title: Effect of weight loss with or without orlistat treatment on adipocytokines, inflammation, and oxidative markers in obese women. Orlistat for overweight subjects with nonalcoholic steatohepatitis: A randomized, prospective trial. Effects of different weight loss protocols on serum leptin levels in obese females. [Impact of weight loss on adipocytokines, C-reactive protein and insulin sensitivity in hypertensive women with central obesity]. Effect of the orlistat on serum endotoxin lipopolysaccharide and adipocytokines in South Asian individuals with impaired glucose tolerance. Comparison of orlistat treatment and placebo in obese type 2 diabetic patients Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patients. Insulin and leptin concentrations in obese humans during long-term weight loss. Weight loss larger than 10% is needed for general improvement of levels of circulating adiponectin and markers of inflammation in obese subjects: a 3-year weight loss study. Rise of plasma ghrelin with weight loss is not sustained during weight maintenance. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. Effects of a weight-reduction program with orlistat on serum leptin levels in obese women: A 12-week, randomized, placebo-controlled study. Orlistat for obesity: benefits beyond weight loss. Effects of 1-year orlistat treatment compared to placebo on insulin resistance parameters in patients with type 2 diabetes. Orlistat and L-carnitine compared to orlistat alone on insulin resistance in obese diabetic patients. Oral glucose tolerance test effects on endothelial inflammation markers in healthy subjects and diabetic patients.
abstract: OBJECTIVE The aim of this study was to evaluate the levels of adipose tissue related hormones , cytokines , and antioxidative substances in obese women before and after intervention with diet alone or with diet plus an inhibitor of gastrointestinental lipase-orlistat .  DESIGN Seventy-one obese women of childbearing age were included in the study and were r and omly assigned into two groups according to the type of intervention : group A1 ( n=35 ) included women who received  orlistat as well as a hypocaloric diet , and group A2 ( n=36 ) included women who were only on hypocaloric diet . The intervention period lasted 6 months . Anthropometric parameters , such as Body Weight ( BW ) , Body Mass Index ( BMI ) , Waist Circumference ( WC ) , and % Body fat ( BF ) were recorded . Insulin , leptin , resistin , interleukin-6 ( IL-6 ) , insulin like growth factor 1 ( IGF-1 ) , tumor necrosis factor alpha ( TNFalpha ) , adiponectin , hsC-reactive protein ( CRP ) , glutathione peroxidase , and isoprostane were determined by appropriate methodology prior to and following the 6-month intervention period . Insulin resistance was measured using the homeostasis model assessment index ( HOMA-IR ) . All participants had normal glucose tolerance . RESULTS In both groups B MI values were lower after intervention and all measured parameters were ameliorated . A statistically significant difference was found between group A1 ( orlistat plus diet ) and group A2 ( diet only ) with regard to the levels of triglycerides , CRP , TNF-alpha , IGF-1 , and isoprostane , even after correcting for weight loss . CONCLUSION Hypocaloric diet plus orlistat in obese women is superior to diet alone with regard to the changes observed in adipokines , CRP , TNFalpha , triglycerides , IGF-1 , and oxidative stress following intervention The aim of this study was to determine if orlistat , an inhibitor of fat absorption , combined with caloric restriction in overweight subjects with nonalcoholic steatohepatitis results in weight loss and improved liver histology .  