Day 1 :
Keynote Forum
F Buck Willis
Dynasplint System Inc., USA
Keynote: Culmination of Interdisciplinary Protocols for Obesity Reduction
Time : 09:30-10:15

Biography:
F Buck Willis has earned his Medical degree in the British Commonwealth (MBBS) and PhD in Kinesiology. He then directed and completed 12 studies over eight years which led to 20 publications and being chosen as a Fellow of the American College of Sports Medicine. He has over 50 publications (including four books).
Abstract:
Successful obesity reduction must start with identifying and eliminating the causes of this disease. The most common causes which affect an estimated 75% of the US population are hidden food allergies. While these sub-acute allergens do not cause itching, hives, or angioedema, they do cause inflammatory reactions which yield metabolic depression. Other causes include high fructose corn syrup and preservatives like TBHQ (Tertiary Butyl Hydroquinone) which require days to detoxify the volatile, phenol compound. Food allergen elimination itself with ALCAT testing showed significant changes in weight, body fat percentage reduction and BMI reduction (p<0.0001). In that comparison study the second category subjects combined treatment of food allergen elimination with PAN-5 protocols. The combined treatment showed a significantly difference (p<0.0001) with 75% greater weight loss (-12.4 Kg), 80% greater fat percentage reduction (-5.4%) and 70% greater BMI reduction (3.6). The PAN-5 acronym is from the combination of these protocols: Portion-size meal control (consuming <2 cups), five times per day; Aerobic-surge exercise (HR elevated ≥75% max for 2 minutes), performed 5/day; and Natural foods eaten five times per day (within the <2 cup portion size). There is significant evidence that hidden food allergies may be one meaningful cause of the growing obesity epidemic and eliminating food allergens will reduce daily weight gains and empower continual weight loss. The combination of the evidence-based protocols in PAN-5 have shown even greater changes (improvement) by eating smaller portion sizes more frequently, participating in a brief, high intensity aerobic-surge exercise for two minutes (5 days) and eating natural foods five times a day (within the portion size).
Keynote Forum
Hani Oweira
Hirslanden Clinics, Zurich
Keynote: Surgery of the Liver and Intra-operative Interventions. What is possible Today
Time : 10:15- 11:00

Biography:
Hani Oweira is a Surgeon in the Hirslanden Clinics in Zurich and Cham and partner of the Surgical Center of Hirslanden Kliniken Zürich.
Abstract:
Liver resections are performed to manage benign and malignant focal lesions in the liver and the post-operative outcome was improved over time due to improvement of surgical techniques which get benefit from understanding the liver anatomy and segmentation with improvement of hemostasis techniques. Anatomy wise liver is divided to 2 lobes (right and left) ant into 8 segments classified by Couinaud based on vascular inflow and outflow. There are many techniques for liver parenchymal transection started with clamp-crush technique and developed to ultrasonic vibration (harmonic shear), Cavitron Ultrasonic Surgical Aspirator (CUSA), hydrojet, radiofrequency dissector and recently staplers. There are numerous types of resection could be divided to major (>2 segments) and minor (<2 segments) and could be divided into anatomical (right and left hepatectomy, right anterior and posterior sectionectomy and left lateral sectionectomy), non-anatomical resection and individual segmentectomy. There are many other interventional procedures can be done during surgery for hepatic focal lesions rather than surgery as Radiofrequency Ablation (RFA), cryoablation or Irreversible Electroporation (IRE) which usually kept as combined intervention with surgery in deep parenchymal lesions which is difficult to be removed without injuring or scarifying a major hepatic structure. Also one of the elegant techniques in management of hepatic focal lesions especially malignant one is adjuvant or pre-operative angio-embolization or chemo/radio embolization which deprives the lesion from its blood supply and supplying it with chemo or radiotherapy which may decrease the size of lesion and make it easier and accessible to be removed. In addition to that, systemic chemotherapy could have benefit in malignant lesions as it may decrease the size of the lesions and minimize the liver parenchyma needed to be resected to remove the whole lesion and sometimes it changes non-resectable liver lesions to resectable one.
Keynote Forum
Richard Visser
Vera Health Group, Aruba
Keynote: The Aruba Project, a road map for population approach to combating obesity
Time : 11:15-12:00

