The sleep paradox: The effect of weekend catch-up sleep on homeostasis and circadian misalignment

Weekend catch-up sleep involves not only changes in sleep duration between weekdays and weekends but also changes in sleep timing. When people sleep less during the weekdays, they accumulate sleep debt and extend their sleep duration on weekends to compensate, which is related with the homeostatic process. Thus, extend their sleep duration on weekends seems to be a protectively strategy of daytime function, mental and physical health. However, not all studies support this protective effect. Sleep duration changes with sleep timing. The difference in sleep timing between weekdays and weekends might bring social jet lag (SJL). Sleep duration changes with sleep timing. The difference in sleep timing between weekdays and weekends can lead to SJL, representing the discrepancy between the biological clock and the social clock. This makes SJL an indicator of circadian misalignment, which is associated with poor daytime function, reduced nighttime sleep quality, and an increased risk of depression, metabolic disturbances, and other diseases. Paradoxically, the protective effect of weekend catch-up sleep duration on the homeostatic process (compensating for sleep debt) and the potential impact of weekend catch-up sleep timing on the circadian process (circadian misalignment) contradict each other. A more comprehensive understanding of weekend catch-up sleep is essential to investigate its mechanisms using the two-process model and other influencing factors.

Effect of brief intense stair climbing on cardiorespiratory fitness and metabolic risk factors in inactive young men with obesity: A randomized controlled trial

BACKGROUND AND AIM

We investigated the effects of brief, intense stair climbing on cardiorespiratory fitness (CRF) and cardiometabolic risk factors in young Korean men with obesity.

METHODS AND RESULTS

Twenty-four healthy men (age: 25.8 ± 2.4 years, BMI: 27.1 ± 2.5 kg/m2) were randomized into either the stair climbing exercise group (n = 12) or the control group (no exercise intervention, n = 12). The stair climbing exercise (5 days per week for 4 weeks) included a 3-min warm-up, followed by three 20-s bouts of vigorous stair climbing [≥80 % of age-predicted maximal heart rate (MHR)], with 2-min of recovery in between. Peak oxygen uptake (VO2peak) and body composition were measured by maximal treadmill test and bioelectrical impedance analysis, respectively. A fasting blood sample was obtained after a 10-h overnight fast to measure cardiometabolic markers. All participants completed the study and attended 97.1 % of all scheduled exercise sessions. There was significant group x time effect on CRF, such that the stair climbing exercise group had significant improvements in VO2peak (pre: 38.7 ± 5.2 versus post: 41.6 ± 5.7 ml/kg/min, P < 0.01) and exercise duration (pre: 10.4 ± 1.8 versus post: 12.1 ± 1.9 min, P < 0.01) during a maximal treadmill test, but with decreases in VO2peak and no change in the exercise duration the control group. Body weight, body fat and metabolic variables were unchanged after stair climbing exercise.

CONCLUSION

Brief, intense stair climbing with a total time commitment of 10 min per day is effective for improving VO2peak in young men with obesity.

CLINICAL TRIAL REGISTRATION

KCT0008139.

Meta-analysis of the Effect of Semaglutide on Blood Pressure in Obese Populations

OBJECTIVE

The aim was to systematically evaluate the effect of semaglutide on blood pressure in obese populations using meta-analysis methods.

METHODS

Randomized controlled trials on the effect of semaglutide on blood pressure regulation published from the inception of the databases to October 2024 were searched for in PubMed, Embase, the Cochrane Library, and Web of Science. Stata software was used for statistical analysis of the outcome measures in all included studies. Egger's test was applied to assess the risk of publication bias.

RESULTS

A total of 22 studies involving 15,347 participants were included in this meta-analysis. The results showed that, compared to the control group, the semaglutide group significantly reduced systolic blood pressure (SBP) (mean difference [MD] - 2.90, 95% confidence interval [CI] - 3.70 to - 2.11; P < 0.01) and diastolic blood pressure (DBP) (MD - 0.86, 95% CI - 1.34 to - 0.38; P < 0.01). Further subgroup analysis revealed that, compared to diabetic populations, semaglutide had a more significant reduction in SBP (- 1.87, 95% CI - 2.67 to - 1.06, vs - 5.02, 95% CI - 6.10 to - 3.94) and DBP (- 0.43, 95% CI - 0.89 to 0.02, vs - 1.96, 95% CI - 3.12 to - 0.80) in non-diabetic populations. The higher dose of semaglutide (2.4 mg) was found to significantly lower SBP (MD - 4.31, 95% CI - 5.18 to - 3.44) and DBP (MD - 1.84, 95% CI - 2.70 to - 0.98), although mild heterogeneity was present. Sensitivity analysis showed that the exclusion of any single study did not significantly affect the final results.

CONCLUSION

Current evidence suggests that semaglutide can lower SBP and DBP, and increasing the dosage can enhance the blood pressure-lowering effect.

Efficacy and safety of once-weekly tirzepatide in Japanese participants with type 2 diabetes who have obesity or overweight: Subpopulation analysis of the SURMOUNT-2 trial

AIM

To assess the efficacy and safety of once-weekly tirzepatide in Japanese participants with obesity and type 2 diabetes (T2D).

MATERIALS AND METHODS

This subpopulation analysis of 41 Japanese participants from three clinical trial sites in the SURMOUNT-2 trial evaluated the efficacy and safety of tirzepatide as an adjunct to lifestyle interventions in adults with body mass index ≥27 kg/m2 and a diagnosis of T2D with glycated haemoglobin ≥7% to ≤10%. Coprimary endpoints were mean percent change in body weight and proportion of participants who achieved ≥5% body weight reduction at week 72. Percent change in body weight was compared between tirzepatide and placebo using a mixed model for repeated measures.

RESULTS

The mean percent change (standard error) in body weight from baseline to week 72 was statistically significantly greater for both tirzepatide 10 mg (p = 0.001) and 15 mg (p = 0.013) compared with placebo: -12.4% (1.8%) and -10.2% (1.8%), respectively, compared with -3.5% (1.8%). At week 72, 85.7% and 78.6% of participants in the tirzepatide 10 mg and 15 mg groups, respectively, had a body weight reduction of ≥5%, versus 46.2% of participants receiving placebo. Reductions in glycemic parameters, waist circumference and systolic blood pressure, as well as numerical improvements in the lipid profile, were also observed with tirzepatide. No new safety concerns were identified.

CONCLUSIONS

In Japanese adults with obesity and T2D, once-weekly treatment with tirzepatide (10 or 15 mg) demonstrated significant reductions in body weight compared with placebo, with the safety profile generally consistent with previous studies.

Hair growth stimulated by allogenic adipose-derived stem cells supplemented with ATP in a mouse model of dihydrotestosterone-induced androgenetic alopecia

BACKGROUND

Androgenetic alopecia (AGA), also known as male or female pattern hair loss, is the most prevalent form of alopecia worldwide. Current treatments are based on hormone drugs, topical vasodilators and hair transplants. Newer options include stem cell therapy targeted at recovering the capacity for hair follicle regeneration. This study examines the effects of intradermally administering allogenic adipose-derived stem cells (ASCs) per se or supplemented with ATP in a mouse model of dihydrotestosterone (DHT)-induced AGA.

METHODS

Male and female C57BL6-strain mice were treated with DHT to induce AGA and then given injections of treatment solution in a defined area of the depilated back skin, and the same injections three days later. The treatments tested were several concentrations of ASCs combined with two ATP formulations. Photographs of the treated zones were taken on days 7, 10, 14, 17 and 21 and subjected to Image J analysis. On day 21, skin samples were also obtained for histological analysis. The main outcome measure was percentage treated surface area showing hair regrowth on treatment days 17 and 21 expressed as five categories: null, poor, moderate, intense and complete (20, 40, 60, 80 and 100% respectively).

RESULTS

The experimental groups found to show the highest number of male individuals with intense/complete hair regrowth on day 21 were those in which mice received low dose ASCs (1 ∙ 106) combined either with liposomal ATP or non-liposomal ATP. Both these groups showed significant differences compared to controls. In females, while low dose ASC treatments and the high dose ASC + liposomal ATP treatment led to no hair regrowth improvement over the control treatment, medium dose ASC (2 × 106) + non-liposomal ATP gave rise to greater regrowth scores.

CONCLUSIONS

Hair regrowth was improved in all experimental groups in which male mice were administered stem cell solutions supplemented with ATP. In female mice, the highest hair regrowth scores were observed for the medium dose ASC + liposomal ATP treatment.

Grip strength, metabolic syndrome, and type 2 diabetes mellitus: a prospective study

Objectives

This study examines the impact of absolute grip strength (AGS) and relative grip strength (RGS) on the risk of developing type 2 diabetes mellitus (DM), especially in relation to metabolic syndrome (MetS).

Methods

1,935 participants were adults aged 51 to 81 years with an average observation period of 6.50 years. The diagnosis of DM was based on American Diabetes Association. The JAMA 5030J1 dynamometer was used to measure the grip strength. Multivariable extended Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for DM incidence.

Results

The DM risk increased with the number of MetS risk factors. High AGS was associated with a reduced DM risk (HR = 0.66, 95% CI = 0.44-0.99), but association disappeared when adjusted for MetS. High RGS was significantly associated with a reduced risk of DM incidence (HR = 0.49, 95% CI = 0.33-0.72), even after adjusting for MetS (HR = 0.63, 95% CI = 0.42-0.94). With the presence of MetS, higher AGS was associated with a greater increase in the DM risk compared to lower AGS, while higher RGS was associated with a less increase in the DM risk compared to lower RGS.

Conclusion

This study demonstrates that RGS is a more reliable predictor of DM risks than AGS. Additionally, MetS significantly increases DM risk, particularly in individuals with obesity and hypertension. The study highlights the importance of assessing muscle quality in DM prevention and suggest that improving muscle quality may help mitigate DM risk.