Fifty overweight subjects ( body mass index = > or=27 ) with biopsy proven nonalcoholic steatohepatitis were r and omized to receive a 1,400 Kcal/day diet plus vitamin E ( 800 IU ) daily with or without orlistat ( 120 mg three times a day ) for 36 weeks . Liver biopsies were repeated at week 36 . Twenty-three subjects in the orlistat/diet/vitamin E group and 18 in the diet/vitamin E group completed the study . The mean age was 47 + /- 9.0 ( st and ard deviation ) years and mean body mass index was 36.4 + /- 6.3 kg/m(2 ) . Four subjects were diabetic . The orlistat group lost a mean of 8.3 % body weight compared to 6.0 % in the diet plus vitamin E group ( not significant ) . Both groups also had similarly improved serum aminotransferases , hepatic steatosis , necroinflammation , ballooning , and nonalcoholic fatty liver disease activity scores . Stratified according to weight loss instead of treatment group , a loss of > or=5 % body weight ( n = 24 ) compared to < 5 % body weight ( n = 17 ) correlated with improvement in insulin sensitivity ( P = 0.001 ) and steatosis ( P = 0.015 ) . Comparing subjects who lost > or=9 % of body weight ( n = 16 ) , to those that did not ( n = 25 ) , improved insulin sensitivity ( P < 0.001 ) , adiponectin ( P = 0.03 ) , steatosis ( P = 0.005 ) , ballooning ( P = 0.04 ) , inflammation ( P = 0.045 ) , and nonalcoholic fatty liver disease activity score ( P = 0.009 ) were seen . Increases in adiponectin strongly correlated with improved ballooning and nonalcoholic fatty liver disease activity score ( P = 0.03 ) . Orlistat did not enhance weight loss or improve liver enzymes , measures of insulin resistance , and histopathology . However , subjects who lost > or=5 % of body weight over 9 months improved insulin resistance and steatosis , and those subjects who lost > or=9 % also achieved improved hepatic histologic changes We investigated the effects of different weight loss protocol s on leptin levels in obese females with the aim of addressing the leptin resistance which has been found to be an aggravating factor in obesity . Twenty-four obese females enrolled to one of three 12-week weight loss protocol s : orlistat-induced weight loss ( OWL , n=8 ) , exercise-induced weight loss ( EWL , n=8 ) and orlistat plus exercise-induced weight loss ( OEWL , n=8 ) . Serum leptin levels were measured in duplicate by radioimmunoassay . There were significant reductions ( P<0.01 ) in body weight and fat mass after the 12 week period in all groups : -11.4+/-0.5 kg and -9.8+/-0.5 kg ( OEWL ) , -8.3+/-0.8 kg and -5.7+/-0.9 kg ( OWL ) , -8.9+/-1.2 kg and -7.4+/-1.2 kg ( EWL ) , respectively . Serum leptin levels were also decreased markedly in all groups : -59.2 % ( OEWL1 ) , -37.8 % ( OWL ) and -48.6 % ( EWL ) ( P<0.01 all ) . In addition , there were marked decreases in leptin levels for each kilogram of fat mass after the 12 week period : -48.2+/-7.2 % ( OEWL ) , -27.8+/-4.8 % ( OWL ) and -39.3+/-4.3 % ( EWL ) ( P<0.01 all ) . Decreases in serum leptin levels expressed per kilogram of fat mass were significantly higher in the OEWL group compared to the OWL group ( P=0.03 ) . Consequently , an exercise training program in adjunct to pharmacotherapy provides higher weight reduction and fat mass loss in obesity treatment . It also seems to have further beneficial effects on leptin resistance , as indicated by decreases in leptin levels expressed per kilogram of fat mass OBJECTIVE To assess the impact of weight reduction on serum adipocytokines , C-reactive protein ( CRP ) , and insulin sensitivity in hypertensive female patients with central obesity . METHODS This study was performed using the data base and stored serum sample s of female patients who had participated in an intervention study focused on weight loss . Thirty hypertensive women aged 18 to 65 , body mass index ( BMI ) > 27 kg/m2 , and central obesity were selected . They were r and omly assigned to receive either a low-calorie diet plus orlistat 120 mg three times daily or a low-calorie diet alone for 16 weeks . Patients who experienced weight loss greater than 5 % ( n = 24 ) were assessed for blood pressure , anthropometric parameters , visceral fat , insulin resistance ( HOMA-R - homeostasis model assessment of insulin resistance ) and sensitivity ( ISI - Insulin Sensitivity Index ) indices , plus serum lipids , adipocytokines ( adiponectin , leptin , IL-6 , and TNF-alpha ) and CRP levels . RESULTS After BMI had been reduced by approximately 5 % in both groups , visceral fat , fasting glucose , triglycerides , and TNF-alpha decreased . Only the orlistat group , which was more insulin resistant at baseline , showed a significant reduction in blood glucose after oral glucose load , in addition to increased insulin