Archives of Pharmacy

Dietary interventions in obesity: a narrative review

Olina Dudašova Petrovičova — 2024-06-27

The World Health Organization highlights that in 2022 around 890 million adults and 160 million children and adolescents globally were obese, indicating a significant public health concern. Obesity results from an energy imbalance, where calorie intake exceeds calorie expenditure, leading to an increase in the size of fat cells and subsequently to metabolic dysfunction and inflammation. Management of obesity involves lifestyle adjustments, including dietary modifications and increased physical activity, with calorie-restricted diets and meal replacements often recommended to achieve weight loss and lower overall energy intake. Weight loss programs include a low-carbohydrate, low-fat, or high-protein diet. In addition, the influence of the Mediterranean diet and dietary fiber on regulating body weight has been increasingly studied in recent years. Dietary products for weight control, including meal replacements, are regulated and offer options for people who want to lose weight. More personalized nutrition approaches are emerging that focus on individual needs, genetic factors and gut microbiota composition to optimize health outcomes. Although personalized nutrition promises to explain how nutrition-related health problems may be solved, further research should investigate health outcomes in individuals living with obesity.

Natural Products in the Management of Obesity

Iskra Davkova — 2024-06-27

Treating overweight and obesity with medications generally offers initial advantages but can result in weight regain after stopping the drugs, as well as in medication-related side effects, and the potential for substance misuse. The allure of herbal products lies in their natural origin, thus leading individuals towards these products in search of a healthier and more sustainable approach to weight loss. Understanding how herbal products interact with biological systems is crucial for assessing their therapeutic potential. Anti-obesity herbal products and their compounds can act through different mechanisms, such as: appetite suppression, digestion and absorption blocking, stimulation of thermogenesis, inhibition of adipogenesis, and modulation of these processes through gene expression. The physiological effects and therapeutic properties exhibited by herbal products are ascribed to the presence and activity of their active components, such as polyphenols, tannins, flavonoids, anthocyanins, stanols, sterols and alkaloids. Furthermore, the synergistic effects of various phytochemicals have been explored to enhance their anti-obesity properties.

Safety issues of herbal weight loss dietary supplements: hepatotoxicity and adulteration

Zoran Zhivikj — 2024-06-27

Herbal weight loss supplements are widely used in the management of obesity, but consistent data to support long-term weight loss efficacy and safety are missing. Besides, legal framework for food supplements is less restrictive than regulation of medications. The objective of this review is to give weight to the fact that many weight loss supplements contain herbal compounds with unknown mechanism of action, increasing the risk for adverse effects, even toxicity, especially in co-administration with prescribed drugs. Hepatotoxicity ranging from elevated transaminases and autoimmune-like hepatitis to acute liver failure appears to be underrecognized, but is not uncommonly encountered. Another and even more serious concern is adulteration of weight loss supplements by illegal addition of unauthorized substances or medications to provide quick effects and to increase sales. Here are some significant data regarding the possible hepatotoxicity of frequently used herbal extracts, as well as the health risks related to some common adulterants. Towards safer use of supplements, a comprehensive and critical discussion of current regulatory principles is essential to address the existing gap between the increased use of food supplements and the lack of knowledge about their benefits, providing better protection for consumers.

Obesity Management - a Clinician’s Perspective

Snežana Polovina — 2024-06-27

The global epidemic of obesity has affected almost every country in the world, causing an enormous social and health burden. Although many counter-measures have been introduced against this epidemic, obesity is still on the rise. An important step in this area was made when obesity was classified as a disease. The recognition of obesity as a disease enables governments and state agencies to develop their own plans to curb the obesity epidemic. Obesity has been recognized as a problem from ancient times, and different measures have been suggested as solutions. Modern management of obesity is currently based on the following therapeutic principles: diet, exercise, psychological support, pharmacological treatment, and bariatric surgery. The history of pharmaceutical treatment is rather long and full of withdrawals of the drugs due to various reasons. New perspectives and promising results were introduced with a class of drugs based on incretins. These drugs were developed as agonists of gastrointestinal peptides in a mono form or a combination of two or three different agonists, achieving results similar to the effects of bariatric surgery. Currently, about 70 different therapeutical principles are in the process of development. Problems related to the drugs on the market are their high prices, limited capacity for production, and lack of experience regarding long-term use.

Biochemistry and laboratory diagnosis of obesity

Neda Milinković — 2024-06-27

Until now, a lot of research has been carried out which significantly helped in understanding and solving the problem of obesity. Despite this, there has been an upward in obesity trend at the global level. The role of laboratory diagnostics in the field of obesity is of great importance to doctors for establishing a diagnosis and monitoring the effects of therapy. Determining biochemical parameters also contributes to practical usefulness in the prevention of this disease, and prevention of consequent complications. Routinely available biochemical analyses are usually used to diagnose and monitor the effects of obesity therapy. The initial association related to laboratory analyses refers to parameters of lipid status, but there are a variety of routine laboratory parameters that can help in understanding and monitoring obesity from different angles. Timely and adequate management of obesity is also of interest from an economic aspect. For this reason, the topic of this research is to summarize the latest aspects of the concept of obesity, specifically from the point of view of biochemistry and laboratory diagnostics. Taking into account the complexity of this disease, it is important to point out the future perspectives and challenges that inevitably arise before both laboratory professionals and healthcare providers in general.

