Improving Implementation of NCD Care in Low- and Middle-Income Countries: The Case of Fixed Dose Combinations for Hypertension in Kenya

Health systems in low- and middle-income countries face the challenge of addressing the growing burden of non-communicable diseases (NCDs) with scarce resources to do so. There are cost-effective interventions that can improve management of the most common NCDs, but many remain poorly implemented. One example is fixed dose combinations (FDCs) of medications for hypertension. Included in WHO's Essential Medicines List, FDCs combine two or more blood pressure lowering agents into one pill and can reduce burden on patients and the health system. However, implementation of FDCs globally is poor. We aimed to identify health systems factors affecting implementation of evidence-based interventions for NCDs, and opportunities to address these, using the case study of FDCs in Kenya. We conducted semi-structured interviews with 39 policy-makers and healthcare workers involved in hypertension treatment policy and identified through snowball sampling. Interview data were analyzed thematically, using the Access Framework to categorize themes. Our interviews identified factors operating at the global, national, county, and provider levels. These include lack of global implementation guidance, context specific cost-effectiveness data, or prioritization by procurement agencies and clinical guidelines; perceived high cost; poor data for demand forecasting; insufficient budget for procurement of NCD medications; absence of prescriber training and awareness of clinical guidelines; and habitual prescribing behavior and understaffing limiting capacity for change. We propose specific strategies to address these. The findings of this work can inform efforts to improve implementation of other evidence-based interventions for NCDs in low-income settings.

Machine learning-based analyses of contributing factors for the development of hypertension: a comparative study

OBJECTIVES

Sufficient attention has not been given to machine learning (ML) models using longitudinal data for investigating important predictors of new onset of hypertension. We investigated the predictive ability of several ML models for the development of hypertension.

METHODS

A total of 15 965 Japanese participants (men/women: 9,466/6,499, mean age: 45 years) who received annual health examinations were randomly divided into a training group (70%, n = 11,175) and a test group (30%, n = 4,790). The predictive abilities of 58 candidates including fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, were investigated by statistics analogous to the area under the curve (AUC) in receiver operating characteristic curve analyses using ML models including logistic regression, random forest, naïve Bayes, extreme gradient boosting and artificial neural network.

RESULTS

During a 10-year period (mean period: 6.1 years), 2,132 subjects (19.1%) in the training group and 917 subjects (19.1%) in the test group had new onset of hypertension. Among the 58 parameters, systolic blood pressure, age and FLI were identified as important candidates by random forest feature selection with 10-fold cross-validation. The AUCs of ML models were 0.765-0.825, and discriminatory capacity was significantly improved in the artificial neural network model compared to that in the logistic regression model.

CONCLUSIONS

The development of hypertension can be simply and accurately predicted by each ML model using systolic blood pressure, age and FLI as selected features. By building multiple ML models, more practical prediction might be possible.

A decision rule algorithm for the detection of patients with hypertension using claims data

Objectives

Claims data covers a large population and can be utilized for various epidemiological and economic purposes. However, the diagnosis of prescriptions is not determined in the claims data of many countries. This study aimed to develop a decision rule algorithm using prescriptions to detect patients with hypertension in claims data.

Methods

In this retrospective study, all Iran Health Insurance Organization (IHIO)-insured patients from 24 provinces between 2012 and 2016 were analyzed. A list of available antihypertensive drugs was generated and a literature review and an exploratory analysis were performed for identifying additional usages. An algorithm with 13 decision rules, using variables including prescribed medications, age, sex, and physician specialty, was developed and validated.

Results

Among all the patients in the IHIO database, a total of 4,590,486 received at least one antihypertensive medication, with a total of 79,975,134 prescriptions issued. The algorithm detected that 76.89% of patients had hypertension. Among 20.43% of all prescriptions the algorithm detected as issued for hypertension, mainly were prescribed by general practitioners (55.78%) and hypertension specialists (30.42%). The validity assessment of the algorithm showed a sensitivity of 100.00%, specificity of 48.91%, positive predictive value of 69.68%, negative predictive value of 100.00%, and accuracy of 76.50%.

Conclusion

The algorithm demonstrated good performance in detecting patients with hypertension using claims data. Considering the large-scale and passively aggregated nature of claims data compared to other surveillance surveys, applying the developed algorithm could assist policymakers, insurers, and researchers in formulating strategies to enhance the quality of personalized care.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01519-y.

Genotype frequency analysis of rs2025804 LEPR genetic variant in Iranian population

Objectives

The LEPR gene is a key focus in obesity research, with studies linking its polymorphisms to various diseases like polycystic ovarian syndrome and energy intake disorders. This study aims to investigate the prevalence of the rs2025804 variant within LEPR and its distribution among healthy individuals across diverse ethnic groups in Iran.

Methods

The frequency of the rs2025804 genotype in the LEPR gene was analyzed in 1142 healthy adults representing different ethnicities in Iran. Saliva samples were randomly collected, and genomic DNA was extracted using a standard kit. Genotyping was performed using the Illumina Infinium Global Screening Array-24 BeadChip. Genotype and allele frequencies were calculated using SPSS software version 22, with a 95% confidence level.

Results

Among the 1142 individuals surveyed across 29 provinces, 683 (59.81%) had genotype AA, 408 (35.73%) had genotype AG, and 51 (4.47%) had genotype GG. The allele frequencies for A and G were found to be 1774 (77.67%) and 510 (22.32%), respectively. Our findings show a unique allele distribution compared to other ethnic groups, with genotype AA being the most prevalent (59.81%), followed by AG (35.73%) and GG (4.47%). Allele frequencies are A (77.67%) and G (22.32%).

Conclusions

This study documents the genotype and allele frequencies of rs2025804 in the LEPR gene among healthy Iranians for the first time. Routine LEPR genotyping could potentially serve as a screening tool for obesity-related disorders, given these results. This enhances our understanding of genetic diversity and holds promise for targeted healthcare interventions.

Sex-specific effect of maternal pre-pregnancy BMI on neuropsychiatric development of offspring

BACKGROUND/OBJECTIVE

Children of overweight and obese mothers had an increased risk of neuropsychiatric problems. It remains unclear if the association varies by child sex. This study aimed to identify the associations between maternal pre-pregnancy BMI and child sex-specific neuropsychiatric development outcomes during childhood. We aimed to examine whether maternal pre-pregnancy BMI was related to offspring's neurodevelopment and explore if associations vary by child sex.

METHODS

This was a retrospective cohort study. Overall, 2013 children conceived by assisted reproductive technology (ART) were recruited and divided into four groups categorized by maternal pre-pregnancy BMI. The neuropsychiatric development outcomes were measured using CBCL/4-16 and WISC-IV. Multiple linear regressions were used to evaluate the association between maternal BMI and the Questionnaire score of the offspring.

