Day 2 :
Keynote Forum
Gerry Leisman
The National Institute for Brain and Rehabilitation Sciences, Israel
Keynote: What the neuro and rehabilitation sciences can offer the management of obesity and weight management?
Time : 10:00-10:40
Biography:
Gerry Leisman is Director and Professor of the National Institute for Brain and Rehabilitation Sciences in Nazareth, Israel and as Professor of Restorative Neurology at Universidad de Ciencias Médicas Facultad Manuel Fajardo, Havana, Cuba. He has examined self-organizing systems in thenervous system applied to cognitive functions in memory,kinesiology, optimization, consciousness, and autism. He has appliedoptimization strategies to movement, gait, and cognition. In the 1970’s, he was one of the fi rst to identify functional disconnectivities in the brain.His work in Rehabilitation Sciences, has applied the tools ofIndustrial Engineering to those with developmental disabilities and to health promotion in adults using the tools of neuro and cognitive sciences.
Abstract:
Objectives: To apply the knowledge of neuroscience in managing obesity and movement in education and office environments.
Methods: We review data that motor processes contribute to cognitive function. We present fi ndings of how movement
contributes to synaptogenesis and neuroplasticity and increased BDNF in rats and brain state changes in children and adults.
Results: Motor and cognitive processes have dynamical bidirectional relationships. Rodent research has revealed that exercise infl uences the striatum by increasing dopamine signaling and angiogenesis. In children, higher aerobic fitness levels are associated with greater hippocampal volumes, superior performance on tasks of attentional and interference control, and elevated event-related brain potential indices of executive function.
Conclusions: We endeavor to integrate the Neurosciences, Cognitive Psychology and Biomechanics in providing a fundamental understanding of the relation between intention, decision-making, and movement in the context of functional connectivity, awareness, attention, and action. Th e lack of movement represented in offi ce work and youngsters fettered to video games reduces the ability to formulate eff ective connectivities. Because children and adults are becoming increasingly overweight, unhealthy and unfi t, understanding the neurocognitive benefi ts of an active lifestyle during childhood has important public health and educational implications. Methods will be discussed to eff ect weight and health management in educational and workplace environments.
Keynote Forum
Edita Stokić
Clinical Center of Vojvodina, Serbia
Keynote: Nontypical points of obesity
Time : 10:40-11:20
Biography:
Edita Stokić, MD, PhD, is an Endocrinologist, Professor of Internal Medicine-Endocrinology, employed in the Clinic of Endocrinology, Diabetes and Metabolic Disorders of the Clinical Centre of Vojvodina in Novi Sad, Medical Faculty, Serbia. In 2005, she was appointed as Chief of Department. She is currently the Vice President of Serbian Association for the Study of Obesity and Chairman of the Continuing Education Board (Society of Physicians of Vojvodina of the Medical Society of Serbia). She was President of the Internal Medicine Section and President of Endocrinology Section within same Society. She is an author or co-author of 412 scientifi c articles, and has publications on obesity, dyslipidemias and diabetes. She has also published monographs namely Obesity is a Treatable Disease, and Obesity and Adipose Tissue Distribution – Metabolic Consequences.
Abstract:
During past few years the prevalence of obesity has increased dramatically. Obesity traditionally has been defi ned as adisease characterized by body fat accumulation to an extent that causes health disturbances, such as insulin resistance, type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease, stroke, sleep apnea, gallbladder disease and some types of cancer. On the other side, obesity isn’t homogeneous disease- cardiometabolic disturbances, which are associated with obesity, do not, however, aff ect all obese people. Several studies suggest that "Metabolically healthy but obese" - MHO people show specifi c phenotype and body composition differences compared with obese patients “at risk”. MHO individuals exhibit lower total and intra-abdominal fat mass, lower ectopic fat accumulation and favorable metabolic, hormonal, immune and inflammatory profi le. It is not clear what induces potential transition from metabolically healthy to unhealthy profile, and whether genetic, environmental, lifestyle and psychosocial factors have role. Metabolically obese but normal weight – MONW individuals present a subgroup of individuals with normal BMI, and with insulin resistance, higher risk of developing type 2 diabetes, cardiovascular disease, atherosclerosis and mortality. Th e early identifi cation of individuals with the MONW phenotype would be benefi cial and may have important therapeutic implications. Clinical guidelines should be target more to MHO population, especially to standardization of definition criteria. Future studies should elucidate mechanisms of preserved favorable metabolic profile, and specifi c dynamics of metabolic and neuroendocrine processes in MHO individuals, which may be helpful in tailoring potential interventions.
