Belgian expert opinion: how to reduce the residual risk in atherogenic dyslipidaemic patients: place of fibrates.

The demographics of dyslipidaemia have changed towards a more complex atherogenic dyslipidaemia involving increased levels of LDL-C, in particular highly atherogenic small dense particles, hypertriglyceridaemia and low HDL, together with increased levels of markers of cardiovascular inflammation, thrombogenesis and endothelial dysfunction. Statins were shown to significantly lower cardiovascular morbidity and mortality, but there still remains a high residual risk in dyslipidaemic patients, in particular with metabolic syndrome, type 2 diabetes, or low HDL levels. Fibrates have been shown to reduce plasma triglycerides and increase HDL-C, while improving inflammation, thrombogenesis and endothelial dysfunction.

Long-term effect of CB1 blockade with rimonabant on cardiometabolic risk factors: two year results from the RIO-Europe Study.

Aims: Rimonabant, the first selective cannabinoid type 1 receptor blocker, has been shown to produce weight loss and improvements in several cardiometabolic risk factors over 1 year. We report the 2 year efficacy and tolerability data of rimonabant.

Methods And Results: Patients with a body mass index > or =30 or >27 kg/m(2) with treated/untreated hypertension, dyslipidaemia, or both, were randomized to double-blind treatment with placebo, rimonabant 5 or 20 mg once daily plus a calorie-restricted diet for 2 years.

The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents.

The prevalence of childhood obesity is increasing worldwide. One of the obesity-related complications that has received increasing attention in recent years is sleep-disordered breathing. Obese children are at a higher risk of developing sleep-disordered breathing, including habitual snoring, obstructive sleep apnea syndrome and desaturations preceded by central apneas.

The metabolic syndrome and the liver.

Together with the worldwide epidemic proportions of obesity the incidence of 'the metabolic syndrome' is rising across countries. The metabolic syndrome is described as a complex condition that is linked to (intra-abdominal) obesity and is characterized by insulin resistance, dyslipidaemia and hypertension. Several definitions for the metabolic syndrome have been suggested, all trying to identify individuals at high risk for both type 2 diabetes and cardiovascular disease.

[Sitagliptine (Januvia): incretin enhancer potentiating insulin secretion for the treatment of type 2 diabetes].

Sitagliptin (Januvia) is the first selective antagonist of dipeptidylpeptidase-4, an enzyme that degrades glucagon-like peptide-1 (GLP-1). This hormone is mainly secreted by ileal L cells and this secretion is abnormally low in patients with type 2 diabetes. Sitagliptin increases post-meal insulin secretion ("incretin effect) by enhancing the postprandial GLP-1 response ("incretin enhancer"), in a glucose-dependent manner.

Exploiting the antidiabetic properties of incretins to treat type 2 diabetes mellitus: glucagon-like peptide 1 receptor agonists or insulin for patients with inadequate glycemic control?

Type 2 diabetes mellitus is associated with progressive decreases in pancreatic beta-cell function. Most patients thus require increasingly intensive treatment, including oral combination therapies followed by insulin. Fear of hypoglycemia is a potential barrier to treatment adherence and glycemic control, while weight gain can exacerbate hyperglycemia or insulin resistance.

Overweight in adolescents: differences per type of education. Does one size fit all?

Objective: To assess the lifestyle and prevalence of overweight among 16- to 18-year-old adolescents attending 4 different types of secondary education (SE).

Design: Cross-sectional school-based survey.

Participants: A community sample of 994 adolescents (body mass index [BMI]: 15-43 kg/m2).

[Medication of the month. Rimonabant (Acomplia): first CB1 receptor antagonist of the endocannabinoid system].

Rimonabant (Acomplia) is the first selective CB1 receptor blocker of the endocannabinoid system. Clinical trials showed that, compared to placebo, rimonabant 20 mg/ day consistently increases weight loss, reduces waist circumference, improves atherogenic dyslipidaemia (low HDL cholesterol, high triglycerides, high small dense LDL), diminishes insulin resistance, reduces HbA1c levels, and contributes to lower blood pressure and C-reactive protein levels. Almost half of the most important metabolic effects occur beyond weight loss, suggesting direct peripheral effects of rimonabant, especially in visceral adipose tissue as suggested by the increase in adiponectin levels.

Efficacy and safety of rimonabant for improvement of multiple cardiometabolic risk factors in overweight/obese patients: pooled 1-year data from the Rimonabant in Obesity (RIO) program.

Objective: To better define the efficacy and safety of rimonabant, the first selective cannabinoid type 1 (CB(1)) receptor antagonist, in a large population of overweight and obese patients using pooled efficacy data from three Phase III nondiabetes Rimonabant in Obesity and Related Metabolic Disorders (RIO) studies, selected efficacy data from the RIO-Diabetes study, and pooled safety data for all four RIO studies.

Research Design And Methods: The RIO studies enrolled patients who were either overweight (BMI >27 kg/m(2)) with at least one comorbidity (i.e.

Analysis of genetic variations in the resistin gene shows no associations with obesity in women.

Resistin is thought to be involved in the development of obesity and insulin resistance. Polymorphisms in the gene encoding resistin could contribute to this link, but different studies have yielded contradictory results. In this study, we investigated whether polymorphisms in resistin are involved in the development of obesity in a Belgian female population.

Current concepts in gastric motility in diabetes mellitus.

This review addresses the current concepts in our understanding of the epidemiology, mechanisms, symptoms, clinical consequences, diagnosis and treatment of delayed gastric emptying in patients with diabetes. Upper gastrointestinal symptoms, particularly postprandial fullness, nausea, vomiting and abdominal bloating, occur in 30-50% of patients with diabetes. The use of scintigraphic techniques, and more recently breath test, has shown that as many as 50% of diabetic patients have gastroparesis.

