Impact of Weight Loss and Regain on Quality of Life: Mirror Image or Differential Effect?

Objective: To compare the impact of weight regain and weight loss on health‐related quality of life. Research Methods and Procedures: Subjects were 122 (106 women, 16 men) overweight and obese participants in a weight reduction program (phentermine‐fenfluramine and dietary counseling) who had initially lost at least 5% of their total body weight and then regained at least 5% of their weight during the follow‐up period. Follow‐up periods ranged from 10 to 41 months (mean, 28 months). Participants completed the Impact of Weight on Quality of Life‐Lite, an obesity‐specific health‐related quality of life (HRQOL) measure, at 3‐month intervals. Results: Mean BMI at baseline was 40.9 ± 6.6 kg/m² (range, 29.2 to 63.7 kg/m²). Average weight loss from entry was 18.8 ± 6.7% (range, 6.0% to 43.7%), and average regain was 10.1 ±4.4% of baseline weight (range, 5.0% to 30.6%). The effects of weight regain on HRQOL mirrored the effects of weight loss—rates of HRQOL change were similar in magnitude but different in direction for comparable weight loss and regain. Those with more severe initial impairments in HRQOL experienced greater improvements in HRQOL during weight loss as well as greater deterioration during weight regain than those with less severe impairments. Discussion: Weight loss and regain produced mirror image changes in HRQOL. The initial severity of HRQOL impairment had a greater impact on the magnitude of HRQOL change than the direction of weight change. Findings underscore the importance of maintaining weight loss for the purposes of retaining obesity‐specific HRQOL benefits.     

Calidad de vida y satisfacción con el tratamiento de sujetos con diabetes tipo 2: resultados en España del estudio PANORAMA

ObjectivesFew studies are available on quality of life and treatment satisfaction of patients with type 2 diabetes mellitus (T2DM). Both of them were the primary objectives of the PANORAMA (NCT00916513) study. Metabolic control, treatment patterns, and management by healthcare professionals were also evaluated.Material and methodsThis multicenter, cross-sectional, observational study randomly recruited>40 year-old patients with T2DM from Spanish healthcare centers. HbA1c was measured using the same technique in all patients, who also completed quality of life (EQ-5D and ADDQoL) and treatment satisfaction (DTSQ) questionnaires and the Hypoglycemia Fear Survey (HFS-II).ResultsFifty-four investigators recruited 751 patients, 60.3% of whom had HbA1c levels <7%. Approximately 25% of patients on monotherapy had HbA1c values ≥ 7%, Patients with longer disease duration and more complex treatments, especially with insulin, showed the poorer control. Despite good overall treatment satisfaction (mean 29.3±6.1, 0 to 36-point scale), patients with a poorer metabolic control, previous hypoglycemia episodes, and more complex therapies had a worse QoL and a greater fear of suffering hypoglycemia.ConclusionsDespite advances in metabolic control, there are still areas to improve. Early addition of safe drugs to monotherapy would help achieve control objectives without increasing the risk of hypoglycemia, and delaying the start of insulin therapy. This would also improve QoL and treatment satisfaction.     

Durable remission of diabetes after bariatric surgery: What is the underlying pathway?

