Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, 16132, Italy.
ESOMAS Department, University of Turin and Collegio Carlo Alberto, Turin, Italy.
J Transl Med. 2024 Jun 6;22(1):536. doi: 10.1186/s12967-024-05322-4.
The challenge of addressing obesity persists in healthcare, necessitating nuanced approaches and personalized strategies. This study aims to evaluate the effects of diverse therapeutic interventions on anthropometric and biochemical parameters in individuals with overweight and obesity within a real-world clinical context.
A retrospective analysis was conducted on 192 patients (141 females, 51 males) aged 18 to 75, with a BMI ranging from 25 to 30 (14.1%) and BMI ≥ 30 (85.9%), observed over a 12-month period at our Endocrinology Unit. Treatment cohorts comprised individuals following different regimens: Mediterranean Diet (MD), with an approximate daily intake of 1500 kcal for women and 1800 kcal for men (71% patients); Ketogenic Diet (KD), utilizing the VLCKD protocol characterized by a highly hypocaloric dietary regimen < 800 kcal/day (14% patients); metformin, administered using the oral formulation (5% patients); pharmacological intervention with GLP1-RA administered via subcutaneous injection with incremental dosage (10% patients). Supply constraints limited the efficacy of Liraglutide, whereas Semaglutide was excluded from comparisons due to its unavailability for obesity without diabetes. Blood tests were conducted to assess lipid profile, glycemic profile, and anthropometric parameters, including BMI, waist circumference, and waist-to-height ratio.
Significant BMI changes were observed from baseline to 6 months across MD, KD, and Liraglutide groups (p < 0.05). KD exhibited notable reductions in waist circumference and waist-to-height ratio within the initial quarter (p < 0.05), with a significant triglyceride decrease after 6 months (p < 0.05), indicating its efficacy over MD. Liraglutide demonstrated a substantial reduction in HbA1 levels in the first quarter (p < 0.05). During the first three months, the ANOVA test on fasting blood glucose showed a statistically significant impact of the time variable (p < 0.05) rather than the specific treatments themselves (Liraglutide and KD), suggesting that adherence during the early stages of therapy may be more critical than treatment choice.
Positive outcomes from targeted interventions, whether pharmacological or dietary should encourage the exploration of innovative, long-term strategies that include personalized treatment alternation. The absence of standardized protocols underscores the importance of careful and tailored planning in managing obesity as a chronic condition.
在医疗保健领域，解决肥胖问题仍然具有挑战性，需要采用细致入微的方法和个性化策略。本研究旨在评估在真实临床环境中，针对超重和肥胖个体，不同治疗干预措施对人体测量学和生化参数的影响。
对在我们内分泌科接受治疗的 192 名患者（141 名女性，51 名男性）进行回顾性分析，年龄在 18 至 75 岁之间，BMI 范围在 25 至 30（14.1%）和 BMI≥30（85.9%）之间，观察时间为 12 个月。治疗组包括遵循以下不同方案的个体：地中海饮食（MD），女性每日摄入约 1500 卡路里，男性摄入约 1800 卡路里（71%的患者）；生酮饮食（KD），采用 VLCKD 方案，饮食方案热量非常低，每日摄入<800 卡路里（14%的患者）；二甲双胍，口服制剂（5%的患者）；通过皮下注射递增剂量的 GLP1-RA 进行药物干预（10%的患者）。由于供应限制，利拉鲁肽的疗效受到限制，而由于没有用于肥胖症的司美格鲁肽，因此将其排除在比较之外。进行血液检查以评估血脂谱、血糖谱和人体测量学参数，包括 BMI、腰围和腰高比。
MD、KD 和利拉鲁肽组从基线到 6 个月时 BMI 均有显著变化（p<0.05）。KD 在最初的四分之一时间内显著降低了腰围和腰高比（p<0.05），并在 6 个月后显著降低了甘油三酯（p<0.05），表明其优于 MD。利拉鲁肽在第一个季度显著降低了 HbA1 水平（p<0.05）。在前三个月的空腹血糖 ANOVA 检验中，时间变量具有统计学意义（p<0.05），而不是特定的治疗方法本身（利拉鲁肽和 KD），这表明在治疗的早期阶段坚持治疗可能比治疗选择更为关键。
针对超重和肥胖患者的靶向干预措施（包括药物和饮食）取得了积极的结果，这应该鼓励探索包括个性化治疗转换在内的创新、长期策略。缺乏标准化方案突显了在管理肥胖作为慢性疾病时仔细和量身定制规划的重要性。
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