Effect of rimonabant on blood pressure in overweight/obese patients with/without co-morbidities: analysis of pooled RIO study results.

Objective: Rimonabant, the first selective cannabinoid type 1 (CB1) receptor blocker, has been shown to improve multiple cardiometabolic risk factors in overweight/obese patients. This analysis assessed the impact of rimonabant on blood pressure in the pooled population from four large trials with similar design - the Rimonabant-In-Obesity (RIO) programme.

Methods: RIO-Europe (n = 1507) and RIO-North America (n = 3040) recruited overweight/obese patients, and RIO-Lipids (n = 1033) and RIO-Diabetes (n = 1045) recruited overweight/obese patients with untreated dyslipidaemia or type 2 diabetes, respectively.

Variants in the FTO gene are associated with common obesity in the Belgian population.

Three independent studies, of which two genome-wide scans, have reported an association between SNPs in the FTO (Fat mass and obesity associated) gene and obesity, in different European cohorts. We selected the SNPs with the strongest evidence for association from the first two studies and genotyped 1099 obese patients and 268 healthy control individuals. Both SNPs were significantly associated with obesity, enabling us to replicate earlier findings from Caucasian cohorts in a Belgian population sample.

Autoimmune gastritis in type 1 diabetes: a clinically oriented review.

Context: Autoimmune gastritis and pernicious anemia are common autoimmune disorders, being present in up to 2% of the general population. In patients with type 1 diabetes or autoimmune thyroid disease, the prevalence is 3- to 5-fold increased. This review addresses the epidemiology, pathogenesis, diagnosis, clinical consequences, and management of autoimmune gastritis in type 1 diabetic patients.

International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries.

Background: Abdominal adiposity is a growing clinical and public health problem. It is not known whether it is similarly associated with cardiovascular disease (CVD) and diabetes mellitus in different regions around the world, and thus whether measurement of waist circumference (WC) in addition to body mass index (BMI) is useful in primary care practice.

Methods And Results: Randomly chosen primary care physicians in 63 countries recruited consecutive patients aged 18 to 80 years on 2 prespecified half days.

Metabolic syndrome in youth: a cross-sectional school-based survey.

Aim: To assess the prevalence of metabolic syndrome (MetS) among students attending vocational secondary school (VSE). VSE provides practice-oriented education in which young people learn a specific occupation. Previously we reported VSE to be the type of education with the highest prevalence of overweight and obesity.

Reducing cardiometabolic risk through selective antagonism of CB1 receptors.

Over the past 15 years, research on the endogenous cannabinoid (CB) system-now usually referred to as the endocannabinoid system (ECS)-has identified the significant effects of the ECS on the regulation of food intake and lipid and glucose metabolism in animals and humans. Endocannabinoids are endogenous lipids capable of binding to endogenous CB1 and CB2 receptors. CB1 receptors are present in the hypothalamic nuclei, which are involved in the control of energy balance and body weight, and in the mesolimbic system, which mediates the motivation to consume palatable food, as well as in adipocytes, the gut, and the liver.

PAI-1 activity, but not fibrinogen or von Willebrand factor, is inversely related to LDL particle size in type 2 diabetes.

Background: Levels of fibrinogen, von Willebrand factor (vWF) and plasminogen activator inhibitor-1 (PAI-1) have been associated with small low-density lipoprotein (LDL) particles. However, it is not clear whether these associations are independent of visceral adiposity or other components of the metabolic syndrome such as triglycerides or insulin resistance.

Methods: Visceral adipose tissue (VAT; CT-scan), fibrinogen, von Willebrand factor antigen (vWF:Ag), PAI-1 activity and different metabolic parameters such as total cholesterol (chol), HDL-chol, triglycerides, insulin resistance (homeostasis model assessment; HOMA-IR) were determined in 41 women and 78 men with type 2 diabetes.

The G1422A variant of the cannabinoid receptor gene (CNR1) is associated with abdominal adiposity in obese men.

Since recent data suggest that the endocannabinoid system controls food intake through central, and lipogenesis via peripheral CB1 receptors, we hypothesized that genetic variation at the cannabinoid receptor-1 (CNR1) locus could have an effect on adiposity. We investigated, whether a specific CNR1 G1422A genotype is associated with anthropometric markers of obesity and fat distribution in adult obese individuals. A total of 1,064 obese subjects (BMI > or = 30 kg/m2) without diabetes, impaired glucose tolerance or other endocrine diseases and 251 healthy control persons were genotyped for the G1422A variant (rs1049353) with a TaqMan assay.

Adiponectin levels do not predict clinical onset of type 1 diabetes in antibody-positive relatives.

Aims/hypothesis: Insulin resistance has been proposed as a risk factor for type 1 diabetes. We investigated whether adiponectin, an insulin sensitiser, can serve as an additional predictive marker for type 1 diabetes in first-degree relatives of known patients.

Methods: Adiponectin was followed in 211 persistently islet antibody-positive (Ab+) first-degree relatives of type 1 diabetic patients and in 211 age- and sex-matched persistently antibody-negative relatives, and correlated with antibody status, random proinsulin:C-peptide ratio and HLA-DQ genotype.

[Conference report: Belgian consensus on metabolic problems associated with atypical antipsychotics].

Background: The current literature supports that schizophrenia (and bipolar disorders) appear to be associated with a higher prevalence of type 2 diabetes. Because of the silent nature of diabetes mellitus, and the fact that schizophrenic patients are not screened comprehensively for the disease, the true prevalence of hyperglycemia and diabetes may be substantially underestimated. Notably, it has been suggested that schizophrenia as such carries an increased risk, as certain characteristics of schizophrenic patients such as unhealthy life style promote the diabetes risk.