Milking mesenchymal stem cells: Updated protocols for cell lysate, secretome, and exosome extraction, and comparative analysis of their therapeutic potential

The potential of the cell lysate, secretome, and extracellular vesicles (EVs) of mesenchymal stem cells (MSCs) to modulate the immune response and promote tissue regeneration has positioned them as a promising option for cell-free therapy. Currently, many clinical trials in stem cells-derived EVs and secretome are in progress various diseases and sometimes the results are failing. The major challenge on this roadmap is the lack of a standard extraction method for exosome, secretome, and lysate. The most optimal method for obtaining the secretome of MSCs for clinical utilization involves a comprehensive approach that includes non-destructive collection methods, time optimization, multiple collection rounds, optimization of culture conditions, and quality control measures. Further research and clinical studies are warranted to validate and refine these methods for safe and effective utilization of the MSC exosome, secretome, and lysate in various clinical applications. To address these challenges, it is imperative to establish a standardized and unified methodology to ensure reliable evaluation of these extractions in clinical trials. This review seeks to outline the pros and cons of methods for the preparation of MSCs-derived exosome, and secretome/lysate, and comparative analysis of their therapeutic potential.

Effects of whole-body vibration exercise on cardiorespiratory fitness, muscular strength and body fat in women with overweight and obesity: A randomized pilot study

BACKGROUND AND AIM

Whole-body vibration (WBV) exercise has been acknowledged as an alternative exercise method for improving functional capacity. We examined the effects of an 8-week WBV exercise on cardiorespiratory fitness (CRF), muscular strength (MS) and body composition in young women.

METHODS AND RESULTS

Twenty-six inactive women with overweight and obesity (age: 30.2 ± 8.0 years, BMI: 25.7 ± 1.9 kg/m2) were randomly assigned to WBV exercise (n = 13) or control (n = 13) groups. The WBV exercise group participated in static and dynamic exercises on a vibration platform (3 sessions/week, 60 min/session) for 8 weeks. The control group maintained their usual lifestyle without structured exercise. CRF was measured by VO2peak and MS index was measured by the 1-RM (kg) for the chest and leg press, expressed relative to body weight (kg). Body composition was assessed by bioelectrical impedance analysis. Of the 26 participants randomized, 23 participants (13 WBV and 10 controls) completed the intervention, with 94.2 % exercise adherence rate. A two-way repeated measures ANOVA revealed that the WBV exercise group had reductions (p < 0.05 for all) in body weight (-2.4 kg), BMI (-0.9 kg/m2), body fat (-2.8 kg) and waist circumference (-3.5 cm) compared to the control group. VO2peak (pre: 27.9 ± 4.8 vs. post: 30.7 ± 4.4 ml/kg/min, p = 0.005) and MS index (pre: 2.0 ± 0.4 vs. post: 3.0 ± 0.7, p < 0.001) increased in the WBV exercise group, but not in the control group.

CONCLUSION

WBV exercise is effective for improving fitness and body fat in young women with overweight and obesity.

Patients' experiences with GLP1-RAs - a systematic review

BACKGROUND

Obesity is a complex condition and a recognized public health challenge. Previous treatment options were associated with high failure rates, but recent trials have shown that significant weight loss can be achieved with GLP1-RAs. However, little is known about the patient's experiences with GLP1-RAs.

OBJECTIVES

This paper systematically reviews research on patients' experience with GLP1-RAs.

METHODS

A literature search in PubMed, PsycINFO, Embase and Sociological Abstracts included studies on adults' experiences with GLP1-RAs, regardless of methodology. Exclusions of studies: mental illness, pregnancy, former bariatric surgery, PCOS. Study quality and transparency were assessed according to design, using thematic analysis for synthesis.

RESULTS

Nine studies, selected from 7,607 records, encompassed three qualitative studies (semi-structured interviews), three RCTs, two narrative reviews and one survey study. The analysis identified five key themes: (1) Patients are willing to accept adverse events, like gastrointestinal disorders, for successful weight loss, (2) Patients experience improved physical functioning, well-being, and active daily living as a result of weight loss, (3) Patients express diverse opinions and skills regarding the medication's usability, (4) Patients believe that the medication improves their ability to manage sweet cravings, (5) Gender seems to affect patients' experiences with the medication, with females reporting more benefits than males.

CONCLUSION

Despite a huge demand and usage of GLP1-RAs, qualitative research on patients' experiences is scarce. Further studies are crucial for understanding short and long-term patient experiences.

Efficacy of phentermine/topiramate extended release in weight management and metabolic profiles: A multicentre study in South Korea

AIMS

Clinical trials have demonstrated the effectiveness of the phentermine and topiramate combination in weight management. This research evaluated the efficacy and safety of phentermine/topiramate extended release (ER) for weight management, focusing on alterations in body weight and metabolic parameters in routine clinical practice.

MATERIALS AND METHODS

We retrospectively included people with obesity who initiated phentermine/topiramate ER between January 2020 and April 2023 at 10 tertiary hospitals in South Korea. The study assessed body weight changes at 5-6 months and for those who continued, at 12 months, along with metabolic parameters. Total body weight was measured using calibrated electronic scales with participants in light indoor clothing.

RESULTS

The cohort included 1839 patients (540 men and 1299 women), with a 5-6-month continuation rate of 48%. At 5-6 months, the mean weight reduction was 7.9%, with sex-specific losses of 7.1% in men and 8.2% in women. Over 56% of participants achieved more than 5% weight loss, with 23% exceeding a 10% reduction. Younger participants, women and those with moderate to severe obesity exhibited more pronounced weight loss compared to older men and individuals with mild obesity, respectively. Concurrently, phentermine/topiramate ER treatment improved glucose regulation, lipid profiles and decreased blood pressure: the HbA1c decreased by 0.4 ± 0.9%, low-density lipoprotein (LDL) cholesterol by 10 ± 32 mg/dL and systolic blood pressure by 6 ± 15 mmHg (all p < 0.001). Treatment was well-tolerated, with a 15% incidence of mild adverse events like paresthesia, dry mouth and insomnia. At 12 months, patients who persisted in treatment (21%) experienced an average weight loss of 9.6%, with 65% surpassing a 5% weight loss.

CONCLUSION

The study suggests phentermine/topiramate ER is an effective option for obesity management in a South Korean population, though long-term adherence remains a challenge.

Phytoactives for Obesity Management: Integrating Nanomedicine for Its Effective Delivery

Obesity is a global health concern that requires urgent investigation and management. While synthetic anti-obesity medications are available, they come with a high risk of side-effects and variability in their efficacy. Therefore, natural compounds are increasingly being used to treat obesity worldwide. The proposition that naturally occurring compounds, mainly polyphenols, can be effective and safer for obesity management through food and nutrient fortification is strongly supported by extensive experimental research. This review focuses on the pathogenesis of obesity while reviewing the efficacy of an array of phytoactives used for obesity treatment. It details mechanisms such as enzyme inhibition, energy expenditure, appetite suppression, adipocyte differentiation, lipid metabolism, and modulation of gut microbiota. Comprehensive in vitro, in vivo, and preclinical studies underscore the promise of phytoactives in combating obesity, which have been thoroughly reviewed. However, challenges, such as poor bioavailability and metabolism, limit their potential. Advances in nanomedicines may overcome these constraints, offering a new avenue for enhancing the efficacy of phytoactives. Nonetheless, rigorous and targeted clinical trials are essential before applying phytoactives as a primary treatment for obesity.

Risk factors for atraumatic isolated subscapularis tear: glenoid retroversion

BACKGROUND

Subscapularis tendon (SSC) tears have recently become an area of current research focus. However, the risk factors for atraumatic isolated SSC tears, particularly anatomical factors, remain poorly determined. Therefore, the purpose of this study was to identify the associated factors contributing to isolated SSC tears.

METHODS

This study involved single shoulders of 605 subjects drawn from a cohort of rural residents. The inclusion criteria required each subject to sign an informed consent document and to have a complete clinical evaluation. The exclusion criteria comprised the absence of a complete magnetic resonance imaging study, current medication use that might have affected serum lipid levels, a history of shoulder trauma or surgery, and the presence of osteoarthritis, calcific tendinitis, frozen shoulder, or superior or posterosuperior rotator cuff tear. Diagnoses of isolated SSC tear were based on magnetic resonance imaging findings. Logistic regression analysis was conducted using demographic, physical, social, anatomical, comorbidities, and serological parameters. Anatomical variables included the supraspinatus fossa glenoid angle on axial (SGAX), a method to measure glenoid version, coracohumeral distance on axial and sagittal plans, and coracoid index. When multicollinearity among studied variables was detected, separate multivariable analyses were performed to address this issue, with each analysis including only one of those multicollinear variables along with the other significant variables obtained from univariate analyses.

RESULTS

Among anatomical variables, coracohumeral distance on axial and sagittal planes, as well as the coracoid index, did not show significant associations. However, SGAX, an index of glenoid version, was found to be significantly associated with atraumatic isolated SSC tears. Greater glenoid retroversion is significantly associated with atraumatic isolated SSC tears, along with age, waist circumference, dominant side involvement, manual labor, diabetes, metabolic syndrome, and biceps tendon injury (P ≤ .013).

CONCLUSIONS

The SGAX, serving as an index for glenoid version, is an independently associated factor for atraumatic isolated subscapularis tendon tears, with greater glenoid retroversion being an anatomical risk factor for these tears, along with overuse-related factors such as dominant-side involvement and manual labor, as well as metabolic factors such as obesity, diabetes, metabolic syndrome, and biceps tendon injury.

Adipocyte-derived shed Syndecan-4 suppresses lipolysis contributing to impaired adipose tissue browning and adaptive thermogenesis

Lipolysis in white adipose tissue (WAT) provides fatty acids as energy substrates for thermogenesis to increase energy expenditure. Syndecan-4 (Sdc4) is a transmembrane proteoglycan bearing heparan sulfate chains. Although single nucleotide polymorphisms (SNPs) of the Sdc4 gene have been identified linking to metabolic syndromes, its specific function in adipose tissue remains obscure. Here, we show that Sdc4 serves as a regulator of lipid metabolism and adaptive thermogenesis. Sdc4 expression and shedding are elevated in the white adipose tissue (WAT) of diet-induced obese mice. Adipocyte-specific deletion of Sdc4 promotes lipolysis and WAT browning, thereby raising whole-body energy expenditure to protect against diet-induced obesity. Mechanistically, fibroblast growth factor 2 (FGF2) is a paracrine factor that maintains energy homeostasis. Elevated shed Sdc4 concentrates and delivers FGF2 to fibroblast growth factor receptor 1 (FGFR1) on adipocytes, which in turn suppresses lipolysis by reducing hormone-sensitive lipase (HSL) activity, thus exaggerating adipose tissue dysfunction upon high-fat diet induction. Sdc4-deficient adipocytes show higher lipolytic and thermogenic capacity by enhancing HSL phosphorylation and UCP1 expression. Overall, our study reveals that adipocyte-derived shed Sdc4 is a novel suppressor of lipolysis, contributing to decreased energy expenditure, thus exaggerating obesity. Targeting shed Sdc4 is a potential therapeutic strategy for obesity.