Biography:
Richard Visser has studied the problem and implemented solutions from many perspectives as a Clinical Researcher, Academic, Educator, Activist, Politician, Entrepreneur, concerned citizen and parent. His work has made vital contributions to a great understanding of the biological, sociological and psychological factors surrounding childhood obesity. He has presented papers in Geneva at the congress hosted by the International Association of the Study of Obesity and he is currently collaborating with the Department of Public and Occupational Health in the Netherlands on a proposal for combating the disease throughout the Caribbean. Early in 2008, he was appointed by the Government of Aruba to Head the Obesity Task Force and a year later, he began his four year term as Aruba’s Minister of Health and Sport.
Abstract:
Obesity as a disease has reached historical, maximal peak values, with nearly one-third of the world’s population suffering from obesity and obesity-related conditions. We are now witnessing the impact of this epidemic upon the global health status, with non-communicable diseases on the rise. We have also witnessed the shortcomings and failures of past actions taken when obesity is already present. In Aruba, a prevalence of 36% of childhood obesity was found in 2005, with a tendency to increase as compared to the data prior to 2000. Actions to improve healthy eating habits, reduce sedentary lifestyle and enable a social environment to prevent obesity were carried out in a systematic plan in the period from 2009-2013 and a positive change was observed in the incidence of obesity compatible with complete deceleration of the epidemic and improvement in health indicators. Through the lessons learned from the project as executed in Aruba, we demonstrated how a specific road map can be developed, implemented and highly successful in addressing the obesity epidemic. The roadmap includes steps such as population AL baseline study, an awareness campaign, an approved action plan by the stakeholders and Government, changes in infrastructure, the creation of an institute to promote a healthy lifestyle, an introduction to the exercise is medicine initiative and a study of progress with ongoing monitoring.
- Obesity and Weight Management | Sports Nutrition| Childhood obesity

Chair
F Buck Willis
Dynasplint System Inc., USA

Co-Chair
Hani Oweira
Hirslanden Clinics, Zurich
Session Introduction
Muhammad Amjad
IGI Insurance Limited, Pakistan
Title: Impact of sports and physical activities on the obesity of school-going children

Biography:
Muhammad Amjad is an experienced General Insurance Professional who has earned over 27 years work experience in three different market in Pakistan, namely Islamabad, Faisalabad and Peshawar. He has completed his MSc in Rural Sociology, MBA Sales and Marketing, Certificate of Insurance CII, UK and PhD in Rural Sociology from University of Agriculture Faisalabad. He has great interest in social and management sciences research particularly child hood obesity, marketing, management, nutrition and general health of people. He is the General Manager and Regional Head at IGI General Insurance Limited; a packages group company, he has served this organization for around 23 years so far. Besides formal education, he has also attended numerous professional courses.
Abstract:
Weight that is higher than the healthy weight for a given height is known as overweight or obese. Body Mass Index (BMI) is considered a screening tool for overweight or obesity. If BMI of a person is less than 18.5 it will be underweight range. If BMI is 18.5 to 25, it will be considered normal. If BMI is 25.0 to 30, it will be within overweight range and If BMI is 30.0 or higher, it will be within obese range. At an individual level, BMI can be used as a screening tool but is not diagnostic of the body fatness or the health of an individual. A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual’s health status and risks. Factors such as food habits, family history, increased BMI, environmental conditions, etc. are responsible for the obesity in children. Issue of children obesity is world spread phenomenon. This study was conducted in two districts in Pakistan with sample size of 600 respondents. Schools were categorized as elite private schools, government schools and rural areas schools. The obtained data then was analyzed by using descriptive statistics, bivariate analysis and multivariate to find the relative significance of independent variables in explaining dependent variable. The obesity of the children was affecting students’ academic performance, physical health and psychological health. A strong inverses relationship was found among sports facilities in schools, physical activities, participation in sport and obesity of the children. All possible measures should be taken by all concerned to address children obesity as this epidemic may make our future assets as sick and sluggish.
Inga Thorsdottir
University of Iceland, Iceland
Title: Feeding in the first year of life and risk for overweight and obesity