RESULTS

Compared with those who were conceived by normal BMI mothers, girls born to Underweight mothers have less depression (β [95%CI]: -3.98[-6.99, -0.96], P < 0.01), hyperactivity (β [95%CI]: -3.09[-6.08, -0.10)], P < 0.05), and brutality (β [95%CI]: -2.45[-4.75, -0.16], P < 0.05) problems. Among boys, maternal overweight and obese were associated with increased behavioral problems, including schizoid (obese vs normal: β [95%CI]: 7.60[1.21, 13.98], P < 0.05), depression(β [95%CI]: 7.83[2.22, 13.44], P < 0.01), social problems(β [95%CI]: 8.17[1.57, 14.77], P < 0.05), obsessive-compulsive(β [95%CI]: 7.95[0.45, 15.45], P < 0.05), social withdrawal(β [95%CI]: 5.99[1.02, 10.96], P < 0.05), hyperactivity(β [95%CI]: 12.66[8.06, 17.25], P < 0.01), aggressive behavior(β [95%CI]: 13.28[8.31, 18.26], P < 0.01), rule-breaking behavior(β [95%CI]: 9.26[2.86, 15.66], P < 0.01), and total problems(β [95%CI]: 12.14[7.27, 17.00], P < 0.01).

CONCLUSION

Maternal pre-pregnancy overweight and obesity were associated with neurobehavioral problems in boys, while underweight and overweight have protective effects in girls. Future research should examine sex differences and long-term consequences in the offspring born to maternal obesity.

Genome-wide Mendelian randomization mapping the influence of plasma proteome on major depressive disorder

Plasma proteins play critical roles in a series of biological processes and represent a major source of translational biomarkers and drug targets. In this study, we performed Mendelian randomization (MR) to explore potential causal associations of protein quantitative trait loci (pQTL, n = 54,219) with major depressive disorder (MDD) using summary statistics from the PGC (n = 143,265) and further replicated in FinnGen cohort (n = 406,986). Subsequently, gene expression quantitative trait loci (eQTL) of identified proteins were leveraged to validate the primary findings in both PGC and FinnGen cohorts. We implemented reverse causality detection using bidirectional MR analysis, Steiger test, Bayesian co-localization and phenotype scanning to further strengthen the MR findings. In primary analyses, MR analysis revealed 2 plasma protein significantly associated with MDD risk at Bonferroni correction (P < 3.720 × 10-5), including butyrophilin subfamily 2 member A1 (BTN2A1, OR = 0.860; 95 % CI, 0.825-0.895; P = 1.79 × 10-5) and butyrophilin subfamily 3 member A2 (BTN3A2, OR = 1.071; 95 % CI, 1.056-1.086; P = 3.89 × 10-6). Both the identified proteins had no reverse causality. Bayesian co-localization indicated that BTN2A1 (coloc.abf-PPH4 = 0.620) and BTN3A2 (coloc.abf-PPH4 = 0.872) exhibited a shared variant with MDD, a finding that was subsequently validated by HEIDI test. In the replication stage, BTN2A1 and BTN3A2 were successfully validated in the FinnGen cohort. This study genetically determined BTN2A1 and BTN3A2 were associated with MDD and these findings may have clinical implications for MDD prevention.

The associations of body composition, fitness, and physical activity with balance in children: The Arkansas Active Kids study

BACKGROUND

Balance plays an important role in children's motor development. However, the factors that are associated with balance in children are not yet fully understood.

RESEARCH QUESTION

We aimed to investigate the association of body composition, physical fitness, and daily physical activity on balance in children.

METHODS

The sample was composed of 219 children (53 % females), aged 9.0 (IQR = 2.2) years with a body mass index (BMI)-percentile of 74.9 (IQR = 48.7). Balance was evaluated through a force platform in the upright bipedal stance under different sensory conditions. Anthropometry, body composition (dual-energy x-ray absorptiometry), knee maximal strength (isokinetic dynamometer), aerobic capacity (indirect calorimetry), and daily physical activity (accelerometry and questionnaires) were also assessed.

RESULTS

Higher levels of body mass, waist circumference, and fat mass were associated with worse balance, whereas greater knee extension strength and peak oxygen uptake were linked to enhanced balance. Among those, fat mass percentage and waist circumference were the most important factors associated with balance performance. Moreover, it was observed that the associations between the identified anthropometric and body composition measures with balance could be counteracted by physical fitness and physical activity levels.

SIGNIFICANCE

Our findings revealed that anthropometric measures, body composition, and physical fitness levels are associated with children's balance. Furthermore, physical fitness and physical activity may be especially relevant, as they could help mitigate the detrimental effect of excess fat mass on postural control.

Dietary indices to measure diet quality in older cancer survivors: A scoping review on tools, their components and association with health outcomes

BACKGROUND

Older cancer survivors live with more comorbidities and have a higher mortality rate compared to the general older population. A high-quality diet that adheres to evidence based dietary recommendations and guidelines may help mitigate these issues. This can be assessed using dietary quality indices (DQIs), which objectively summarize scores for selected dietary components.

OBJECTIVE

Identify the DQIs available in the literature for older cancer survivors, and their associations with health outcomes.

METHOD

Five databases were searched to identify peer-reviewed articles in English, from inception to 12th November 2024. Two researchers independently screened 3,145 studies, extracted and qualitatively assessed data from 28 included reports from 16 studies.

RESULTS

12 DQIs and 40 unique components within these indices were identified and summarised narratively. Total vegetables (n = 8), total fruits (n = 8), whole grains (n = 6), saturated fat (n = 8), and salt/sodium (n = 8) were the most frequently incorporated components within a DQI. All DQIs were derived from evidence-based dietary guidelines. Only three DQIs were specifically designed for oncology population. Higher diet quality was associated with higher HR-QoL in breast, prostate, and colorectal cancer survivors in all but one study. The associations between mortality and diet quality were inconsistent, depending on the type of cancer and the mortality type i.e., cancer-specific or other causes.

CONCLUSIONS

DQIs are associated with important health outcomes. A major knowledge gap exists in DQIs suitable for older cancer survivors. Future research should develop DQIs to better assess how high-quality diets enhance health outcomes in older cancer survivors.

Design, synthesis, and biological evaluation of novel quinoline carboxylic acid based styryl/alkyne hybrid molecule as a potent anti-adipogenic and antidyslipidemic agent via activation of Wnt/β-catenin pathway

Obesity has emerged as the root cause for various metabolic disorders worldwide and hence demands for urgent attention. In the same stride, a series of quinoline carboxylic acid-based styryl/alkyne hybrids were designed, synthesized, and evaluated for their anti-adipogenic activity. Based on the structure-activity relationship, functional groups and essential substituents to potentiate the anti-adipogenic activity were identified. The potent compound (E)-6-fluoro-2-(4-(4-methylstyryl)phenyl)quinoline-4-carboxylic acid (5m) suppresses the adipogenesis with IC50 value of 0.330 μM. In vitro studies in 3T3-L1 preadipocytes cell line show that compound 5m prevents adipogenesis by stopping the cell cycle at the early phase of differentiation, which is caused by stimulation of the Wnt3a/β-catenin pathway. Further compound 5m improves the blood lipid profile and reduces adipogenic marker proteins in the epididymal white adipose tissue (eWAT) of dyslipidemic hamster at 100 mg/kg/day oral dose. Treatment with compound 5m reduces the hypertrophied adipose tissue along with the decrease in the levels of adipogenic marker proteins such as PPARγ and CEBPα. The pharmacokinetic result establishes the molecule 5m to be stable with significant oral bioavailability. Henceforth, the present study provides a unique insight into the anti-adipogenic/anti-dyslipidemic properties of a novel styryl-quinoline carboxylic acid scaffold with a scope to enhance the anti-adipogenic potency for therapeutic intervention of obesity.

Metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes and the glucagon-like peptide-1 mechanism

Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus (T2DM), focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1. This surgical procedure alters the direction of nutrient flow, activates distal ileal L cells, and increases endogenous glucagon-like peptide-1 levels, supporting glucose homeostasis, enhancing insulin sensitivity, regulating body weight, and improving cardiovascular health. This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ, providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders. Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery, integrating hormone level measurements, metabolic marker analysis, and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management. Multidisciplinary collaboration involving support from endocrinology, nutrition, and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM. This collaboration optimizes surgical outcomes and enhances metabolic management. Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM, providing an additional intervention option for patients with T2DM and metabolic disorders.

The role of 15 mA and 77.5 Hz transcranial alternating current stimulation in blood pressure regulation: A post hoc analysis of a randomized controlled trial

BACKGROUND

Transcranial alternating current stimulation (tACS) at 77.5 Hz and 15 mA, targeting the forehead and mastoid areas, has proven efficacious in patients with major depressive disorder (MDD) by simultaneously stimulating multiple brain nuclei and regions, many of which are critical for blood pressure regulation. This post hoc analysis aimed to assess the potential blood pressure-lowering effects of 77.5 Hz, 15 mA tACS in first-episode drug-naive MDD patients with normotension.

METHODS

Data from a previous randomized controlled trial (RCT) involving first-episode drug-naive MDD patients were analyzed. Participants underwent 20 sessions of either active tACS or sham stimulation. Vital signs, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), were measured at baseline, after treatment (Week 4), and at follow-up (Week 8). Multivariate linear regression and Generalized Estimating Equations (GEE) models were used to evaluate the effects of the treatment on blood pressure.

RESULTS

Totally 68 participants were analysis (33 in the sham group and 35 in the active group). By Week 4, the active tACS group exhibited a significant reduction in both SBP and DBP compared to the sham group (coefficient - 2.04, 95 % CI -3.01 to -1.07, p < 0.001 on SBP, and coefficient - 1.92, 95 % CI -2.69 to -1.18, p < 0.001 on DBP).

CONCLUSIONS

tACS at 77.5 Hz and 15 mA can effectively reduce SBP and DBP in first-episode drug-naive depressive individuals with normotension, with greater reductions observed in those with higher baseline levels.

Validation of the Microlife BP3T01-1B blood pressure monitoring device in adults and adolescents according to the ISO 81060-2:2018 protocol

BACKGROUND

Accurate measurement of blood pressure (BP) is crucial for the diagnosis and ongoing management of hypertension. Only devices that have been validated using an established protocol should be used to measure BP. The aim of this study was to validate the Microlife BP3T01-1B, an automated upper-arm BP measuring device, according to the DIN EN ISO 81060-2:2018-11 (ANSI/AAMI/ISO 81060-2:2018) standard protocol.

METHODS

BP measurements were performed in 85 adults and adolescents (age range: 13-86 years) using the same-arm sequential method of the DIN EN ISO 81060-2:2018-11 protocol, alternating between the test device and a reference mercury sphygmomanometer.

RESULTS

A total of 255 valid comparisons were available for the analysis of criterion 1. The mean ± SD difference between the test device and the reference device values was -2.56 ± 7.53 mmHg for SBP and -3.10 ± 5.65 mmHg for DBP. The mean differences met the pass criterion of less than or equal to ±5 mmHg and the SD values met the pass criterion of ≤8 mmHg. All 85 participants were included in the analysis of criterion 2. The mean ± SD intraindividual difference between the test and reference devices was -2.56 ± 6.15 mmHg for SBP and -3.10 ± 4.85 mmHg for DBP. Both were within the required pass range of SD ≤6.43 mmHg for SBP and SD ≤6.20 mmHg for DBP.

CONCLUSION

The Microlife BP3T01-1B BP monitoring device fulfilled the criteria of the DIN EN ISO 81060-2:2018-11 (ANSI/AAMI/ISO 81060-2:2018) protocol in a general population and can be recommended for the measurement of BP in adults and adolescents.

The importance of thiamine availability in the thermogenic competency of human adipocytes

Brown and beige adipocytes express uncoupling protein 1 (UCP1), which is located in the inner mitochondrial membrane and facilitates the dissipation of excess energy as heat. The activation of thermogenic adipocytes is a potential therapeutic target for treating type 2 diabetes mellitus, obesity, and related co-morbidities. Therefore, identifying novel approaches to stimulate the function of these adipocytes is crucial for advancing therapeutic strategies. Currently, there are limited amount of human adipocyte cell line models available to study the regulatory mechanisms of browning and key players in thermogenesis. The Simpson-Golabi-Behmel syndrome (SGBS) preadipocyte cell line has been proven as a valuable model to investigate human adipocyte biology. In this study, we investigated how excess thiamine (vitamin B1), and the inhibition of thiamine transporters affect the expression of thermogenic markers and functional parameters during adrenergic stimulation in SGBS adipocytes. We found that limiting thiamine availability by pharmacological inhibitors impeded the dibutyryl-cAMP (db-cAMP)-dependent induction of thiamine transporter 1 and 2 (encoded by SLC19A2 and SLC19A3), UCP1, PGC1a, and other browning markers, as well as proton leak respiration which is associated with UCP1-dependent heat generation. Contrarily, excess thiamine enhanced the db-cAMP-dependent induction of thiamine transporters, while UCP1, PGC1a, and other browning markers were upregulated. In addition, abundant amounts of thiamine increased the basal, unstimulated coupled and uncoupled respiration, and the expression of mitochondrial complex subunits. Our study highlights the critical role of excess thiamine in the thermogenic activation of SGBS adipocytes and its potential to enhance thermogenesis.

Tumor-Infiltrating Lymphocytes as Mediators of the Obesity and Papillary Thyroid Carcinoma Lymph Node Metastasis Association: An Observational Retrospective Cohort Study

BACKGROUND

Obesity increases the risk of papillary thyroid carcinoma (PTC) and lymph node metastasis (LNM), possibly via modulation of the tumor immunological microenvironment.

MATERIALS AND METHODS

The STROCSS guideline was followed to conduct a retrospective cohort study. Binary logistic regression analysis with odds ratios (OR) was performed to assess the association between tumor-infiltrating lymphocytes (TILs), obesity, and LNM. Using The Cancer Genome Atlas (TCGA) data, we examined the relationship between immune cell subsets and obesity-regulating molecules in thyroid cancer tissues. The Cox regression risk model was used to analyze the prognosis of thyroid cancer.