Nonlinear Association Between Serum 25-Hydroxyvitamin D and Cardiac Autonomic Dysfunction in Diabetic Foot: A Threshold Effect on Heart Rate Variability

BACKGROUND

Previous studies have shown that vitamin D deficiency was associated with both cardiac autonomic dysfunction and the development of diabetic foot (DF). However, the impact of vitamin D levels on heart rate variability (HRV) in individuals with DF, a high-risk group, remains unclear. We explored the association between vitamin D status and HRV in individuals with DF.

METHODS

A total of 458 individuals with DF were assessed for vitamin D levels by 25-hydroxyvitamin D (25(OH)D) and evaluated for cardiovascular autonomic function using both time and frequency domains of the HRV measures. Multivariate regression analysis and restricted cubic spline regression were employed to examine the associations.

RESULTS

Vitamin D levels were positively associated with HRV indices in people with DF, including standard deviation of the normal sinus interval (SDNN), standard deviation of the 5-min average RR intervals (SDANN), low-frequency power (LF), high-frequency power (HF), and the LF/HF ratio (all p < 0.05). The associations between serum 25(OH)D and cardiac autonomic dysfunction were nonlinear. When 25(OH)D levels were < 50 nmol/L, the odds ratio (OR) for predicted cardiac autonomic dysfunction per SD increase in 25(OH)D was 0.56 (95% CI, 0.44-0.72). However, no significant effect was observed when 25(OH)D levels exceeded 50 nmol/L.

CONCLUSIONS

This study demonstrates that lower 25(OH)D levels are associated with reduced HRV in individuals with DF. Specifically, when 25(OH)D levels fall below 50 nmol/L, the risk of cardiac autonomic dysfunction in people with DF significantly increases.

The effect of GLP-1RAs on mental health and psychotropics-induced metabolic disorders: A systematic review

BACKGROUND

Mental illnesses and psychotropic drug use are associated with an increased risk of weight gain and metabolic disorders. Growing evidence suggests that agonists of the glucagon-like peptide-1 receptor (GLP-1RAs) might be safe and effective weight loss medications. However, the current evidence for the use of GLP-1RAs in individuals with obesity and mental illness is limited.

OBJECTIVE

Evaluation of the safety and the impact of GLP-1RAs on mental health and psychotropics-induced metabolic disorders such as obesity and type 2 diabetes (T2D).

METHODS

A literature search from January 1st, 2010 to August 31st, 2024 was conducted using PubMed and Cochrane Library online databases. Studies comprising adults with obesity or/and T2D and mental illness were included. Studies that examined individuals with obesity or/and T2D without mental illness and completed psychiatric questionnaires before and after GLP-1RAs treatment were also included.

RESULTS

From the 36 included studies 18 examined the weight-reducing effect of GLP-1RAs in patients with mental disorders and the other studies examined patients without mental illness. GLP-1RAs lead to a significant weight loss and improvement of glycemic control in patients with mental illness on psychotropics. They showed a beneficial effect on mental health in patients with and without mental disorders and were not associated with a worsening of mental state, suicidality, new-onset mental illness, or increased psychiatric admissions.

CONCLUSION

GLP-1RAs are safe and effective weight loss treatments for individuals with obesity and mental illness exerting a positive effect on mental state and quality of life. There is a need for RCTs with larger sample sizes, a longer treatment duration and longer follow-up periods to evaluate the long-term effect of GLP-1RAs. It would be of great interest to conduct studies investigating the use of GLP-1RAs with the purpose to treat mental illness in order to directly assess their use in improving mental health.

Association of weekend catch-up sleep with depression: A systematic review and meta-analysis

BACKGROUND

Weekend catch-up sleep (WCS) may alleviate weekday sleep deprivation, but its relationship with depression risk remains unclear. This systematic review and meta-analysis aims to explore the association between WCS and depression risk.

METHODS

A comprehensive search was conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus for observational studies published up to June 1, 2024. Data extraction and bias assessment were independently performed by two reviewers. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, with model selection based on the I2 statistic. Sensitivity analyses and publication bias tests were also conducted.

RESULTS

A total of ten cross-sectional studies (326,871 participants) were included. Meta-analysis showed that WCS was significantly associated with a reduced risk of depression (OR = 0.80, 95 % CI: 0.68-0.90). Subgroup analyses showed moderate amounts of WCS (0-2 h) may be protective, but WCS beyond 2 h had limited protective effects against depression. Qualitative analyses showed that the protective effect of WCS against depression was more pronounced in men and middle-aged adults, and was particularly applicable to those who were sleep-deprived on weekdays.

LIMITATIONS

The cross-sectional design of included studies limits causality inference, and the sample primarily represents populations from the United States and South Korea, potentially affecting generalizability.

CONCLUSIONS

Moderate WCS is associated with lower depression risk in those with weekday sleep deficits, while excessive WCS may have diminishing or adverse effects. Further research should examine optimal WCS duration and underlying mechanisms.

Investigating the associations between weekend catch-up sleep and insulin resistance: NHANES cross-sectional study

BACKGROUND

Insulin resistance (IR) is a precursor to metabolic syndrome. Weekend catch-up sleep (WCS) is practiced to compensate for insufficient weekday sleep, but its impact on IR remains unclear. This study investigated associations between WCS and severe IR risk.

METHODS

Data from 1,903 adults participating in the National Health and Nutrition Examination Survey 2017-2020 were analyzed. IR was assessed using the Homeostatic Model Assessment for IR (HOMA-IR) and Metabolic Score for IR (METS-IR), with severe IR defined as the highest quartile. WCS was calculated by subtracting weekday sleep duration from weekend sleep duration and was categorized into five groups. Weighted logistic regression and restricted cubic spline analyses were performed to examine associations between WCS patterns and severe IR risk. Percentages reported were weighted to account for sampling design and population distribution.

RESULTS

The majority of participants were under 60 yrs (75.2%, n = 1,344) and had a body mass index below 30 kg/m2 (59.2%, n = 1,082). Slightly more than half of the participants were female (51.3%, n = 990). A U-shaped relationship between WCS duration and severe IR risk was observed, with the lowest risk at approximately 0.7-1.0 h of WCS. Short WCS durations (0 < WCS ≤ 1 h) were associated with a significantly reduced risk of severe IR as defined by HOMA-IR (OR = 0.63, 95% CI: 0.41-0.97, P = 0.037) compared to stable sleep pattern (WCS = 0). Long WCS durations (WCS ≥ 2 h) were associated with an increased risk of severe IR as defined by METS-IR (OR = 1.88, 95% CI: 1.13-3.14, P = 0.018). Sensitivity analyses showed that the reduction in severe IR risk associated with short WCS durations was more significant in individuals with weekday sleep durations of seven hours or less.

CONCLUSIONS

WCS duration exhibits a U-shaped association with severe IR risk, with approximately 0.7-1.0 h of WCS linked to the lowest risk. Both insufficient and excessive WCS are associated with increased severe IR risk, emphasizing the importance of optimal sleep patterns for metabolic health.

Interventions to mitigate infant food insecurity in high-income countries: an overview of current evidence

Aim

Infant food insecurity (IFI) is a critical and often overlooked issue in high-income countries. This scoping review aims to identify and summarise interventions that reduce food insecurity or improve nutrition amongst families with infants in these regions.

Subject and methods

We searched the major electronic databases and websites of relevant UK and international organisations from 2010 to 2023 to identify reports written in English assessing food insecurity affecting infants (aged 0 to 2 years). The findings were presented in tables and summarised narratively.

Results

Out of 6194 records identified, 104 studies were screened, with only two studies meeting the inclusion criteria. Both studies were conducted in the USA. The KIND (Keeping Infants Nourished and Developing) intervention improved preventive care for food-insecure families, increasing lead level test completion rates and well-infant visits, but it did not affect weight-for-length at 9 months. The GWCC (Group Well-Child Care) intervention aimed at promoting responsive feeding amongst low-income caregivers but showed no significant impact on infant growth in the first year. However, caregiver interviews revealed important feeding-related themes.

Conclusion

Evidence on interventions addressing infant food insecurity is limited, with none found in the UK. The KIND and GWCC interventions showed mixed outcomes, improving some aspects of care but not significantly affecting infant growth metrics. These findings highlight the need for further research to develop more effective strategies to address the nutritional needs of vulnerable infants in high-income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41110-025-00343-5.

Association between muscular strength, abdominal obesity, and incident nonalcoholic fatty liver disease in a Korean population

This study aimed to examine the association between relative handgrip strength (rHGS) and nonalcoholic fatty liver disease (NAFLD) incidence, considering abdominal obesity (ABO) status. This nationwide Korean cohort included 24,297 participants without NAFLD at baseline. Participants were categorized into sex-specific tertiles of rHGS (low, mid, and high). Multivariate Cox proportional hazards regression models were used to evaluate NAFLD incidence in relation to rHGS levels and/or ABO status. Over 100,381 person-years of follow-up, 1,735 participants (10.81% men and 6.01% women) developed NAFLD. High rHGS was associated with a 29% and 60% risk reduction for incident NAFLD in men and women, respectively, compared with low rHGS, despite men having significantly higher rHGS than women. Conversely, ABO increased NAFLD risk by 2.3 and 3.8 times in men and women, respectively. Even among women with ABO, mid and high rHGS were associated with a 23% and 36% risk reduction in incident NAFLD, respectively, compared with low rHGS. However, there was no significant relationship between rHGS levels and NAFLD incidence in men with ABO. Higher rHGS levels may prevent NAFLD, particularly in women. In individuals with ABO, high rHGS markedly decreased NAFLD risk in women but not in men.

Efficacy of rice bran extract for alleviating depressive symptoms in adults: A randomized, double-blind, placebo-controlled trial

BACKGROUND

Preclinical research indicates the potential benefit of rice bran extract supplements (RBS) in improving depressive-like behaviors and symptoms.

OBJECTIVE

We aimed to evaluate the efficacy and safety of an 8-week administration of RBS in alleviating depressive symptoms among adults with mild-to-moderate symptom severity.