Biography:
Inga Thorsdottir is a Professor of Human Nutrition, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland. She is currently Dean of the SHS UI. She has coordinated many research projects and supervised doctoral students. She has received many honors for her pioneer and scientific work. She has been involved in nutrition recommendations since the 1990s.
Abstract:
Influences early in life have been observed to program body weight and the risk for developing obesity. Infant feeding has been associated with later BMI measures. High weight gain in infancy has also been associated with later overweight. We investigated infant diet and growth in two nation-wide cohorts (born 1995-96 and 10 years later 2005) through the first year of life and with a follow-up at the age of six years. Recommendations about infant diet were changed in early 2000. The comparison between the cohorts showed lower prevalence of overweight in the latter cohort which could be attributed to a changed diet, e.g. lower protein intake. In a randomized controlled trial comparing infants exclusively breastfed for 4 vs. 6 months, we did not observe a difference in growth between the groups, which was explained by small difference in intake between the two groups. According to several systematic literature reviews there is strong evidence for a protective effect of breastfeeding against overweight and obesity in childhood and adolescence. Furthermore, higher protein intake in infancy and early childhood is convincingly associated with increased growth and higher BMI in childhood. Protein intake between 15 E% and 20 E% in early childhood has been associated with an increased risk of being overweight later in life. Breast-milk is the optimal infant diet and official recommendations world-wide have followed the WHO’s recommendation on exclusive breastfeeding for the infant’s first six months and continued breastfeeding parallel to giving other food until one or two year of age or as long as it suits the family. Increased knowledge has strengthened the evidence for this recommendation but more studies are needed. Beside further studies on infant feeding and later obesity, investigations on early nutrition and e.g. asthma and ADHD are needed.
- Liver Diseases | Liver transplantation and Surgery | Liver and Biliary
Location: 2
Session Introduction
Zhuo Wang
Southern University of Science and Technology, China
Title: Stat3 tyrosine phosphorylation is critical for hepatocellular carcinoma proliferation, survival and angiogenesis in response to lipopolysaccharide

Biography:
Zhuo Wang is a well-qualified, highly skilled and motivated person with more than 8-year work experience in liver disease. She has completed her PhD degree from Hong Kong Polytechnic University in 2014 and currently she is working at Southern University of Science and Technology. Her recent research focuses on liver fibrosis and liver cancer.
Abstract:
Hepatocellular Carcinoma (HCC) is a long-term sequence of chronic inflammatory liver injury and hepatic injury is associated with a defective intestinal barrier and increased hepatic exposure to bacterial products including Lipopolysaccharide (LPS), which promotes hepatocarcinogenesis. Despite its clinical signiï¬cance, mediators responsible for the high risk of inflammation to develop HCC in the chronically injured liver remain to be clarified. Here, we report a novel mechanism by which LPS/Signal Transducer and Activator of Transcription 3 (STAT3) signaling promotes the angiogenesis in HCC both in vitro and in vivo. STAT3 activated by LPS increases the production of Vascular Endothelial Growth Factor (VEGF) by tumor cells, which in turn stimulates the migration and tubulogenesis of endothelial cells through STAT3 activation and hence promotes angiogenesis in HCC. Moreover, our data suggested that hypoxia-induced VEGF expression, which also contributes to angiogenesis in HCC, was in a STAT3-dependent pathway. Our findings not only provide a potential mechanism by which bacterial infection enhances HCC oncogenesis through promoting the angiogenesis in liver, but also suggest that targeting STAT3 might be an effective therapeutic strategy in HCC treatment considering the dual roles of STAT3 in angiogenesis.
- Liver Diseases diagnosis | Liver Cancer | Viral Hepatitis C
Location: 1
Session Introduction
Naomi Ferguson
Medical Officer, Seychelles
Title: Cost-effectiveness of treating hepatitis C in Seychelles with direct-acting antivirals as compared to no treatment

