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Objective: Semaglutide, a glucagon-like peptide-1 receptor agonist is approved for weight loss and diabetes treatment, but limited literature exists regarding semaglutide use in patients with advanced chronic kidney disease (CKD). Therefore, this project assessed the safety and efficacy of semaglutide among patients with estimated glomerular filtration rate (eGFR) 15-29 mL/min/1.73 m 2 (CKD stage 4), eGFR<15 mL/min/1.73 m 2 (CKD stage 5) or on dialysis., Methods: This is a retrospective electronic medical record based analysis of consecutive patients with advanced CKD (defined as CKD 4 or greater) who were started on semaglutide (injectable or oral). Data was collected between January 2018 and January 2023. Investigators verified CKD diagnosis and manually extracted data. Data were analyzed using Fisher's exact test, paired t test, linear mixed effects models and Wilcoxon signed rank test., Results: Seventy-six patients with CKD 4 or greater who initiated semaglutide were included. Most patients had a history of type 2 diabetes mellitus (96.0%), and most were males (53.9%). The mean age was 66.8 y (SD 11.5) with the mean body mass index was 36.2 (SD 7.5). The initial doses were 3 mg orally and 0.25 mg by injection. Maximum prescribed dose was 1 mg (injectable) in 28 (45.2%) patients and 14 mg (orally) in 2 (14.2%) patients. Patients received semaglutide for a median duration of 17.4 (IQR 0.43, 48.8) months. Forty-eight (63.1%) patients reported no adverse effects associated with the therapy. Mean weight decreased from 106.2 (SD 24.2) to 101.3 (SD 27.3) kg (P < .001). Eight patients (16%) with type 2 diabetes mellitus T2DM discontinued insulin after starting semaglutide. Mean hemoglobin A1c (HbA1c) decreased from 8.0% (SD 1.7) to 7.1% (SD 1.3) (P < .001). Adverse effects were the primary reason for semaglutide discontinuation (37.0%), with nausea, vomiting, and abdominal pain being the most common complaints., Conclusions: Based on this retrospective study semaglutide appears to be tolerated by most individuals with CKD 4 or greater despite associated gastrointestinal side effects similar to those observed in patients with better kidney function and leads to an improvement of glycemic control and insulin discontinuation in patients with T2DM. Modest weight loss (approximately 4.6% of the total body weight) was observed on the prescribed doses. Larger prospective randomized studies are needed to comprehensively assess the risks and benefits of semaglutide in patients with CKD 4 or greater and obesity., Competing Interests: Disclosure Dr Aleksandra Kukla participated in NovoNordisk Advisory Board in 2020 but recieved no personal compensation. Dr Matthew M. Clark, Associate Editor, Obesity. Intellectual Property, Phenomix Science, Inc, Pheno-Diet: Individualized Lifestyle Intervention for Obesity Management Based on Obesity Phenotypes., (Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the outcomes of kidney transplant (KT) candidates with obesity undergoing sleeve gastrectomy (SG) to meet the criteria for KT., Methods: Retrospective analysis was conducted of electronic medical records of KT candidates with obesity (body mass index >35 kg/m 2 ) who underwent SG in our institution. Weight loss, adverse health events, and the listing and transplant rates were abstracted and compared with the nonsurgical cohort., Results: The SG was performed in 54 patients; 50 patients did not have surgery. Baseline demographic characteristics were comparable at the time of evaluation. Mean body mass index ± SD of the SG group was 41.7±3.6 kg/m 2 at baseline (vs 41.5±4.3 kg/m 2 for nonsurgical controls); at 2 and 12 months after SG, it was 36.4±4.1 kg/m 2 and 32.6±4.0 kg/m 2 (P<.01 for both). In the median follow-up time of 15.5 months (interquartile range, 6.4 to 23.9 months), SG was followed by active listing (37/54 people), and 20 of 54 received KT during a median follow-up time of 20.9 months (interquartile range, 14.7 to 28.3 months) after SG. In contrast, 14 of 50 patients in the nonsurgical cohort were listed, and 5 received a KT (P<.01). Three patients (5.6%) experienced surgical complications. There was no difference in overall hospitalization rates and adverse health outcomes, but the SG cohort experienced a higher risk of clinically significant functional decline., Conclusion: In KT candidates with obesity, SG appears to be effective, with 37% of patients undergoing KT during the next 18 months (P<.01). Further research is needed to confirm and to improve the safety and efficacy of SG for patients with obesity seeking a KT., (Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Bariatric surgery is increasingly recognized as a safe and effective treatment for obesity in patients with chronic kidney disease (CKD), including stages 4, 5, and 5D (on dialysis). Among the available surgical methods, sleeve gastrectomy (SG) is the most commonly performed weight loss procedure and is mainly done to facilitate kidney transplantation (KT). However, many KT candidates treated with SG remain on the transplant waiting list for months to years, with some never receiving a transplant. Therefore, appropriate candidates for SG must be selected, and post-SG management should address the unique needs of this population, with a focus on sustaining the metabolic benefits of surgery while minimizing potential side effects related to rapid weight loss which may inadvertently lead to muscle and bone catabolism. Multidisciplinary post-SG care in this