RESULTS

After adjusting for confounding factors, our findings revealed that overweight and obesity were associated with a decrease in TIL infiltration (OR 0.876, p = 0.005 and OR 0.795, p = 0.001, respectively). Furthermore, these conditions were observed to be correlated with increased likelihood of LNM (OR 1.134, p = 0.005 and OR 1.307, p < 0.001, respectively). On the contrary, TIL infiltration was inversely associated with LNM (OR 0.868, p < 0.001). When controlling for TIL infiltration as the sole variable, the combination of obesity and TIL infiltration did not independently predict LNM (adjusted OR 1.442, p = 0.113). However, obesity alone was found to elevate the likelihood of LNM (adjusted OR 1.539, p = 0.02). Additionally, adiponectin (a crucial adipokine) was reduced in obesity and demonstrated a negative correlation with the abundance of infiltrated dendritic cells and regulatory T cells, as evidenced by TCGA data analysis. Furthermore, ADIPOR2 expression negatively correlated with LNM and positively associated with unfavorable prognosis in PTC, with a hazard ratio of 0.480 (p = 0.007).

CONCLUSIONS

TIL infiltration may affect obesity-associated PTC LNM. Obesity may affect LNM and result in poor prognosis through ADIPOR2 regulation of antitumor immune cells.

Sex differences in the obesity paradox of body compositions in non-small cell lung cancer

OBJECTIVES

This study investigated the correlation between body mass index (BMI), bioelectrical impedance analysis (BIA)-derived specific body compositions, and the obesity paradox, with a focus on sex differences in non-smallcell lung cancer (NSCLC).

METHODS

This study is a multicenter prospective cohort. Association with survival was determined using Cox proportional hazard regression analysis. The mediating effect of systemic inflammation on the association between body composition and survival rate was determined using mediation analysis.

RESULTS

Fat mass had a strong positive correlation with BMI, but a weak positive correlation with other BIA-derived body compositions. Obese, overweight, and normal weight patients had significantly longer median survival than patients with BMI <18.5 ([23.2 versus 18.5 versus 17.5 versus 15.8] months, P < 0.001). Increased BMI and BIA-derived body composition indicators were associated with decreased all-cause mortality. Multivariable-adjusted analysis demonstrated that BMI, fat mass (FM), fat-free mass, muscle mass, bone mass, protein mass, total body water, extracellular water, and intracellular water were independent protective factors affecting the prognosis of patients with NSCLC. A difference in body compositions performance in the prognostic assessment of the different sexes was observed. Fat-related body compositions exhibited a significant obesity paradox in females compared to in males. Systemic inflammation played a crucial role in the relationship between body compositions and disease prognosis, with a mediating effect on body fat in males (31%) and females (19.7%).

CONCLUSIONS

The obesity paradox exists among patients with NSCLC and is not influenced by specific body compositions. In addition, this paradox is notably more common in female patients.

TRIAL REGISTRATION

Registration number: ChiCTR1800020329.

Evaluation of Aktiia cuffless blood pressure monitor across 24-h, daytime, and night-time measurements versus ambulatory monitoring: a prospective, single-centre observational study

OBJECTIVES

Cuffless blood pressure (BP) monitors represent an innovative approach to BP assessment, overcoming the traditional episodic nature of readings obtained from cuff-based, oscillometric modalities. Nonetheless, the comparison of these cuffless devices against their cuff-based counterparts remain debated.

METHODS

This study evaluated BP readings from a cuffless, continual BP monitor (Aktiia monitor, Neuchâtel, Switzerland) and a standard 24-h ambulatory BP monitor (ABPM; Dyasis 3, Novacor, Paris, France) in 54 patients undergoing a 12-week cardiac rehabilitation program in Neuchâtel, Switzerland. Comparisons encompassed 24-h, daytime (9 a.m.-9 p.m.), and night-time (11 p.m.-7 a.m.) systolic and diastolic BP (SBP, DBP) using a 7-day average from Aktiia overlapping a 1-day average from ABPM. Nocturnal dip analysis was performed with 1-day average from Aktiia coinciding with ABPM measurements.

RESULTS

No significant differences emerged between the Aktiia and ABPM monitors for 24-h and daytime SBP (24-h: 2.6 ± 12.3 [-0.2, 5.4] mmHg, r  = 0.57, P  = 0.06; daytime: 1.2 ± 12.4 [-1.6, 4.0] mmHg, r  = 0.60, P  = 0.38). Night-time SBP showed more evident differences (12.5 ± 14.4 [9.3, 15.8] mmHg, r  = 0.39, P  < 0.001). DBP were within clinical range across 24-h and daytime (24-h: -2.9 ± 7.9 [-4.7, -1.1] mmHg, r  = 0.63, P  = 0.002; daytime: -3.1 ± 8.2 [-5.0, -1.3] mmHg, r  = 0.64, P  = 0.001), and showed significant differences for night-time (4.1 ± 8.5 [2.2, 6.0] mmHg, r  = 0.57, P  < 0.001). The concordance rate with ABPM's nocturnal dip was 79% for 1-day average from Aktiia.

CONCLUSIONS

These results demonstrate that the Aktiia monitor yields BP measurements consistent with an ABPM monitor despite some systematic differences during night-time readings. The Aktiia monitor holds potential for future use in continual BP monitoring.

CLINICAL TRIAL REGISTRATION

NCT04548986. URL: https://clinicaltrials.gov/study/NCT04548986?tab=results.

Bariatric surgery prior to pancreas transplantation: a retrospective matched case-control study

BACKGROUND

The clinical impact of bariatric surgery (BS) prior to pancreas transplantation (PTx) is unclear.

SETTING

University of Minnesota Hospital, Minneapolis, MN.

METHODS

This was a single center retrospective case-controlled study of all patients January 1, 1998 and May 1, 2024 with a history of BS prior to PTx. Patients were matched (1:3) with control patients by recipient age, body mass index (BMI) at PTx, type of transplant, primary versus retransplant, and year of PTx.

RESULTS

Among 1542 transplants, 17 patients had a history of BS prior to PTx, with an overall incidence of 1.1%. Eleven patients underwent roux-en-y gastric bypass, 5 underwent sleeve gastrectomy (SG), and one underwent vertical-banded gastroplasty. Eleven underwent simultaneous pancreas kidney transplant, 5 underwent pancreas transplant alone, and one underwent pancreas after kidney transplant. The median time (interquartile range [IQR]) between BS and PTx was 2.9 yrs (4.6) and ranged from .7 to 20.6 yrs. Compared to the non-BS group, patients in the BS group had similar rates of graft thrombosis (5.9% versus 3.9%, P = .76) and rejection (29.4% versus 29.4%, P > .99). Length of stay following PTx (P = .22), number of 30-day readmissions (P = .24), and number of 1-year readmissions (P = .70) were not different between the two groups. Median death-censored graft survival (9.4 yrs versus median not reached, P = .23) and patient survival (9.4 yrs versus median not reached, P = .18) were similar between the BS and non-BS groups. Finally, six patients underwent BS with the specific intention of reaching the acceptable BMI threshold for PTx. Median BMI was reduced from 37.4 prior to BS to 26.4 at time of PTx. Median time from BS to PTx was 2.4 yrs. At 4 yr follow-up, graft and patient survival was 100%.