METHODS

This randomized, double-blind, placebo-controlled trial included 100 adults (aged 19-75 years) with scores of 7-24 on the Korean version of the Hamilton Depression Rating Scale (K-HDRS). Participants were randomly assigned to receive 1 g/day of RBS or a placebo for 8 weeks. Evaluations at baseline and after 8 weeks included mood assessments using K-HDRS, the Korean version of the Beck Depression Inventory-II (K-BDI-II), the Patient Health Questionnaire-9 (K-PHQ-9), the Beck Anxiety Inventory (K-BAI), and other psychological scales. Biomarker measurements included serum brain-derived neurotrophic factor, serotonin, dopamine, and salivary cortisol.

RESULTS

In the RBS and placebo groups, 47 and 50 participants, respectively, completed the intervention. At 8 weeks, the RBS group exhibited greater reductions in K-HDRS scores compared to the placebo group (P<0.001), with adjusted differences of -5.73 (95% confidence interval [CI]: -7.07, -4.39; intention-to treat analysis [ITT]) and -5.95 (95% CI: -7.33, -4.57, per-protocol analysis [PP]), corresponding to percent changes of -45.1% (ITT) and -46.0% (PP), respectively. A trend toward greater reductions in the percent changes of K-BDI-II and K-BAI scores was observed in the RBS group compared to the placebo group (ITT and PP). Notably, K-PHQ-9 scores were lower in the RBS group than in the placebo group (P=0.026, PP) after 8 weeks of treatment. However, no significant intergroup differences were identified in other questionnaire scores or biomarker measurements. No adverse events were reported.

CONCLUSION

RBS may provide a beneficial effect on depressive symptoms of mild-to-moderate severity in adults. This trial was registered at clinicaltrials.gov as NCT05180136. https://clinicaltrials.gov/study/NCT05180136.

Association between proteinuria changes and colorectal cancer incidence: evidence from a nationwide cohort study

BACKGROUND

The presence of excess proteins in the urine, known as proteinuria, has been linked to various health conditions, including chronic kidney disease and cancer. Emerging evidence suggests an association between proteinuria and colorectal cancer, a leading global cause of cancer-related morbidity and mortality. However, the impact of changes in proteinuria status on colorectal cancer risk remains unclear. Understanding this relationship may identify proteinuria as a modifiable risk factor for colorectal cancer prevention.

METHODS

This retrospective cohort study analyzed data from 3,043,138 adults aged over 19 years who participated in biennial health screenings by the South Korean National Health Insurance Service in 2010 and 2012. Participants were classified into four groups based on changes in proteinuria status: no proteinuria, newly developed proteinuria, recovered proteinuria, and persistent proteinuria. Proteinuria was measured using dipstick urinalysis, and colorectal cancer diagnoses were identified using medical records. Cox proportional hazards models adjusted for age, sex, body mass index, lifestyle behaviors, and other confounders were used to estimate cancer risk.

RESULTS

Over a median follow-up period of 9.19 years, 36,846 participants (1.2%) developed colorectal cancer. After adjusting for multiple confounding factors, including age, sex, lifestyle behaviors, medication use, diabetes, hypertension, dyslipidemia, and chronic kidney disease, the persistent proteinuria group demonstrated a significantly higher risk of colorectal cancer compared with the proteinuria-free group (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.13-1.42). Additionally, greater severity of proteinuria was associated with progressively increased colorectal cancer risk (aHR for overt proteinuria [+ 2 to + 4], 1.17; 95% CI, 1.05-1.29).

CONCLUSIONS

Changes in proteinuria status are significantly associated with colorectal cancer risk. Persistent proteinuria poses the highest risk, while transient proteinuria also elevates risk compared to individuals without proteinuria. Regular monitoring and management of proteinuria could potentially be beneficial in identifying individuals at higher colorectal cancer risk, suggesting its possible role as an indicator for targeted prevention strategies. However, further research, including randomized controlled trials, is necessary to confirm any causal relationship.

Diabetes and Uterine Fibroid Diagnosis in Midlife: Study of Women's Health Across the Nation (SWAN)

CONTEXT

Fibroids are noncancerous uterine tumors potentially associated with cardiovascular risk factors.

OBJECTIVE

We aimed to examine prospectively associations of glucose, insulin, sex hormone-binding globulin (SHBG), and diabetes with incidence of fibroid diagnoses in midlife.

METHODS

Participants in the Study of Women's Health Across the Nation (SWAN) cohort (n = 2570) reported fibroid diagnoses at enrollment (1996-1997) and 13 follow-up visits (1996-2013). At all visits, we measured glucose, insulin, and SHBG in fasting blood samples and calculated homeostatic model assessment for insulin resistance (HOMA-IR). Diabetes was defined using glucose levels, self-reported diabetes, or diabetes medication use. We used discrete-time survival models to estimate hazard ratios (HR) and 95% CI for associations of time-varying biomarkers and diabetes with incident fibroid diagnoses, adjusted for demographics and health care utilization. We also evaluated effect modification by menopausal status.

RESULTS

At baseline, 2.7% of participants (n = 70) were using diabetes medication. Time-varying glucose, insulin, HOMA-IR, and SHBG were not associated with fibroid diagnosis. However, diabetes was associated with a 28% lower incidence of fibroid diagnosis (adjusted HR 0.72, 95% CI 0.44, 1.17), driven by participants using metformin (adjusted HR 0.49, 95% CI 0.21, 1.12), though precision was limited. After stratification by menopausal status, higher HOMA-IR and insulin were associated with greater incidence of fibroid diagnosis during premenopause but not perimenopause, while the inverse association between diabetes and fibroids was strongest during perimenopause.

CONCLUSION

The effect of diabetes and biomarkers on fibroids may vary by menopausal status. Fibroid risk may increase with insulin resistance and decrease with diabetes treatment.

Risk of Hearing Loss in Patients Treated with Exendin-4 Derivatives: A Network Meta-Analysis of Glucagon-like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors

Background/Objectives: Emerging evidence suggests an association between glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter 2 (SGLT2) inhibitors with altered risk of damage in the inner ear system. However, limited research exists on the relationship between these medications and subsequent irreversible hearing loss. We conducted this network meta-analysis (NMA) to evaluate the comparative risk of hearing loss associated with such medications. Methods: In this NMA, we used a confirmatory approach to specifically focus on particular adverse effects of interest (i.e., incidence of hearing loss here) based on the Cochrane recommendation. A Bayesian-based NMA of randomized controlled trials (RCTs) of GLP-1 receptor agonists or SGLT2 inhibitors was conducted. The primary outcome was the hearing loss events. Results: Our NMA of 29 RCTs with 145,895 participants found that only two exendin-4 derivatives-lixisenatide and high-dose efpeglenatide (i.e., 6 mg/week)-showed increased hearing loss events compared to controls. No other GLP-1 receptor agonists or SGLT2 inhibitors demonstrated significantly elevated hearing loss risk. Lixisenatide ranked highest in risk among all investigated regimens. Conclusions: This comprehensive NMA identifies a significant association between exendin-4 derivatives (lixisenatide and efpeglenatide) and potential ototoxicity. Clinicians should carefully consider this potential ototoxicity when prescribing exendin-4 derivatives, particularly in patients with pre-existing hearing loss risk factors.

Systematic Review: Does Exercise Training Influence Ghrelin Levels?

Ghrelin, a gastric-derived peptide, regulates appetite, food intake, and energy homeostasis. Body weight plays a crucial role in modulating circulating ghrelin levels. Since exercise training is one of the most valuable tools for controlling body weight, it is relevant to consider whether exercise can influence total ghrelin secretion. This study aims to perform a systematic review of the effect of acute/chronic exercise on plasma ghrelin levels. An extensive literature search was carried out on various databases, including PubMed, ScienceDirect, and Google Scholar. The search was conducted using English keywords such as acute-exercise, transient-exercise, exercise, chronic-exercise, training, physical-activity, physical-training, exercise training, and total-ghrelin, ghrelin, appetite-related-peptides, gastrointestinal-peptides, gastrointestinal-hormones, and appetite-regulating-hormone. Initially, 2104 studies were identified. After evaluating study quality, data from 61 relevant studies were extracted for inclusion in this review. Most studies indicated that short-term acute aerobic exercise did not affect total ghrelin levels regardless of exercise intensity, characteristics, or growth hormone (GH) secretion. However, long and very-long aerobic/chronic exercise increased total ghrelin levels, mainly in overweight/obese individuals. Acute/chronic exercise may differentially influence total ghrelin secretion. Short-term acute aerobic exercise induces stable plasma ghrelin concentrations, independent of GH secretion. Long-term aerobic training increased its levels mainly in overweight/obese individuals through body composition and oxidative stress reduction. Additionally, total ghrelin secretion is more sensitive to exercise/training duration than exercise/training intensity.

The Enteric Neuronal Circuitry: A Key Ignored Player in Nutrient Sensing Along the Gut-Brain Axis

The role of the gut-to-brain axis in the regulation of nutrient sensing has been studied extensively for decades. Research has mainly centered on vagal afferent and efferent neurotransmission along the gastrointestinal tract, followed by the integration of luminal information in the nodose ganglia and transmission to vagal integral sites in the brain. The physiological and cellular mechanisms of nutrient sensing by enterocytes and enteroendocrine cells have been well established; however, the roles of the enteric nervous system (ENS) remain elusive. Recent advances in targeting specific neuronal subpopulations and imaging techniques unravel the plausible roles of the ENS in nutrient sensing. In this review, we highlight physiological, cellular, and molecular insights that direct toward direct and indirect roles of the ENS in luminal nutrient sensing and vagal neurotransmission along the gut-brain axis and discuss functional maladaptations observed during metabolic insults, as observed during obesity and associated comorbidities, including type 2 diabetes.

GLP-1 receptor agonists in obesity treatment: Effects on cardiometabolic variables and cardiovascular disease

Obesity is associated with an increased cardiovascular risk. Drugs with glucagon-like peptide-1 receptor agonist (arGLP-1) action for overweight/obesity, such as liraglutide, semaglutide, and tirzepatide, have shown improvements in weight and body composition, as well as in parameters related to glucose metabolism, hypertension, dyslipidemia (reduction of triglycerides and increase in HDL cholesterol), and metabolic dysfunction-associated steatotic liver disease. Additionally, semaglutide 2.4mg sc has shown a reduction in cardiovascular mortality, non-fatal myocardial infarction or stroke, and symptoms of heart failure, while tirzepatide has demonstrated a reduction in cardiovascular mortality and heart failure symptoms in patients with obesity and heart failure. The availability of these new drugs with arGLP-1 action represents a paradigm shift in the treatment of obesity, as they achieve greater weight loss and improvements in cardiometabolic comorbidities.

