktion und/oder Halten des Gewichts) in Kombination mit einer Veranderung des Bewegungs- und Ernahrungsverhaltens. Die medizinische Ernahrungstherapie ist integraler Teil des Diabetesmanagements und soll individualisiert und PatientInnen-zentriert erfolgen. Das Ziel ist die positive Beeinflussung des postprandialen Glukoseanstiegs sowie insgesamt des Glukose- und Fettstoffwechsels, die Gewichtskontrolle sowie die Pravention bzw. Verzogerung von T2DM assoziierten Komplikationen.

Published
2019

37. Insulintherapie bei Typ 2 Diabetes mellitus (Update 2019)

Author

Peter Fasching, Hermann Toplak, Bernhard Föger, Michael Roden, Susanne Kaser, Christoph H. Saely, Heidemarie Abrahamian, Anton Luger, G. Schernthaner, Thomas R. Pieber, Raimund Weitgasser, Claudia Francesconi, Yvonne Winhofer-Stöckl, Harald Sourij, Heinz Drexel, Bernhard Paulweber, Lars Stechemesser, Birgit Rami-Merhar, Michaela Riedl, Christian Schelkshorn, Monika Lechleitner, Johanna Brix, Helmut Brath, Sabine E. Hofer, Thomas C. Wascher, R. Prager, Martin Clodi, Michael Resl, Harald Stingl, Joakim Huber, Friedrich Hoppichler, Alexandra Kautzky-Willer, Julia K. Mader, Bernhard Ludvik, Jürgen Harreiter, Sandra Zlamal-Fortunat, and Elke Fröhlich-Reiterer

Subjects
Gynecology, Thesaurus (information retrieval), medicine.medical_specialty, business.industry, Insulin, medicine.medical_treatment, Type 2 Diabetes Mellitus, General Medicine, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, business
Abstract

Die vorliegende Leitlinie nimmt Bezug auf die Indikation und praktische Umsetzung der Insulintherapie bei Typ 2 Diabetes, insbesondere auch im Hinblick auf die unterschiedlichen Formen der Insulintherapie.

Published
2019

38. 'Diabesity' – Adipositas und Typ-2-Diabetes (Update 2019)

Author

Bernhard Ludvik, Jürgen Harreiter, Thomas C. Wascher, Hermann Toplak, Deborah R. Leitner, Karin Schindler, and Friedrich Hoppichler

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business
Abstract

Adipositas und Typ-2-Diabetes werden seit einigen Jahren vermehrt unter dem Namen „Diabesity“ zusammengefasst. Das tragt dem Umstand Rechnung, dass die Adipositas dem Diabetes in den meisten Fallen haufig vorangeht und wohl der wichtigste Faktor in der weltweiten Zunahme des Typ-2-Diabetes ist. Der Body-Mass-Index (BMI) ist individuell betrachtet ein sehr grobes Mas der Korperverfettung. Sogar Normalgewichtige konnen bei Muskelmangel zu viel Korperfett aufweisen (Sarkopenie), weswegen zusatzlich Messungen des Bauchumfanges und des Korperfettes empfohlen werden (z. B. Bioimpedanzanalyse [BIA]). Lebensstilmanagement mit Ernahrungsumstellung und Bewegung ist eine der wichtigsten Masnahmen in der Diabetespravention und -therapie. In der Therapie des Typ-2-Diabetes hat das Gewicht als sekundarer Zielparameter zunehmende Bedeutung erlangt. Auch die Wahl der antidiabetischen Therapie, aber auch der Begleittherapien nimmt immer mehr darauf Rucksicht. Welchen Stellenwert Antiadiposita in der antidiabetischen Therapie erlangen werden, wird durch zukunftige Studien mit Gewicht als primarem Endpunkt zu klaren sein. Die bariatrische Chirurgie ist derzeit bei einem Typ-2-Diabetes mit BMI >35 kg/m2 indiziert und kann zumindest teilweise zur Diabetesremission beitragen, sie muss aber in ein entsprechendes lebenslanges Betreuungskonzept eingebunden sein.

Published
2019

39. High-protein, low-glycaemic meal replacement decreases fasting insulin and inflammation markers — a 12-month subanalysis of the ACOORH trial

Author

Kerstin Kempf, Martin Röhling, Winfried Banzer, Klaus Michael Braumann, Martin Halle, David McCarthy, Hans Georg Predel, Isabelle Schenkenberger, Susanne Tan, Hermann Toplak, Aloys Berg, Stephan Martin, on behalf of ACOORH Study Group, and ACOORH Study Group

Subjects
Male, 0301 basic medicine, obesity, Meal replacement, medicine.medical_treatment, Medizin, Overweight, 0302 clinical medicine, Weight loss, Insulin, TX341-641, Meals, fasting insulin, Meal, Nutrition and Dietetics, Fasting, Middle Aged, multicentre study, Intention to Treat Analysis, Female, Dietary Proteins, medicine.symptom, RCT, Adult, medicine.medical_specialty, Patient Dropouts, protein-rich, 030209 endocrinology & metabolism, Article, Young Adult, 03 medical and health sciences, Diabetes mellitus, Internal medicine, medicine, Humans, overweight, ddc:610, dewey570, Aged, Inflammation, Nutrition. Foods and food supply, business.industry, Body Weight, lifestyle intervention, medicine.disease, Obesity, 030104 developmental biology, Glycemic Index, low-carbohydrate, Chronic Disease, low-glycaemic meal replacement, weight reduction, Metabolic syndrome, business, Biomarkers, Food Science
Abstract

Lifestyle interventions, including meal replacement, are effective in the prevention and treatment of type-2-diabetes and obesity. Since insulin is the key weight regulator, we hypothesised that the addition of meal replacement to a lifestyle intervention reduces insulin levels more effectively than lifestyle intervention alone. In the international multicentre randomised controlled ACOORH (Almased Concept against Overweight and Obesity and Related Health Risk) trial, overweight or obese persons who meet the criteria for metabolic syndrome (n = 463) were randomised into two groups. Both groups received nutritional advice focusing on carbohydrate restriction and the use of telemonitoring devices. The intervention group substituted all three main meals per day in week 1, two meals per day in weeks 2–4, and one meal per day in weeks 5–26 with a protein-rich, low-glycaemic meal replacement. Data were collected at baseline and after 1, 3, 6 and 12 months. All datasets providing insulin data (n = 446) were included in this predefined subanalysis. Significantly higher reductions in insulin (−3.3 ± 8.7 µU/mL vs. −1.6 ± 9.8 µU/mL), weight (−6.1 ± 5.2 kg vs. −3.2 ± 4.6 kg), and inflammation markers were observed in the intervention group. Insulin reduction correlated with weight reduction and the highest amount of weight loss (−7.6 ± 4.9 kg) was observed in those participants with an insulin decrease &gt, 2 µU/mL. These results underline the potential for meal replacement-based lifestyle interventions in diabetes prevention, and measurement of insulin levels may serve as an indicator for adherence to carbohydrate restriction.

Published
2021

40. Effects of a Protein-Rich, Low-Glycaemic Meal Replacement on Changes in Dietary Intake and Body Weight Following a Weight-Management Intervention—The ACOORH Trial

Author

Martin Röhling, Andrea Stensitzky, Andrea Beck, Hermann Toplak, Klaus-Michael Braumann, Isabelle Schenkenberger, David McCarthy, Kerstin Kempf, Dagmar Führer-Sakel, Camila L. P. Oliveira, Hans-Georg Predel, Aloys Berg, and Martin Halle

Subjects
Adult, Male, Meal replacement, Medizin, dewey610, meal replacement, 030209 endocrinology & metabolism, lcsh:TX341-641, Overweight, Article, Eating, 03 medical and health sciences, 0302 clinical medicine, Animal science, Nutrient, Risk Factors, Weight loss, Weight management, medicine, Humans, Obesity, 030212 general & internal medicine, Life Style, Meals, protein-rich diet, Nutrition and Dietetics, business.industry, Body Weight, INT, Weight change, Middle Aged, medicine.disease, nutritional reports, Female, medicine.symptom, weight loss, Energy Intake, business, lcsh:Nutrition. Foods and food supply, Food Science
Abstract

Although meal replacement can lead to weight reduction, there is uncertainty whether this dietary approach implemented into a lifestyle programme can improve long-term dietary intake. In this subanalysis of the Almased Concept against Overweight and Obesity and Related Health Risk (ACOORH) study (n = 463), participants with metabolic risk factors were randomly assigned to either a meal replacement-based lifestyle intervention group (INT) or a lifestyle intervention control group (CON). This subanalysis relies only on data of participants (n = 119) who returned correctly completed dietary records at baseline, and after 12 and 52 weeks. Both groups were not matched for nutrient composition at baseline. These data were further stratified by sex and also associated with weight change. INT showed a higher increase in protein intake related to the daily energy intake after 12 weeks (+6.37% [4.69, 8.04] vs. +2.48% [0.73, 4.23], p &lt, 0.001) of intervention compared to CON. Fat and carbohydrate intake related to the daily energy intake were more strongly reduced in the INT compared to CON (both p &lt, 0.01). After sex stratification, particularly INT-women increased their total protein intake after 12 (INT: +12.7 g vs. CON: &minus, 5.1 g, p = 0.021) and 52 weeks (INT: +5.7 g vs. CON: &minus, 16.4 g, p = 0.002) compared to CON. Protein intake was negatively associated with weight change (r = &minus, 0.421, p &lt, 0.001) after 12 weeks. The results indicate that a protein-rich dietary strategy with a meal replacement can improve long-term nutritional intake, and was associated with weight loss.