CONCLUSIONS

This represents the largest series of patients with BS prior to PTx. Perioperative complications are not increased in patients undergoing PTx with a history of prior BS and long-term outcomes are equivalent. Patients with a prohibitive BMI for PTx eligibility should be considered for BS without concern for detrimental effect on post-transplant outcomes.

Liver lipid metabolism, oxidative stress, and inflammation in glutamine-supplemented ob/ob mice

Glutamine availability may be reduced in chronic diseases, such as type 2 diabetes mellitus (T2DM)-induced by obesity. Herein, the antioxidant, anti-inflammatory and lipid metabolism effects of chronic oral glutamine supplementation in its free and dipeptide form were assessed in ob/ob mice. Adult male C57BL/6J ob/ob mice were supplemented with L-alanyl-L-glutamine (DIP) or free L-glutamine (GLN) in the drinking water for 40 days, whilst C57BL/6J Wild-type lean (WT) and control ob/ob mice (CTRL) received fresh water only. Plasma and tissue (skeletal muscle and liver) glutamine levels, and insulin resistance parameters (e.g., GTT, ITT, insulin) were determined. Oxidative stress (e.g., GSH system, Nrf2 translocation), inflammatory (e.g., NFkB translocation, TNF-α gene expression) and lipid metabolism parameters (e.g., plasma and liver triglyceride levels, SRBP-1, FAS, ACC, and ChRBP gene expression) were also analyzed. CTRL ob/ob mice showed lower glutamine levels in plasma and tissue, as well as increased insulin resistance and fat in the liver. Conversely, chronic DIP supplementation restored glutamine levels in plasma and tissues, improved glucose homeostasis and reduced plasma and liver lipid levels. Also, Nrf2 restoration, reduced NFkB translocation, and lower TNF-α gene expression was observed in the DIP group. Interestingly, chronic free GLN only increased muscle glutamine stores but reduced overall insulin resistance, and attenuated plasma and liver lipid metabolic biomarkers. The results presented herein indicate that restoration of body glutamine levels reduces oxidative stress and inflammation in obese and T2DM ob/ob mice. This effect attenuated hepatic lipid metabolic changes observed in obesity.

The influence of preoperative fat distribution on post-bariatric surgery body mass index and body weight loss

BACKGROUND

The body weight following bariatric surgery is a primary concern for both healthcare professionals and surgical candidates. However, it remains unclear whether variations in preoperative fat distribution influence weight loss outcomes.

OBJECTIVE

The aim of this study was to evaluate the effect of abdominal fat distribution on postoperative weight loss and body mass index (BMI) reduction, and to clarify the role of different fat depots in weight loss outcomes.

METHODS

Preoperative data from patients with overweight or obesity, along with their weight records at 1, 2 and 5 years following surgery, were retrospectively collected. Multiple levels of abdominal fat areas were measured using computerized tomography imaging. Statistical analyses included Pearson's correlation coefficients, multiple linear regressions, ridge regressions, decision tree regressions and paired t tests to evaluate the associations and influences.

RESULTS

A total of 139 patients were initially included. The statistical analysis results indicated that umbilical subcutaneous adipose tissue (SAT) was an independent factor influencing weight and BMI loss at the 1-year follow-up (n = 67, p < 0.01). Furthermore, umbilical SAT demonstrated significant correlations with sustained BMI reduction over the long term.

CONCLUSION

Umbilical SAT is a significant factor in postoperative weight and BMI loss. Patients with greater SAT may experience more substantial weight and BMI reductions following surgery, offering new insights into personalized weight loss strategies and alternative approaches for assisted weight loss.

Near-infrared fluorescence imaging tool with large Stokes shift for sensitively detecting carboxylesterase 2 and monitoring its expression in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) now affects more than one quarter of the global population and becomes a heavy public health burden. However, the underlying mechanism for the pathogenesis of NAFLD is still not clear. Carboxylesterase 2 (CES2), highly abundant in the liver and intestine, plays an important role in endogenous lipid metabolism and lipolysis. So far, the literatures for the role of CES2 in the development of NAFLD are still limited. In this study, we designed and synthesized a near-infrared fluorescent probe (HP-LZ-CES2) which can be specifically recognized and hydrolyzed by CES2, releasing a benzoate residue and a fluorophore (HP-LZ) with good fluorescence signal. With this probe, CES2 levels can be quantitatively measured in vitro and qualitatively visualized in living cells and mice. The probe has the advantages of large Stokes shift, high detection sensitivity and good selectivity. Further, the CES2 expression levels were visually investigated in both high-fat cells as the in vitro model for NAFLD and high-fat diet fed mouse as the in vivo model for NAFLD. The cell imaging experiments indicated a reduction of fluorescence signal in high-fat hepatic cells. The in vivo experiments showed an obvious reduction of fluorescence in the liver of NAFLD mouse model, which is consistent with the hepatic cell experiments. In contrast, an enhancement of fluorescence was observed in the intestine of NAFLD mouse model. As a result, the NAFLD mouse model can be visually distinguished from the normal chow mouse by vision. Therefore, the proposed probe can be an auxiliary tool for the diagnosis of NAFLD and a visual tool for understanding CES2's role in the development of NAFLD.

Actual weight loss trajectories after bariatric surgery compared with the SOPHIA prediction tool: An observational comparison study

AIMS

Estimation of post-bariatric surgery weight loss is important for informed clinical decisions, yet existing predictive models lack accuracy and reliability. We assessed the effectiveness of the validated Stratification of Obesity Phenotypes to Optimize Future Therapy (SOPHIA) bariatric weight trajectory prediction tool in our patient population.

MATERIALS AND METHODS

We conducted a retrospective study of 178 adults who underwent bariatric surgery over a 3-year period. Actual weights at baseline and annually over 5 years of follow-up were compared with predicted weights to calculate mean difference and median absolute deviation (MAD).

RESULTS

The study comprised 157 women (88.2%) and 21 men (11.8%) with mean (standard deviation) age of 46.9 (10.6) years and baseline weight of 138.4 (23.5) kg. The bariatric surgical procedures included 148 (83.1%) gastric bypass, 19 (10.7%) sleeve gastrectomy and 11 (6.2%) gastric band operations. The proportion of patients with actual weights within the prediction interquartile range (IQR) was 50.7%, 43.2% and 38.8% at 12, 24 and 60 months, respectively. The mean difference between actual and predicted weight at 60 months was 0.6 (16.7) kg, p = 0.654 (paired t test). The mean MAD at 60 months was 12.9 (95% CI, 11.3-14.4) kg, indicating moderate predictive utility. The predictive accuracy was highest for gastric bypass. Subgroup analysis revealed greater accuracy in patients without diabetes/pre-diabetes, and in nonsmokers.