Glucagon-Like Peptide 1 Receptor Agonists and Mental Health: A Systematic Review and Meta-Analysis

Importance

People with obesity and diabetes have poorer psychiatric and cognitive outcomes and lower quality of life (QOL) compared with those without. Glucagon-like peptide 1 receptor agonists (GLP1-RAs) are treatments for diabetes and obesity that may also influence psychiatric outcomes.

Objective

To conduct a meta-analysis of randomized placebo-controlled trials to evaluate psychiatric, cognitive, and QOL outcomes with GLP1-RA treatment.

Data Sources

MEDLINE, Embase, PsycINFO, and CENTRAL databases were searched from inception through June 24, 2024.

Study Selection

Double-blind placebo-controlled trials comparing GLP1-RA to placebo in adults with overweight/obesity and/or diabetes, reporting on psychiatric, cognition, or QOL outcomes, were included.

Data Extraction and Synthesis

Data extraction was performed in parallel by 2 reviewers. Random-effects meta-analysis was performed. Effect size measures were log risk ratios (log[RR]) and standardized mean differences (Hedges g). The quality of studies was appraised using the Cochrane risk-of-bias tool (RoB2). Certainty of evidence was assessed via GRADEpro.

Main Outcomes and Measures

Main outcomes were risk of psychiatric adverse events (serious and nonserious) and change in mental health symptom severity, health-related quality of life, and cognition.

Results

Eighty randomized clinical trials involving 107 860 patients were included in the meta-analysis. The mean (SD) age of participants across studies in the meta-analysis was 60.1 (7.1) years; 43 251 were female (40.1%) and 64 608 male (59.9%). GLP1-RA treatment was not associated with a significant difference in risk of serious psychiatric adverse events (log[RR] = -0.02; 95% CI, -0.20 to 0.17; P = .87) and nonserious psychiatric adverse events (log[RR] = -0.03; 95% CI, -0.21 to 0.16], P = .76), or depressive symptom change (g = 0.02; 95% CI, -0.51 to 0.55; P = .94), compared with placebo. GLP1-RA treatment was associated with improvements in restrained eating (g = 0.35; 95% CI, 0.13 to 0.57; P = .002) and emotional eating behavior (g = 0.32; 95% CI, 0.11 to 0.54; P = .003) and in mental health-related QOL (g = 0.15; 95% CI, 0.07 to 0.22; P < .001), physical health-related QOL (g = 0.20; 95% CI, 0.14 to 0.26; P < .001), diabetes-related QOL (g = 0.23; 95% CI, 0.15 to 0.32; P < .001), and weight-related QOL (g = 0.27; 95% CI, 0.18 to 0.35; P < .001) compared with placebo.

Conclusions and Relevance

In patients with overweight/obesity and/or diabetes , GLP1-RA treatment is not associated with increased risk of psychiatric adverse events or worsening depressive symptoms relative to placebo and is associated with improvements in QOL, restrained eating, and emotional eating behavior. These findings provide reassurance regarding the psychiatric safety profile of GLP1-RAs and suggest that GLP1-RA treatment contributes to both physical and emotional well-being.

The Interplay Between Psychological and Neurobiological Predictors of Weight Regain: A Narrative Review

Introduction: Obesity is a global health problem requiring effective interventions to achieve weight loss and maintain it in the long term. A major challenge for clinicians is weight regain (WR), defined as progressive weight gain following successful weight loss. WR is affected by multiple factors, including psychological traits linked to specific brain alterations. Understanding these mechanisms is crucial in developing strategies to prevent WR and to ensure effective weight control. Objectives: This narrative review aims to gather current findings on the psychological and neurobiological determinants of WR and to discuss the interplay between these factors. Methods: A literature search was conducted on PubMed, Medline, and Web of Science for English-language studies published between December 1990 and November 2024. Results: WR is driven by interconnected psychological and neurobiological factors that influence eating behavior and the regulation of body weight. Certain personality traits and emotional patterns are associated with specific changes in brain activity, which together affect vulnerability to WR. Although distinct mechanisms can be identified, the complexity of homeostatic and nonhomeostatic appetite control suggests that no single factor predominates. Conclusions: This review highlights the dynamic interplay between psychological and neurobiological predictors of WR. However, due to the narrative nature of this review, the focus on selected determinants, and the limited quality and size of the available studies, further research is needed to comprehensively understand causality and to improve relapse prevention strategies.

Interplay of Chronic Kidney Disease and the Effects of Tirzepatide in Patients With Heart Failure, Preserved Ejection Fraction, and Obesity: The SUMMIT Trial

BACKGROUND

Obesity leads to both heart failure with a preserved ejection fraction (HFpEF) and to chronic kidney disease (CKD); CKD may both influence the clinical course of obesity-related HFpEF; and incretin-based drugs may influence renal function.

OBJECTIVES

This analysis had dual objectives: 1) to evaluate the influence of CKD on the clinical responses to tirzepatide in patients with obesity-related HFpEF; and 2) to investigate the complexity of tirzepatide-related changes in renal function. For both objectives, we focused on discrepancies between creatinine-based and cystatin C-based estimates of the estimated glomerular filtration rate (eGFR).

METHODS

The SUMMIT trial randomly assigned 731 patients with HFpEF and a body mass index ≥30 kg/m2, who were enriched for participants with CKD. Patients received either placebo or tirzepatide for a median of 104 weeks and were followed for cardiovascular death or worsening heart failure events and for changes in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) after 52 weeks. Because of the confounding produced by obesity and changes in muscle mass, eGFR was assessed at randomization and after 12, 24, and 52 weeks by both creatinine-based and cystatin C-based formulae.

RESULTS

Patients with CKD (based on creatinine or cystatin C) had greater severity of heart failure, as reflected by: 1) worse functional class, KCCQ-CSS scores, and 6-minute walk distance; 2) higher levels of NT-proBNP and cardiac troponin T; and 3) a 2-fold increase in the risk of worsening heart failure events. CKD did not influence the effect of tirzepatide to reduce the relative risk of major adverse heart failure events and to improve KCCQ-CSS, quality of life, and functional capacity, but the absolute risk reduction in the primary events was numerically greater in patients with CKD. Regarding renal function assessments, baseline eGFR-cystatin C was consistently ≈9 mL/min/1.73 m2 lower than that eGFR-creatinine, with significant individual variance. Furthermore, tirzepatide increased eGFR at 52 weeks, assessed by both creatinine-based and cystatin C-based formulae, but with considerable discordance in individual patients. Tirzepatide produced a decline in eGFR at 12 weeks with eGFR-creatinine (but not eGFR-cystatin C), and it led to an improvement in eGFR at 52 weeks in all patients (when assessed by cystatin C), but only in patients with CKD (when assessed by eGFR-creatinine).

CONCLUSIONS

The triad of obesity, HFpEF, and CKD identifies patients with considerable functional impairment and an unfavorable prognosis, who nevertheless respond favorably to tirzepatide. Long-term tirzepatide improves renal function (both by cystatin C and creatinine), but the measurement of eGFR in patients with obesity receiving incretin-based drugs is likely to be skewed by the effects of fat and muscle mass (and by changes in body composition) on the synthesis of both cystatin C and creatinine. (A Study of Tirzepatide [LY3298176] in Participants With Heart Failure With Preserved Ejection Fraction [HFpEF] and Obesity: The SUMMIT Trial; NCT04847557).

Protective Effects of a Standardized Water Extract from the Stem of Ipomoea batatas L. Against High-Fat Diet-Induced Obesity

Background/Objectives: Obesity is a major health concern that can lead to various chronic diseases. Little is known about the anti-obesity effect of a standardized hot water extract from the stems of Ipomoea batatas (WIB). This study aimed to evaluate the therapeutic potential of WIB as a natural alternative to conventional anti-obesity treatments by assessing its effects on body weight, fat accumulation, and key metabolic biomarkers in a high-fat diet-induced obesity model. Methods: A high-fat diet (HFD) induced obesity in C57BL/6 mice. The mice were then treated orally with either orlistat (positive control) or WIB. Changes in body weight, food intake, and fat weight were measured, along with blood lipid profiles and adipokines. Western blot analyses were conducted to determine protein levels in each tissue. H&E staining in white adipose tissue and liver, and the gut microbiota composition were analyzed. Results: WIB treatment significantly reduced body weight and fat mass compared to the HFD group and demonstrated comparable effects to orlistat. WIB improved blood lipid profiles and adipokine levels. H&E staining revealed reduced fat accumulation in the white adipose tissue and liver. Also in those tissues, WIB restored expression levels of sterol regulatory element-binding protein-1 (SREBP-1) and CCAAT/enhancer-binding protein α (C/EBPα) and increased AMP-activated protein kinase (AMPK) phosphorylation. In brown adipose tissue, WIB enhanced AMPK phosphorylation and upregulated thermogenic-related proteins, including peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α), peroxisome proliferator-activated receptor α (PPARα), sirtuin 1 (SIRT1), uncoupling protein-1 (UCP-1), and cytochrome C oxidase subunit 4 (COX-IV). Analysis of gut microbiota revealed that WIB normalized β-diversity and reversed HFD-induced phyla imbalances (notably in Bacteroidetes, Firmicutes, and Proteobacteria). Conclusions: By reducing adiposity under the conditions tested in a murine model, improving metabolic markers, and favorably modulating gut microbiota, WIB demonstrates potential in mitigating obesity-related risks. These findings suggest that WIB may serve as a promising natural substance for the management of obesity. Further studies are warranted to confirm its efficacy and explore the potential underlying mechanisms in overweight or obese humans as a health supplement to help manage or prevent obesity.