Keynote Forum
Vaclav Bun
Charles University, Czech Republic
Keynote: Movement activities like a tool of obesity and weight management
Time : 11:45-12:25
Biography:
Vaclav Bunc has obtained his PhD from TU Prague in 1979. He is a Vice-dean of Faculty of Physical Education and Sport at Charles University Prague. His main research topics are obesity management, application of mathematical methods and models in PE and sport, evaluation of physical fitness, exercise physiology, functional and physical testing in laboratory and field, body composition, BIA methods and moving regimes for prevention. He has published more than 350 papers in Czech and internationally reputed journals and is serving as an Editorial Board Member of repute.
Abstract:
The current epidemic of obesity is a problem not only to public health, but each individual. It is up to about 5% of cases the problem of education and not medicine. For an effective intervention it is necessary in the first place timely to identify its initial stages and simultaneously identify the variables that can aff ect by the external interventions. Th e basic tool for successful intervention is to change the lifestyle of intervened individuals – from sedentary to active. The first step is early diagnostics and then selecting individual approach that respects the health, previous experience physical, physical fitness, time and economic conditions and the relationship with its surroundings to influence obesity of the subject. The movement intervention with the weekly energy content ranged from 1500 kcal to 2700 kcal (depending on subject’s body mass) in the time duration of 5 months is able to cause a decline in the mean %BF of about 24.0%, and increase in the mean VO2peak about 14.0% (both independently on body mass, age and gender). We can conclude that an exercise program with a similar energy content, form and intensity causes the similar changes in BC and in motor and functional performance in subjects, diff ering in body mass, age and gender.
- Control & Prevention of Obesity | Exercise and lifestyle changes | Yoga and Naturopathy
Chair
Gerry Leisman
The National Institute for Brain and Rehabilitation Sciences, Israel
Co-Chair
Yi-Hao Yu
Greenwich Hospital, USA
Session Introduction
Andrea Romani
Case Western Reserve University, USA
Title: Mg2+ deficiency results in increased intra-hepatic cortisol production through the H6PD/11- β-HSD1 machinery: Role of NF-kB and inflammatory cytokines
Time : 12:25-12:55
Biography:
Andrea Romani, MD, PhD, obtained his Medical Degree from the University of Siena, Italy and his PhD from the University of Turin, Italy. Upon completing his Postdoctoral studies under Dr. Scarpa, he joined the faculty in the Department of Physiology and Biophysics, Case Western Reserve University, where he is currently Associate Professor. He has published almost 90 peer review articles in high profi le journals together with numerous invited reviews and book chapters. He is currently serving as an Editorial Board Member for Archives of Biochemistry and Biophysics, Magnesium Research, World Journal of Gastro-Intestinal Physio-Pathology among others.
Abstract:
Tissue and serum Mg2+ defi ciency have been observed in several endocrine pathologies including diabetes and metabolic syndrome, but it is still undefi ned to which extent an altered Mg2+ homeostasis contributes to the onset of these pathologies and/or their complications. In the present study, we report that Mg2+ defi cient hepatocyte exhibit an increased entry of G6P into the endoplasmic reticulum, where the substrate is oxidized by the H6PD to generate NADPH. As H6PD operates in conjunction with 11β-HSD1, the increased level of NADPH is utilized by the latter enzyme to convert inactive cortisone to active cortisol. Administration of cortisone to Mg2+ defi cient hepatocytes results in a marked production of cortisol, which in turn enhances gluconeogenesis and alters intrahepatic fatty acid synthesis, thus increasing intrahepatic triglyceride levels. Protein and mRNA expression of H6PD and 11β-HSD1 are both increased 3-4 fold in Mg2+ defi cient cells. Mg2+ defi cient hepatocytes also exhibit decreased insulin responsiveness, which is further compromised by cortisol production. Returning cellular Mg2+ content to its physiological levels, results in a dramatic decrease in cortisol production, and in the progressive renormalization of expression and activity of H6P, 11β-HSD1, and cortisol-responsive genes. Investigation into the underlying mechanism of action suggest that under Mg2+ defi cient conditions 11β-HSD1 expression and activity increase as a consequence of increased nuclear translocation of NF-kB and increased expression of infl ammatory cytokines (namely IL-1β and/or TNFα). Taken together, our results suggest that by increasing H6PD and 11β-HSD1 activity and expression, Mg2+ deficiency sets the conditions for an increased intrahepatic production of cortisol and decreased insulin responsiveness. Th is altered hormonal balance can play a major role in the onset and progression of the metabolic syndrome and its associated complications.
