Odd Erik Johansen

This study aimed to evaluate a web-based self-assessment tool for COPD case finding using algorithm-based COPD risk stratification, and to compare breathlessness (mMRC) and respiratory health-related quality of life (HRQoL) across risk groups and with self-reported COPD. We conducted a cross-sectional web-based survey of anonymous visitors completing a web-based self-assessment tool including demographics, COPD risk factors, breathlessness (mMRC), and respiratory HRQoL (CAT and K-BILD). Only respondents with complete responses were analyzed. COPD risk was algorithmically classified as high- or low-risk based on responses to age, smoking or dust exposure, respiratory symptoms, history of exacerbations, and the mMRC score. Individuals classified as having a high-risk of COPD received a prompt recommendation to consult their general practitioners. Group comparisons were performed using chi-square or ANCOVA, adjusting for covariates (age, sex, and current smoking). All analyses were exploratory, without corrections for multiple testing. In total, 57 847 people visited the website between Oct 2018 and Nov 2024, of whom 8779 (63% female) completed the full survey. Of those 8779 (63% female), 799 reported a COPD diagnosis (mean age 64.1 years). The high-risk (n = 6569) and the low-risk (n = 1411) groups were younger than the self-reported COPD group (58.4, and 54.6 vs 60.1 years, P < .0001). Self-reported COPD was associated with a lower proportion of never smokers than the high- and low-risk groups (7.1% vs 15.0% and 22.0%, respectively; P < .0001). Individuals with self-reported COPD had greater breathlessness (mMRC: 1.74 ± 1.28, 1.39 ± 1.0 and 0 ± 0) and poorer HRQoL (CAT 18.9 ± 7.9, 15.9 ± 8.0 and 10.6 ± 5.5; K-BILD 64.4 ± 19.2, 73.1 ± 18.6 and 87.4 ± 12.8) than both high- and low-risk groups (all P < .0001). Breathlessness and respiratory HRQoL differed across algorithm-based COPD risk stratification groups, and the algorithmically identified high-risk group showed a profile closer to self-reported COPD than the low-risk group. These findings support a web-based self-assessment tool as an approach for early COPD case finding and identifying undiagnosed COPD, although further validation is required.

Objectives: Oral enzyme combination (OEC) therapy with bromelain, trypsin and rutoside reduces pain and improves function in patients with knee osteoarthritis (OA). Here, we investigated several potential biological mechanisms underlying the clinical effects of OEC therapy in patients with established knee OA with respect to innate immunity, systemic inflammation and cartilage turnover (EudraCT 2020-003154-80, NCT05038410). Methods: Patients (age ≥40 years, body mass index (BMI) ≤35 kg/m²) with symptomatic knee OA were randomised to either placebo or OEC, administered 2×3 tablets/day, for 8 weeks before crossing over after a 4-week washout period. Different markers exploring innate immunity, inflammation and cartilage matrix degradation have been measured in the blood using immunoassays or cytometric methods. Data from the modified intention-to-treat population (mITT) were analysed using a generalised linear mixed model. No correction for multiple comparisons was made due to the exploratory nature of the study. Results: Altogether, 45 patients were randomised; 43 completed both treatment sequences (mITT; mean age: 63.3 years; mean BMI: 27.4 kg/m²; mean global Knee injury and Osteoarthritis Outcome Score (KOOS): 48.7). OEC significantly increased levels of α2-macroglobulin (p=0.038) and interleukin-10 (p<0.0001) while decreasing urinary carboxyl-terminal cross-linked telopeptide of type II collagen (p=0.038). Patients administered OEC exhibited significant improvements in KOOS Pain (p=0.0464) and Symptoms (p=0.026) subdomains but not globally. OEC was well tolerated, with no serious related adverse events reported in either group. Conclusions: One of the key findings of this proof-of-mechanism study is that OEC modulates IL-10 production, suggesting an anti-inflammatory effect in patients with knee OA. This main finding contributes to explaining the effects of OEC on pain and function in these patients. Trial registration number: NCT05038410.

Background/Objectives: Obesity is a chronic, progressive, recurrent disease associated with impaired health, affecting an increasing proportion of the population worldwide. Newer-generation incretin-based therapies (IBTs) (liraglutide, semaglutide, and tirzepatide) have shown greater efficacy than older anti-obesity medications. This systematic literature review provides an overview of the evidence on the symptomatic adverse events (AEs) and patient-reported outcomes of IBTs to facilitate clinical decision-making. Methods: A systematic search was conducted using a predefined search strategy to identify controlled trials and real-world evidence (RWE) studies assessing IBTs. Results: Among 4414 publications identified, 81 (>400,000 participants) were included. Liraglutide (n = 49), semaglutide (n = 34), and tirzepatide (n = 7) were used in 48 clinical and 33 RWE studies. Gastrointestinal (GI) AEs were most common: placebo-subtracted incidences were 5–39% for nausea, −7–39% for diarrhea, 2–31% for constipation, 0–26% for vomiting, and 2–20% for abdominal pain, with no clear difference across IBTs. Most AEs were mild or moderate and mainly occurred during dose escalation. Quality of life outcomes were reported in 27 publications and generally showed improvements with IBTs. Conclusions: This study confirms that GI AEs are common with IBTs. Clinicians should keep the AE profile of IBTs in mind and consider where additional preventative measures may be required.