Published
2021
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41. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Author

Jie Lin, Snejana Tisheva, Ishwar C. Verma, Francesco Cipollone, Liam R. Brunham, Florentina Predica, Perla A.C. Gonzalez, Jocelyne Inamo, André R. Miserez, Belma Pojskic, Michel Farnier, Avishay Ellis, Katia Bonomo, Ibrahim Al-Zakwani, Maria Grazia Zenti, Humberto A. Lopez, Khairul Shafiq Ibrahim, Erkin M. Mirrakhimov, Alexey Meshkov, Jose P. de Moura, Muthukkaruppan Annamalai, Raul D. Santos, F. Paillard, Maria Del Ben, Jan Lacko, Miguel T. Rico, Ximena Reyes, Laura E.G. de Leon, Noor Shafina Mohd Nor, Ulrich Julius, Mohammed A. Batais, Dieter Böhm, Ta-Chen Su, Takuya Kobayashi, Magdalena Chmara, Marco Gebauer, Marcos M. Lima-Martínez, Ravshanbek D. Kurbanov, Daisaku Masuda, Amro El-Hadidy, Melanie Schüler, Francisco Fuentes, Florian J. Mayer, Helena Vaverkova, F. Ulrich Beil, Juraj Bujdak, Mario Stoll, Isabelle Ruel, Elena Dorn, Thomas M. Stulnig, Abubaker Elfatih, Rano B. Alieva, Jiri Vesely, Valérie Carreau, Cristina M. Sibaja, Sophie Béliard, Olivier Ziegler, Adriana Branchi, Daniel Schurr, G.B. John Mancini, Tai E. Shyong, Eric L.T. Siang, Mafalda Bourbon, Zerrin Yigit, Meral Kayıkçıoğlu, Jacques Genest, Wei Yu, Michal Vrablík, Shavkat U. Hoshimov, Dan Gaita, Antonio Pipolo, Ashraf H.A. AlQudaimi, Walter Speidl, Gianfranco Parati, Zaliha Ismail, Victoria M. Zubieta, René Valéro, Tomas Salek, Hana Halamkova, Gustavs Latkovskis, Nicole Allendorf-Ostwald, Agnes Perrin, Vladimir Soska, Anastasia Garoufi, Francisco Araujo, Nacu C. Portilla, Thomas Segiet, Charalambos Koumaras, Hila Knobler, Fatih Sivri, Hani Altaradi, Ivan Pećin, Long Jiang, Alexander Dressel, Marlena Woś, Jana Franekova, D. Agapakis, Quitéria Rato, Dirk J. Blom, Marcin A. Bartlomiejczyk, Krzysztof Dyrbuś, Maurizio Averna, Phivos Symeonides, Yung A. Chua, Asim Rana, András Nagy, Juan C.G. Cuellar, Alexander Jäkel, Maya Safarova, Neama Luqman, Amalia-Despoina Koutsogianni, Patrick Tounian, Jose A. Alvarez, Ada Cuevas, Corinna Richter, Sybil Charrieres, Vitaliy Zafiraki, Michalis Doumas, Angela Lux, Thanh Huong Truong, Elaine Chow, José Luis Díaz-Díaz, Jesus R.H. Almada, Sabine Füllgraf-Horst, Gustavo G. Retana, Claudio Borghi, Gianni Biolo, Ivajlo Tzvetkov, Patrícia Pais, Mehmet Akbulut, Kumiko Nagahama, Oner Ozdogan, Frank Leistikow, Jianxun He, Alexander R.M. Lyons, Poranee Ganokroj, Luis E.S. Mendia, Ann-Cathrin Koschker, Gabriela A.G. Ramirez, Dainus Gilis, Karin Balinth, José Ramiro Cruz, Paolo Calabrò, Alberico L. Catapano, Emmanouil Skalidis, Hamida Al-Barwani, Genovefa Kolovou, Carolyn S.P. Lam, Yoto Yotov, Yaacov Henkin, Gabriella Iannuzzo, Aimi Z. Razman, Alma B.M. Rodriguez, Hans Dieplinger, Darlington E. Obaseki, Ursulo J. Herrera, Arcangelo Iannuzzi, Christoph Säly, Elena Olmastroni, Francisco G. Padilla, S.A. Nazli, Ioanna Gouni-Berthold, Miriam Kozárová, Urh Groselj, Igor Shaposhnik, Lorenzo Iughetti, Nawal Rwaili, Cinthia E. Jannes, Andrea Bartuli, Mikhail Voevoda, Marat V. Ezhov, Yanyu Duan, Alper Sonmez, Mustafa Yenercag, Ariane Sultan, Natasza Gilis-Malinowska, Tavintharan Subramaniam, Mohamed Ashraf, Jing Pang, Kota Matsuki, Tao Jiang, Gerald Klose, Eduardo A.R. Rodriguez, Lucie Solcova, Riccardo Sarzani, Mahmoud Traina, Alejandra Vázquez Cárdenas, Gordon A. Francis, Adolat V. Ziyaeva, Ronen Durst, Maciej Banach, Francisco Silva, Heribert Schunkert, Børge G. Nordestgaard, Ziyou Liu, Ahmad Bakhtiar Md Radzi, Hana Rosolova, Andrea Bäßler, Abdulhalim Jamal Kinsara, Noël Peretti, Victor Gurevich, Margarita T. Tamayo, Abdullah Tuncez, Florian Höllerl, Ljubica Stosic, Jianguang Qi, Anja Kirschbaum, Jitendra P.S. Sawhney, Michael Scholl, Kausik K. Ray, Mohamed Bendary, Hapizah Nawawi, Adrienne Tarr, Barbora Nussbaumerova, B.C. Brice, Kurt Huber, Noor Alicezah Mohd Kasim, A. Rahman A. Jamal, Vaclava Palanova, Giacomo Biasucci, Pucong Ye, Eva Cubova, Roopa Mehta, Rüdiger Schweizer, Veronica Zampoleri, Jacek Jóźwiak, Alyaa Al-Khateeb, Jing Hong, Katarina Raslova, Kirsten B. Holven, Tatiana Rozkova, Reinhold Busch, Alexander Klabnik, Konrad Hein, Eloy A.Z. Carrillo, Robin Urbanek, Livia Pisciotta, Fatma Y. Coskun, Jose J.G. Garcia, Valerio Pecchioli, Azra D. Nalbantic, Weerapan Khovidhunkit, Jernej Kovac, Michaela Kadurova, Mohammed Al-Jarallah, Vita Saripo, Christos V. Rizos, Jie Peng, Ang L. Chua, Dorothee Deiss, Nor A.A. Murad, Aneta Stróżyk, See Kwok, Gökhan Alici, Gillian J. Pilcher, John J.P. Kastelein, Dmitry Duplyakov, Calin Lengher, Milena Budikova, C. Azzopardi, Christina Antza, Luis E.V. Arroyo, Khalid Al-Jumaily, Ahmad Al-Sarraf, Carlos A. Aguilar-Salinas, Erkayim Bektasheva, Arta Upena-RozeMicena, Qian Wang, Xumin Wang, Leah Leavit, Radzi Rahmat, Selim Topcu, Željko Reiner, Lorenzo Maroni, Matija Cevc, Elizabeth R. Cooremans, Masatsune Ogura, Tevfik Sabuncu, Ruy D Arjona Villicaña, Andrea Giaccari, Xuesong Fan, Auryan Szalat, Sanjaya Dissanayake, Etienne Khoury, Anja Vogt, Hermann Toplak, Alexis Baass, Isabel Palma, Gaelle Sablon, Dana A. Hay, Ya Yang, Margus Viigimaa, Erik S.G. Stroes, Dror Harats, Konstantin Krychtiuk, Zesen Liu, Aleksandra Parczewska, Yves Cottin, Yichen Qu, Mathilde Di-Fillipo, Agnieszka Konopka, Lamija Pojskic, Guadalupe J. Dominguez, Ahmet Temizhan, Roberto C. Chacon, Ibrahim E. Dural, Qiang Yong, G. Kees Hovingh, Kang Meng, Sandra Kutkiene, Julie Lemale, Reinhold Innerhofer, Alexandros D. Tselepis, Handrean Soran, Wolfgang König, Bassam Atallah, Olena Mitchenko, Jana Cepova, Eduardo M. Rodriguez, Ulrich Laufs, Norhidayah Rosman, Alena Lubasova, V. Durlach, Frederick J. Raal, Elyor Khodzhiboboev, Cristina Pederiva, Hui Yuan, Ashraf Reda, Fahad Alnouri, Konstantinos Tziomalos, Thanh T. Le, Jana Sirotiakova, Régis Hankard, Hector E.A. Cazares, Betsabel Rodriguez, Lenka Pavlickova, Assen Goudev, Julius Katzmann, Diana Boger, Wael Almahmeed, Katarina T. Podkrajsek, Sabina Zambon, Fahri Bayram, Nadia Citroni, Samir Rafla, Vincent Rigalleau, Aleksandr B. Shek, Hani Sabbour, Berenice G. Guzman, Shoshi Shpitzen, Eric Tarantino, Ahmed Bendary, Fedya Nikolov, Jean Bergeron, Stefan Kopf, Iva Rasulic, Gerald F. Watts, Muhammad I.A. Hafidz, Mehmet B. Yilmaz, Kathrin Biolik, Ira A. Haack, Robert A. Hegele, Sonia Dulong, Bartosz Wasąg, Osama Sanad, Susana Correia, Zhenjia Wang, Dana Biedermann, Christel König, Helena Podzimkova, Ihab Daoud, Mohammad Alghamdi, Dražen Perica, László Márk, Iosif Koutagiar, Volkan Dogan, Vladimir Blaha, Chandrashekhar K. Ponde, Katerina Valoskova, Amer A. Jabbar, Azhari Rosman, Sazzli Kasim, Mesut Demir, Ulugbek I. Nizamov, Aldo Ferreira-Hermosillo, Dilek Yesilbursa, Atef Elbahry, Arshad Abdulrasheed, Omer A. Elamin, Vasileios Athyros, Joanna Lewek, Gergely Nagy, Ursula Kassner, Jian Jiao, Klaus G. Parhofer, Charlotte Nzeyimana, Marcin Pajkowski, Stanislav Zemek, Jose J.C. Macías, Cornelius Müller, G. Sfikas, Leopoldo Pérez de Isla, Yulia Ragino, Fahad Al-Zadjali, Abdul Rais Sanusi, Anna Rita Roscini, Jean Ferrières, Selim Jambart, Jean Pierre Rabes, Laura Schreier, Hofit Cohen, Olivier S. Descamps, N. Lalic, Christine Stumpp, Antonio J. Vallejo-Vaz, Jutta Christmann, Manuela Casula, Mariko Harada-Shiba, Olga Lunegova, Ewa Starostecka, Nicolas D. Oca, Alain Carrié, Achilleas Attilakos, Savas Ozer, Andreea Dumitrescu, Jürgen Merke, Urte Aliosaitiene, Evangelos Liberopoulos, Manuel O. De los Rios Ibarra, Maria J. Virtuoso, Alessandro Lupi, Panagiotis Anagnostis, Ruth Agar, Dorota Ferrieres, George Liamis, José Eduardo Krieger, Mariann Harangi, Fouzia Sadiq, Francois Schiele, Saif Kamal, Mária Audikovszky, Peter Baumgartner, Marta Gazzotti, Daniel Gaudet, Ashanty F. Ortega, Marcin Gruchała, Philippe Moulin, Ljiljana Popovic, Luca Bonanni, E. Kiouri, Mika Hori, Chiara Trenti, Elena Repetti, Carlo Sabbà, Sophie Bernard, Alejandro R. Zazueta, Mirac Vural, Jesus R. Gonzalez, C. Stevens, Francesca Carubbi, Wenhui Wen, Sabri Demircan, Kanika I. Dharmayat, Anne Tybjærg-Hansen, Elizabete Terauda, Claudia Zemmrich, Alphonsus Isara, Fabiola L. Sobrevilla, Anell Hernandez Garcia, Ibrahim Sisic, Justin T. I-Shing, Yvonne Winhofer-Stöckl, Luya Wang, Manfred Mayer, Mohanad Al-ageedi, Judith Wiener, Mohammed Al-Kindi, Anis Safura Ramli, Yan Chen, Denis Angoulvant, Aytekin Oguz, K.H. Wolmarans, Claudio Ferri, Tomáš Freiberger, Lubomira Cermakova, Julieta D.M. Portano, Pierre Henri Ducluzeau, Katerina Vonaskova, Levent H. Can, Mario H.F. Andrade, György Paragh, C. Ebenbichler, Karina J.A. Rivera, Alia Khudari, Elisabeth Steinhagen-Thiessen, Ana C. Alves, Victoria Korneva, Sandra Singh, Georgia Anastasiou, Nur S. Hamzan, Massimo Federici, Lale Tokgozoglu, Hector G. Alcala, Oana Moldovan, Giuseppe Mandraffino, Swarup A.V. Shah, Lukas Burda, Ersel Onrat, Manuel de los Reyes Barrera Bustillo, Mirjana Radovic, Arman Postadzhiyan, Nien-Tzu Chang, Aylin Yildirir, Martin Mäser, Bruno Fink, Svetlana Mosteoru, Ulrike Schatz, Luis A.V. Talavera, Magdalena Dusejovska, Richard Ceska, Faisal A. Al-Allaf, T.F. Ashavaid, Gereon Böll, Sona Machacova, Gonzalo C. Vargas, Antonio Gallo, Elina Pantchechnikova, Lukas Tichy, Gersina Rega-Kaun, Moses Elisaf, Branislav Vohnout, Antonio Bossi, Suad Al-Mukhaini, Natasa Rajkovic, Ursa Sustar, Merih Kutlu, Mohamed Sobhy, Britta Otte, Ana M. Medeiros, Borut Jug, Patrick Couture, Rodrigo Alonso, Wolfgang Seeger, Guzal J. Abdullaeva, Ahmet Celik, Nasreen Al-Sayed, Béla Benczúr, Petra E. Khoury, Rafezah Razali, Ma L.R. Osorio, Ruiying Zhang, Monica M.N. Usme, Humberto Garcia Aguilar, Ceyhun Ceyhan, Antje Spens, Christoph J. Binder, Volker Schrader, Terrance C.S. Jin, Neftali E.A. Villa, Aleksandra Michalska-Grzonkowska, Francesco Purrello, Marshima M. Rosli, Vincent Maher, Dilshad Rasul, Ines Colaço, Ornella Guardamagna, Giuliana Mombelli, Khalid F. AlHabib, Fahmi Alkaf, Marianne Benn, Youmna Ghaleb, Arsenio V. Vazquez, Lakshmi L. Reddy, Salih Kilic, Siti Hamimah Sheikh Abdul Kadir, E. Bilianou, Rossella Marcucci, Sandro Muntoni, Kurt Widhalm, Evangelos A. Zacharis, Kuznetsova T. Yu, Eric Bruckert, Antonia Sonntag, Katerina Rehouskova, Josè Pablo Werba, Leobardo Sauque-Reyna, Myra Tilney, Dov Gavishv, A.M. Fiorenza, Zdenka Krejsova, Hong A. Le, Andrey V. Susekov, Isabel Klein, Mai N.T. Nguyen, Andrejs Erglis, Muge Ildizli, Diane Brisson, Salmi Razali, Winfried März, Ovidio Muñiz-Grijalvo, Justyna Borowiec-Wolna, Ingrid Buganova, Ngoc T. Kim, Yue