Coronary Bypass Surgery: Purpose, Procedure and Recovery
Dietary Changes May Treat Obesity By Giving Mitochondria A Boost
According to the World Health Organization (WHO), worldwide obesity rates have more than doubled over the past 30 years.
Globally, 16% of adults are now living with obesity. Formerly an issue in only high-income countries, such as the United States, where more than 40% of adults have obesity, obesity is now prevalent in middle-income countries as well.
According to current guidelines, people with obesity have a body mass index (BMI) — a measure of body fat based on height and weight — of more than 30.
Obesity is linked to several health conditions, including type 2 diabetes, high blood pressure and heart disease, and some cancers.
Chronic low-grade inflammation is a feature of obesity, and research has found that monocytes — a type of white blood cell that plays a key role in immune responses — are a cause of this inflammation.
Now, a small-scale clinical trial in Mexico has found that some diets can improve the energy use of these monocytes leading to increased weight loss.
The study is published in Clinical Nutrition.
Eamon Laird, PhD, an assistant lecturer in nutrition at ATU Sligo, Ireland, who was not involved in this study, told Medical News Today that:
"The findings are very interesting as a novel pilot study for much larger and in depth studies. It provides the potential that change of diet in the form of calorie restriction, intermittent fasting, and ketogenic diet could have significant benefits both for metabolic health and the microbiome. However this is on early pilot data."
The 44 participants who completed the study were aged between 18 and 60 years, with a BMI of 30 to 50 kilograms per square meter (kg/m2). None had any chronic diseases or mental health conditions.
The researchers divided them into four treatment groups, each of which followed a different diet for two months:
At 4 follow-up visits, the participants gave fasting blood samples for analysis, were weighed and had their body composition analysed.
The researchers isolated monocytes from the samples to assess their mitochondrial function. They also analyzed their gut microbiota from stool samples.
"This clinical trial was quite small, and no previous studies have specifically examined how these dietary changes impact mitochondrial function in human monocytes to support these findings. However, there has been some evidence of changes in metabolic tissues in rodent research on calorie restriction and intermittent fasting, and in human research on the ketogenic diet," explained Kelsey Costa, MS, RDN, a registered dietitian nutritionist and founder of Dietitian Insights, who was not involved in the study.
Costa explained the importance of mitochondria to MNT.
"Mitochondrial bioenergetic health refers to the efficiency and functioning of mitochondria, the powerhouses of cells responsible for producing energy," she said.
"This is an important aspect to consider in obesity, as dysfunctional mitochondria may contribute to a variety of health issues, such as insulin resistance, inflammation, and other metabolic disorders," Costa explained.
In this study, the researchers found that monocytes from people on the calorie restricted, intermittent fasting and ketogenic diets had significantly increased mitochondrial function.
The diets also had a positive impact on gut bacteria.
While acknowledging that these are interesting findings, Laird emphasized that additional research is needed to verify them.
"[This study used a] very strict and unique population group as they had to be free of any other chronic disease or conditions — individuals in this BMI range more often than not typically have other conditions associated with obesity such as high blood pressure, COPD [chronic obstructive pulmonary disease], diabetes, raised cholesterol etc., so it is already preselecting a 'healthy' obese group not typical in the population," he pointed out.
"In order to really ascertain clinical significance I would like to see this study replicated but with more participants to have more power — 50:50 balance with males and females and include older adults, include obese adults with any sort of disease or condition, [which would be] closer to [a] real-world scenario," said Laird.
Mir Ali, MD, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, who was also not involved in the current research, shared his thoughts about the study findings with MNT
He told us that "[t]his is another study showing the complex nature of obesity, and how we have much more to learn to prevent and effectively manage this growing health issue."
Despite being a short-term, small-scale study, participants showed some health benefits, which suggest that the interventions are worth exploring further.
In addition to improved mitochondrial function, those on the restrictive diets lost weight and visceral fat — the fat that collects inside the abdomen and can cause health issues — compared with those on their normal diets.
They also had an increase in the diversity of their gut microbiota — a change that may help combat obesity.
"This study reinforces the importance of considering not just weight loss but also changes in metabolic health when it comes to dietary interventions for obesity. It also highlights the potential role of gut bacteria in regulating cellular functions and how diet can influence this relationship."
– Kelsey Costa, MS, RDN
Diabetes And Obesity Can Damage The Liver To Point Of Failure – But Few People Know Their Risk
Metabolic dysfunction-associated steatotic liver disease, or MASLD, is an umbrella term describing conditions related to a buildup of fat in the liver. Formerly known as nonalcoholic fatty liver disease, this condition affects 1 in 4 people worldwide. Among those with type 2 diabetes, insulin resistance, obesity or all three, the prevalence of MASLD increases to 3 in 4 people.