Background: In the past, type 2 diabetes mellitus (DM) was regarded as a progressive, incurable disease for which palliative therapy could not, over the long term, prevent the associated amputations, blindness, renal failure, and early mortality. This is no longer true. Full and durable remission of type 2 DM, with major decreases in morbidity and mortality, is now achieved regularly with several types of surgery that reduce contact between food and the foregut.Objectives: The aims of this article are to review the impact of bariatric surgery on obesity, remission of DM, and obesity-related morbidity and mortality, and the possible mechanisms for this advance.Methods: This article is based on our 2 meta-analyses of the literature published through April 30, 2006, as well as the most significant reports in the bariatric surgical literature that have been published in English since April 30, 2006. The studies included in our second meta-analysis provided the details of the methodology for the present literature review, including the levels of evidence.Results: Results of our 2 meta-analyses were published previously. Briefly, the analyses revealed that the clinical and laboratory manifestations of type 2 DM resolved or improved in most of the patients who underwent bariatric surgery; the responses were greatest in the patients who lost the most excess body weight; and the improvements were maintained for ≥2 years. The studies reported that intestinal operations such as gastric bypass reduced contact between food and the foregut, produced full and durable remission of DM, reduced mortality, and reversed other comorbidities associated with severe obesity (eg, asthma, gastroesophageal reflux, hypertension, stress incontinence). Insulin levels decreased markedly after surgery, as did glycosylated hemoglobin (A1C) and fasting blood glucose levels. Although these effects were initially attributed to weight loss, the rapid reversal of DM within a matter of days after surgery suggest that bariatric surgery changes the signaling mechanism of the gut with pancreatic islet cells, muscles, fat, the liver, and other organs.Conclusions: Bariatric surgery has opened new vistas, producing durable full remission of type 2 DM—a breakthrough previously considered impossible—with normalization of A1C levels over time and discontinuation of all antidiabetes medication for many patients. These advances create new opportunities for exploring the mechanisms of type 2 DM and its control through pharmaceutical approaches. DM is no longer an irreversible, incurable, or hopeless disease.     

The Effects of Chronomodulated Therapy with 5-Fluorouracil (5-Fu) and Folinic Acid (Fa) on the Toxicity and Quality of Life in Patients with Advanced Gastric Cancer

This study was designed to assess the tolerability of chronomodulated infusion chemotherapy, individualized by the rhythm of peripheral blood cells. Twenty patients with metastatic gastric cancer were randomized to chronotherapy or day-time arms of 5-fluorouracil (FU) (600 mg/m², 8 h inf.d1-5) and folinic acid (FA) (20 mg/m², iv, d1-5) in the first cycle and crossed-over to the other arm in the following cycles. Ten of 18 evaluable patients were assigned to chronotherapy arm and eight to day-time in the first cycle. Although there was no significant difference between two arms on enrollment, chronotherapy arm yielded an improvement of 45% of QLQ-C30 scores (p = 0.021) and the day-time arm had 11% improvement (p = 0.575). After the crossing-over, chronotherapy arm, again, had a significant improvement in QLQ-C30 scores, compared to the day-time arm (14% vs. -18%, p = 0.001, respectively). Mucositis/diarrhea was significantly higher in the day-time arm compared to chronotherapy arm (p = 0.015). In conclusion, chronomodulated infusion of 5-FU might improve the quality of life.     

单向纳入式人工胃底活瓣在食管-胃胸内吻合抗返流中的应用研究

目的:探讨单向纳入式人工胃底活瓣用于食管-胃胸内吻合抗返流患者的临床效果。方法:选择2017年3月-2018年3月入院治疗的食管中下段癌根治术患者70例,所有患者均在腹腔镜下完成全胸腹腔镜下食管-胃胸内吻合手术,术后采用胃肠吻合器完成食管胃右胸内吻合完成消化道重建。根据抗返流方法分为对照组(n=35例)和观察组(n=35例)。对照组术后包埋吻合口,观察组术后采用单向纳入式人工胃底活瓣,两组治疗完毕后对患者效果进行评估。记录并比较两组治疗后痊愈、全身衰竭死亡、吻合口瘘、返酸及吐苦水返流症状、烧心感的发生率;采用WHOQol-BREF生活量表对两组治疗前、治疗后生活质量进行比较。结果:观察组治疗后痊愈率显著高于对照组(71.43%vs. 42.86%,P0.05),全身衰竭死亡、吻合口瘘、返酸及吐苦水返流症状、烧心感发生率均明显低于对照组(P0.05)。两组治疗后生理健康、心理状态、社会关系、周围环境及独立能力评分均显著高于治疗前(P0.05),且观察组治疗后生理健康、心理状态、社会关系、周围环境及独立能力评分均高于对照组(P0.05)。结论:单向纳入式人工胃底活瓣用于食管中下段癌根治术患者能降低返流症状的发生率,能提高患者生活质量。