Biography:
Naomi Ferguson is an experienced Medical Officer with a demonstrated history of working in primary health and HIV clinics. She is passionate about strengthening risk communication capacities in African countries with language proficiency in English, French and Seychelles Creole. She is an experienced presenter, which includes the presentation of Seychelles’ Risk Communication capacity during the Joint External Evaluation (JEE) of implementation of International Health Regulations (IHR 2005) in Seychelles in March 2018 and forming part of the external team of Rwanda’s JEE of implementation of IHR in May 2018. She actively participated in the review of the draft of 3rd Edition of the Technical Guideline for the Integrated Disease Surveillance and Response (IDSR) in Brazzaville Congo in March 2018. She is proactive and hardworking with experience of taking multiple duties during the Seychelles’ response to plague epidemic in Madagascar in 2017.
Abstract:
Background & Aim: Approximately 80 million people around the world are living with hepatitis C, and 700,000 people die every year from hepatitis C related complications. Since 2014, oral medications called Directly-Acting Antivirals (DAAs) have been available for curative treatment. In Seychelles, a total of 777 cases of hepatitis C were reported from 2002 to 2016, but up to mid of 2016, the cases were not being treated. Treatment with DAA Harvoni, a combination of Sofosbuvir and Ledipasvir (SOF/LDV), is now being offered conditionally to those at low risk of re-infection. The aim of this study is to establish cost effectiveness of treating all cases of hepatitis C in Seychelles with Harvoni, as compared to no treatment.
Methods: A systematic review was carried out, using MEDLINE, Embase and NHS-EED. Data was extracted from the identified studies, including author, year, title, country, population, intervention and comparators, method (time horizon, perspective, model, clinical data source, cost data source, outcome measures and discount rate), results and discussion. Evidence from the systematic review was used to populate an economic model to calculate cost-effectiveness from Seychelles’ Government perspective. The population characteristics were based on the HCV cohort data from Seychelles. The model structure was also informed by the systematic review and an accompanying grading of economic models using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. The economic model used was a Markov model, using a lifetime horizon and taking a payer’s perspective. Costs were discounted at 3% per annum. Outcome measures included Quality Adjusted Life Years (QALYs). Costs and QALYs were used to calculate Incremental Cost Effectiveness Ratios (ICERs).
Results: Harvoni, was found to be cost-saving in Seychelles HCV cohort, as compared to no treatment, with an ICER of €-753.65/QALY. The treatment was also cost-saving when stratified by gender, with the ICER of male and female being €-783.74/QALY and €-635.20/QALY, respectively. These findings were robust to probabilistic sensitivity analysis.
Conclusion: Treating hepatitis C cases in Seychelles is cost-saving. These results will help inform the policies on strategies to eliminate hepatitis C in Seychelles.
Ma Marylaine Dujunco
St. Luke’s Medical Center, Philippines
Title: Use of acoustic radiation force impulse (ARFI) imaging for the diagnosis of malignant liver tumor among patients with liver tumors: A cross-sectional study

Biography:
Ma Marylaine Dujunco is an working at St. Luke’s Medical Center, Philippines
Abstract:
Background & Aim: Acoustic Radiation Force Impulse (ARFI) imaging is a method to evaluate tissue stiffness. This study aims to evaluate the use of ARFI to non-invasively determine if a liver mass is benign or malignant.
Methodology: This is a two-year cross-sectional study of patients’ diagnosed liver tumors those underwent liver elastography using ARFI at St. Luke’s Medical Center. Liver masses were grouped to either benign or malignant according to their etiology and the mean ARFI value per group was computed. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic accuracy of the ARFI measurement. The optimal cut-off value was chosen to maximize the sensitivity and specificity. A p value <0.05 was considered statistically significant.
Results: Among 90 included patients in the study, 23.3% of the patients had history of other malignancy and 35.5% had cirrhosis. 81.1% of the patients had malignant liver masses. Average ARFI value of malignant masses was 2.24 m/s while that of benign is 1.88 m/s (p=0.113). Based on the ROC curve, a cut off ARFI value of 1.965 m/s has the highest sensitivity and specificity to distinguish malignant from benign liver masses at 65.8% and 58.8%, respectively. Using a cut off ARFI value of 1.02 m/s, the sensitivity and specificity of diagnosing a liver mass to be malignant are 90.4% and 23.5%, respectively. Calculated positive likelihood ratio is 1.18 and negative likelihood ratio of 0.41.
Conclusion: ARFI imaging is a promising method to characterize a liver mass as benign or malignant. It can accurately and objectively assess the stiffness of the liver mass in a non-invasive way. Any liver mass with an ARFI value of ≤1.02 m/s is benign (sensitivity 90.4%, specificity 23.5%). Liver masses with ARFI value of >1.02 m/s is likely malignant hence further investigation is warranted.
- Obesity and Public Health | Childhood obesity | Obesity Medicine
Location: 2
Session Introduction
Daria Skuratovskaia
Immanuel Kant Baltic Federal University, Russia
Title: Additional evidence of link between mtDNA copy number and body mass index