sensitivity . CONCLUSION This study 's findings indicate that a weight loss greater than 5 % is associated with improved inflammatory status and decreased insulin resistance , regardless of changes in adiponectin and TNF-a levels . The greatest improvements in insulin sensitivity experienced by the orlistat-treated patients could not be attributed to the use of this drug because of the higher number of insulin-resistant subjects in this group BACKGROUND Orlistat has been shown to increase adiponectin and reduce progression to type 2 diabetes in obese Caucasians . Some effects of orlistat are thought to be independent of weight loss by altering gut flora and the production of endotoxin lipopolysaccharide ( LPS ) . We studied the effect of dietary treatment with and without orlistat in South Asian individuals with impaired glucose tolerance ( IGT ) on adiponectin and inflammatory markers including LPS . METHODS South Asian individuals were r and omised to either dietary treatment with orlistat or dietary treatment alone . At the end of 12 months , a comparison was made between the two groups for differences in anthropomorphic measurements and serum markers . RESULTS Three hundred and five individuals underwent oral glucose tolerance test of whom 40 had IGT . Complete baseline and 1-year data was available for 31 patients . After 1 year , patients in the orlistat group demonstrated a greater but insignificant decrease in weight ( 4.5 + /- 0.1 kg ) , and a significant increase in adiponectin ( 6.73 + /- 3.2 microg/ml ) and decrease in LPS ( 4.55 + /- 1.98 EU/ml ) compared with- the diet-alone group . In the orlistat group the reduction in LPS was correlated with the increase in adiponectin ( p < 0.005 ) . CONCLUSION The increase in adiponectin levels in the orlistat group would suggest that orlistat may reduce the progression to type 2 diabetes  in South Asian individuals by raising serum adiponectin . The finding that LPS levels are also reduced by orlistat and that this reduction correlates with the increase in adiponectin raises the possibility that the increase in adiponectin may be mediated via an effect on LPS levels Aim : To evaluate the effects of 1-year treatment with orlistat compared with placebo on different inflammatory parameters in type 2 obese diabetic patients . Material s and methods : Two hundred and fifty-four type 2 diabetic patients were r and omized to take orlistat 120 mg three times a day or placebo for 12 months . We evaluated at baseline and after 3 , 6 , 9 and 12 months : leptin , tumor necrosis factor (TNF)-α , adiponectin ( ADN ) , vaspin and high-sensitivity C-reactive protein ( HS-CRP ) , body weight , waist circumference , body mass index ( BMI ) , lipid profile , glycemic profile , fasting plasma insulin ( FPI ) and homeostasis model assessment insulin resistance index ( HOMA-IR ) . Results : Regarding inflammatory parameters , there was a significant improvement of ADN and TNF-α , and a faster decrease of leptin and HS-CRP in the orlistat group compared with the control group . We also recorded a significant reduction of body weight and BMI with orlistat , but not with placebo . A faster improvement of glycemic profile and FPI was obtained with orlistat compared with the controls . Also , there was a significant reduction of lipid profile  with orlistat , not reached with placebo . Conclusions : Orlistat was more effective than placebo in ameliorating inflammatory parameters such as ADN and TNF-α , and anthropometric parameters To evaluate the effects of 1-year treatment with orlistat plus L-carnitine compared to orlistat alone on body weight , glycemic and lipid control , and inflammatory parameters in obese type 2 diabetic patients . Two hundred and fifty-eight patients with uncontrolled type 2 diabetes mellitus ( T2DM ) [ glycated hemoglobin ( HbA(1c ) ) > 8.0 % ] in therapy with different oral hypoglycemic agents or insulin  were enrolled in this study and r and omized to take orlistat 120 mg three times a day plus L-carnitine 2 g one time a day or orlistat 120 mg three times a day . We evaluated the following parameters at baseline and after 3 , 6 , 9 , and 12 months : body weight , body mass index ( BMI ) , glycated hemoglobin ( HbA(1c ) ) , fasting plasma glucose ( FPG ) , postpr and ial plasma glucose ( PPG ) , fasting plasma insulin ( FPI ) , homeostasis model assessment insulin resistance index ( HOMA-IR ) , total cholesterol ( TC ) , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , triglycerides ( Tg ) , adiponectin ( ADN ) , leptin , tumor necrosis factor-α ( TNF-α ) , vaspin , and high-sensitivity C-reactive protein ( Hs-CRP ) . We observed a better decrease in body weight , glycemic profile , HOMA-IR , LDL-C , and ADN and a faster improvement in FPI , TC , Tg , leptin , TNF-α , Hs-CRP  with orlistat plus L-carnitine compared to orlistat alone . We also recorded an improvement in vaspin  with orlistat plus l-carnitine not reached with orlistat alone . Orlistat plus L-carnitine gave a better improvement in body weight , glycemic and lipid profile compared to orlistat alone ; furthermore , a faster and better improvement in inflammatory parameters was observed with orlistat plus L-carnitine compared to orlistat alone BACKGROUND Leptin is likely to be involved in the homeostasis of body weight . Insulin is suggested to regulate both short-term and long-term circulating leptin levels . The present study aims to assess the relation between insulin and leptin levels in obese humans . METHODS Some 53 obese subjects ( body mass index 35.1 + /- 3.9 kg m-2 ( mean + /- SD ) ) were prescribed a hypocaloric diet and r and omized to either a placebo or the intestinal lipase inhibitor orlistat for 2 years .  Serum leptin and insulin levels were determined repeatedly during these 2 years ( 5 times in the fasting condition and twice after an oral glucose load ) . RESULTS Leptin concentrations appeared to be regulated at a specific level for each individual throughout the weight-loss period . The BMI explained 39.7 % of the total variance in leptin levels , the body-fat distribution 17.2 % , individual characteristics 30.3 % ; and the fasting serum insulin concentration 1.0 % . After a mean weight loss of 7.7 + /- 4.9 kg , the time-integrated insulin response to an oral glucose load was significantly lower but the leptin response remained unchanged . CONCLUSIONS The BMI is the main determinant of the circulating leptin concentration in obese humans . Individual characteristics seem to determine the leptin level , given the BMI . In a short-term observational study in obese humans , changes of insulin levels do not appear to be correlated to changes in leptin levels OBJECTIVE To investigate the effects of : I ) short- ( 8 weeks ) , II ) long-term ( 3 years ) weight loss , and III ) the degree of weight loss on circulating levels of adiponectin , high sensitive-C reactive protein ( hs-CRP ) , and fibrinogen in obese subjects . Moreover , to evaluate the effect of the lipase inhibitor , orlistat , on these parameters . DESIGN Weight loss induced in 93 obese subjects ( mean weight : 108.9+/-15.8 kg ) through  8-week very-low-energy diet ( VLED , 800 kcal/day ) followed by r and omization to orlistat or placebo together with lifestyle intervention for further 3 years . Adiponectin and hs-CRP were measured at baseline , after 8 weeks of VLED and 6 , 12 , and 36 months after the VLED by flowmetric xMAP technology ( Luminex Multi-Analyte Profiling System , Luminex Corp. , Austin , TX , USA ) . Fibrinogen was measured in a coagulation assay . RESULTS Weight loss after VLED treatment was 14.3+/-4.5 kg and after 3 years 7.7+/-8.7 kg . Orlistat-treated subjects regained 3.9 kg less than placebo-treated from the end of the VLED to 3 years ( P=0.01 ) . No differences were detected between the two groups regarding changes in adiponectin , hs-CRP , or fibrinogen . Accordingly , the groups were combined for further analyses . Serum adiponectin increased by 22 % ( P<0.05 ) after the VLED but returned to baseline after 3 years . Both short- and long-term weight losses needed to be in excess of 10 % ( approximately 12 kg ) in order to increase adiponectin levels significantly . Weight loss was associated with a significant decrease in hs-CRP . Fibrinogen decreased by 12 % ( P<0.05 ) after 3 years . CONCLUSIONS In obese subjects , weight loss was associated with an increase in serum adiponectin and a decrease in hs-CRP and plasma