Know your Enemy: Nature and Biochemistry of Obesity

Jasna Bjelanović — 2024-06-27

Obesity represents a serious medical condition and has nowadays reached pandemic proportions. Comorbidities associated with obesity are severe, and affect almost all organ systems. Adipose tissue has several important functions: to provide energy storage, maintain body temperature through the process of thermogenesis, and maintain balance in a variety of metabolic patterns. Adipose tissue is an endocrine organ with numerous biochemical roles, and in obese individuals adipose tissue becomes either hypertrophic or hyperplastic, with impaired function. The immune system activity and metabolic regulation in adipose tissue are extremely related processes. A loss of balance on this axis causes numerous disorders associated with obesity, and the basis of these disorders is insulin resistance, which is a hallmark of obesity. Hormones that are almost exclusively produced in adipocytes and studied in various biochemistry processes are leptin, adiponectin and resistin. Successful treatment of obesity nowadays involves lifestyle and diet modification, pharmacotherapy, mainly with glucagon-like peptide-1 agonists, and bariatric surgery, which remains the most effective treatment method for the selected population of severely obese individuals. Positive effects of bariatric surgery are reflected not only in a restriction of food intake, but in hormonal changes, especially those of gut hormones responsible for hunger regulation and energy metabolism.

Effects of probiotic intervention on obesity-related miRNAs

Nina Okuka — 2024-06-27

Obesity is considered to be a chronic complex disease that increases the risk of diabetes, heart diseases and certain cancers. According to the literature, in obese people the gastrointestinal microbiota is disturbed, which could be the cause of the onset of obesity and related diseases. Moreover, there are small non-coding RNAs (microRNAs) that are disturbed in obesity, which are also considered to be a possible mechanism of probiotics’ action. Certain microRNAs are involved in the development and metabolism of adipose tissue cells, as well as the secretion and action of insulin, showing that changed expression of certain miRNAs could have a significant impact on the onset and development of obesity and obesity-related diseases. Thus, miRNAs are considered to be possible markers for the diagnosis and prognosis of various metabolic diseases, and possible therapeutic targets for the treatment of obesity and related diseases. Considering the growing need of the healthcare system for nutraceuticals and dietary supplements that present effective and safe medical nutritive therapy in obese individuals, this work aimed to assess the beneficial effects of probiotics on obesity-related microRNAs. In this review, we described the role of microRNAs and probiotics in obesity and the association between probiotics and obesity-related microRNAs. Circulating miRNAs’ profile in obese individuals significantly differs from that of normal-weight individuals. miRNAs such as miR-155, miR-221, miR-24-3p, and miR-181a are over-expressed, while miR-26b and 125a are under-expressed in obese patients compared to non-obese individuals. It has been found that supplementation with Bifidobacterium bifidum and Lactobacillus acidophilus could downregulate the expression of miR-155 and miR-221, and upregulate the expression of miR-26b. Supplementation with a probiotic formulation containing S. boulardii, L. plantarum 299v, and octacosanol led to the downregulation of miR-155 and miR-24-3p expression. miR-125a and miR-181a were upregulated and downregulated, respectively, after the intervention with L. delbrueckii and L. rhamnosus. After reviewing the available literature, we can conclude that probiotics have beneficial effects on microRNAs altered in obesity, which could provide an effective strategy for the management of obesity.

The Relevance of Microbial Fermentation for Long-Term Health Effects of High Protein Diets

Mirjana Rajilić-Stojanović — 2024-06-27

Proteins are important macronutrients with several beneficial health effects. Today, protein-rich diets are gaining popularity, especially in the context of achieving or preserving a healthy weight. However, epidemiological studies associate long-term consumption of protein-rich diets with adverse health outcomes and increased mortality. These adverse effects, at least partially, are mediated by the activity of microbial products obtained by protein fermentation. Undigested food components reach the colon, where the gut microbiota transforms food residues into various metabolites. Given that side chain groups of amino acids are chemically heterogeneous, undigested proteins provide a mix of substrates for microbial fermentation. By using different amino acids, the gut microbiota can produce toxic, genotoxic, and carcinogenic compounds, but also metabolites that impair normal insulin signaling and cardiovascular function. Biological activity of microbial metabolites can contribute to the development of cardiovascular diseases and cancer, which are associated with high-protein diets. In principle, microbiota metabolic products are beneficial for humans and complementary to human metabolism. However, when diet composition is out of balance (e.g. when proteins are present in an excessive amount), microbiota activity shifts towards production of hazardous metabolites. Therefore, the gut microbiota and its activity must be taken into consideration when designing nutritional strategies to promote health.

