Examinando por Autor "Bruna-Mejias, Alejandro"

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  • Miniatura
    Ítem
    GLP-1RA- and Incretin-Based Therapies Within Lifestyle Interventions for Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis
    (MPDI, 2026) Bruna-Mejias, Alejandro
    Background/Objectives: Glucagon-like peptide-1 receptor agonist (GLP-1RA)- and incretin-based therapies are now central to obesity management. Their clinical value, however, should be interpreted beyond total weight loss, because changes in fat mass, lean mass, physical function, and cardiometabolic risk may depend on the accompanying dietary, behavioral, and exercise co-interventions. This systematic review and meta-analysis evaluated GLP-1RA- and incretin-based therapies delivered within lifestyle interventions in adults with overweight or obesity. Methods: The protocol was registered in PROSPERO (CRD420261360837). PubMed/MEDLINE, Web of Science, Scopus, CINAHL, SPORTDiscus, and CENTRAL were searched from inception to the final search dates. Records were deduplicated in Zotero. Risk of bias was assessed using the Cochrane RoB 2 tool. Random-effects meta-analyses were estimated using restricted maximum likelihood with Hartung–Knapp adjustment when pooling was appropriate. Results: Across all database sources, 1651 records were identified. After removing 113 duplicate records and 212 records with an ineligible publication type before screening, 1326 records were screened. Seventy-seven reports were sought for retrieval, five were not retrieved, 72 were assessed at full text, and 48 reports corresponding to 35 independent parent trials or trial clusters were retained for qualitative synthesis. The primary kilogram-scale meta-analysis included eight independent comparisons and showed greater body-weight reduction with GLP-1RA/incretin-based therapy delivered within a lifestyle background than with placebo/control (mean difference [MD] −10.08 kg, 95% confidence interval [CI] −12.76 to −7.39; 95% prediction interval [PI] −17.86 to −2.29; $I^2 = 95.6\%$). Percentage body-weight change was analyzed separately across 11 independent comparisons and also favored GLP-1RA/incretin-based therapy (MD −9.53 percentage points, 95% CI −11.92 to −7.14; 95% PI −17.58 to −1.48; $I^2 = 95.4\%$). Conclusions: GLP-1RA- and incretin-based therapies delivered within lifestyle interventions are associated with clinically meaningful reductions in body weight in adults with overweight or obesity. Absolute and relative body-weight change metrics should remain analytically separate. The magnitude of benefit varies across trial contexts, and certainty remains limited by risk-of-bias concerns and considerable heterogeneity. Future trials should standardize the reporting of lifestyle co-interventions, body composition, adherence, physical-function outcomes, and safety monitoring.
  • Miniatura
    Ítem
    Occipitalization of the atlas: prevalence, functional and anatomical considerations. A systematic review and meta-analysis
    (Elsevier, 2026) Bruna-Mejias, Alejandro
    Background: Occipitalization of the atlas, defined as a congenital fusion between the first cervical vertebra (C1) and the occipital bone, is an uncommon anatomical variant of the craniovertebral junction. Reported prevalence in the general population varies widely, and the condition is often identified incidentally during imaging or anatomical assessment. Objective: To synthesize available evidence on the prevalence of atlas occipitalization and to describe its anatomical characteristics across different populations and study designs. Methods: A comprehensive literature search was conducted in MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS from inception to January 2025. Study selection and data extraction were performed independently by four reviewers. Methodological quality was assessed using the Anatomical Quality Assessment (AQUA) tool. A random-effects meta-analysis was applied to estimate pooled prevalence values and explore predefined subgroups. Results: Twenty-five studies met the inclusion criteria for qualitative synthesis, of which eleven were included in the meta-analysis, encompassing a total of 4219 subjects. The pooled prevalence of atlas occipitalization was 0.64% (95% confidence interval: 0.00–1.00%). Variability in prevalence estimates was observed across populations and assessment methods. Conclusion: Atlas occipitalization is a rare congenital anatomical variant of the craniovertebral junction. Although often asymptomatic, its identification is anatomically relevant due to potential associations with other craniovertebral anomalies. Awareness of this variant is important for accurate anatomical interpretation and for planning procedures involving the craniovertebral junction.