fibrinogen . Long-term weight loss ( 3 years ) must exceed 10 % to induce a combined significant improvement in these inflammatory markers OBJECTIVE Ghrelin is postulated to be an orexigenic signal that promotes weight regain after weight loss ( WL ) . However , it is not known whether this putative effect of ghrelin is sustained after weight stabilization . The objective of this study was to investigate the relationship of plasma ghrelin concentrations to active WL and weight maintenance in obese subjects . RESEARCH METHODS AND PROCEDURES This study was a r and omized clinical trial , with a 12-month follow-up period . Obese Mexican-American women matched for age and BMI were r and omized to a 12-month WL program ( n = 25 ) or no intervention ( controls , n = 23 ) . Interventions included diet , exercise , and orlistat .  Body weight and fasting ghrelin , leptin , insulin , and glucose concentrations were measured at baseline and 6 and 12 months . RESULTS The WL group lost 8.5 % of body weight after 6 months and maintained the new weight for the next 6 months . Ghrelin concentrations increased significantly at 6 months but returned to baseline at 12 months . Baseline ghrelin concentrations were directly related to the degree of WL achieved after 12 months . Controls experienced no change in BMI or ghrelin levels . There were no associations between plasma ghrelin and leptin or insulin concentrations . DISCUSSION Consistent with previous results , ghrelin rises in response to WL , perhaps as a counterregulatory mechanism . However , the present results indicate that ghrelin concentrations return to baseline with sustained weight maintenance , suggesting that its effects are unlikely to regulate long-term energy balance . Baseline ghrelin concentrations are related to the degree of WL that can be achieved by active weight reduction BACKGROUND The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established . METHODS We enrolled in our study 10,744 overweight or obese subjects , 55 years of age or older , with preexisting cardiovascular disease , type 2 diabetes mellitus , or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events . All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week , single-blind , lead-in period , after which 9804 subjects underwent r and om assignment in a double-blind fashion to sibutramine ( 4906 subjects ) or placebo  ( 4898 subjects ) . The primary end point was the time from r and omization to the first occurrence of a primary outcome event ( nonfatal myocardial infa rct ion , nonfatal stroke , resuscitation after cardiac arrest , or cardiovascular death ) . RESULTS The mean duration of treatment was 3.4 years . The mean weight loss during the lead-in period was 2.6 kg ; after r and omization , the subjects in the sibutramine group achieved and maintained further weight reduction ( mean , 1.7 kg ) . The mean blood pressure decreased in both groups , with greater reductions in the placebo group than in the sibutramine group ( mean difference , 1.2/1.4 mm Hg ) . The risk of a primary outcome event was 11.4 % in the sibutramine group as compared with 10.0 % in the placebo group ( hazard ratio , 1.16 ; 95 % confidence interval [ CI ] , 1.03 to 1.31 ; P=0.02 ) . The rates of nonfatal myocardial infa rct ion and nonfatal stroke were 4.1 % and 2.6 % in the sibutramine group and 3.2 % and 1.9 % in the placebo group , respectively ( hazard ratio for nonfatal myocardial infa rct ion , 1.28 ; 95 % CI , 1.04 to 1.57 ; P=0.02 ; hazard ratio for nonfatal stroke , 1.36 ; 95 % CI , 1.04 to 1.77 ; P=0.03 ) . The rates of cardiovascular death and death from any cause were not increased . CONCLUSIONS Subjects with preexisting cardiovascular conditions who were receiving long-term sibutramine treatment had an increased risk of nonfatal myocardial infa rct ion and nonfatal stroke but not of cardiovascular death or death from any cause . ( Funded by Abbott ; Clinical Trials.gov number , NCT00234832 . BACKGROUND Leptin , which has been identified as an antiobesity hormone , regulates body weight by controlling food intake and energy expenditure via the hypothalamic-pituitary-gonadal axis . It appears that leptin may be an important factor in obesity management . Orlistat , a pancreatic lipase inhibitor , could reduce fat absorption and promote weight loss due to leptin metabolism . OBJECTIVE The purpose of this study was to investigate the effects of orlistat therapy on serum leptin levels . METHODS Obese women ( body mass index [ BMI ] , 30 kg/m(2 ) ) aged 18 to 50 years were r and omly assigned to receive 12 weeks of oral treatment with diet-orlistat ( 120 mg TID ) ( DO group ) or diet-placebo ( DP group ) . During the treatment period , patients were asked to eat a balanced diet of -1200 to 1600 kcal/d . Body composition was determined by bioelectrical impedance . Serum leptin levels were measured using radioimmunoassay at baseline and at study end . RESULTS A total of 24 patients entered the study ; 14 patients ( mean [ SE ] BMI , 37.7 [ 1.1 ] kg/m(2 ) ) received orlistat and 10 patients ( mean [ SE ] BMI , 39.4 [ 1.3 ] kg/m(2 ) ) received placebo . Compared with baseline , mean percentages of loss of body weight and fat mass after 12 weeks of treatment were significant in the DO group ( 9.1 % and 14.8 % , respectively ; both P = 0.001 ) and in the DP group ( 9.5 % and 17.6 % ; both P = 0.005 ) . The between-group differences were not statistically significant . Mean ( SE ) serum leptin levels also decreased significantly after treatment in the DO group ( 16.2 [ 1.2 ] vs 9.0 [ 1.0 ] ng/mL ; P = 0.001 ) and in the DP group ( 19.3 [ 2.1 ] vs 9.7 [ 1.4 ] ng/mL ; P = 0.005 ) . The between-group difference was not statistically significant . CONCLUSIONS In this study of obese women , orlistat treatment was associated with a similar decrease in body weight , fat mass , and serum leptin levels as placebo over a 12-week period . In this regard , short-term orlistat therapy may not provide an additional effect on serum leptin levels , and reduction in leptin levels were closely related to the decrease in fat mass Orlistat lowers lipids and improves insulin sensitivity , but its effect on other metabolic syndrome related parameters is not known . To assess its influence on adiponectin , high sensitive C-reactive protein ( hs-CRP ) and other metabolic syndrome related parameters , this study enrolled 106 participants in a weight-reduction program and categorized them into a group of 51 who had been treated with orlistat 360 mg/day for one year and a group of 55 age and sex and body mass index ( BMI ) matched controls . The orlistat group had greater changes in BMI , % body fat ( % BF ) , waist circumference , and insulin resistance , hs-CRP , leptin and adiponectin levels after one year on the program than the controls . After adjusting for % BF and waist circumference , change of serum leptin and adiponectin levels remained significantly different . It was found that orlistat could effectively manage obesity related co-morbidities , especially insulin resistance and atherosclerosis risk . It decreases leptin and increases adiponectin independent of % BF and waist circumference . Therefore , orlistat appears to have anti-diabetic and anti-atherogenic properties and may help prevent metabolic syndrome in the overweight people WHAT IS KNOWN AND OBJECTIVE The behavioural approach is usually slow and not always sufficient to achieve optimal targets in weight and metabolic control in obese diabetic patients , and a pharmacological treatment is often necessary . The aim of this study was to compare the effects of orlistat and placebo on body weight , glycaemic and lipid profile and insulin resistance in patients with type 2 diabetes . METHODS Two hundred and fifty-four obese , diabetic patients were enrolled in this study and r and omized to take orlistat 360 mg or placebo for 1year . We evaluated at baseline and after 3 , 6 , 9 and 12months body weight , waist circumference ( WC ) , body mass index ( BMI ) , glycated haemoglobin ( HbA(1c ) ) , fasting plasma glucose ( FPG ) , post-pr and ial plasma glucose ( PPG ) , fasting plasma insulin ( FPI ) , homeostasis model assessment insulin resistance index ( HOMA-IR ) , lipid profile , retinol-binding protein-4 ( RBP-4 ) , resistin , visfatin and high-sensitivity C-reactive protein ( Hs-CRP ) . RESULTS AND DISCUSSION We observed a significant reduction in body weight , WC , BMI , lipid profile , RBP-4 