Purpose: Whey protein (WP) consumption prior to a meal curbs appetite and reduces postprandial glucose (PPG) through stimulating endogenous GLP-1 secretion and insulin. Methods: We assessed the metabolic effects of a concentrated WP, using a new micelle-technology (WPM), in people with type 2 diabetes (T2D) and overweight or obesity (NCT04639726). In a randomized-crossover design, participants performed two 240 min lunch meal (622 kcal) tests 7 ± 4 days apart. After an overnight fast and a standardized breakfast, 10 g (125 mL) WPM (40 kcal) or placebo (125 mL water, 0 kcal) was consumed 15 min ahead of the mixed-nutrient meal. Effects on PPG (primary endpoint), insulin, GLP-1, and branched-chain amino acids (BCAAs) were evaluated with frequent blood sampling. Changes in incremental areas under the concentration curve (iAUC) were compared using a mixed model. Results: Twenty-six individuals (14 females, mean ± SD age 62.0 ± 8.3 years, HbA1c 58 ± 12 mmol/mol/7.5 ± 1.1%, BMI 29.2 ± 4.8 kg/m²) completed both tests. WPM significantly reduced PPG iAUC_0–2h by 22% (p = 0.028), and iAUC_0–3h numerically by −18% (p = 0.090) vs. placebo. WPM also increased insulin iAUC_0–1h by 61% (p < 0.001), and iAUC_0–3h by 30% (p = 0.004), respectively. Total GLP-1 iAUC_0–2h was enhanced by 66% (p < 0.001). Postprandial plasma BCAA patterns were characterized by a rapid increase and larger iAUC_0–2h (all p < 0.001) after WPM. No adverse events were ascribed to consuming WPM. Conclusions: A 125 mL pre-meal drink containing just 10 g WPM before a mixed meal reduced PPG and increased insulin, GLP-1, and BCAAs. WPM may therefore serve as a metabolic modulator in people with T2D living with overweight or obesity.

We assessed the glucometabolic effects of oligomalt, a novel fully slowly digestible carbohydrate, compared with maltodextrin, in cross-over randomized controlled trials (NCT05058144; NCT05963594) involving healthy volunteers (HV), people with overweight or obesity (PwO), and people with type 2 diabetes (T2D). We tested 33 g and/or 50 g of oligomalt/maltodextrin, which were dissolved in 300 mL of water and consumed after fasting in the morning. The primary exploratory endpoint was the incremental area under the curve (iAUC) for postprandial glucose, assessed by frequent blood sampling over 3 h. Insulin levels were also assessed. In the HV cohort, a 4 h hydrogen breath test was performed with 15 g of inulin as a positive control. Analysis was performed by a mixed model. Oligomalt elicited a lower post-prandial glucose response compared to maltodextrin in HV (50 g, n = 15 [7 women], mean age/BMI 31 years/22.6 kg/m²), in PwO (33 g and 50 g, n = 26 [10 women], age/BMI 44 years/29.9 kg/m², mean HbA1c 5.3%), and in people with T2D (50 g, n = 22 [13 women], age/BMI 61 years/31.8 kg/m², HbA1c 7.4%), with significant reductions observed in PwO and T2D for the 0–1 h window (HV: −19% [p = 0.149]/PwO_33g-38% [p = 0.0002]/PwO_50g-28% [p = 0.0027]/T2D-38% [p < 0.0001]; the 0–2 h window (HV: −17% [p = 0.311]/PwO_33g-34% [p = 0.0057]/PwO_50g-21% [p = 0.0415]/T2D-37% [p < 0.0001]), and the 0–3 h window (HV: −15% [p = 0.386]/PwO_33g-30% [p = 0.0213]/PwO_50g0−19% [p = 0.0686]/T2D−37% [p = 0.0001]). The post-prandial insulin response was significantly lower, by 38–60%, across all populations, dose, and time points, with oligomalt. In HV, the breath-hydrogen pattern was comparable between oligomalt and maltodextrin, but increased significantly with inulin. These data support the glucometabolic advantages of oligomalt over maltodextrin, hence confirming it as a healthier carbohydrate, and underscoring its full digestibility. This therefore opens up the possibility for the incorporation of oligomalt in relevant food products/matrices.

Aim: The effects of weight loss with a partial or total meal replacement programme (MRP) on atherosclerotic cardiovascular disease (ASCVD) risk factors are not fully understood, in particular in people at higher CV risk. In the 52‐week randomized controlled OPTIWIN study in men and women with obesity, meal replacement programme (total for first 26 weeks, partial for the ensuing 26 weeks) with OPTIFAST (OP) resulted in significantly greater weight loss compared with a low‐calorie food‐based (FB) dietary plan, both as part of a comprehensive lifestyle intervention [OP (n = 135)/FB (n = 138) week 26: −12.4%/−6.0%, p < .001; week 52: −10.5%/−5.5%, p < .001]. Here, we examined effects on ASCVD risk factors and 10‐year ASCVD risk. Materials and Methods: Participants with body mass index 30‐55 kg/m ² and age 18‐70 years, and not on anti‐obesity medications, were recruited. The effects on systolic and diastolic blood pressure (SBP, DBP), lipid parameters and 10‐year ASCVD risk were analysed as changes over time using linear mixed models. Subgroup analyses were conducted for changes in SBP, DBP and ASCVD risk by categories of age (2 , 10‐year ASCVD risk p = .024]. All lipid parameters as well as 10‐year ASCVD risk were significantly improved with OP versus FB. A similar, but slightly attenuated pattern was observed at 52 weeks. Across subgroups, greater reductions for SBP, DBP and ASCVD risk were generally seen with OP versus FB with quantitatively higher baseline SBP and age, and in men. Conclusions: In people with obesity at low ASCVD risk, OP significantly reduced cardiovascular risk factors and 10‐year predicted risk for ASCVD.