The Role of the Reflective Thinking Scale for International Students in China Through Factor Analysis

Reflective thinking is crucial for academic success, personal development, and cultural adaptation. Therefore, this study aimed to analyze the role of the Reflective Thinking Scale (RTS) for international students in Chinese universities. Data were collected from 482 international students in Northwestern China. Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), Reliability, and Correlation Analysis were employed to validate the RTS. The qualitative phase used semi-structured interviews and reflective journals. The results revealed a four-factor structure for the RTS: habitual action, understanding, reflection, and critical reflection. The scale showed strong reliability (Cronbach's α = 0.77) with significant positive correlations between reflective thinking and academic performance. The qualitative phase drew on 26 interviews and 22 reflective journals, analyzed thematically. Six themes emerged, highlighting reflection's role in academic regulation, language acquisition, cultural adaptation, emotional processing, and personal identity development. The findings confirm the cross-cultural validity of the RTS and underscore the importance of scaffolded reflective practices in international education. This study also extends theoretical links between reflective thinking, transformative learning, cognitive flexibility, and self-regulated learning. Implications are offered for educators, curriculum designers, and researchers seeking to enhance reflective learning environments for diverse student populations.

Nighttime sleep duration and the prevalence of hyperuricemia: a systematic review and network meta-analysis

Objective

According to clinical observation and recent studies, there is a significant association between night sleep duration and hyperuricemia. In this study, systematic review and network meta-analysis were performed to evaluate the risk of hyperuricemia associated with different nighttime sleep durations.

Methods

Seven databases were searched from database inception to March 2020. Two reviewers independently performed study selection, quality appraisal, and data extraction. Conventional meta-analysis was conducted using either a fixed-effects or random-effects model according to statistical heterogeneity. A Bayesian network meta-analysis was conducted using the consistency model.

Results

Six studies with 416,684 patients and involving different nighttime sleep durations were included. The network meta-analysis showed that compared with normal nighttime sleep duration, the pooled risk ratio (RR) for short nighttime sleep duration was 1.26 (95% confidence interval [CI] 1.22-1.30, p < 0.00001). Compared with long nighttime sleep duration, pooled RR of HUA with normal nighttime sleep duration was 0.81 (95% CI 0.67-0.99, p = 0.03). Compared with long nighttime sleep duration, pooled RR of HUA with short nighttime sleep duration was 1.07 (95% CI 0.90-1.28, p = 0.43).

Conclusion

The evidence in this network meta-analysis illustrates that both short and long sleep duration increased the risk of hyperuricemia, and short sleep duration was more harmful. Further high-quality studies are required to explore the Mechanism of the nighttime sleep duration influencing hyperuricemia.

Systematic review registration

https://www.crd.york.ac.uk/, CRD42024519628.

Understanding the gap: a balanced multi-perspective approach to defining essential digital health competencies for medical graduates

BACKGROUND

Rapid technological advancements have left medical graduates potentially underprepared for the digital healthcare environment. Despite the importance of digital health education, consensus on essential primary medical degree content is lacking. Focusing on core competence domains can address critical skills while minimising additions to an already demanding curriculum. This study identifies the minimum essential digital health competency domains from the perspectives of learners, teachers, and content experts aiming to provide a framework for integrating digital health education into medical curricula.

METHODS

We conducted focus groups with students (n = 17), and semi-structured interviews with medical educators (n = 12) and digital sector experts (n = 11) using video conferencing. Participants were recruited using purposive sampling. The data were analysed using framework analysis and inductive thematic analysis to identify common themes.

RESULTS

Four core themes and eleven sub-themes were identified and aggregated into four essential competency domains: "Understand the Local Digital Health Ecosystem and Landscape", "Safe, Secure and Ethical Information Literacy and Management", "Proficiency in Digital Health Tools and Associated Technologies" and "Scholarly Research and Evidence-based Practice". Medical educator and digital sector expert participants provided the greatest source of data for curriculum content consideration. Students demonstrated varying levels of aptitude, confidence, and interest in technology.

CONCLUSION

Our balanced engagement with learners, educators, and digital health experts enabled the identification of a context-relevant framework for the minimum essential digital health competence domains for graduating medical students. The identification of focused, clinically relevant core competencies makes them amenable to integration into an existing curriculum tailored to local contexts. This approach addresses limitations of restricted curricular space and accommodates varying student interests, confidence and aptitude in technology. The delivery approach should consider a student-centred adaptive modality that takes advantage of advances in artificial intelligence (AI) as an effective pedagogical tool.

Differences in Expert Perspectives on AI Training in Medical Education: Secondary Analysis of a Multinational Delphi Study

Unlabelled

In this secondary analysis of a multinational Delphi study, experts from low- and middle-income countries were less likely than those from high-income countries to consider artificial intelligence (AI) learning outcomes mandatory in preregistration medical education, potentially reflecting underlying global inequalities in medical AI education and highlighting the need for adaptable AI competency frameworks.

Association between resolved hepatitis B virus infection and depression in American adults : a cross-sectional study

Hepatitis B virus (HBV) infection is a global health concern, and it can potentially affect mental health like depression. Resolved HBV infection, often perceived as a milder form of HBV infection, are often overlooked, and the association between it and depression remains unclear. This study aims to investigate the association between resolved HBV infection and depression. A cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, including 20,655 adult Americans. Resolved HBV infection was defined as HBV surface antigen (HBsAg) negative and HBV core antibody (HBcAb) positive. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) score. Propensity score matching (PSM) was performed to balance baseline characteristics. Algorithms such as inverse probability of treatment weighting (IPTW) were also applied. Among the participants, 1,551 (7.5%) were reported to have resolved HBV infection. Depression was reported by 1,796 participants (8.7%), with a higher prevalence among those with resolved HBV infection (10.6%) compared to those without HBV infection(8.5%). PSM and IPTW revealed a significantly positive association between resolved HBV infection and depression (PSM: OR = 1.40, 95%CI 1.09-1.79, p = 0.008; IPTW: OR = 1.48, 95%CI 1.26-1.74, p < 0.001). Subgroup and sensitivity analyses supported the robustness of the findings. The results suggest a complex relationship between resolved chronic viral infections and mental health. Based on this finding, it is advisable to conduct psychological monitoring and offer support to individuals who have achieved a functional cure for HBV. Further prospective studies are still needed to reveal the potential mechanism.

Arterial stiffness, high fasting glucose, and fatty liver as risk factors for visceral obesity in middle-aged Chinese individuals: a cross-sectional study

The prevalence of obesity is increasing rapidly worldwide, particularly in Asia. Visceral obesity, characterized by intra-abdominal fat accumulation, is a precursor to metabolic syndrome, encompassing hyperglycemia, dyslipidemia, and hypertension, which elevate the risk of atherosclerosis and cardiovascular disease. A visceral fat area (VFA) of ≥100 cm2 is a recognized threshold for diagnosing obesity-related metabolic syndrome. This study aimed to identify independent risk factors for VFA ≥100 cm2 in middle-aged Chinese individuals from the general population. We analyzed data from 148 participants (mean age: 49.3 ± 10.8 years; 54% male) who underwent health check-ups. VFA and subcutaneous fat area were assessed using computed tomography, while arterial stiffness and fatty liver were evaluated via brachial-ankle pulse wave velocity (baPWV) and abdominal ultrasonography, respectively. Between-group comparisons (VFA ≥100 cm2 vs. VFA <100 cm2) were conducted using unpaired t-tests and Mann-Whitney U tests, and logistic regression analysis identified risk factors. Multivariable regression analysis revealed that baPWV ≥1,400 cm/s (odds ratio [OR] = 5.71, p = 0.011), waist circumference ≥85 cm (OR = 5.46, p = 0.026), fasting blood glucose (FBG) ≥100 mg/dL (OR = 5.69, p = 0.030), male sex (OR = 12.79, p = 0.029), and fatty liver (OR = 3.99, p = 0.042) were significant independent risk factors for VFA ≥100 cm2. Among these, baPWV ≥1,400 cm/s was the most significant, showing a positive correlation with VFA (r = 0.365, p < 0.001). Visceral obesity (VFA ≥100 cm2) is a critical target for interventions addressing metabolic syndrome, metabolic dysfunction-associated fatty liver disease (MAFLD), and cardiovascular disease, particularly in males.

Safety assessment of multiple systemic administration of human mesenchymal stem cell-conditioned medium for various chronic diseases

Conditioned medium (CM) derived from human mesenchymal stem cells (MSCs) has shown potential as a therapeutic agent. However, the safety of its administration in human remains largely unexplored. This study evaluated the safety of multiple systemic administrations of MSC-CM, specifically adipose-derived and umbilical cord-derived MSC-CM, in 55 patients with various chronic diseases. Symptom assessments and blood tests were conducted before and after administration to monitor adverse events and measure the inflammatory marker C-reactive protein (CRP), respectively. The results demonstrated no serious adverse events attributed to MSC-CM administration. Although minor adverse events were observed, their causal relationship with MSC-CM remained unclear. Additionally, MSC-CM administration slightly reduced CRP levels, regardless of the administration route (intraarterial, intravenous, or inhalation). Additionally, a significant reduction in CRP levels was observed in patients with elevated CRP levels (CRP > 0.3) following MSC-CM administration. These findings suggest that repeated systemic administration of MSC-CM is likely safe and may have anti-inflammatory effects.

Anti-Hyperuricemic and Nephroprotective Effects of Hydrolysate Derived from Silkworm Pupae (Bombyx mori): In Vitro and In Vivo Study

BACKGROUND

Hyperuricemia is a prevalent metabolic disorder characterized by elevated serum uric acid (UA) levels.

METHODS

In this study, hydrolysate (SPP) derived from silkworm pupae protein was isolated and identified, demonstrating anti-hyperuricemic activity. The research aimed to investigate its anti-hyperuricemic and nephroprotective effects, along with potential mechanisms, through in vitro assays and in vivo experiments using potassium oxonate/hypoxanthine-induced hyperuricemic mice.

RESULTS

The SPP exhibited significant xanthine oxidase (XOD) inhibitory activity, with an IC50 value of 7.41 mg/mL. Furthermore, SPP administration effectively reduced serum UA, blood urea nitrogen (BUN), creatinine levels, and renal pro-inflammatory cytokines in hyperuricemic mice. Mechanistic studies revealed that the anti-hyperuricemic effects of SPP may involve XOD inhibition and the modulation of renal UA transporters, specifically upregulating organic anion transporter 1 (OAT1) and ATP-binding cassette subfamily G member 2 (ABCG2) expression. Histopathological analysis and inflammatory cytokine profiling further demonstrated that SPP alleviated renal inflammation and pathological damage.

CONCLUSIONS

These findings suggest that SPP possesses a notable urate-lowering efficacy and renal protective properties, highlighting its potential as a therapeutic agent for the management and prevention of hyperuricemia (HUA).