and visfatin in the orlistat group but not in control group . Faster improvements in HbA(1c ) , PPG , FPI , HOMA-IR , resistin and Hs-CRP were recorded with orlistat than with placebo . A similar decrease in FPG was seen in the two groups . Significant predictors of change in insulin resistance ( HOMA-IR ) were RBP-4 and resistin concentration in the orlistat group ( r=-0·53 , P<0·05 , and r=-0·59 , P<0·01 , respectively ) . WHAT IS NEW AND CONCLUSION To the best of our knowledge , this is the first study investigating the effect of orlistat on insulin resistance and markers of inflammation . Orlistat improved lipid profile and led to faster glycaemic control and insulin resistance parameters than the control , without any serious adverse event . Orlistat also improved RBP-4 and visfatin , effects not observed with placebo Our study wants to evaluate the effects of one year treatment with orlistat plus L-carnitine compared to orlistat alone on body weight , glycemic and lipid control , and insulin resistance state in type 2 diabetic patients . Two hundred and fifty-eight patients with uncontrolled type 2 diabetes mellitus ( T2DM ) [ glycated hemoglobin ( HbA(1c ) ) > 8.0 % ] in therapy with different oral hypoglycemic agents or insulin  were enrolled in this study and r and omised to take orlistat 120 mg three times a day plus L-carnitine 2 g one time a day or orlistat 120 mg three times a day . We evaluated at baseline , and after 3 , 6 , 9 , and 12 months these parameters : body weight , body mass index ( BMI ) , HbA(1c ) , fasting plasma glucose ( FPG ) , post-pr and ial plasma glucose ( PPG ) , fasting plasma insulin ( FPI ) , homeostasis model assessment insulin resistance index ( HOMA-IR ) , total cholesterol ( TC ) , low density lipoprotein-cholesterol ( LDL-C ) , high density lipoprotein-cholesterol ( HDL-C ) , triglycerides ( Tg ) , retinol binding protein-4 ( RBP-4 ) , resistin , visfatin , high sensitivity-C reactive protein ( Hs-CRP ) . We observed a faster , and better decrease of body weight , HbA(1c ) , FPG , PPG , LDL-C , HOMA-IR with orlistat plus L-carnitine compared to orlistat . A faster improvement of TC , Tg , FPI , resistin , RBP-4 , visfatin , and Hs-CRP was reached with orlistat plus L-carnitine compared to orlistat . We can safely conclude that the association of orlistat plus L-carnitine was better than orlistat in improving body weight , glycemic and lipid profile , insulin resistance , and inflammatory parameters and no significant adverse events were recorded The aim of this study was to evaluate the effect of an oral glucose tolerance test ( OGTT ) on the level of endothelial dysfunction and vascular inflammation markers in healthy subjects ( H ) and diabetic overweight patients ( D ) . We enrolled 256 healthy subjects and 274 type 2 diabetic patients . We evaluated blood glucose ( BG ) , soluble intercellular adhesion molecule-1 ( sICAM-1 ) , interleukin-6 ( IL-6 ) , high-sensitivity C reactive protein ( hsCRP ) , soluble vascular cell adhesion molecule-1 ( sVCAM-1 ) , soluble E-selectin ( sE-selectin ) , and tumor necrosis factor-alpha ( TNF-alpha )  at baseline and after OGTT . We observed that BG , sICAM-1 , IL-6 , hs-CRP , sVCAM-1 , sE-selectin , and TNF-alpha values were higher in D group than in H group . In a large sample of adult healthy subjects and type 2 diabetics we observed that both answer to an OGTT with a significant increase in biomarkers of systemic low- grade inflammation and endothelial dysfunction such as hsCRP , IL-6 , TNF-alpha , sICAM-1 , sVCAM-1 , and sE-selectin . Type 2 diabetics experienced , however , a more significant increase in TNF-alpha , and sE-selectin
target: In meta-regression , changes in plasma concentrations of adiponectin , leptin and CRP were associated with duration of treatment , but not with either change in BMI or baseline BMI values .
  CONCLUSION Orlistat is effective in increasing plasma concentrations of adiponectin and decreasing those of leptin and CRP
background: AIMS To conduct a systematic review and meta- analysis of relevant r and omized clinical trials ( RCTs ) to ascertain the effect size of orlistat in modulating plasma levels of adipokines , ghrelin and C-reactive protein ( CRP ) .