Wu, István Reiber, Jose C.A. Martinez, Pavel Malina, Sandy Elbitar, Stephan Matthias, Ali F. Abdalsahib, Zlatko Fras, Wilson E Sadoh, Lucas Kleemann, Tayfun Sahin, Martin P. Bogsrud, Fabio Pellegatta, Mohamed A. Shafy, Yuntao Li, Martine Paquette, Zuhier Awan, Arturo Pujia, Xiantao Song, Renata Cifkova, Alexandre C. Pereira, Ioannis Skoumas, Roman Cibulka, Tadej Battelino, Mariusz Gąsior, Ghada Kazamel, Lahore S.U. Shah, Eran Leitersdorf, Niki Katsiki, Daniel Elías-López, Khalid Al-Rasadi, Grete Talviste, Sarka Mala, Rocio M. Alvarado, Pavel Kraml, Gerret Paulsen, Angelina Passaro, Zsolt Karányi, Carine Ayoub, Vera Adamkova, Ivo Petrov, Turky H. Almigbal, Rohana Abdul Ghani, Franck Boccara, Brian W. McCrindle, François Martin, Jamshed J. Dalal, Shitong Cheng, Khalid Al-Waili, Chaoyi Zhang, Ramon M. Prado, Lubica Cibickova, Lubomira Fabryova, Tobias Wiesner, Thuhairah Hasrah Abdul Rahman, Tan J. Le, Marcello Arca, Sabine Scholl-Bürgi, Juan R. Saucedo, Georgijs Nesterovics, Carla V.M. Valencia, Alexander Stadelmann, Vasileios Kotsis, Lina Badimon, Shizuya Yamashita, Jose C.M. Oyervides, Lay K. Teh, Susanne Greber-Platzer, Marianne Abifadel, Ruta Meiere, Wibke Reinhard, Pablo Corral, Nina Schmidt, Alain Pradignac, A. David Marais, Marta Jordanova, Marzena Romanowska-Kocejko, Johannes Scholl, Brian Tomlinson, Laura G.G. Herrera, Loukianos S. Rallidis, Pedro Mata, Sameh Emil, Matej Mlinaric, Emile Ferrari, Suraya Abdul Razak, Alexandra Ershova, Andrie G. Panayiotou, Alinna Y.R. Garcia, Kairat Davletov, Katarina Lalic, Doan L. Do, Krzysztof Chlebus, Ricardo A. Carrera, Daniel I.P. Vazquez, Nikolaos Sakkas, Liyuan Xu, Mays Altaey, Aysa Hacioglu, Alexandro J. Martagon, Marta Żarczyńska-Buchowiecka, Michael Schömig, Jürgen Homberger, Andrea Benso, Bertrand Cariou, Ardon Rubinstein, Omer Gedikli, Emre Durakoglugil, Mei Chong, Bahadir Kirilmaz, Suhaila Abd Muid, Jose M. Salgado, Berenice P. Aparicio, Mutaz Alkhnifsawi, Bruno Vergès, Cécile Yelnik, Goreti Lobarinhas, Zaneta Petrulioniene, Sylvia Asenjo, Aytul B. Yildirim, László Bajnok, Vallejo-Vaz A.J., Stevens C.A.T., Lyons A.R.M., Dharmayat K.I., Freiberger T., Hovingh G.K., Mata P., Raal F.J., Santos R.D., Soran H., Watts G.F., Abifadel M., Aguilar-Salinas C.A., Alhabib K.F., Alkhnifsawi M., Almahmeed W., Alnouri F., Alonso R., Al-Rasadi K., Al-Sarraf A., Al-Sayed N., Araujo F., Ashavaid T.F., Banach M., Beliard S., Benn M., Binder C.J., Bogsrud M.P., Bourbon M., Chlebus K., Corral P., Davletov K., Descamps O.S., Durst R., Ezhov M., Gaita D., Genest J., Groselj U., Harada-Shiba M., Holven K.B., Kayikcioglu M., Khovidhunkit W., Lalic K., Latkovskis G., Laufs U., Liberopoulos E., Lima-Martinez M.M., Lin J., Maher V., Marais A.D., Marz W., Mirrakhimov E., Miserez A.R., Mitchenko O., Nawawi H., Nordestgaard B.G., Panayiotou A.G., Paragh G., Petrulioniene Z., Pojskic B., Postadzhiyan A., Raslova K., Reda A., Reiner, Sadiq F., Sadoh W.E., Schunkert H., Shek A.B., Stoll M., Stroes E., Su T.-C., Subramaniam T., Susekov A.V., Tilney M., Tomlinson B., Truong T.H., Tselepis A.D., Tybjaerg-Hansen A., Vazquez Cardenas A., Viigimaa M., Wang L., Yamashita S., Kastelein J.J.P., Bruckert E., Vohnout B., Schreier L., Pang J., Ebenbichler C., Dieplinger H., Innerhofer R., Winhofer-Stockl Y., Greber-Platzer S., Krychtiuk K., Speidl W., Toplak H., Widhalm K., Stulnig T., Huber K., Hollerl F., Rega-Kaun G., Kleemann L., Maser M., Scholl-Burgi S., Saly C., Mayer F.J., Sablon G., Tarantino E., Nzeyimana C., Pojskic L., Sisic I., Nalbantic A.D., Jannes C.E., Pereira A.C., Krieger J.E., Petrov I., Goudev A., Nikolov F., Tisheva S., Yotov Y., Tzvetkov I., Baass A., Bergeron J., Bernard S., Brisson D., Brunham L.R., Cermakova L., Couture P., Francis G.A., Gaudet D., Hegele R.A., Khoury E., Mancini G.B.J., McCrindle B.W., Paquette M., Ruel I., Cuevas A., Asenjo S., Wang X., Meng K., Song X., Yong Q., Jiang T., Liu Z., Duan Y., Hong J., Ye P., Chen Y., Qi J., Li Y., Zhang C., Peng J., Yang Y., Yu W., Wang Q., Yuan H., Cheng S., Jiang L., Chong M., Jiao J., Wu Y., Wen W., Xu L., Zhang R., Qu Y., He J., Fan X., Wang Z., Chow E., Pecin I., Perica D., Symeonides P., Vrablik M., Ceska R., Soska V., Tichy L., Adamkova V., Franekova J., Cifkova R., Kraml P., Vonaskova K., Cepova J., Dusejovska M., Pavlickova L., Blaha V., Rosolova H., Nussbaumerova B., Cibulka R., Vaverkova H., Cibickova L., Krejsova Z., Rehouskova K., Malina P., Budikova M., Palanova V., Solcova L., Lubasova A., Podzimkova H., Bujdak J., Vesely J., Jordanova M., Salek T., Urbanek R., Zemek S., Lacko J., Halamkova H., Machacova S., Mala S., Cubova E., Valoskova K., Burda L., Bendary A., Daoud I., Emil S., Elbahry A., Rafla S., Sanad O., Kazamel G., Ashraf M., Sobhy M., El-Hadidy A., Shafy M.A., Kamal S., Bendary M., Talviste G., Angoulvant D., Boccara F., Cariou B., Carreau V., Carrie A., Charrieres S., Cottin Y., Di-Fillipo M., Ducluzeau P.H., Dulong S., Durlach V., Farnier M., Ferrari E., Ferrieres D., Ferrieres J., Gallo A., hankard R., Inamo J., Lemale J., Moulin P., Paillard F., Peretti N., Perrin A., Pradignac A., Rabes J.P., Rigalleau V., Sultan A., Schiele F., Tounian P., Valero R., Verges B., Yelnik C., Ziegler O., Haack I.A., Schmidt N., Dressel A., Klein I., Christmann J., Sonntag A., Stumpp C., Boger D., Biedermann D., Usme M.M.N., Beil F.U., Klose G., Konig C., Gouni-Berthold I., Otte B., Boll G., Kirschbaum A., Merke J., Scholl J., Segiet T., Gebauer M., Predica F., Mayer M., Leistikow F., Fullgraf-Horst S., Muller C., Schuler M., Wiener J., Hein K., Baumgartner P., Kopf S., Busch R., Schomig M., Matthias S., Allendorf-Ostwald N., Fink B., Bohm D., Jakel A., Koschker A.-C., Schweizer R., Vogt A., Parhofer K., Konig W., Reinhard W., Bassler A., Stadelmann A., Schrader V., Katzmann J., Tarr A., Steinhagen-Thiessen E., Kassner U., Paulsen G., Homberger J., Zemmrich C., Seeger W., Biolik K., Deiss D., Richter C., Pantchechnikova E., Dorn E., Schatz U., Julius U., Spens A., Wiesner T., Scholl M., Rizos C.V., Sakkas N., Elisaf M., Skoumas I., Tziomalos K., Rallidis L., Kotsis V., Doumas M., Athyros V., Skalidis E., Kolovou G., Garoufi A., Bilianou E., Koutagiar I., Agapakis D., Kiouri E., Antza C., Katsiki N., Zacharis E., Attilakos A., Sfikas G., Koumaras C., Anagnostis P., Anastasiou G., Liamis G., Koutsogianni A.-D., Karanyi Z., Harangi M., Bajnok L., Audikovszky M., Mark L., Benczur B., Reiber I., Nagy G., Nagy A., Reddy L.L., Shah S.A.V., Ponde C.K., Dalal J.J., Sawhney J.P.S., Verma I.C., Altaey M., Al-Jumaily K., Rasul D., Abdalsahib A.F., Jabbar A.A., Al-ageedi M., Agar R., Cohen H., Ellis A., Gavishv D., Harats D., Henkin Y., Knobler H., Leavit L., Leitersdorf E., Rubinstein A., Schurr D., Shpitzen S., Szalat A., Casula M., Zampoleri V., Gazzotti M., Olmastroni E., Sarzani R., Ferri C., Repetti E., Sabba C., Bossi A.C., Borghi C., Muntoni S., Cipollone F., Purrello F., Pujia A., Passaro A., Marcucci R., Pecchioli V., Pisciotta L., Mandraffino G., Pellegatta F., Mombelli G., Branchi A., Fiorenza A.M., Pederiva C., Werba J.P., Parati G., Carubbi F., Iughetti L., Iannuzzi A., Iannuzzo G., Calabro P., Averna M, Biasucci G., Zambon S., Roscini A.R., Trenti C., Arca M., Federici M., Del Ben M., Bartuli A., Giaccari A., Pipolo A., Citroni N., Guardamagna O., Bonomo K., Benso A., Biolo G., Maroni L., Lupi A., Bonanni L., Zenti M.G., Matsuki K., Hori M., Ogura M., Masuda D., Kobayashi T., Nagahama K., Al-Jarallah M., Radovic M., Lunegova O., Bektasheva E., Khodzhiboboev E., Erglis A., Gilis D., Nesterovics G., Saripo V., Meiere R., Upena-RozeMicena A., Terauda E., Jambart S., Khoury P.E., Elbitar S., Ayoub C., Ghaleb Y., Aliosaitiene U., Kutkiene S., Kasim N.A.M., Nor N.S.M., Ramli A.S., Razak S.A., Al-Khateeb A., Kadir S.H.S.A., Muid S.A., Rahman T.A., Kasim S.S., Radzi A.B.M., Ibrahim K.S., Razali S., Ismail Z., Ghani R.A., Hafidz M.I.A., Chua A.L., Rosli M.M., Annamalai M., Teh L.K., Razali R., Chua Y.A., Rosman A., Sanusi A.R., Murad N.A.A., Jamal A.R.A., Nazli S.A., Razman A.Z., Rosman N., Rahmat R., Hamzan N.S., Azzopardi C., Mehta R., Martagon A.J., Ramirez G.A.G., Villa N.E.A., Vazquez A.V., Elias-Lopez D., Retana G.G., Rodriguez B., Macias J.J.C., Zazueta A.R., Alvarado R.M., Portano J.D.M., Lopez H.A., Sauque-Reyna L., Herrera L.G.G., Mendia L.E.S., Aguilar H.G., Cooremans E.R., Aparicio B.P., Zubieta V.M., Gonzalez P.A.C., Ferreira-Hermosillo A., Portilla N.C., Dominguez G.J., Garcia A.Y.R., Cazares H.E.A., Gonzalez J.R., Valencia C.V.M., Padilla F.G., Prado R.M., De los Rios Ibarra M.O., Villicana R.D.A., Rivera K.J.A., Carrera R.A., Alvarez J.A., Martinez J.C.A., de los Reyes Barrera Bustillo M., Vargas G.C., Chacon R.C., Andrade M.H.F., Ortega A.F., Alcala H.G., de Leon L.E.G., Guzman B.G., Garcia J.J.G., Cuellar J.C.G., Cruz J.R.G., Garcia A.H., Almada J.R.H., Herrera U.J., Sobrevilla F.L., Rodriguez E.M., Sibaja C.M., Rodriguez A.B.M., Oyervides J.C.M., Vazquez D.I.P., Rodriguez E.A.R., Osorio M.L.R., Saucedo J.R., Tamayo M.T., Talavera L.A.V., Arroyo L.E.V., Carrillo E.A.Z., Isara A., Obaseki D.E., Al-Waili K., Al-Zadjali F., Al-Zakwani I., Al-Kindi M., Al-Mukhaini S., Al-Barwani H., Rana A., Shah L.S.U., Starostecka E., Konopka A., Lewek J., Bartlomiejczyk M., Gasior M., Dyrbus K., Jozwiak J., Gruchala M., Pajkowski M., Romanowska-Kocejko M., Zarczynska-Buchowiecka M., Chmara M., Wasag B., Parczewska A., Gilis-Malinowska N., Borowiec-Wolna J., Strozyk A., Wos M., Michalska-Grzonkowska A., Medeiros A.M., Alves A.C., Silva F., Lobarinhas G., Palma I., de Moura J.P., Rico M.T., Rato Q., Pais P., Correia S., Moldovan O., Virtuoso M.J., Salgado J.M., Colaco I., Dumitrescu A., Lengher C., Mosteoru S., Meshkov A., Ershova A., Rozkova T., Korneva V., Yu K.T., Zafiraki V., Voevoda M., Gurevich V., Duplyakov D., Ragino Y., Safarova M., Shaposhnik I., Alkaf F., Khudari A., Rwaili N., Al-Allaf F., Alghamdi M., Batais M.A., Almigbal T.H., Kinsara A., AlQudaimi A.H.A., Awan Z., Elamin O.A., Altaradi H., Rajkovic N., Popovic L., Singh S., Stosic L., Rasulic I., Lalic N.M., Lam C., Le T.J., Siang E.L.T., Dissanayake S., I-Shing J.T., Shyong T.E., Jin T.C.S., Balinth K., Buganova I., Fabryova L., Kadurova M., Klabnik A., Kozarova M., Sirotiakova J., Battelino T., Kovac J., Mlinaric M., Sustar U., Podkrajsek K.T., Fras Z., Jug B., Cevc M., Pilcher G.J., Blom D.J., Wolmarans K.H., Brice B.C., Muniz-Grijalvo O., Diaz-Diaz J.L., de Isla L.P., Fuentes F., Badimon L., Martin F., Lux A., Chang N.