Simply over-eating might not account for the rise in obesity
The notion that obesity is caused by eating too much or exercising too little , that is , that it arises from an energy imbalance , is too simplistic according to a recently published narrative review . 1 The current obesity paradigm is based on the energy balance model ( EBM ), which purports that “ energy in equals energy out ”. Using this EBM , it is conceptually simple to explain how an individual gains weight ; they disturb this balance by either putting more energy in ( that is , eating too much ) or not expending enough energy , that is , too little exercise . The net result is a calorie surplus which is responsible for obesity . This model has become so deeply entrenched within the psyche that the only conceivable way to lose weight is through a calorie deficit by eating less or exercising more . The EBM has become mainstream and widely endorsed by professional health organisations . For example , in the UK , according to the National Health Service , obesity is “ generally caused by consuming more calories , particularly those in fatty and sugary foods , than you burn off through physical exercise .” 2
But is the EBM the best theory to account for obesity ? Not according to
Ludwig et al , 1 who propose that the carbohydrate-insulin model ( CIM ) is a more appropriate model . The model posits that the metabolic response to calories is based , not on the calorie content per se , but the source of dietary calories . For instance , the authors claim that intake of a high glycaemic load which includes rapidly digestible carbohydrates such as white
bread , cakes etc , is the key driver for a positive energy balance and ultimately weight gain . High glycaemic foods increase insulin secretion and uptake of glucose into muscle and liver cells as well as stimulating lipogenesis . The CIM therefore suggests that , in itself , a positive energy balance does not lead to obesity and that it is a shift of dietary intake ( that is , to high
Myocarditis and pericarditis rare after COVID-19 vaccination
Myocarditis refers to an inflammation of the heart muscle whereas pericarditis is an inflammation of the outer lining of the heart . The annual , global incidence of myocarditis has been estimated at 1.5 million cases or 10 – 20 cases per 100,000 people . 1
Epidemiological data on the incidence of pericarditis is limited , although the incidence has been recorded as 0.1 – 0.2 % of hospitalised patients and 5 % of patients admitted to an emergency department with non-ischaemic chest pain . 2 However , in recent months , attention has been drawn to a possible association between COVID-19 vaccination and an increase in the number of cases of both myocarditis and pericarditis . The symptoms suggestive of either myocarditis or pericarditis include new-onset and persistent chest pain , shortness of breath or palpitations following COVID-19 vaccination . An early hint that COVID-19 vaccination might be responsible for myocarditis was reported in a press release by the Israeli Ministry of Health . 3 The release stated that 275 cases of myocarditis had been reported , of which 148 had occurred within 30 days of vaccination and that cases were mostly in younger men ( aged 16 – 19 years ) and usually after the second vaccination dose .
Since this initial report , further cases have been documented , and in order to provide some much-needed perspective on the incidence of both conditions post-vaccination , a team from the Drug Safety Research Unit , Southampton , UK , has collated all of the available evidence reported from multiple regions across the world . 4 The team turned to spontaneous reporting systems including the Yellow Card Scheme ( UK ), the Vaccine Adverse Event Reporting System ( VAERS ) in the US and EudraVigilance , used by the European Economic Area . The team searched for events labelled “ myocarditis ” and “ pericarditis ” in each of the databases . The number of people vaccinated in each of the databases was also determined and reporting rates for both conditions were calculated per million vaccines administered for those who had received at least one dose of each vaccine brand . The datalock point was 6 August 2021 for VAERSA and EudraVigilance and 4 August for the Yellow Card Scheme .
Findings At the time of datalock in the UK , the team calculated that there were approximately 7.93 cases of myocarditis and 6.73 cases of pericarditis per million vaccinees who had received at least one dose of the BNT162b vaccine . Similarly , for the Moderna vaccine , there were 2.07 cases of myocarditis and 1.79 cases of pericarditis per million vaccinated .
In the US , there were 6.47 cases ( myocarditis ) and 3.53 ( pericarditis ) among fully vaccinated individuals from the BNT162b vaccine and 3.65 ( myocarditis ) and 2.69 ( pericarditis ) from the Moderna vaccine among those fully vaccinated . In Europe , there were 4.23 cases ( myocarditis ) and 2.87
32 | Issue 99 | 2021 | hospitalpharmacyeurope . com