CONCLUSIONS

The SOPHIA study tool provides accurate postoperative weight forecasts for some subgroups of patients, but its precision diminishes with time. This study reiterates the necessity for better personalized weight prediction tools to inform bariatric surgery decision-making.

Blood pressure measurement at kiosks in public spaces: systematic review and consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability endorsed by the International Society of Hypertension and the World Hypertension League

Kiosk devices for unsupervised self-measurement of blood pressure (BP) are being used in public spaces and healthcare settings in several countries. This statement by the European Society of Hypertension (ESH) Working Group on BP Monitoring and Cardiovascular Variability provides a review of the published evidence on kiosk BP devices and consensus recommendations for their requirements and clinical use. A systematic literature search identified 54 relevant studies. Kiosk BP measurements appeared to be close to office BP [mean difference systolic 0.2 mmHg (95% confidence intervals -1.3 to 1.8); diastolic -0.4 mmHg (-3.5 to 2.7)], and higher than daytime ambulatory and home BP [mean difference 6.0 mmHg (1.6-10.4)/5.0 (2-8) and 8.1 mmHg (-2.6 to 18.9)/0.2 (-9.6 to 10.0), respectively]. Randomized or observational studies using kiosk BP measurements for hypertension screening or for assessing hypertension control were also included, as well as studies investigating users' and healthcare professionals' opinions, acceptability, and perspectives regarding kiosk BP measurements, and validation studies of kiosk BP devices. These studies had considerable heterogeneity in design, setting, methodology, measurement protocol, and sample size. Thus, at present, the clinical utility of kiosk BP measurements is uncertain. This ESH consensus statement acknowledges the potential of kiosk BP measurement as an emerging method for unsupervised self-measurement in the context of opportunistic screening for hypertension in apparently healthy people and the long-term monitoring of people with diagnosed hypertension. Requirements for the design, validation, function, and use of kiosk BP monitors are provided, together with the pending research questions on their optimal implementation in clinical practice.

MASLD, At-Risk MASH and Increased Liver Stiffness Are Associated With Young Adulthood Obesity Without Residual Risk After Losing Obesity

BACKGROUND

Obesity can result in persistent metabolic changes despite weight loss, which may affect liver health. We aimed to investigate associations between young adulthood obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), at-risk steatohepatitis and increased liver stiffness measurement (LSM) in a general population setting.

METHODS

We studied NHANES 2017-2020 community-dwelling participants aged > 40 years with BMI ≥ 18.5 and no heart failure. Weight at age 25 was obtained through questionnaires and compared to current weight. Assessment included controlled attenuation parameter (CAP) and LSM. Associations between obesity status change with MASLD or at-risk metabolic dysfunction-associated steatohepatitis (MASH) and increased LSM were investigated and adjusted for demographics and metabolic health.

RESULTS

The cohort comprised 4,580 participants (57% stable non-obesity, 33% gained obesity, 2% lost obesity and 8% stable obesity). Compared to stable no-obesity, stable obesity was strongly associated with MASLD (odds ratio [OR]: 5.47, 95% confidence interval [95%CI]: 3.97-7.66) as was gained obesity (OR: 4.68, 95% CI: 3.93-5.59), whereas no increased risk was demonstrated for lost obesity (OR: 1.26, 95% CI: 0.76-2.10). Similar associations for stable obesity and gained obesity with at-risk MASH and LSM ≥ 8 kPa were demonstrated. No residual risk was found for lost obesity (MASH-OR: 1.05 95% CI: 0.36-2.49; LSM ≥ 8 kPa-OR: 0.85, 95% CI: 0.29-1.97). Results were consistent in sensitivity analysis where obesity change was calculated over the past 10 years and weight change was stratified in normal weight/overweight/obesity.

CONCLUSION

Young adulthood obesity is an important risk factor for MASLD, at-risk MASH and increased LSM among the general population aged 40-80 years. Losing obesity resulted in normalisation of odds for MASLD, at-risk MASH and increased LSM. These findings underline the importance of preventing and treating young adulthood obesity to maintain liver health.

Rationale and design for Healthy Hearts in Manufacturing (HHM): A pragmatic single-arm hybrid effectiveness-implementation study for hypertension management and tobacco cessation

Background

Heart disease is the leading cause of mortality in the United States and contributes more than $320 billion annually in health care costs and lost productivity. Manufacturing employment is associated with higher rates of hypertension and smoking. Many large manufacturers provide health services to employees and their family members through worksite health centers (WHCs). Several quality improvement interventions for hypertension and tobacco cessation have shown to be effective in community-based primary care sites. The Healthy Hearts in Manufacturing (HHM) study aims to implement and test these interventions in WHCs.

Methods

Two organizations that operate WHCs at manufacturing sites volunteered to participate in the 58-month HHM research study. The HHM intervention involves monthly coaching to assist WHCs with implementing evidence-based strategies for hypertension management and tobacco cessation advocated by the Million Hearts initiative and the U.S. Preventive Services Task Force. A pragmatic, Type II hybrid effectiveness-implementation study design is used to evaluate HHM. The approach is inspired by the stepped-wedge cluster-randomized trial to assess intervention effectiveness. We will conduct interviews to identify facilitators and barriers to implementation and budget impact analysis to estimate the financial impact of the HMM interventions and the potential healthcare savings to companies and Medicare.

Results

Twelve WHCs were randomly selected to enroll in HHM. The WHCs are in nine states and provide primary care services for employees and family members of four manufacturing companies. Baseline patient smoking rates ranged from 13 % to 59 % across WHCs. The percentage of patients with blood pressure of 140/90 or greater ranged from 7 % to 56 % across WHCs.

Conclusion

This exploratory five-year research study will identify facilitators and barriers to implementing the HHM interventions in WHCs, evaluate the effectiveness of hypertension management and use of tobacco screening and cessation, and provide evidence of HHM's potential cost-effectiveness for employers and Medicare.

Unexpected cardiovascular risks of glucagon-like peptide-1 receptor agonist and aspirin co-administration in individuals with obesity, with and without type 2 diabetes: A propensity score matched cohort study

AIMS

To examine the cardiovascular safety of combining glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with aspirin in individuals with obesity, both with and without type 2 diabetes (T2D).

MATERIALS AND METHODS

This propensity score matched cohort study analysed data from 2 946 579 individuals with obesity, with and without T2D, using the TriNetX US and Global dataset. Participants were categorized into four matched groups: those receiving GLP-1 RA plus aspirin versus those receiving GLP-1 RA alone, for both diabetic and non-diabetic individuals. Cardiovascular outcomes and adverse events were evaluated over 5 years using Cox proportional hazards models.