-T., Ganokroj P., Akbulut M., Alici G., Bayram F., Can L.H., Celik A., Ceyhan C., Coskun F.Y., Demir M., Demircan S., Dogan V., Durakoglugil E., Dural I.E., Gedikli O., Hacioglu A., Ildizli M., Kilic S., Kirilmaz B., Kutlu M., Oguz A., Ozdogan O., Onrat E., Ozer S., Sabuncu T., Sahin T., Sivri F., Sonmez A., Temizhan A., Topcu S., Tuncez A., Vural M., Yenercag M., Yesilbursa D., Yigit Z., Yildirim A.B., Yildirir A., Yilmaz M.B., Atallah B., Traina M., Sabbour H., Hay D.A., Luqman N., Elfatih A., Abdulrasheed A., Kwok S., Oca N.D., Reyes X., Alieva R.B., Kurbanov R.D., Hoshimov S.U., Nizamov U.I., Ziyaeva A.V., Abdullaeva G.J., Do D.L., Nguyen M.N.T., Kim N.T., Le T.T., Le H.A., Tokgozoglu L., Catapano A.L., Ray K.K., Vallejo-Vaz, A. J., Stevens, C. A. T., Lyons, A. R. M., Dharmayat, K. I., Freiberger, T., Hovingh, G. K., Mata, P., Raal, F. J., Santos, R. D., Soran, H., Watts, G. F., Abifadel, M., Aguilar-Salinas, C. A., Alhabib, K. F., Alkhnifsawi, M., Almahmeed, W., Alnouri, F., Alonso, R., Al-Rasadi, K., Al-Sarraf, A., Al-Sayed, N., Araujo, F., Ashavaid, T. F., Banach, M., Beliard, S., Benn, M., Binder, C. J., Bogsrud, M. P., Bourbon, M., Chlebus, K., Corral, P., Davletov, K., Descamps, O. S., Durst, R., Ezhov, M., Gaita, D., Genest, J., Groselj, U., Harada-Shiba, M., Holven, K. B., Kayikcioglu, M., Khovidhunkit, W., Lalic, K., Latkovskis, G., Laufs, U., Liberopoulos, E., Lima-Martinez, M. M., Lin, J., Maher, V., Marais, A. D., Marz, W., Mirrakhimov, E., Miserez, A. R., Mitchenko, O., Nawawi, H., Nordestgaard, B. G., Panayiotou, A. G., Paragh, G., Petrulioniene, Z., Pojskic, B., Postadzhiyan, A., Raslova, K., Reda, A., Sadiq, F., Sadoh, W. E., Schunkert, H., Shek, A. B., Stoll, M., Stroes, E., Su, T. -C., Subramaniam, T., Susekov, A. V., Tilney, M., Tomlinson, B., Truong, T. H., Tselepis, A. D., Tybjaerg-Hansen, A., Vazquez Cardenas, A., Viigimaa, M., Wang, L., Yamashita, S., Kastelein, J. J. P., Bruckert, E., Vohnout, B., Schreier, L., Pang, J., Ebenbichler, C., Dieplinger, H., Innerhofer, R., Winhofer-Stockl, Y., Greber-Platzer, S., Krychtiuk, K., Speidl, W., Toplak, H., Widhalm, K., Stulnig, T., Huber, K., Hollerl, F., Rega-Kaun, G., Kleemann, L., Maser, M., Scholl-Burgi, S., Saly, C., Mayer, F. J., Sablon, G., Tarantino, E., Nzeyimana, C., Pojskic, L., Sisic, I., Nalbantic, A. D., Jannes, C. E., Pereira, A. C., Krieger, J. E., Petrov, I., Goudev, A., Nikolov, F., Tisheva, S., Yotov, Y., Tzvetkov, I., Baass, A., Bergeron, J., Bernard, S., Brisson, D., Brunham, L. R., Cermakova, L., Couture, P., Francis, G. A., Gaudet, D., Hegele, R. A., Khoury, E., Mancini, G. B. J., Mccrindle, B. W., Paquette, M., Ruel, I., Cuevas, A., Asenjo, S., Wang, X., Meng, K., Song, X., Yong, Q., Jiang, T., Liu, Z., Duan, Y., Hong, J., Ye, P., Chen, Y., Qi, J., Li, Y., Zhang, C., Peng, J., Yang, Y., Yu, W., Wang, Q., Yuan, H., Cheng, S., Jiang, L., Chong, M., Jiao, J., Wu, Y., Wen, W., Xu, L., Zhang, R., Qu, Y., He, J., Fan, X., Wang, Z., Chow, E., Pecin, I., Perica, D., Symeonides, P., Vrablik, M., Ceska, R., Soska, V., Tichy, L., Adamkova, V., Franekova, J., Cifkova, R., Kraml, P., Vonaskova, K., Cepova, J., Dusejovska, M., Pavlickova, L., Blaha, V., Rosolova, H., Nussbaumerova, B., Cibulka, R., Vaverkova, H., Cibickova, L., Krejsova, Z., Rehouskova, K., Malina, P., Budikova, M., Palanova, V., Solcova, L., Lubasova, A., Podzimkova, H., Bujdak, J., Vesely, J., Jordanova, M., Salek, T., Urbanek, R., Zemek, S., Lacko, J., Halamkova, H., Machacova, S., Mala, S., Cubova, E., Valoskova, K., Burda, L., Bendary, A., Daoud, I., Emil, S., Elbahry, A., Rafla, S., Sanad, O., Kazamel, G., Ashraf, M., Sobhy, M., El-Hadidy, A., Shafy, M. 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U., Klose, G., Konig, C., Gouni-Berthold, I., Otte, B., Boll, G., Kirschbaum, A., Merke, J., Scholl, J., Segiet, T., Gebauer, M., Predica, F., Mayer, M., Leistikow, F., Fullgraf-Horst, S., Muller, C., Schuler, M., Wiener, J., Hein, K., Baumgartner, P., Kopf, S., Busch, R., Schomig, M., Matthias, S., Allendorf-Ostwald, N., Fink, B., Bohm, D., Jakel, A., Koschker, A. -C., Schweizer, R., Vogt, A., Parhofer, K., Konig, W., Reinhard, W., Bassler, A., Stadelmann, A., Schrader, V., Katzmann, J., Tarr, A., Steinhagen-Thiessen, E., Kassner, U., Paulsen, G., Homberger, J., Zemmrich, C., Seeger, W., Biolik, K., Deiss, D., Richter, C., Pantchechnikova, E., Dorn, E., Schatz, U., Julius, U., Spens, A., Wiesner, T., Scholl, M., Rizos, C. V., Sakkas, N., Elisaf, M., Skoumas, I., Tziomalos, K., Rallidis, L., Kotsis, V., Doumas, M., Athyros, V., Skalidis, E., Kolovou, G., Garoufi, A., Bilianou, E., Koutagiar, I., Agapakis, D., Kiouri, E., Antza, C., Katsiki, N., Zacharis, E., Attilakos, A., Sfikas, G., Koumaras, C., Anagnostis, P., Anastasiou, G., Liamis, G., Koutsogianni, A. -D., Karanyi, Z., Harangi, M., Bajnok, L., Audikovszky, M., Mark, L., Benczur, B., Reiber, I., Nagy, G., Nagy, A., Reddy, L. L., Shah, S. A. V., Ponde, C. K., Dalal, J. J., Sawhney, J. P. S., Verma, I. C., Altaey, M., Al-Jumaily, K., Rasul, D., Abdalsahib, A. F., Jabbar, A. A., Al-ageedi, M., Agar, R., Cohen, H., Ellis, A., Gavishv, D., Harats, D., Henkin, Y., Knobler, H., Leavit, L., Leitersdorf, E., Rubinstein, A., Schurr, D., Shpitzen, S., Szalat, A., Casula, M., Zampoleri, V., Gazzotti, M., Olmastroni, E., Sarzani, R., Ferri, C., Repetti, E., Sabba, C., Bossi, A. C., Borghi, C., Muntoni, S., Cipollone, F., Purrello, F., Pujia, A., Passaro, A., Marcucci, R., Pecchioli, V., Pisciotta, L., Mandraffino, G., Pellegatta, F., Mombelli, G., Branchi, A., Fiorenza, A. M., Pederiva, C., Werba, J. P., Parati, G., Carubbi, F., Iughetti, L., Iannuzzi, A., Iannuzzo, G., Calabro, P., Averna, M., Biasucci, G., Zambon, S., Roscini, A. R., Trenti, C., Arca, M., Federici, M., Del Ben, M., Bartuli, A., Giaccari, A., Pipolo, A., Citroni, N., Guardamagna, O., Bonomo, K., Benso, A., Biolo, G., Maroni, L., Lupi, A., Bonanni, L., Zenti, M. G., Matsuki, K., Hori, M., Ogura, M., Masuda, D., Kobayashi, T., Nagahama, K., Al-Jarallah, M., Radovic, M., Lunegova, O., Bektasheva, E., Khodzhiboboev, E., Erglis, A., Gilis, D., Nesterovics, G., Saripo, V., Meiere, R., Upena-RozeMicena, A., Terauda, E., Jambart, S., Khoury, P. E., Elbitar, S., Ayoub, C., Ghaleb, Y., Aliosaitiene, U., Kutkiene, S., Kasim, N. A. M., Nor, N. S. M., Ramli, A. S., Razak, S. A., Al-Khateeb, A., Kadir, S. H. S. A., Muid, S. A., Rahman, T. A., Kasim, S. S., Radzi, A. B. M., Ibrahim, K. S., Razali, S., Ismail, Z., Ghani, R. A., Hafidz, M. I. A., Chua, A. L., Rosli, M. M., Annamalai, M., Teh, L. K., Razali, R., Chua, Y. A., Rosman, A., Sanusi, A. R., Murad, N. A. A., Jamal, A. R. A., Nazli, S. A., Razman, A. Z., Rosman, N., Rahmat, R., Hamzan, N. S., Azzopardi, C., Mehta, R., Martagon, A. J., Ramirez, G. A. G., Villa, N. E. A., Vazquez, A. V., Elias-Lopez, D., Retana, G. G., Rodriguez, B., Macias, J. J. C., Zazueta, A. R., Alvarado, R. M., Portano, J. D. M., Lopez, H. A., Sauque-Reyna, L., Herrera, L. G. G., Mendia, L. E. S., Aguilar, H. G., Cooremans, E. R., Aparicio, B. P., Zubieta, V. M., Gonzalez, P. A. C., Ferreira-Hermosillo, A., Portilla, N. C., Dominguez, G. J., Garcia, A. Y. R., Cazares, H. E. A., Gonzalez, J. R., Valencia, C. V. M., Padilla, F. G., Prado, R. M., De los Rios Ibarra, M. O., Villicana, R. D. A., Rivera, K. J. A., Carrera, R. A., Alvarez, J. A., Martinez, J. C. A., de los Reyes Barrera Bustillo, M., Vargas, G. C., Chacon, R. C., Andrade, M. H. F., Ortega, A. F., Alcala, H. G., de Leon, L. E. G., Guzman, B. G., Garcia, J. J. G., Cuellar, J. C. G., Cruz, J. R. G., Garcia, A. H., Almada, J. R. H., Herrera, U. J., Sobrevilla, F. L., Rodriguez, E. M., Sibaja, C. M., Rodriguez, A. B. M., Oyervides, J. C. M., Vazquez, D. I. P., Rodriguez, E. A. R., Osorio, M. L. R., Saucedo, J. R., Tamayo, M. T., Talavera, L. A. V., Arroyo, L. E. V., Carrillo, E. A. Z., Isara, A., Obaseki, D. E., Al-Waili, K., Al-Zadjali, F., Al-Zakwani, I., Al-Kindi, M., Al-Mukhaini, S., Al-Barwani, H., Rana, A., Shah, L. S. U., Starostecka, E., Konopka, A., Lewek, J., Bartlomiejczyk, M., Gasior, M., Dyrbus, K., Jozwiak, J., Gruchala, M., Pajkowski, M., Romanowska-Kocejko, M., Zarczynska-Buchowiecka, M., Chmara, M., Wasag, B., Parczewska, A., Gilis-Malinowska, N., Borowiec-Wolna, J., Strozyk, A., Wos, M., Michalska-Grzonkowska, A., Medeiros, A. M., Alves, A. C., Silva, F., Lobarinhas, G., Palma, I., de Moura, J. P., Rico, M. T., Rato, Q., Pais, P., Correia, S., Moldovan, O., Virtuoso, M. J., Salgado, J. M., Colaco, I., Dumitrescu, A., Lengher, C., Mosteoru, S., Meshkov, A., Ershova, A., Rozkova, T., Korneva, V., Yu, K. T., Zafiraki, V., Voevoda, M., Gurevich, V., Duplyakov, D., Ragino, Y., Safarova, M., Shaposhnik, I., Alkaf, F., Khudari, A., Rwaili, N., Al-Allaf, F., Alghamdi, M., Batais, M. A., Almigbal, T. H., Kinsara, A., Alqudaimi, A. H. A., Awan, Z., Elamin, O. A., Altaradi, H., Rajkovic, N., Popovic, L., Singh, S., Stosic, L., Rasulic, I., Lalic, N. M., Lam, C., Le, T. J., Siang, E. L. T., Dissanayake, S., I-Shing, J. T., Shyong, T. E., Jin, T. C. S., Balinth, K., Buganova, I., Fabryova, L., Kadurova, M., Klabnik, A., Kozarova, M., Sirotiakova, J., Battelino, T., Kovac, J., Mlinaric, M., Sustar, U., Podkrajsek, K. T., Fras, Z., Jug, B., Cevc, M., Pilcher, G. J., Blom, D. J., Wolmarans, K. H., Brice, B. C., Muniz-Grijalvo, O., Diaz-Diaz, J. L., de Isla, L. P., Fuentes, F., Badimon, L., Martin, F., Lux, A., Chang, N. -T., Ganokroj, P., Akbulut, M., Alici, G., Bayram, F., Can, L. H., Celik, A., Ceyhan, C., Coskun, F. Y., Demir, M., Demircan, S., Dogan, V., Durakoglugil, E., Dural, I. E., Gedikli, O., Hacioglu, A., Ildizli, M., Kilic, S., Kirilmaz, B., Kutlu, M., Oguz, A., Ozdogan, O., Onrat, E., Ozer, S., Sabuncu, T., Sahin, T., Sivri, F., Sonmez, A., Temizhan, A., Topcu, S., Tuncez, A., Vural, M., Yenercag, M., Yesilbursa, D., Yigit, Z., Yildirim, A. B., Yildirir, A., Yilmaz, M. B., Atallah, B., Traina, M., Sabbour, H., Hay, D. A., Luqman, N., Elfatih, A., Abdulrasheed, A., Kwok, S., Oca, N. D., Reyes, X., Alieva, R. B., Kurbanov, R. D., Hoshimov, S. U., Nizamov, U. I., Ziyaeva, A. V., Abdullaeva, G. J., Do, D. L., Nguyen, M. N. T., Kim, N. T., Le, T. T., Le, H. A., Tokgozoglu, L., Catapano, A. L., Ray, K. K., and EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Borghi C