Donald E Wesson
Texas A&M HSC College of Medicine, USA
Title: Treatment of metabolic acidosis in chronic kidney disease yields better weight control with fruits and vegetables than with currently recommended sodium-based alkali therapy
Time : 13:55-14:25
Biography:
Donald E Wesson, MD, FACP is currently Professor of Medicine and the Vice Dean of Texas A&M University College of Medicine in Temple, Texas. Prior to this position, he was the S C Arnett Professor of Medicine and Chairman of the Department of Internal Medicine and Physiology at Texas Tech University Health Sciences Center and had been Associate Professor of Medicine at the Baylor College of Medicine where he was Assistant Chief of the Nephrology Section at the Houston VA Hospital. He received his undergraduate degree from the Massachusetts Institute of Technology. He earned his Medical Degree from Washington University School of Medicine and completed his Residency and Internship at Baylor College of Medicine. He is the recipient of multiple teaching awards at Baylor and Texas Tech.
Abstract:
Background: Current guidelines recommend sodium-based alkali therapy for metabolic acidosis in chronic kidney disease (CKD) but recent data support that base-producing fruits and vegetables (F+V) also improve metabolic acidosis in CKD. Because CKD increases cardiovascular risk, weight reduction in overweight CKD patients appears desirable given its cardiovascular and other benefi ts. A diet high in F+V might promote weight reduction as well as improve metabolic acidosis in CKD.
Methods: We randomized 108 subjects with CKD stage 3 estimated glomerular fi ltration rate (30-59 ml/min/1.73 m2), metabolic acidosis with plasma total CO2 (PTCO2) >22 but <24 mM, and baseline BMI >25 as follows: F+V (n=36) added to reduce dietary potential renal acid load (PRAL) 50%, oral NaHCO3 (HCO3, n=36) to reduce PRAL 50%, or no alkali (Usual Care, n=36). All received standard kidney protection measures and were followed for 5 years.
Results: Baseline PTCO2 (23.0±0.6, 23.1±0.6, and 23.0±0.5, p=0.62) and BMI (28.8±2.1, 28.3±2.0, and 28.2±2.1, p=0.45) were not diff erent among F+V, HCO3, and Usual Care, respectively. Five-year PTCO2 was higher in HCO3 (23.9±0.4 mM) and F+V (23.8±0.4 mM) than Usual Care (21.9±0.4 mM, p <0.01 vs. HCO3 and F+V). By contrast, fi ve-year BMI was lower (p<0.03) in F+V (26.6±1.7) than both HCO3 (28.4±1.9) and Usual Care (27.8±1.7).
Conclusions: Treating CKD patients with either NaHCO3 or F+V improved metabolic acidosis similarly but BMI was lowest with F+V. Better weight control with F+V than NaHCO3, the latter being the currently recommended treatment option, supports F+V as the preferred treatment strategy for metabolic acidosis in overweight CKD patients.
Yi-Hao Yu
Greenwich Hospital, USA
Title: Treatment modalities potentially suitable for patients with hedonic obesity
Time : 14:25-14:55
Biography:
Yi-Hao Yu is an Endocrinologist of Northeast Medical Group, Yale-New Haven Health System, Connecticut, USA. He is Medical Director of Center for Behavioral & Nutrition Health and Inpatient Diabetes Program at Greenwich Hospital. Previously, he was Faculty of several universities and served as Director of Nutrition Services at Columbia Presbyterian Hospital, Director of Nutrition Fellowship Program at Columbia University and Medical Director of Discovery Medicine & Clinical Pharmacology at Bristol-Myers Squibb Company. He completed his MD and PhD at NYU School of Medicine. He has published more than 20 original research papers in the top-notch medical and scientific journals and many reviews/book chapters in the fi eld of “Diabetes, obesity and associated metabolic disorders”.
