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Combination of exercise and GLP-1 receptor agonist treatment reduces severity of metabolic syndrome, abdominal obesity, and inflammation: a randomized controlled trial
Background
Identifying and reducing cardiometabolic risks driven by obesity remains a healthcare challenge. The metabolic syndrome is associated with abdominal obesity and inflammation and is predictive of long-term risk of developing type 2 diabetes and cardiovascular disease in otherwise healthy individuals living with obesity. Therefore, we investigated the effects of adherent exercise, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), or the combination on severity of metabolic syndrome, abdominal obesity, and inflammation following weight loss.
Methods
This was a randomized, double-blinded, placebo-controlled trial. During an 8-week low-calorie diet (800 kcal/day), 195 adults with obesity and without diabetes lost 12% in body weight. Participants were then evenly randomized to four arms of one-year treatment with:
placebo
, moderate-to-vigorous
exercise
(minimum of 150 min/week of moderate-intensity or 75 min/week of vigorous-intensity aerobic physical activity or an equivalent combination of both), the GLP-1 RA
liraglutide
3.0 mg/day, or a
combination
(exercise + liraglutide). A total of 166 participants completed the trial. We assessed the prespecified secondary outcome metabolic syndrome severity z-score (MetS-Z), abdominal obesity (estimated as android fat via dual-energy X-ray absorptiometry), and inflammation marker high-sensitivity C-reactive protein (hsCRP). Statistical analysis was performed on 130 participants adherent to the study interventions (per-protocol population) using a mixed linear model.
Results
The diet-induced weight loss decreased the severity of MetS-Z from 0.57 to 0.06, which was maintained in the placebo and exercise groups after one year. MetS-Z was further decreased by liraglutide (− 0.37, 95% CI − 0.58 to − 0.16, P < 0.001) and the combination treatment (− 0.48, 95% CI − 0.70 to − 0.25, P < 0.001) compared to placebo. Abdominal fat percentage decreased by 2.6, 2.8, and 6.1 percentage points in the exercise, liraglutide, and combination groups compared to placebo, respectively, and hsCRP decreased only in the combination group compared with placebo (by 43%, P = 0.03).
Conclusion
The combination of adherent exercise and liraglutide treatment reduced metabolic syndrome severity, abdominal obesity, and inflammation and may therefore reduce cardiometabolic risk more than the individual treatments.
Trial registration
EudraCT number: 2015-005585-32, ClinicalTrials.gov: NCT04122716
Journal Article
The first rings
\"Jessica Cruz and Simon Baz both earned their power rings, but are they ready to face the deadly legacy that accompanies them? The very first Lantern--the mad Volthoom--has returned, and his plan to regain the powers he lost billions of years ago leads straight to Earth's emerald warriors! Before Jessica and Simon can return to Sector 2814 and the comforts of Earth upon completing their Green Lantern training, they must escort a Guardian of the Universe to the ancient Vault of Shadows. But when the Guardian is revealed to be a disguised Volthoom, the ensuing battle thrusts the Green Lanterns into an unexpected journey through time and space! Denied their rings' full powers, how will they return home in time to defeat Volthoom?\"-- Provided by publisher.
Book
Structured exercise alters the gut microbiota in humans with overweight and obesity—A randomized controlled trial
ObjectivesStudies suggest that exercise affects the composition and function of the human gut microbiota, yet this has not been investigated in a randomized controlled trial. The primary aim of this study was to assess if exercise alters the diversity, composition and functional potential of the gut microbiota in free-living humans. A secondary aim was to test whether alpha diversity was associated with phenotypical outcomes.MethodsEighty eight participants with overweight or obesity completed a 6-month randomized controlled trial with 4 arms; habitual living (CON), active commuting by bike (BIKE) and leisure-time exercise of moderate (MOD) or vigorous intensity (VIG). Faecal samples for 16 s rRNA gene amplicon sequencing were collected prior to randomization and again after 3 and 6 months, with simultaneous registration of phenotypical outcomes and diet.ResultsShannon’s diversity index increased by 5% in VIG (CI95 1–9%, P = 0.012) at 3 months compared with CON. No associations were observed between alpha diversity and phenotypical outcomes. Beta diversity changed in all exercise groups compared with CON, particularly the participants in VIG showed decreased heterogeneity. No genera changed significantly. The inferred functional potential of the microbiota in the exercise groups was increased, primarily at 3 months and in MOD.ConclusionStructured exercise induced subtle changes to the human gut microbiota. Cardiorespiratory fitness and fat mass were not associated with alpha diversity.