Subjects
Male, Settore MED/09 - Medicina Interna, Arterial disease, Cross-sectional study, Adult population, Coronary Disease, Disease, Global Health, Medical and Health Sciences, Doenças Cardio e Cérebro-vasculares, Anticholesteremic Agent, Monoclonal, Prevalence, Registries, Familial Hypercholesterolemia, Humanized, Stroke, 11 Medical and Health Sciences, LS2_9, Studies Collaboration, Anticholesteremic Agents, General Medicine, Heart Disease Risk Factor, Middle Aged, FHSC global registry data, Europe, Treatment Outcome, Lower prevalence, Guidance, lipids (amino acids, peptides, and proteins), Female, Proprotein Convertase 9, Familial hypercholesterolaemia, Life Sciences & Biomedicine, Human, Adult, medicine.medical_specialty, Combination therapy, FHSC global registry, heterozygous familial hypercholesterolaemia, Cardiovascular risk factors, Antibodies, Monoclonal, Humanized, Insights, Antibodies, NO, Hyperlipoproteinemia Type II, Clinician, Medicine, General & Internal, Internal medicine, General & Internal Medicine, Health Sciences, medicine, Humans, EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Cross-Sectional Studie, Science & Technology, Global Perspective, business.industry, Cholesterol, LDL, medicine.disease, Cross-Sectional Studies, Heart Disease Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitor, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract

Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53.6%] women) from 56 countries were included in the study. Of these, 31 798 (75.4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84.2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46.2 years (IQR 34.3-58.0); median age at diagnosis of familial hypercholesterolaemia was 44.4 years (32.5-56.5), with 40.2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17.4% (2.1% for stroke and 5.2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81.1%) were receiving statins and 3691 (21.2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5.43 mmol/L (IQR 4.32-6.72) among patients not taking lipid-lowering medications and 4.23 mmol/L (3.20-5.66) among those taking them. Among patients taking lipid-lowering medications, 2.7% had LDL cholesterol lower than 1.8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1.8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p, Pfizer Independent Grant for Learning Change [16157823]; Amgen; Merck Sharp Dohme; Sanofi-Aventis; Daiichi Sankyo; Regeneron; National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK; NIHR; Czech Ministry of Health [NU20-02-00261]; Canadian Institutes of Health Research; Austrian Heart Foundation; Tyrolean Regional Government; Gulf Heart Association, The EAS FHSC is an academic initiative that has received funding from a Pfizer Independent Grant for Learning & Change 2014 (16157823) and from investigator-initiated research grants to the European Atherosclerosis Society-Imperial College London from Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron. KKR acknowledges support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK. KID acknowledges support from a PhD Studentship from NIHR under the Applied Health Research programme for Northwest London, UK (the views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health). TF was supported by a grant from the Czech Ministry of Health (NU20-02-00261). JG receives support from the Canadian Institutes of Health Research. The Austrian Familial Hypercholesterolaemia registry has been supported by funds from the Austrian Heart Foundation and the Tyrolean Regional Government. The Gulf Familial Hypercholesterolaemia registry was done under the auspices of the Gulf Heart Association.