Abstract:
Hedonic obesity is caused by persistent overeating driven by hedonic hunger resulting from dysfunctional neural circuitries that govern reward and emotion. Excessive food intake in this case is a consequence of complicated food-seeking behavior to achieve reward and satisfaction, rather than to meet energy needs. If there were non-caloric foods that can satisfy patients’ hedonic needs without adding calories, there would be no obesity issue in this subpopulation of patients. This is in contrast to metabolic obesity, in which the obese weight is sustained because of the increased caloric needs demanded by an elevated body weight set point. In metabolic obesity, if patients take in less calories than what are required to maintain the homeostatic set point, their bodies would respond by conserving energy and constantly seeking for more calories; they would be constantly hungry until the obese body weight is restored. In this presentation, I'll discuss some of the future treatment options, mostly still in the pipeline at this time which would allow food intake to satisfy hedonic needs and reward but prevent excessive caloric assimilation. Th ese treatment options will most likely be successful in the subpopulation of patients who have hedonic obesity.
Zhong Chen
Shanghai Jiao Tong University, PR China
Title: Statins usage, exercise and coronary artery disease
Time : 14:55-15:25
Biography:
Zhong Chen has completed his PhD from Nanjing Medical University, China. He is the Executive Director of Department of Cardiology at Shanghai Jiao Tong University Affi liated Sixth People’s Hospital, East Campus. He has published more than 20 papers in reputed journals and also serves as an Editorial Board Member of two international journals.
Abstract:
Coronary artery disease (CAD) is one of the major causes of death in most of the western countries and the largest developing country, China. More importantly, the prevalence of obesity and type-2 diabetes is increasing rapidly in China. Patients with diabetes have an increased incidence of atherosclerotic cardiovascular disease. Patients with CAD and diabetes belong to a very-highrisk population, which deserves more attention from doctors, health professionals and the public. Cholesterol-lowering therapy with statins in primary and secondary prevention cardiovascular diseases have been well verifi ed and acknowledged by many guidelines and low-density lipoprotein cholesterol (LDL-C) control is still the first target goal. However, knowledge gap and under-use of statins still exist. Physical activity has been proved to be associated with reduced risk and increased survival of CAD and increased risk of sudden cardiac death (SCD). Th is inconsistency deserves further investigation. Thus we try to review the available literatures and further discuss this topic.
Munira Alghafaily
King Saud University, Saudi Arabia
Title: Is BMI ≥50 kg/m2 a predictor of higher morbidity during doing laparoscopic sleeve gastrectomy? An observational study at King Khalid University Hospital Saudi Arabian experience
Time : 15:25-15:55
Biography:
Munira Alghafaily is a fi nal year Medical student at King Saud University, Saudi Arabia. She is currently works in the areas of Cardiology, Gastroenterology and Laparoscopic Sleeve Gastrectomy.
Abstract:
Objectives: Th is study was to assess operative and post-operative complications, of laparoscopic sleeve gastrectomy (LSG), in superobese and compare it to morbid obese on in KKUH, Saudi Arabia.
Methods: We reviewed the 708 medical records of consecutive patients who underwent LSG surgery at KKUH from 2009 till 2015. Then, we compared our SMO (BMI≥50 kg/m2) patients data results to (our /international reports) MO (BMI<50 kg/m2) patients category who underwent LSG.
Results: Male sex was predominant in SMO (63.6%). Both groups had homogeneous baseline characteristics and comorbidities except sleep apnea which was higher in SMO. Th ere was no signifi cant diff erence in the duration of operation, length of stay, and recovery room time between the two groups. Mean number of trocars was 4 for both groups. HDU admission: 62 (28.6%) patients of SMO and 32 patients of MO. No conversion to open or documented intraoperative complications in both groups. For post-operative complications: has developed in 6% of patients in SMO included 1.4% of patients developed leakage, and 10 patients developed bleeding in the drain. On the other hand, 4.3% of patients in MO had developed complications, includes, (2.2%) patients developed
leak, 2% patients developed bleeding that four patients only needed blood transfusion. Th ere was no surgical mortality.
Conclusion: Th ere’s no signifi cant diff erence in the duration of operation, number of trocars and intra operative complication between SMO and MO. Th e BMI ≥50 kg/m2 is not a predictor of higher morbidity during doing LSG if done in a tertiary care center with dedicated bariatric center services.