Journal Article
Out of time
\"The Green Lantern duo of Simon Baz and Jessica Cruz venture into space to train with the rest of the Green Lantern Corps for the first time! But will both of them reach the Corps after Jessica is jettisoned out of transluminal travel and forced to find her way through the void of space?\"-- Provided by publisher.
Book
Synthesis of Medium-Sized Heterocycles by Transition-Metal-Catalyzed Intramolecular Cyclization
Medium-sized heterocycles (with 8 to 11 atoms) constitute important structural components of several biologically active natural compounds and represent promising scaffolds in medicinal chemistry. However, they are under-represented in the screening of chemical libraries as a consequence of being difficult to access. In particular, methods involving intramolecular bond formation are challenging due to unfavorable enthalpic and entropic factors, such as transannular interactions and conformational constraints. The present review focuses on the synthesis of medium-sized heterocycles by transition-metal-catalyzed intramolecular cyclization, which despite its drawbacks remains a straightforward and attractive synthesis strategy. The obtained heterocycles differ in their nature, number of heteroatoms, and ring size. The methods are classified according to the metal used (palladium, copper, gold, silver), then subdivided according to the type of bond formed, namely carbon–carbon or carbon–heteroatom.
Journal Article
الفراشة : من لاجئة إلى أولمبية : حكايتي مع الإنقاذ والأمل والانتصار
في طفولتها، كان حلم يسرى مارديني أن تصبح سباحة محترفة تمثل سوريا في البطولات الرياضية الأولمبية، إلا أن اشتداد وتيرة المعارك في دمشق في العام 2015 قلص حلمها ليتحول إلى البقاء على قيد الحياة فقط. كحال عشرات آلاف السوريين الحالمين في العيش بسلام، انطلقت يسرى مع أختها سارة وبعض أقاربهما في رحلة اللجوء المهولة إلى أوروبا حاملتين معهما أحلامهما بحياة أمنة ومعاودة احتراف السباحة من جديد. لكن في منتصف الرحلة بين تركيا واليونان، توقف محرك القارب المطاطي عن العمل وبدأ القارب المحمل بالركاب في الغرق، وعلى الرغم من محاولاتهم العديدة للاستغاثة إلا أن أحدا لم يستجب لهم. فقفزت يسرى ذات السبعة عشرة أعوام وأختها وبعض الركاب الآخرين عن القارب لتخفيف الوزن عنه والسباحة به إلى أن وصلوا إلى اليونان، لتكمل بعدها الأختين رحلتهما الخطيرة برا إلى ألمانيا. من السباحة لإنقاذ حياتها وحياة أصدقائها إلى السباحة حلما بالميدالية الأولمبية، تروين يسرى قصتها الاستثنائية من لاجئة هاربة من بلد مزقته الحرب إلى أولمبية في دورة الألعاب الأولمبية الصيفية لعام 2016 في البرازيل.
Book
Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined
In this trial, adults with obesity without diabetes were randomly assigned, after an 8-week low-calorie diet, to 1 year of placebo, an exercise program, liraglutide, or exercise plus liraglutide. Combined treatment with exercise and liraglutide improved healthy weight loss maintenance more than either treatment alone.
Journal Article
Teen Titans. Volume 5, The trial of Kid Flash
\"When Titans Fall. He trained under the Dark Knight himself. But then Red Robin stepped out from under the Batman's shadow to start a new team of teenaged heroes like himself. As the Teen Titans, they battled against threats no other, older team could face. He never could have imagined that their greatest threats would come from within. Spinning out of the events of \"Forever Evil,\" the team is lost in the timestream, repeatedly slammed together only to be torn apart again. Superboy has been targeted by the murderous Son of Superman he was cloned from. Raven's deal with her devilish father Trigon--her freedom for the Titans' soul--has almost been sealed. And the carefree crimefighter called Kid Flash is about to be called to account for crimes that defy comprehension. As the trial of the friend and hero they thought they knew nears its dreaded verdict, the Teen Titans will be forced to make a fateful decision. Will they stand together-- or fall apart?\" -- page 4 of cover.
Book
The prediabetes conundrum: striking the balance between risk and resources
The current definition of prediabetes is controversial and subject to continuous debate. Nonetheless, prediabetes is a risk factor for type 2 diabetes, is highly prevalent and is associated with diabetic complications and mortality. Thereby, it has the potential to become a huge strain on healthcare systems in the future, necessitating action from legislators and healthcare providers. But how do we best reduce its associated burden on health? As a compromise between differing opinions in the literature and among the authors of this article, we suggest stratifying individuals with prediabetes according to estimated risk and only offering individual-level preventive interventions to those at high risk. At the same time, we argue to identify those with prediabetes and already established diabetes-related complications and treat them as we would treat individuals with established type 2 diabetes.
Graphical abstract
Journal Article