RESULTS

Individuals with obesity treated with GLP-1 RAs plus aspirin showed significantly higher risks of various cardiovascular events compared to those on GLP-1 RAs alone. In non-diabetic obese individuals, the combination therapy increased risks of hypertensive heart diseases (HR 1.40, 95% CI 1.15-1.60), ischaemic heart disease (HR 2.39, 95% CI 1.92-2.97) and heart failure (HR 1.97, 95% CI 1.54-2.53). Similar patterns were observed in individuals with T2D. Atrial fibrillation and cardiac arrhythmias showed increasing hazard ratios over time. The combination therapy also led to more frequent adverse events, including gastrointestinal bleeding.

CONCLUSIONS

The combination of GLP-1 RAs with aspirin in individuals with obesity, both with and without T2D, was associated with increased cardiovascular risks compared to GLP-1 RA monotherapy. These findings suggest that there may be risks associated with the combined use of these treatments and highlight the need for further research into this possible complication with regard to treatment.

Antitumoral effectiveness and safety of intravenous versus subcutaneous administration of immunomodulatory peptide GK-1 in a murine breast cancer model

INTRODUCTION

GK-1 is a safe and effective molecule with high antimetastatic activity against murine breast and skin cancer. GK-1 treatment enhances cytotoxic response of CD8+ lymphocytes against the tumor and modifies the oxidative stress in the tumor. This study was designed to compare the antitumor efficacy of GK-1 by subcutaneous (SC) versus intravenous (IV) route of administration in the 4T1 mouse mammary carcinoma model and to extend its innocuity in heart and kidney, key tissues for observing damage induced by anticancer drugs and immunotherapy.

MATERIAL AND METHODS

BALB/c female mice were injected orthotopically with 1000 4T1 cells. When palpable primary tumors of about 1 mm3 were detected, GK-1 (5 mg/kg) was administered IV or SC weekly for 21 days. Tumor growth and mouse weight were monitored weekly. The primary tumor weight and volume, the number of lung metastases, and programmed cell death protein 1 (PD-1) expression were recorded after 28 days of starting treatment. Kidney, heart, spleen, serum, and blood samples from naïve mice were obtained to evaluate the safety of GK-1 administration by measuring the degree of damage to these tissues with specific cytotoxic markers.

RESULTS

Subcutaneous or intravenous administration of GK-1 significantly increased the lifespan of mice and significantly reduced the primary tumor weight and volume and the number of lungs macrometastases. GK-1 reduced the expression of PD-1 in tumor-infiltrating lymphocytes in mice regardless of the route of immunization used, which is especially encouraging. No evidence of damage to kidney or heart tissues was detected in the tumor-free mice.

CONCLUSIONS

This study supports that subcutaneous GK-1 administered, has an efficacy non-inferior to intravenous administration, well-tolerated with a similar safety profile and therefore offers a less invasive valid treatment alternative.

Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

BACKGROUND

Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050.

METHODS

Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends.

FINDINGS

Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989-1·01) adult males and 1·11 billion (1·10-1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397-407] individuals), followed by India (180 million [167-194]) and the USA (172 million [169-174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8-160·3) in males and 104·9% (95% UI 100·9-108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39-4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4-269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121-162) by 2050, making it the country with the fourth-largest population with overweight and obesity.

INTERPRETATION

No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

BACKGROUND

Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions.

METHODS

Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5-14 years, typically in school and cared for by child health services) and older adolescents (aged 15-24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990-2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage.

FINDINGS

Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6-96·6) individuals aged 5-14 years and 80·6 million (78·2-83·3) aged 15-24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15-24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5-14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7-17·2) of those aged 5-14 years are forecasted to have obesity by 2050 (186 million [141-221]), compared with 14·2% (11·4-15·7) of those aged 15-24 years (175 million [136-203]). We forecasted that by 2050, there will be more young males (aged 5-14 years) living with obesity (16·5% [13·3-18·3]) than overweight (12·9% [12·2-13·6]); while for females (aged 5-24 years) and older males (aged 15-24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041-50: children and adolescents (males and females aged 5-24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5-14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5-14 years in Australasia; females aged 15-24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15-24 years in high-income North America.

INTERPRETATION

Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis.

FUNDING

Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

Diabetes status, duration, and risk of dementia among ischemic stroke patients

BACKGROUND

The influence of duration of type 2 diabetes mellitus (T2DM) on the likelihood of developing new-onset dementia in post-stroke population is not well understood. Therefore, we aimed to clarify the relationship between the duration of T2DM and the risk of developing dementia in the post-stroke population.

METHODS

Leveraging the Korean National Health Insurance Database, this study included 118,790 individuals with a history of stroke but no previous dementia diagnosis. We classified diabetes status into five categories: normoglycemia, impaired fasting glucose (IFG), newly diagnosed T2DM, and established T2DM with durations of less than 5 years and 5 years or more. The primary endpoint was the incidence of all-cause dementia.

RESULTS

Among 118,790 participants (average age 64.26 ± 9.95 years, 48% male), 16.7% developed dementia during an average follow-up of 7.3 ± 2.3 years. Participants with a history of T2DM for less than five years at cohort entry had a 26.7% higher risk of developing all-cause dementia compared to those with normoglycemia. Those with T2DM for five years or longer had a 46.7% increased risk, with an adjusted hazard ratio (aHR) of 1.466 (95% confidence interval [CI], 1.408-1.527). Specifically, the risk of developing Alzheimer's disease (AD) and vascular dementia (VaD) rose by 43.4% and 51.4%, respectively, for individuals with T2DM lasting more than five years (aHR 1.434, 95% CI 1.366-1.505; aHR 1.514, 95% CI 1.365-1.679, respectively).

CONCLUSIONS

Our findings demonstrated a significant association between an extended duration of T2DM and an increased risk of developing all-cause dementia, including AD and VaD in post-stroke population. These results emphasize proactive dementia prevention approaches in stroke survivors, particularly those with longstanding T2DM.

Hypertension research 2024 update and perspectives: blood pressure management

This mini-review article presents a comprehensive update on recent advancements in blood pressure management, based on original research published between 2023 and 2024. As part of the "Hypertension Research 2024 Update and Perspectives", the review integrates insights from the JSH2024 Fukuoka Declaration, emphasizing the concept of "NEO-HYPERTENSION harmonized with society". The strategies proposed in this review aim to realize this concept by promoting lifelong blood pressure management, preemptive medicine, and leveraging digital health technologies. Key strategies include adherence to treatment guidelines, overcoming clinical inertia, and the utilization of new digital tools and novel antihypertensive agents. Additionally, the review explores the significance of multidisciplinary collaboration and non-pharmacological therapies, as well as the importance of setting individualized treatment goals tailored to patients' unique backgrounds. By aligning with the JSH's vision, this review offers a fresh perspective on contemporary clinical practices and future directions. These updates aim to contribute to improved patient outcomes and global health advancements in hypertension care.

