Objective: Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery. Methods: This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. Results: In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups. Conclusions: Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.

This study compared the efficacy and tolerability of three enteral formulas in critically ill patients with COVID-19 who were ventilated and in the prone position: (a) immunomodulatory (IMM), (b) ω3 and (c) maltodextrins (MD). Primary outcome was the percentage of patients who received both 80 % of their protein and calorie targets at 3 d after enrolment. Secondary, mechanical ventilation-free time, ICU mortality and markers of nutritional status. Tolerance of enteral nutrition was evaluated by diarrhoea and gastroparesis rate. A total of 231 patients were included, primary outcome achieved was in ω3 group (76·5 % v. 59·7 and 35·2 %, P < 0·001) v. IMM and MD groups. Mechanical ventilation-free time was longer in ω3 and MD groups: 23·11 (sd 34·2) h and 22·59 (sd 42·2) h v. 7·9 (sd 22·6) h (P < 0·01) in IMM group. Prealbumin final was 0·203 ± 0·108 g/L and 0·203 ± 0·095 g/L in IMM and ω3 groups v 0·164 ± 0·070 g/L (p < 0·01) MD group. Transferrin were 1·515 ± 0·536 g/L and 1·521 ± 0·500 g/L in IMM and ω3 groups v 1·337 ± 0·483 g/L (p < 0·05) MD group. Increase of lymphocytes was greater in ω3 group: 1056·7 (sd 660·8) cells/mm³v. 853·3 (sd 435·9) cells/mm³ and 942·7 (sd 675·4) cells/mm³ (P < 0·001) in IMM and MD groups. Diarrhoea and gastroparesis occurred in 5·1 and 3·4 %, respectively. The findings of this study indicate that enteral nutrition is a safe and well-tolerated intervention. The ω3 formula compared with IMM and MD did improve protein and calorie targets.