Biography:
Daria Skuratovskaia conducts his research in the field of genetic studies of the metabolic syndrome and its complications. She studies the polymorphic variants of adipokine and cytokine genes responsible for the formation of insulin resistance in obesity. In addition, she investigates the relationship between the components of NF-ĸB and Wnt signaling pathways with mitochondrial biogenesis.
Abstract:
Mitochondrial DNA (mtDNA) encodes core subunits of oxidative phosphorylation complex and as a result of a complex regulatory crosstalk between nuclear and mitochondrial genomes the total number of mtDNA copies fits the requirements of each cell type. Deviations from the optimal number of mtDNA copies are expected to be deleterious and thus can cause some diseases and agin. The reasons of potential deviations in mtDNA copies might be genetic or environmental such as hormonal imbalance in non-hereditary diseases. We studied 193 individuals (69 men; 124 women) who were divided into two cohorts, with and without obesity. The types of tissues were analyzed from each individual- peripheral venous blood, liver, Subcutaneous Adipose Tissues (SAT) and Visceral Adipose Tissue (VAT) from both greater omentum and mesenterium. The absolute mtDNA copies per cell were measured by droplet digital PCR and were significantly lower in peripheral blood than in the other tissues examined, 228±31 in peripheral blood, 1158±151 in liver, 1312±142 in greater omentum, 1161±86 in mesenterium and 1418±219 in SAT. The Body Mass Index (BMI) correlates positively with the mtDNA copies in SAT and negatively with peripheral blood mtDNA copies. There are positive correlations between greater omentum and mesenterium mtDNA copies (cor=0.44, p<0.05) and between SAT and greater omentum (cor=0.48, p<0.05). Multiple regression model revealed that blood and SAT mtDNA copy number affect the change in BMI (multiple R2: 0.4491, adjusted R2: 0.3471, p-value: 0.004633). Thus, we have revealed positive relationships between BMI and mtDNA copies in SAT and fat depots, but negative relationship between BMI and mtDNA copies in peripheral venous blood.
Ehud Goldhammer
Technion Israel Institute of Technology, Israel
Title: The impact of exercise training on circulating S-Klotho in lean and obese coronary artery disease patients

Biography:
Ehud Goldhammer has his expertise in exercise physiology and cardiac rehabilitation, obesity, metabolic syndrome and heart failure patient's rehabilitation in particular. His passion in improving the health and wellbeing of coronary artery patients led him to establish (1982) the first cardiac rehabilitation center in the northern part of Israel, encouraging women, elderly, old people and minorities to join cardiac rehabilitation programs. Since the establishment of this center he tried to promote exercise programs for obese, diabetic, hypertensive and heart failure patients. Most of his research projects were done in exercise physiology, in the various subsets of coronary artery disease patients (diabetics, obese, hypertensive and heart failure patients).
Abstract:
Background: Klotho protein is a membrane-based circulating protein that regulates cell metabolism, as well as the lifespan modulating activity of Fibroblast Growth Factors (FGFs). Higher plasma circulating Klotho levels reduce cardiovascular risk, suggesting Klotho has a protective role in cardiovascular diseases. Recent studies have identified Klotho as a target gene for Peroxisome Proliferator-Activated Receptor-γ (PPAR-γ), a master regulator of adipocyte differentiation and an adipogenesis-promoting factor. Aerobic exercise reduces the risk of cardiovascular events and mortality in patients with proven Coronary Artery Disease (CAD), thus, S-Klotho serum levels were assessed in lean and obese patients in order to find out whether exercise can modulate its activity.
Purpose: To assess the impact of 12 weeks exercise training program on S-Klotho in obese vs. lean CAD patients and to assess possible correlation between S-Klotho and diabetes.
Methodology: S-Klotho was assessed pre and post 12 weeks supervised aerobic exercise program (45 min/4-5 sessions/week) in 2 groups, Group-A=27 CAD patients with BMI≤29, age 59.7 years±2.2 SD and Gropup-B=13 CAD patients with BMI≥30, age 63 years±2.4 SD. All patients had a recent (<45 days) Aortocoronary By-Pass Surgery (CABG) years, Myocardial Infarction (MI) or Percutaneous Intervention (PCI). Assessment was done twice, prior to exercise program and at the end of 12 weeks intervention. Serum S-Klotho levels were analyzed using α-Klotho enzyme linked immuno-sorbent assay (ELISA) kit (IBL, Immuno-Biological Laboratories Co., Japan), Germany.
Results: No difference (p=0.21) was found at baseline for S-Klotho levels between the two groups, 730.49 pg/ml±201.20 SD and 715.33 pg/ml±209.11 SD respectively, while a difference was found following exercise intervention, 843.27 pg/ml±210.56 SD in the obese patients group compared to 767.51pg/ml±167.46 SD in lean patients group, p=0.037. S-Klotho had an inverse correlation with diabetes at baseline and following exercise program, r=-0.59 and -0.61 respectively (p<0.05).
Conclusion: Aerobic exercise may modulate S-Klotho activity, among obese patients in particular, thus conferring a possible mechanism for the enhanced survival of coronary artery patients engaged in aerobic exercise program. If it contributes to the obesity paradox it should be further investigated.