As a diabetologist, the possibility of liver disease is on my mind every time I see a patient. Understanding your risk of developing this common yet underrecognized condition is essential to treating it.
What is MASLD?
MASLD is a complex disorder with both environmental and genetic contributions. In its early stages, liver cells accumulate fat in a process called steatosis. Major sources of this fat include adipose tissue as well as fatty acids the liver makes in response to insulin resistance and excess caloric intake. This fat accumulation can enlarge the liver and interfere with its normal functioning.
Over time, fatty acids activate enzymes, which can produce toxic byproducts capable of causing liver cell injury, inflammation and scarring. This condition is better known as MASH, or metabolic dysfunction-associated steatohepatitis. Progression to MASH is more common in the presence of other risk factors such as type 2 diabetes, insulin resistance and metabolic syndrome.
Left unaddressed, MASLD and MASH can progress to liver scarring, failure and, in some cases, cancer. They also increase risk of death from cardiovascular disease and liver-related complications.
In the U.S., MASH is the leading cause of liver transplants due to hepatic cancer among women and in those 65 and older. It is also on track to overtake hepatitis B and C as the main reason people develop liver cancer and thus need a liver transplant.
Liver disease and type 2 diabetes
Three out of four people with type 2 diabetes have MASLD. Linking liver disease, type 2 diabetes and obesity is the key role insulin resistance plays in their genesis.
Obesity is associated with increased fat deposits around the internal organs and higher levels of fatty acids delivered to the liver. Accumulation of fat in the liver increases its resistance to insulin.
Normally, insulin suppresses glucose production in the liver when blood sugar is high. When the liver becomes resistant to insulin, it produces more glucose despite elevated blood sugar levels, which in turn contributes to the development of type 2 diabetes.
A 2015 meta-analysis found that people with MASLD have a nearly twofold greater risk of developing type 2 diabetes than those without the disease. MASLD is also more likely to progress to MASH in the presence of type 2 diabetes.
MASLD disproportionately affects certain ethnic groups. For instance, 1 in 5 people of Hispanic descent in the U.S. Have MASLD, with or without diabetes. This is thought to be related to genetic mutations that affect how the liver cells process fat. One particular mutation more common in Hispanic people promotes steatosis by interfering with the cells' ability to clear fat deposits.
Treating MASLD and MASH
The silver lining is that management of obesity and type 2 diabetes – such as through lifestyle changes – is very similar to management of MASLD. The most critical early interventions for type 2 diabetes can also help with MASLD, and this is not surprising given how closely interrelated these two conditions are.
The best way to reverse the early stages of MASLD is with weight loss through healthy eating habits and regular exercise. The aim is to shed at least 5% to 10% of initial body weight, maintain that weight loss through sustainable and realistic lifestyle choices, and avoid excess alcohol intake to limit additional liver injury.
New medications to treat diabetes, such as GLP-1 receptor agonists like Ozempic and Mounjaro, as well as SGLT2 inhibitors like Jardiance or Invokana, have also shown benefit in early stages of MASLD. These drugs promote weight loss, which in turn improves MASLD. In addition, studies have shown that Ozempic and Mounjaro could reverse MASH, even with inflammation and fibrosis.
Older medications used for diabetes, such as pioglitazone, typically can also help reduce the progression of MASH by reducing insulin resistance.
In people with severe obesity or who have not had success with lifestyle changes and weight loss drugs, bariatric surgery is another highly effective option to treat MASLD, as it is associated with significant and sustained weight loss.
New drugs are also in the pipeline. The Food and Drug Administration recently approved a new medication called resmetirom to treat MASH with advanced liver scarring.
However, a cure for this chronic disease remains elusive. This is why it is essential to diagnose MASLD as early as possible and use proven measures that can be maintained long term. Treatments and lifestyle changes need to be deployed as early as possible, before inflammation and scarring have firmly set in. MASH gets trickier to treat in more advanced stages when liver damage becomes irreversible. For instance, while Ozempic may help treat early MASH, it doesn't benefit patients with more advanced stages of liver scarring.
Ignorance is not bliss
Very few people are aware of MASLD and its health implications, including those living with it. While roughly over 35% of U.S. Adults have MASLD, less than 5% are aware they have liver disease.
MASH can be difficult to diagnose because it either causes no symptoms or can be mistaken for other conditions. Patients may have the condition for years and not be aware that it is slowly and meticulously causing damage. In that sense, MASH is strikingly similar to type 2 diabetes or high cholesterol.