Glucagon-like peptide 1 (GLP-1) receptor agonists' use during pregnancy: Safety data from regulatory clinical trials

AIMS

The prevalence of diabetes and obesity continues to rise in women of reproductive age, with significant implications for both mother and foetus. Glucagon-like peptide-1 receptor agonists are effective treatments of diabetes and obesity. However, no Glucagon-like peptide-1 receptor agonists are currently approved for use during pregnancy. We describe the outcomes of unplanned pregnancies during regulatory clinical trials of Glucagon-like peptide-1 receptor agonists submitted to the Food and Drug Administration and European Medicines Agency.

MATERIALS AND METHODS

A search was conducted of the regulatory documentation published by the European Medicines Agency and the Food and Drug Administration on unplanned pregnancies during regulatory clinical trials of Glucagon-like peptide-1 receptor agonists. Clinical and Medical Reviews published by the Center for Drug Evaluation and Research at the Food and Drug Administration for every Glucagon-like peptide-1 receptor agonist prior to market authorisation were assessed to gather information on unplanned pregnancies that occurred while females were partaking in the clinical development programmes of such drugs.

RESULTS

Evidence in women having planned pregnancies is lacking, and the only evidence thus far relies on pregnancies occurring inadvertently during Glucagon-like peptide-1 receptor agonist trials. The incidence of congenital abnormalities in humans appears relatively low following Glucagon-like peptide-1 receptor agonist use during pregnancy.

CONCLUSIONS

Key knowledge gaps must be addressed before the introduction of the Glucagon-like peptide-1 receptor agonist class of drugs for pregnant women. Currently, Glucagon-like peptide-1 receptor agonists should be stopped as soon as the patient becomes aware of a pregnancy. The establishment of patient registries designed to capture data relating to cases of Glucagon-like peptide-1 receptor agonist exposure during pregnancy is a high priority, and where data already exist, the findings need to be published.

Perioperative Risk Factors of Postoperative Pressure Injuries in Patients after Surgical Hematoma Evacuation of Intracranial Hemorrhage: A Retrospective Cohort Study

OBJECTIVE

To identify the incidence and perioperative risk factors of postoperative pressure injuries (PIs) in patients with intracranial hemorrhage who had surgical evacuation of hematoma.

METHODS

This retrospective cohort study was conducted at a tertiary care university hospital. Researchers collected medical record data from April 2010 to March 2020 and conducted backward selection in multiple logistic regression.

RESULTS

Of the 386 patients identified, 103 (26.7%) developed postoperative PIs. The most common site of PI was the coccyx (n = 56; 38.9%). More than half of the patients had stage 2 PIs, and 43 (41.7%) developed PIs 14 or more days after surgery. Three variables were associated with an increased risk of postoperative PI: older age (P = .025), receiving a packed red blood cell transfusion while in the ICU (P = .004), and staying in the ICU for more than 7 days (P < .001).

CONCLUSIONS

The present findings indicate that risk factors for postoperative PIs include older age, requiring a blood transfusion, and longer ICU stays, which may increase nursing workload regardless of surgery type. Future research on postoperative PIs in patients undergoing neurosurgery should consider additional ICU work environment factors, including nurse-to-patient ratio and immobility-related factors such as duration of medical device use. Further, international comparisons of risk factors for postoperative PIs among patients undergoing neurosurgery are needed.

Role of Microneedles for Improved Treatment of Obesity: Progress and Challenges

Obesity is a global metabolic health epidemic characterized by excessive lipid and fat accumulation, leading to severe conditions such as diabetes, cancer, and cardiovascular disease. Immediate attention and management of obesity-related health risks are most warranted. The imbalance between fat absorption, metabolic rate, and environmental and genetic factors is responsible for obesity. Treatment typically involves lifestyle modifications, pharmacotherapy, and surgery. While lifestyle changes are crucial, effective treatment often necessitates medication as a preferred adjunct strategy. However, medications commonly used, such as oral pharmacotherapy, often show side effects due to systemic exposure and, thus, may not effectively target the intended areas, leading to drug loss. On the other hand, transdermal administration of drugs with microneedle (MN)-based technologies, a painless drug delivery approach with patient compliance, is gaining interest as an alternative obesity treatment, as it directly targets adipose tissue via local delivery, minimizing system exposure and dose reduction. This Review addresses the pathophysiology of obesity, current treatment strategies, challenges in the treatment of obesity using conventional formulations, the importance of the use of nano-based medications through transdermal delivery, and the use of MNs as a promising platform for the effective delivery of nanoparticle-based anti-obesity medications. The potential of combining MNs with stimuli-responsive and non-responsive adjuvant therapies to enhance treatment efficacy and patient outcomes is explored. In addition, the limitations and future perspectives related to the use of MNs for obesity are addressed to highlight the transformative potential of this technology for obesity management. MNs hold promise in precisely delivering anti-obesity drugs while requiring lower dosages and minimizing side effects compared to conventional oral or injectable therapies and ultimately improving the quality of life for individuals struggling with obesity and its associated comorbidities.

Regulating Effect of Weekend Catch-up Sleep on Association of Hepatic Steatosis with Atherosclerotic Cardiovascular Disease

Background

Both insufficient and excessive catch-up sleep durations have been implicated in influencing the risk of cardiovascular diseases (CVDs) and metabolic disorders. However, the specific impact of weekend catch-up sleep (WCS) on the relationship between hepatic steatosis (HS) and atherosclerotic cardiovascular disease (ASCVD) remains unclear.

Aims

This cross-sectional study aims to examine the potential regulatory effect of WCS on the association between controlled attenuation parameter (CAP) and ASCVD.

Methods

Weighted logistic regression analyses were employed to evaluate the associations of CAP and WCS with ASCVD, expressed in terms of odds ratios (ORs) and 95% confidence intervals (CIs). The study also explored the effect of WCS on the CAP-ASCVD relationship and assessed the potential regulatory role of WCS in subgroups based on age, gender, body mass index, and obesity status.

Results

Eligible participants were categorized into two groups: those with an ASCVD risk < 7.5% (n = 1536) and those with an ASCVD risk ≥ 7.5% (n = 1612). After adjusting for covariates, CAP ≥ 274 dB/m was associated with a higher likelihood of ASCVD compared to the CAP < 274 dB/m (OR, 1.84, 95% CI, 1.24-2.73). When compared to a WCS duration of 0-1 hour, WCS ≥ 1 hour was found to increase the potential ASCVD risk associated with CAP (OR, 3.29, 95% CI, 1.41-7.68). Furthermore, among individuals with WCS ≥ 1 hour, CAP ≥ 274 dB/m was linked to a higher ASCVD risk than among those with CAP < 274 dB/m (OR, 3.72, 95% CI, 1.99-6.93). Additionally, in subgroups of participants aged ≥ 60 years, females, non-obese and obese individuals, WCS ≥ 1 hour was associated with an increased ASCVD risk related to CAP (all, p < 0.05).

Conclusion

A WCS duration of ≥ 1 hour may be associated with an increased ASCVD risk in adults with HS aged ≥ 40 years. However, further research is necessary to clarify the causal relationships between WCS, HS, and ASCVD.

Relationship between weekend catch-up sleep and the risk of diabetic kidney disease

OBJECTIVE

To investigate the association between weekend catch-up sleep (WCS) and the risk of diabetic kidney disease (DKD). Subjects and.

METHODS

Data from 1,621 adults aged 18 years or older from the National Health and Nutrition Examination Survey 2017-2020 were obtained for this cross-sectional study. WCS was calculated as the mean weekend sleep duration minus the mean weekday sleep duration. The outcomes were DKD, a reduced estimated glomerular filtration rate (eGFR), and proteinuria. The associations between WCS and DKD, the reduced eGFR or proteinuria were evaluated via a weighted multivariate logistic regression model. Subgroup analyses were performed for different sexes and participants with or without hypertension.

RESULTS

A total of 583 diabetic patients had DKD, of whom 198 patients displayed reduced eGFRs and 499 patients had proteinuria. After adjusting for all confounding factors, Group 4 (weekend CUS ≥ 2 and < 3 hours) still had lower odds of DKD [odds ratio (OR) = 0.51, 95% confidence interval (CI): 0.28-0.93] and proteinuria (OR = 0.51, 95% CI: 0.27-0.96). Additionally, subgroup analyses stratified by sex and hypertension consistently revealed connections in female diabetic patients (OR = 0.40, 95% CI: 0.20-0.78 for DKD; OR = 0.47, 95% CI: 0.22-0.97 for proteinuria) and in diabetic patients with hypertension (OR = 0.39, 95% CI: 0.18-0.81 for DKD; OR = 0.38, 95% CI: 0.19-0.77 for proteinuria). However, the fully adjusted model revealed no such association between WCS and a reduced eGFR.

CONCLUSION

WCS was found to decrease the likelihood of developing DKD and proteinuria among American adult patients diagnosed with diabetes, particularly among female patients or those with hypertension.

Effects of Collagen Supplements on Skin Aging: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Collagen supplements are promoted to help aging skin. However, no meta-analysis of randomized controlled trials (RCTs) has examined their effects by funding source and study quality, which may influence outcomes.

METHODS

PubMed, Embase, and Cochrane Library were searched from inception to June 14, 2024.

RESULTS

A total of 23 RCTs with 1474 participants were analyzed. In a meta-analysis of all 23 RCTs, collagen supplements significantly improved skin hydration, elasticity, and wrinkles. However, in the subgroup meta-analysis by funding source, studies not receiving funding from pharmaceutical companies revealed no effect of collagen supplements for improving skin hydration, elasticity, and wrinkles, while those receiving funding from pharmaceutical companies did show significant effects. Similarly, high-quality studies revealed no significant effect in all categories, while low-quality studies revealed a significant improvement in elasticity.

CONCLUSIONS

There is currently no clinical evidence to support the use of collagen supplements to prevent or treat skin aging.

Association of body roundness index with uterine fibroids in women of childbearing age: a cross-sectional analysis of NHANES 1999-2006

BACKGROUND AND AIM

Previous studies have shown an association between obesity and uterine fibroids (UF). Body roundness index (BRI) is an anthropometric measure associated with obesity. However, the association with UF has not been thoroughly elucidated, and further investigation is required to explore the possible link. Our study investigated the possible link between BRI and UF in women aged 20 to 44 years, with a view to providing effective scientific evidence for health management and disease prevention in this population.