population may lead to overall better health on the transplant waiting list, resulting in a higher percentage of post-SG patients ultimately receiving KT. To tailor the effective treatment for these patients, clinicians should acknowledge that patients with CKD stage 4-5D have different nutritional needs and are metabolically and psychosocially distinct from the general bariatric surgery population. Sarcopenia is highly prevalent and may be exacerbated by muscle catabolism following SG if not adequately addressed. Blood pressure, glucose, and bone metabolism are all affected by the CKD stage 4-5D, and therefore require distinct diagnostic and management approaches. Long-standing chronic disease, associated comorbidities, and low adherence to medical therapies require ongoing comprehensive psychosocial assessment and support. This paper aims to review and consolidate the existing literature concerning the intersection of CKD stage 4-5D and the consequences of SG. We also suggest future clinical outcome studies examining novel treatment approaches for this medically complex population., (Copyright © 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

An accurate method to heat treat flour samples has been used to quantify the effects of heat treatment on flour functionality. A variety of analytical methods has been used such as oscillatory rheology, rheomixer, solvent retention capacity tests, and Rapid Visco Analysis (RVA) in water and in aqueous solutions of sucrose, lactic acid, and sodium carbonate. This work supports the hypothesis that heat treatment facilitates the swelling of starch granules at elevated temperature. Results furthermore indicated improved swelling ability and increased interactions of flour polymers (in particular arabinoxylans) of heat treated flour at ambient conditions. The significant denaturation of the proteins was indicated by a lack of gluten network formation after severe heat treatments as shown by rheomixer traces. Results of these analyses were used to develop a possible cake flour specification. A method was developed using response surfaces of heat treated flour samples in the RVA using i) water and ii) 50% sucrose solution. This can uniquely characterise the heat treatment a flour sample has received and to establish a cake flour specification. This approach might be useful for the characterisation of processed samples, rather than by baking cakes. Hence, it may no longer be needed to bake a cake after flour heat treatment to assess the suitability of the flour for high ratio cake production, but 2 types of RVA tests suffice., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Menopause marks the end of ovarian function and it is called 'early' or 'premature' if it occurs before 45 years. Very little is known about the menopause transition in Diabetic women. Metabolic disorders like diabetes will accelerate the reproductive ageing and determine premature ovarian failure by various mechanisms. Early menopause along with diabetes has a synergistic effect over the incidence of cardiovascular diseases and other illnesses. There is no data regarding menopausal age in Indian population. Hence, present study was aimed at understanding the age of menopause in diabetic Indian women., Materials and Methods: This study was carried out at a tertiary care, teaching hospital in Southern India. Post-menopausal women who attended the Department of Medicine during August 2013 to August 2014, were included in the study. Six hundred patients were recruited by a systematic random sampling, 300 diabetic and 300 non-diabetic after obtaining their consents. They were all non-smokers, took mixed diet and other somatometric variables were similar in both the groups., Results: Average age of menopause among diabetic women was 44.65 years which is much earlier than the menopause in non-diabetic women (48.2 years). Out of the 600 women, 212 women had an early menopause (<45 yrs.). Among them, 54 were non-diabetic and 158 were diabetic. Present study also revealed a higher BMI among the diabetics than the non-diabetic women. This may be due to the changes in body composition and increase in abdominal fat after menopause. This change is more in diabetics due to the disturbances in insulin sensitivity and glucose metabolism., Conclusion: The present study confirms that Type 2 Diabetes increases the risk of early menopause. The study reinforces the importance of early diagnosis and treatment of diabetes for a long term well being of a woman.

Within the baking industry, the control of dough properties is required to achieve final product quality and consistency. Traditional methods for dough testing are slow and off-line and do not provide fundamental rheological information. There is therefore a need for the development of fast and on-line instruments capable of providing relevant data for baking. Ultrasonics provide a non-destructive, rapid and low cost technique for the measurement of physical food characteristics. In this work, the water content of dough is investigated using ultrasonic techniques. The capability of ultrasound measurements for discriminating flours for different purposes is also studied. Doughs from more than 30 flours were characterised rheologically using a Chopin Alveograph and a Brabender Extensograph. Ultrasound measurements on the doughs prepared from these flours were also performed. The measurements were correlated, showing that ultrasound was an alternative measurement method to discriminate types of flours for different purposes.