Published
2021

42. Prediabetes Conversion to Normoglycemia is Superior Adding a Low-Carbohydrate and Energy Deficit Formula Diet to Lifestyle Intervention—A 12-Month Subanalysis of the ACOORH Trial

Author

Martin Röhling, Kerstin Kempf, Winfried Banzer, Aloys Berg, Klaus-Michael Braumann, Susanne Tan, Martin Halle, David McCarthy, Michel Pinget, Hans-Georg Predel, Jürgen Scholze, Hermann Toplak, Stephan Martin, and ACOORH study group

Subjects
Adult, Blood Glucose, Male, medicine.medical_specialty, Medizin, 030209 endocrinology & metabolism, lcsh:TX341-641, Type 2 diabetes, prediabetes, Overweight, Article, law.invention, Prediabetic State, 03 medical and health sciences, Diet, Carbohydrate-Restricted, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Lifestyle intervention, medicine, Humans, 030212 general & internal medicine, Prediabetes, Obesity, Life Style, Meals, dewey570, Glycemic, Food, Formulated, Meal, Nutrition and Dietetics, lifestyle intervention, formula diet, Middle Aged, medicine.disease, multicenter study, Diabetes Mellitus, Type 2, low-carbohydrate, Hyperglycemia, Female, medicine.symptom, Risk Reduction Behavior, lcsh:Nutrition. Foods and food supply, RCT, Food Science
Abstract

Lifestyle interventions have been shown to reverse hyperglycemia to normoglycemia. However, these effects are not long-lasting and are accompanied with high dropout rates. As formula diets have been shown to be simple in usage and effective in improving glycemic control, we hypothesised that adding a low-carbohydrate and energy deficit formula diet to a low-intensity lifestyle intervention is superior in reversing prediabetes compared with lifestyle intervention alone. In this predefined subanalysis of an international, multicenter randomised controlled trial (Almased Concept against Overweight and Obesity and Related Health Risk (ACOORH) study (ID DRKS00006811)), 141 persons with prediabetes were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 45) or a lifestyle intervention group accompanied with a formula diet (INT, n = 96). Both groups were equipped with telemonitoring devices. INT received a low-carbohydrate formula diet substituting three meals/day (~1200 kcal/day) within the first week, two meals/day during week 2–4, and one meal/day during week 5–26 (1300–1500 kcal/day). Follow-up was performed after 52 weeks and 105 participants (75%, INT: n = 74, CON: n = 31) finished the 26-week intervention phase. Follow-up data after 52 weeks were available from 93 participants (66%, INT: n = 65, CON: n = 28). Compared with CON, significantly more INT participants converted to normoglycemia after 52 weeks (50% vs. 31%, p &lt, 0.05). The risk reduction led to a number-needed-to-treat of 5.3 for INT. Lifestyle intervention with a low-carbohydrate formula diet reduces prediabetes prevalence stronger than lifestyle intervention alone and is effective for type 2 diabetes prevention.

Published
2020

43. Meal replacement by formula diet reduces weight more than a lifestyle intervention alone in patients with overweight or obesity and accompanied cardiovascular risk factors-the ACOORH trial

Author

Martin, Halle, Martin, Röhling, Winfried, Banzer, Klaus Michael, Braumann, Kerstin, Kempf, David, McCarthy, Nina, Schaller, Hans Georg, Predel, Jürgen, Scholze, Dagmar, Führer-Sakel, Hermann, Toplak, Aloys, Berg, and Michel, Pinget

Subjects
Cardiovascular Diseases, Heart Disease Risk Factors, Risk Factors, Humans, Obesity, Overweight, Life Style, Meals, Diet
Abstract

As formula diets have demonstrated to be effective in reducing weight, we hypothesised that in patients with overweight or obesity and accompanied cardiovascular risk factors, combining a liquid formula diet with a lifestyle intervention is superior in reducing weight and improving cardiovascular risk factors than lifestyle intervention alone.In this multicenter RCT 463 participants with overweight or obesity (BMI: 27-35 kg/m²; at least one additional co-morbidity of the metabolic syndrome) were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 155) or a lifestyle intervention group including a liquid meal replacement (INT, n = 308). Both groups used telemonitoring devices (scales and pedometers), received information on healthy diet and were instructed to increase physical activity. Telemonitoring devices automatically transferred data into a personalised online portal and acquired data were discussed. INT obtained a liquid meal replacement substituting three meals/day (~1200 kcal) within the first week. During weeks 2-4, participants replaced two meals/day and during weeks 5-26 only one meal/day was substituted (1300-1500 kcal/day). Follow-up was conducted after 52 weeks. Intention-to-treat analyses were performed. Primary outcome was weight change. Secondary outcomes comprised changes in cardiometabolic risk factors including body composition and laboratory parameters.From the starting cohort 360 (78%, INT: n = 244; CON: n = 116) and 317 (68%, INT: n = 216; CON: n = 101) participants completed the 26-weeks intervention phase and the 52-weeks follow-up. The estimated treatment difference (ETD) between both groups was -3.2 kg [-4.0; -2.5] (P 0.001) after 12 weeks and -1.8 kg [-2.8; -0.8] (P 0.001) after 52 weeks.A low-intensity lifestyle intervention combined with a liquid meal replacement is superior regarding weight reduction and improvement of cardiovascular risk factors than lifestyle intervention alone.

Published
2020

44. Efficacy and tolerability of alirocumab in Austrian clinical practice – results of the non-interventional PEARL-AT study

Author

Elisabeth M Schwaiger, Thomas Steinmaurer, Verena Gräff, Hermann Toplak, Rudolf Prager, Deborah R. Leitner, Thomas Metzner, and Ludmilla Kedenko

Subjects
Male, medicine.medical_specialty, animal structures, Hypercholesterolemia, 030204 cardiovascular system & hematology, Antibodies, Monoclonal, Humanized, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Alirocumab, business.industry, PCSK9 Inhibitors, fungi, food and beverages, Cholesterol, LDL, General Medicine, Middle Aged, Proprotein convertase, medicine.disease, Clinical Practice, Tolerability, Concomitant, Non interventional, Kexin, Female, business, Dyslipidemia
Abstract

Proprotein convertase subtilisin/kexin type 9 inhibition can be an effective treatment in patients with primary hypercholesterolemia, particularly in cases with concomitant coronary heart disease, peripheral artery occlusive disease or cerebrovascular occlusive disease for secondary prevention after an acute atherosclerotic ischemic event. The primary objective of the PEARL-AT study was to assess effectiveness and safety of alirocumab in a real-world setting in Austria. Non-interventional, prospective study conducted across Austria between September 2016 and July 2018. 113 patients, for whom the decision for treatment with alirocumab according to the Austrian Summary of Product Characteristics (SmPC) was made, were enrolled and were followed-up over 24 weeks. The primary endpoint of the study was the average change of low density lipoprotein cholesterol (LDL-C) levels by week 24. In total, 112 patients with at least one post-baseline visit were included. Alirocumab was initiated using 75 mg (57.1%) and 150 mg (42.9%) every two weeks. Average LDL-C levels decreased by 75.0 mg/dl at week 24 in 87 patients with available LDL-C at baseline and week 24 (in 25 patients LDL-C was missing at least at one time point). The mean relative change of LDL-C was −50.0% (median: 57.8%, SD: 28.4). Throughout the study, 46 adverse events were documented in 21 (18.6%) patients. The most frequent adverse events were gastrointestinal disorders. The present data indicate a good overall efficacy of alirocumab in a real-world Austrian population. Effectiveness and safety were both in line with the clinical trial program as well as previous real-world observations.

Published
2020
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45. Obesity and cardiovascular risk

Author

Konstantinos Tsioufis, Vasilios Kotsis, Guido Grassi, Christina Antza, Cristina Sierra, Gino Seravalle, Theodosios D Filippatos, Bojan Jelaković, Antonio Coca, Deborah R. Leitner, Nick Finer, Lale Tokgozoglu, Pau Redon, Vasilios G. Athyros, Moses Elisaf, Jens Jordan, Dragan Micic, Stella Stabouli, Empar Lurbe, Hermann Toplak, Peter M. Nilsson, Josep Redon, Kotsis, V, Jordan, J, Micic, D, Finer, N, Leitner, D, Toplak, H, Tokgozoglu, L, Athyros, V, Elisaf, M, Filippatos, T, Redon, J, Redon, P, Antza, C, Tsioufis, K, Grassi, G, Seravalle, G, Coca, A, Sierra, C, Lurbe, E, Stabouli, S, Jelakovic, B, and Nilsson, P

Subjects
cardiovascular risk, obesity, medicine.medical_specialty, Consensus, hypertension, Physiology, Physical exercise, Disease, Type 2 diabetes, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Diabetes mellitus, Internal Medicine, medicine, Humans, guidelines, 030212 general & internal medicine, Intensive care medicine, Exercise, Life Style, Stroke, Dyslipidemias, diabetes, business.industry, dyslipidemia, medicine.disease, Obesity, Diabetes Mellitus, Type 2, Cardiovascular Diseases, diabete, Heart failure, Cardiology and Cardiovascular Medicine, business, guideline, Dyslipidemia
Abstract

Obesity is a key factor for cardiovascular diseases and complications. Obesity is associated with hypertension, dyslipidemia and type II diabetes, which are the major predictors of cardiovascular disease in the future. It predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke that are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications.Epidemiology and mechanisms of obesity-induced hypertension, diabetes and dyslipidemia will be reviewed and the role of lifestyle modification and treatment strategies in obesity will be updated and analyzed. The best treatment options for people with obesity, hypertension, diabetes and dyslipidemia will discussed.

Published
2018

46. Lipide: Diagnostik und Therapie bei Diabetes mellitus (Update 2019)

Author

Bernhard Föger, Harald Stingl, Heinz Drexel, Bernhard Paulweber, Christoph H. Saely, den Ausschuss Leitlinien, Thomas C. Wascher, Hermann Toplak, Friedrich Hoppichler, Martin Clodi, and Thomas M. Stulnig

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Diabetes mellitus, Hyperlipidemia, medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business, medicine.disease
Abstract

Hyper- und Dyslipidamie tragen zur kardiovaskularen Morbiditat und Mortalitat diabetischer Patienten bei. Uberzeugende Daten zeigen, dass eine medikamentose Therapie mit Statinen das kardiovaskulare Risiko von Patienten mit Diabetes senken kann. Der vorliegende Artikel stellt die Behandlungsvorschlage der Osterreichischen Diabetes Gesellschaft zum Einsatz lipidsenkender Medikamente dar.