METHODS

This cross-sectional study analysis included data from 4043 women of childbearing age from the National Health and Nutrition Examination Survey (NHANES) database 1999-2006.We applied multiple regression analysis to study the association between BRI and UF, subgroup analysis was used to ensure broad applicability and representativeness of conclusions, and finally linear correlation between BRI and UF was explored by smooth curve fitting.

RESULTS

This study involved 4,043 female participants aged 20-44 years, of whom 331 (8.19%) had fibroids. After controlling for all potential confounders, each additional unit of BRI increased the prevalence of UF by 7% (OR = 1.07,95% CI: 1.01,1.12), Sensitivity analysis by dividing BRI into four groups found a 54% increase in the prevalence of UF within the fourth quartile (Q4) of BRI compared with the first quartile (Q1) of BRI (OR = 1.54, 95% CI: 1.08, 2.20).The link between BRI and UF maintained in subgroup analyses. Furthermore, the study showed a linear positive correlation between BRI and the probability of UF prevalence.

CONCLUSIONS

Higher levels of BRI may be linked to a higher prevalence of UF, according to studies conducted on American women of childbearing age. The study's conclusions highlight how important BRI is for managing and preventing UF.

Development of a Predictive Model for Metabolic Syndrome Using Noninvasive Data and its Cardiovascular Disease Risk Assessments: Multicohort Validation Study

BACKGROUND

Metabolic syndrome is a cluster of metabolic abnormalities, including obesity, hypertension, dyslipidemia, and insulin resistance, that significantly increase the risk of cardiovascular disease (CVD) and other chronic conditions. Its global prevalence is rising, particularly in aging and urban populations. Traditional screening methods rely on laboratory tests and specialized assessments, which may not be readily accessible in routine primary care and community settings. Limited resources, time constraints, and inconsistent screening practices hinder early identification and intervention. Developing a noninvasive and scalable predictive model could enhance accessibility and improve early detection.

OBJECTIVE

This study aimed to develop and validate a predictive model for metabolic syndrome using noninvasive body composition data. Additionally, we evaluated the model's ability to predict long-term CVD risk, supporting its application in clinical and public health settings for early intervention and preventive strategies.

METHODS

We developed a machine learning-based predictive model using noninvasive data from two nationally representative cohorts: the Korea National Health and Nutrition Examination Survey (KNHANES) and the Korean Genome and Epidemiology Study. The model was trained using dual-energy x-ray absorptiometry data from KNHANES (2008-2011) and validated internally with bioelectrical impedance analysis data from KNHANES 2022. External validation was conducted using Korean Genome and Epidemiology Study follow-up datasets. Five machine learning algorithms were compared, and the best-performing model was selected based on the area under the receiver operating characteristic curve. Cox proportional hazards regression was used to assess the model's ability to predict long-term CVD risk.

RESULTS

The model demonstrated strong predictive performance across validation cohorts. Area under the receiver operating characteristic curve values for metabolic syndrome prediction ranged from 0.8338 to 0.8447 in internal validation, 0.8066 to 0.8138 in external validation 1, and 0.8039 to 0.8123 in external validation 2. The model's predictions were significantly associated with future cardiovascular risk, with Cox regression analysis indicating that individuals classified as having metabolic syndrome had a 1.51-fold higher risk of developing CVD (hazard ratio 1.51, 95% CI 1.32-1.73; P<.001). The ability to predict long-term CVD risk highlights the potential utility of this model for guiding early interventions.

CONCLUSIONS

This study developed a noninvasive predictive model for metabolic syndrome with strong performance across diverse validation cohorts. By enabling early risk identification without laboratory tests, the model enhances accessibility in primary care and large-scale screenings. Its ability to predict long-term CVD risk supports proactive intervention strategies, potentially reducing the burden of cardiometabolic diseases. Further research should refine the model with additional clinical factors and broader population validation to maximize its clinical impact.

GLP-1 receptor agonists, are we witnessing the emergence of a paradigm shift for neuro-cardio-metabolic disorders?

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as groundbreaking therapeutic agents in managing a spectrum of metabolic disorders, demonstrating remarkable efficacy across multiple organ systems and disease states. These compounds are not only well-established in the treatment of type 2 diabetes (T2D) and obesity-conditions for which they have received widespread approval-but also exhibit promising potential in addressing cardiovascular disease (CVD) and Metabolic dysfunction-associated steatotic liver disease (MASLD). Recent investigations have begun to illuminate the utility of GLP-1RAs in the management of type 1 diabetes (T1D), as well as neurodegenerative disorders such as Alzheimer's and Parkinson's disease and various behavioral disorders. A plethora of clinical trials have consistently validated the capacity of GLP-1RAs to improve glycemic control, promote weight loss, and mitigate cardiovascular risk factors in individuals with T2D and obesity. While their application in T1D remains limited due to safety concerns-particularly regarding the risks of hypoglycemia and hyperglycemic ketoacidosis-emerging data suggest that GLP-1RAs may offer hepatoprotective benefits, potentially reducing liver fat content and decelerating the progression of MASLD. The neuroprotective attributes of GLP-1 RAs have garnered significant interest, with research indicating their potential to alleviate cognitive decline associated with neurodegenerative diseases. Furthermore, preliminary findings highlight the role of GLP-1 RAs in addressing behavioral disorders, emphasizing their extensive therapeutic promise. This comprehensive review synthesizes the current evidence supporting the diverse therapeutic applications of GLP-1RAs, positioning them as "magic drug" therapies for metabolic and neurological disorders. As ongoing research continues to explore innovative applications and combinations of GLP-1RAs, the landscape of disease management in metabolic and neurological contexts is poised for transformative advancements. This review will also critically assess safety considerations and underscore the need for personalized treatment strategies to optimize patient outcomes in these complex and often comorbid conditions.

Semaglutide 2.4 mg in French people living with Class 3 obesity and comorbidities: Baseline characteristics and real-world safety data

AIM

- To describe baseline characteristics and safety data of real-world use of semaglutide 2.4 mg.

METHODS

- Patients with a body mass index (BMI) ≥40 kg/m2 and at least one of the following treated weight-related comorbidities (WRC: hypertension, dyslipidemia, obstructive sleep apnea, cardiovascular disease) were eligible to receive treatment through Temporary Utilization Authorization (TUA: March to June 2022) or Early Access Program (EAP: July 2022 to October 2023). Data were collected according to Health Authorities' requirements. Only descriptive statistics were used.

RESULTS

- Overall, 5,797 (62.8%) treatment requests were sent by sites specialized in obesity management. In total, 478 and 8,568 patients were treated within TUA and EAP cohorts respectively, with mean follow-up durations of 1.2 and 4.5 months, respectively. Mean (SD) BMI was 48.9 (9.7) and 47.0 (7.4) kg/m2, respectively. Age ranged from 18 to 81 years. In the EAP, 57.4%, 26.5%, 12.3% and 3.7% of patients had 1, 2, 3 and 4 WRC. In addition, 15.5% had type 2 diabetes, 18.1% reported depression and 15.4% had osteoarthritis. In the EAP, 247 (2.9%) patients discontinued treatment after a median time of 2.8 months (IQR: 1.2-5.1), mainly due to adverse events (AEs) (47.0%). During TUA, 3 patients discontinued due to AEs. Pancreatitis was reported in 7 cases overall.

CONCLUSION

- The high number of treatment prescriptions in a short period highlights the high unmet medical need. No new safety concerns were identified in this population with severe obesity treated in a real-world setting.

Lower total cholesterol and HDL-C levels are associated with increased risk of Behçet's disease in a prospective nationwide Korean study

This study explores the relationship between Behçet's disease (BD) and serum lipid levels, focusing on a large cohort to understand the correlation between lipid profile variations and BD. Utilizing data from the Korean National Healthcare Insurance Service, it encompasses 9,914,049 individuals who participated in health screenings in 2009. The research identifies patients diagnosed with BD during a follow-up period and analyzes their lipid profiles, categorized into quartiles of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). The study calculates adjusted hazard ratios (aHR) considering age, gender, smoking history, alcohol consumption, exercise habits, income, body mass index, hypertension, and diabetes, to evaluate the impact of lipid concentrations on BD development. Results show a significant increase in BD incidence among those with lower TC and HDL-C levels (aHR for lowest vs. highest TC quartile: 1.57, 95% CI 1.40-1.76, p < 0.0001; aHR for lowest vs. highest HDL-C quartile: 1.66, 95% CI 1.48-1.86, p < 0.0001), while LDL-C and TG levels did not exhibit a statistically significant association with BD risk. Additionally, the risk of BD does not escalate in the low HDL group using lipid-lowering agents (aHR: 1.33, 95% CI 0.93-1.90, p = 0.8496). The study concludes that lower TC and HDL-C levels are associated with an increased risk of developing BD.

Clinical studies on anti-obesity medications in Arab countries

OBJECTIVES

To identify and summarize studies carried out in Arab countries on anti-obesity medications (AOMs), with a focus on the types of medications investigated, study designs, and the efficacy/effectiveness and safety metrics reported.

METHODS

We carried out a comprehensive scoping review of primary studies examining the use of AOMs in adult Arab populations. Five databases (Medline, Embase, Cochrane Library, Index Medicus for the Eastern Mediterranean Region, and e-Marefa) were searched for English-language publications up to October 2024. Data extraction was carried out on study characteristics, participant demographics, interventions, and outcomes related to weight reduction, metabolic parameters, and side effects. The risk of bias (RoB) was assessed using the Newcastle-Ottawa scale for non-randomized studies and a modified RoB tool for randomized controlled trials.

RESULTS

A total of 59 clinical studies published between 2014-2024 were included. The majority (89.8%) were observational in design. Most studies were carried out in Saudi Arabia (40.7%) and the United Arab Emirates (20.3%). Glucagon-like peptide-1 receptor agonists were investigated in 72.9% of the studies, with liraglutide being the most frequently studied agent (54.2%). The most commonly reported efficacy outcomes included changes in total body weight (45.8%), body mass index (39.0%), and the proportion of weight loss (28.8%). Gastrointestinal side effects were reported in 32.2% of patients across studies.

CONCLUSION

Despite the growing body of research on AOMs in Arab countries, most studies remain observational and focus primarily on earlier-generation agents. There is a need for randomized controlled trials to evaluate the efficacy and safety of newer AOMs, such as semaglutide and tirzepatide, within Arab populations to inform culturally and genetically tailored obesity management strategies.