Environmental pollutants and the obesity: proven causalities and open questions

Marijana Ćurčić — 2024-06-27

The link between environmental pollution and obesity is of high importance, because understanding the relationship between the two can provide valuable insights into the complex factors contributing to the obesity epidemic. These chemicals, termed “obesogens,” are believed to disrupt lipid metabolism processes, therefore promoting the development of obesity. Human activities such as industrialization, urbanization, agriculture, and transportation have significantly contributed to environmental pollution. Therefore, the main identified obesogens are BPA found in plastics, food packaging, and thermal paper receipts, phthalates, commonly used in plastics, personal care products, and food packaging, toxic metal(oid)s, determined in non-stick cookware, water-resistant fabrics, and food packaging, pesticides, used in agriculture, as well as other persistent organic pollutants (POPs), and pharmaceuticals (waste). Addressing environmental pollution not only has the potential to improve environmental quality, but also to promote public health and prevent obesity-related diseases. Addressing the causality between pollutants and obesity could be a new and challenging road map for health professionals.

Antiobesity drugs utilization trend analysis and reimbursement lists status – the perspective of selected European countries

Ivana Stević — 2024-06-27

Obesity is a chronic, complex, relapsing disease impacting healthcare systems and the economy worldwide. We aim to analyze the utilization trends of antiobesity drugs, and their reimbursement status on drug lists of health insurance funds (HIF) in selected European countries. The DDD/1000 inhabitants/day methodology is used for utilization trend analysis, where data from official national utilization reports were used. For the reimbursement status analysis of 5 antiobesity drugs (orlistat, semaglutide, liraglutide, naltrexone/bupropion, setmelanotide), the websites of national health insurance funds (HIF) of 22 European countries were screened. Trend analysis revealed fluctuation for almost all antiobesity drugs (the highest decrease seen for orlistat in Serbia, and the highest increase for liraglutide in Croatia). Novel antiobesity drugs show an increasing utilization trend in almost all the countries. In two out of three European countries, antiobesity drugs are not covered by the HIF. Slovenia and Denmark reimburse most of the antiobesity drugs. The Netherlands is the only country where the cost of setmelanotide is paid by the HIF. Our results emphasize the importance of prioritizing the introduction and implementation of new strategies and reimbursement scheme models in global and national antiobesity policies.

Pharmacotherapy of obesity: state of the art and perspectives

Katarina Sićović — 2024-06-27

Obesity is a chronic, progressive, and recurring disease. The prevalence of obesity has reached pandemic proportions, along with overweight-related conditions like diabetes, cardiovascular diseases, and certain cancers. Reducing residual morbidity is the main goal of obesity treatment. Pharmacotherapy is intended for patients who have not responded to lifestyle interventions. There are currently six anti-obesity medications (orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, semaglutide, and tirzepatide) approved for long-term obesity management. Most of them, except orlistat, predominantly act centrally by increasing satiety, as well as reducing appetite and food reward. The most effective anti-obesity drugs are semaglutide and tirzepatide, which might provide weight loss of more than 10% of the initial weight. Although all anti-obesity medications have been demonstrated to improve cardiometabolic risk factors, only liraglutide and semaglutide lower the risk of major cardiovascular events in patients with or without established cardiovascular disease. A personalized approach, considering both drug (weight-reducing capacity and drug safety) and patient (comorbidities, age, and the patient’s preferences) features, guarantees the best results. In this article, we will critically appraise the efficacy and safety of currently approved anti-obesity medications and those in the pipeline.

Role of Pharmacists in the Management of Patients with Obesity

Milena Kovačević — 2024-06-27

Obesity, a chronic disease, is increasingly prevalent worldwide, posing a significant public health challenge. It is often accompanied by comorbidities such as hypertension, cardiovascular disease, dyslipidemia, and diabetes, among others. Pharmacists play a vital role in managing obese patients, being readily accessible members of the healthcare team. Their responsibilities include initiating weight management services, conducting comprehensive patient interviews, devising personalized therapeutic plans, evaluating medications for potential weight gain, monitoring treatment effectiveness and safety, providing patient counseling, and making referrals to other healthcare professionals when necessary. Obesity induces notable changes in body composition that can impact the pharmacokinetic and pharmacodynamic properties of drugs, necessitating adjustments to dosing regimens. Lipophilic drugs typically experience a significant increase in volume distribution, while hydrophilic drugs may see only a moderate rise. The impact of obesity on drug elimination is relatively minor compared to its effects on distribution and varies depending on the specific metabolic or excretory pathway.