Published
2019

47. Clinical-Pathological Conference Series from the Medical University of Graz

Author

Guenter J. Krejs, Elisabeth Fabian, Michaela Brunner-Krainz, Franz Fazekas, Dietmar Schiller, Rainer Schoefl, and Hermann Toplak

Subjects
0301 basic medicine, medicine.medical_specialty, Pathology, Multiple Sclerosis, Atypical multiple sclerosis, Clinical-Pathological Conference, Irritable Bowel Syndrome, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pathological, Irritable bowel syndrome, Fabry disease, business.industry, Multiple sclerosis, General Medicine, Blood Pressure Monitoring, Ambulatory, Middle Aged, medicine.disease, Dermatology, 030104 developmental biology, Quality of Life, Female, business, 030217 neurology & neurosurgery
Published
2017

48. A Proposal of the European Association for the Study of Obesity to Improve the ICD-11 Diagnostic Criteria for Obesity Based on the Three Dimensions Etiology, Degree of Adiposity and Health Risk

Author

Nathalie Farpour-Lambert, Gema Frühbeck, Tommy L S Visscher, Euan Woodward, Dana Müllerová, Ellen E. Blaak, Jason G.C. Halford, Karin Schindler, Volkan Yumuk, Hermann Toplak, Jens-Christian Holm, Dominique Durrer Schutz, Dragan Micic, Jennifer L. Baker, Lauren Lissner, Johannes Hebebrand, Gabriela Roman, RS: NUTRIM - HB/BW section A, RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, and RS: NUTRIM - R1 - Metabolic Syndrome

Subjects
Male, Health (social science), Medizin, Overweight, Terminology, Body Mass Index, Pre-obesity, 0302 clinical medicine, Risk Factors, Medicine, SOCIOECONOMIC-STATUS, 030212 general & internal medicine, 10. No inequality, lcsh:RC620-627, Adiposity, ddc:618, Evidence-Based Medicine, ICD-10, Middle Aged, Obesity/classification/diagnosis/etiology, Causality, 3. Good health, Overweight/diagnosis, Diagnostic and Statistical Manual of Mental Disorders, Europe, lcsh:Nutritional diseases. Deficiency diseases, PUBLIC-HEALTH, Female, medicine.symptom, lcsh:Nutrition. Foods and food supply, Clinical psychology, Adult, medicine.medical_specialty, 030209 endocrinology & metabolism, Context (language use), lcsh:TX341-641, Obesity class, 03 medical and health sciences, Young Adult, International Classification of Diseases, ICD-11, Physiology (medical), MANAGEMENT, Humans, Obesity, Socioeconomic status, METAANALYSIS, ddc:613, Aged, Diagnostic classification, BARIATRIC SURGERY, CONSEQUENCES, OVERWEIGHT, business.industry, Public health, MORTALITY, Body Weight, STAGING SYSTEM, BODY-MASS INDEX, Clinical Information, Physical therapy, business, Attribution
Abstract

Diagnostic criteria for complex medical conditions caused by a multitude of both genetic and environmental factors should be descriptive and avoid any attribution of causality. Furthermore, the wording used to describe a disorder should be evidence-based and avoid stigmatization of the affected individuals. Both terminology and categorizations should be readily comprehensible for healthcare professionals and guide clinical decision making. Uncertainties with respect to diagnostic issues and their implications may be addressed to direct future clinical research. In this context, the European Association of the Study of Obesity (EASO) considers it an important endeavor to review the current ICD-11 Beta Draft for the definition of overweight and obesity and to propose a substantial revision. We aim to provide an overview of the key issues that we deem relevant for the discussion of the diagnostic criteria. We first discuss the current ICD-10 criteria and those proposed in the ICD 11 Beta Draft. We conclude with our own proposal for diagnostic criteria, which we believe will improve the assessment of patients with obesity in a clinically meaningful way. (C) 2017 The Author(s) Published by S. Karger GmbH, Freiburg

Published
2017

49. Was sind Barrieren der Ernährungstherapie bei mangelernährten, hospitalisierten Patienten der Inneren Medizin?

Author

Philipp Schuetz, Rebecca Fehr, Martina Geiser, Zeno Stanga, Hermann Toplak, Pascal Tribolet, and Valerie Bächli

Subjects
Gynecology, medicine.medical_specialty, Nutrition and Dietetics, business.industry, medicine, Medicine (miscellaneous), business
Abstract

Zusammenfassung Hintergrund Die Mangelernährung ist im Spitalalltag ein zentrales Problem und korreliert mit Komplikationen, längeren Spitalaufenthalten und schlechteren Outcomes. Zur Reduktion dieser negativen Aspekte ist ein Ernährungsmanagement bei Risikopatienten sinnvoll, doch die Effizienz dieser Maßnahme ist variabel und es existieren verschiedene Barrieren zur optimalen Umsetzung von Ernährungsinterventionen im Alltag. Das Ziel dieser Studie ist es, die Umsetzbarkeit eines neu etablierten Ernährungsalgorithmus im klinischen Spitalalltag zu überprüfen und potenzielle Barrieren einer Ernährungstherapie aufzuzeigen. Methode Dies ist eine Beobachtungssubstudie des EFFORT-Trials, eine schweizweite, multizentrische, randomisierte, kontrollierte Interventionsstudie, welche den Effekt der Ernährungstherapie auf den Krankheitsverlauf von mangelernährten, hospitalisierten, medizinischen Patienten untersucht. Die untersuchte Population wurde anhand eines klar definierten Ernährungsalgorithmus behandelt, mit dem Ziel, eine bedarfsdeckende Energie- und Proteinzufuhr zu gewährleisten. Anhand von Essprotokollen wurde die Energie- und Proteinzielerreichung berechnet. Um die Assoziation zwischen dem Nichterreichen der Energie- und Proteinziele und vordefinierten Prädiktoren aufzuzeigen, wurde eine multivariate, logistische Regression durchgeführt. Ergebnisse 581 Patienten wurden in die Analyse eingeschlossen. Die Ernährungsziele wurden insgesamt gut erreicht: 83,3 % aller eingeschlossenen Patienten erreichten an mindestens 1 der ersten 5 Spitaltage die Energieziele und 78,7 % die Proteinziele. In der multivariaten Regressionsanalyse war die Zielerreichung in Abhängigkeit von Alter, Geschlecht, Hauptdiagnose und Komorbiditäten nicht unterschiedlich. Lediglich die positive Antwort auf den Appetitverlust hat sich bei der Energiezielerreichung als protektiver Faktor gezeigt (Odds Ratio [OR] Appetitverlust: 0,53; 95 %-KI: 0,3 – 0,94; p = 0,03). Bei den Proteinzielen war der höhere BMI ein Risikofaktor für das Nichterreichen der Ziele (OR pro BMI-Einheit [kg/m2]: 1,05; 95 %-KI: 1,01 – 1,09; p = 0,02). Schlussfolgerungen Der vorgeschlagene Ernährungsalgorithmus ist in der Praxis gut anwendbar und eine Großzahl von hospitalisierten Patienten der medizinischen Abteilung konnten die Ernährungsziele mit rein oralen Maßnahmen (Spitalküche und orale Supplemente), ohne Notwendigkeit einer Eskalation auf enterale oder parenterale Ernährung erreichen. Bei Risikopatienten sollte ein individuelles Assessment stattfinden, um zu klären, wie die Ernährungsziele erreicht werden können.

Published
2017

50. Obesity and Type 2 Diabetes: Two Diseases with a Need for Combined Treatment Strategies - EASO Can Lead the Way

Author

Volkan Yumuk, Dragan Micic, Hermann Toplak, Gema Frühbeck, Euan Woodward, Karin Schindler, and Deborah R. Leitner

Subjects
Adult, medicine.medical_specialty, Health (social science), Bariatric Surgery, lcsh:TX341-641, 030209 endocrinology & metabolism, Comorbidity, Type 2 diabetes, Overweight, 03 medical and health sciences, 0302 clinical medicine, Anti-Obesity Agents, Weight loss, Physiology (medical), Diabetes mellitus, medicine, Humans, Obesity, 030212 general & internal medicine, Child, Intensive care medicine, lcsh:RC620-627, Exercise, Life Style, Glycemic, Health Services Needs and Demand, business.industry, Diabetes, Diabesity, medicine.disease, Combined Modality Therapy, Diet, 3. Good health, lcsh:Nutritional diseases. Deficiency diseases, Diabetes Mellitus, Type 2, Clinical Information, medicine.symptom, business, lcsh:Nutrition. Foods and food supply, Weight gain
Abstract

Obesity is a chronic metabolic disease affecting adults and children worldwide. It has become one of the leading causes of death, as obesity is known to be the main risk factor for a number of non-communicable diseases, in particular type 2 diabetes. This close relationship led to the connotation ‘diabesity', highlighting the fact that the majority of individuals with diabetes are overweight or obese. Until today the BMI is still used to classify overweight and obesity. Since reduced muscle mass is highly prevalent throughout the BMI range, the measurement of body composition is strongly recommended. Moreover, it is essential for monitoring the course of weight reduction, which is part of every effective anti-obesity treatment. Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention (diet and exercise), pharmacotherapy, or bariatric surgery. However, not all of these strategies are suitable for all patients, and any further needs should be considered. Besides, attention should also be drawn to concomitant therapies. These therapies may promote additional weight gain and further trigger the deterioration of blood glucose control. Thus, therapeutic strategies are warranted, which can be easily used for the management of obese patients with type 2 diabetes to achieve their glycemic and weight loss goals.

Published
2017

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