Young people are increasingly being diagnosed with early-onset MASLD. Indeed, MASLD with MASH is the most common pediatric liver condition, affecting nearly 8% of children and adolescents and over 34% of children with obesity in the U.S. These children and adolescents are at high risk of developing type 2 diabetes and have a significantly increased lifetime risk of cardiovascular disease and cancer.
Health care costs for people with type 2 diabetes and MASH are estimated to reach US$55 billion over the next 20 years, accounting for 65,000 liver transplants, 1.37 million cardiovascular-related deaths and 812,000 liver-related deaths.
These grim statistics need not be if MASH is tackled early and aggressively.
If you are one of the millions of Americans with prediabetes or diabetes and are also overweight, you most likely have some degree of MASLD or MASH. Being aware of MASLD and getting checked is the first step to addressing it.
Promptly determining the best way to treat your MASLD or MASH is the next step. An early referral to a liver specialist will help you halt the progression of this challenging and common condition and take advantage of the treatment breakthroughs researchers have made in the past few years.
Dr Madona Azar joined the UMass Memorial Diabetes Center of Excellence care team in 2022 and is an associate professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism at UMass Chan Medical School.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
© The ConversationThe Connection Between Obesity And Kidney Disease
Obesity is a growing health concern worldwide and is known to cause a range of health problems. One of the lesser-known but serious consequences of obesity is its impact on kidney health.
Research has shown that being overweight or obese can significantly increase the risk of developing kidney disease.
Understanding this connection can help in taking steps to prevent and manage kidney disease effectively.
The kidneys are vital organs that filter waste products and excess fluids from the blood, maintaining overall health. When a person is obese, the extra weight puts additional stress on the kidneys.
This can lead to changes in kidney function and structure, making them work harder to filter blood. Over time, this increased workload can cause damage to the kidneys, leading to kidney disease.
One of the primary ways obesity contributes to kidney disease is through the development of conditions like diabetes and high blood pressure. Both of these conditions are common in people who are overweight or obese and are major risk factors for kidney disease.
Diabetes can damage the blood vessels in the kidneys, impairing their ability to function properly. High blood pressure puts extra strain on the blood vessels, including those in the kidneys, which can lead to kidney damage.
Research has shown that obesity itself can directly harm the kidneys. Fat tissue in the body releases hormones and inflammatory substances that can affect the kidneys. For example, a hormone called leptin, which is produced by fat cells, can become elevated in obese individuals.
High levels of leptin have been linked to kidney damage and increased risk of kidney disease. Additionally, obesity can lead to a condition called glomerulopathy, where the tiny filtering units in the kidneys, known as glomeruli, become damaged.
Studies have found a strong association between body mass index (BMI), a measure of body fat based on height and weight, and the risk of developing kidney disease. Individuals with higher BMI are at greater risk of experiencing kidney problems.
For example, a large study published in the Journal of the American Society of Nephrology found that people with obesity were more likely to develop chronic kidney disease compared to those with normal weight.
Weight loss can play a crucial role in improving kidney health and reducing the risk of kidney disease. Research indicates that losing even a modest amount of weight can have significant benefits for kidney function.
Weight loss can help lower blood pressure, improve blood sugar control, and reduce the amount of protein in the urine, which is a marker of kidney damage.
A study published in the Clinical Journal of the American Society of Nephrology showed that obese individuals who lost weight through lifestyle changes or bariatric surgery experienced improvements in kidney function.
Diet and exercise are essential components of weight management and can positively impact kidney health. Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help control weight and reduce the risk of kidney disease.
Reducing salt intake is particularly important for managing blood pressure and protecting the kidneys. Regular physical activity, such as walking, swimming, or cycling, can help achieve and maintain a healthy weight and improve overall kidney function.
In addition to lifestyle changes, regular medical check-ups are important for monitoring kidney health, especially for individuals who are overweight or obese. Healthcare providers can perform tests to assess kidney function and detect any early signs of kidney disease.
Early intervention and treatment can help prevent the progression of kidney disease and improve outcomes.
In summary, obesity is a significant risk factor for kidney disease due to its impact on conditions like diabetes and high blood pressure, as well as direct effects on the kidneys.
Maintaining a healthy weight through diet, exercise, and lifestyle changes can greatly reduce the risk of kidney disease and improve overall kidney health. Regular medical monitoring and early intervention are also crucial in managing and preventing kidney problems.
By understanding the connection between obesity and kidney disease, individuals can take proactive steps to protect their kidney health and overall well-being.
If you care about weight loss, please read studies about the right diet for weight loss in type 2 diabetes, and is it possible to lose weight without diet and exercise.
For more health information, please see recent studies about ginger's journey in weight management , and green tea: a cup of weight loss.
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