The pro-inflammatory cytokine IL6 suppresses mitochondrial function via the gp130-JAK1/STAT1/3-HIF1α/ERRα axis

Chronic inflammation and a decline in mitochondrial function are hallmarks of aging. Here, we show that the two mechanisms may be linked. We found that interleukin-6 (IL6) suppresses mitochondrial function in settings where PGC1 (both PGC1α and PGC1β) expression is low. This suppression is mediated by the JAK1/STAT1/3 axis, which activates HIF1α through non-canonical mechanisms involving upregulation of HIF1A and ERRα transcription, and subsequent stabilization of the HIF1A protein by ERRα. HIF1α, in turn, inhibits ERRα, which is a master regulator of mitochondrial biogenesis, thus contributing to the inhibition of mitochondrial function. When expressed at higher levels, PGC1 rescues ERRα to boost baseline mitochondrial respiration, including under IL6-treated conditions. Our study suggests that inhibition of the IL6 signaling axis could be a potential treatment for those inflammatory settings where mitochondrial function is compromised.

Impact of interdisciplinary tumor boards (ITB) and personalized treatment on survival outcomes in metastatic castration-resistant prostate cancer

PURPOSE

Interdisciplinary tumor boards (ITB) are essential in optimizing treatment recommendations for metastatic castration-resistant prostate cancer (mCRPC) by incorporating oncology guidelines, clinical trials, and patient-specific factors to ensure individualized care. This study examines clinical parameters that influence ITB recommendations, evaluates their adherence to guidelines, and assesses their impact on patient survival.

METHODS

In a retrospective analysis, data from 187 mCRPC patients discussed at an ITB in a tertiary care center in 2018 were evaluated. Patient- and disease-specific factors were correlated with adherence to National Comprehensive Cancer Network® (NCCN®) guidelines and overall survival (OS). The impact of clinical parameters on survival outcomes was assessed through univariate and multivariate analyses.

RESULTS

The median patient age was 72.8 years, with a median prostate-specific antigen (PSA) level of 65.0 ng/ml. Guideline-compliant recommendations were given in 42.9% of cases, while 57.1% received individualized recommendations. Clinical trial eligibility was noted in 24.8% of patients. Individualized ITB recommendations were associated with significantly longer OS (38.3 vs. 21.2 months, p = 0.03). Shorter OS correlated with renal impairment (p = 0.007), symptomatic metastases (p < 0.0001), and visceral metastases (p < 0.0001). Limitations include the retrospective design, lack of follow-up on therapy adherence, and absence of progression-free survival (PFS) data.

CONCLUSION

ITB discussions improve survival in mCRPC patients, mainly due to personalized approaches and better access to clinical trials. Visceral and symptomatic metastases as well as renal impairment are risk factors for reduced OS, emphasizing the need for careful management of these high-risk patients. The results support the expanded use of ITB to improve mCRPC treatment outcomes.

Alcohol consumption among persons living with hypertension: evidence from a population-based study in Cape Verde

BACKGROUND

Despite the well-documented effects of alcohol consumption on hypertension risk, there are persons living with hypertension who consume alcohol and may be at risk of alcohol use disorder (AUD). This paradox poses a critical public health concern and underscores a need to understand the alcohol consumption behavior of persons living with hypertension. This study investigates the prevalence and factors associated with alcohol consumption and AUD among persons living with hypertension in Cape Verde.

METHODS

Using the 2020 WHO STEPS survey, we analyzed the observations of 1,136 adults in Cape Verde. Cross-tabulations, bivariable and multivariable logistic regression were performed in STATA version 18. The results from the multivariable logistic regression model were reported in their adjusted odds ratio (AOR) and corresponding 95% confidence interval (CI).

RESULTS

Overall, 784 (69.1%) of the total sample reported consuming alcohol. The study revealed that 22.8% of those who consumed alcohol experienced AUD. Specifically, alcohol dependence symptoms were prevalent in 13.7% of participants who consumed alcohol in the last 12 months. Social/family problem and functional impairments were prevalent in 11.6% and 8.2%, respectively. Women were significantly less likely to consume alcohol [AOR = 0.17; 95% CI: 0.12-0.25] and experience AUD [AOR = 0.32; 95%CI: 0.20-0.51] compared to men. Additionally, individuals who consumed processed foods high in salt had more than twice the odds of consuming alcohol [AOR = 2.34; 95% CI: 1.62-3.39]. Urban residents [AOR = 1.76; 95% CI: 1.33-2.31] and current smokers [AOR = 2.23; 95% CI: 1.13-4.38] were more likely to consume alcohol. Individuals with higher education [AOR = 4.34; 95% CI: 1.97-9.55] were more likely to consume alcohol but less likely to experience AUD [AOR = 0.09, 95%CI: 0.02-1.87].

CONCLUSION

The high prevalence of alcohol consumption and AUD among persons living with hypertension in Cape Verde signals a critical need for targeted public health strategies. Interventions should prioritize men, urban residents, current smokers, and individuals with higher education, given their higher likelihood of alcohol consumption. Additionally, given the lower likelihood of AUD among highly educated individuals, yet their higher alcohol consumption rates, interventions should balance education on the risks of excessive alcohol use while promoting responsible drinking.

Atherogenic index of plasma, high sensitivity C-reactive protein and incident diabetes among middle-aged and elderly adults in China: a national cohort study

BACKGROUND

The atherogenic index of plasma (AIP) and systematic inflammation, as measured by high-sensitivity C-reactive protein (hsCRP), are predictors of diabetes, but their combined impacts on incident diabetes are poorly understood. Using a nationally representative cohort in China, we aimed to investigate the association of AIP and hsCRP with incident diabetes among middle-aged and elderly adults.

METHODS

This cohort comprised 9,112 participants aged at least 45 years from 125 cities in the China Health and Retirement Longitudinal Study who were free of diabetes at baseline in 2011. Of these, 5,048 participants were followed up until 2015. The AIP was calculated as Log10[TG (mg/dL)/HDL-C(mg/dL)]. Multivariate logistic regression and linear mixed-effect (LME) models were performed to evaluate the associations of AIP, hsCRP, and incident diabetes as well as glycemic biomarkers. Receiver operating characteristic (ROC) curves were used to evaluate their diagnostic values. We conducted a mediation analysis to assess the direct and indirect associations between AIP and hsCRP with diabetes.

RESULTS

489 (9.7%) cases developed diabetes during four years. Higher levels of AIP and hsCRP were independently associated with diabetes. Compared to the lowest quartile of AIP or hsCRP, the highest quartile of AIP (adjusted odds ratio, aOR 2.53, 95% CI: 1.90-3.38) and hsCRP (aOR 2.38, 1.79-3.16) was significantly associated with incident diabetes. The joint effects showed that participants with higher levels of AIP and hsCRP had significantly higher aOR of 2.76 (2.13-3.57). The LME models showed AIP and hsCRP were related to an increased level of fasting blood glucose and glycated hemoglobin. The combination of AIP and hsCRP has better predictive efficacy (area under the curve, AUC: 0.628, 0.601-0.654) for incident diabetes than alone. Mediation analyses showed that high AIP significantly mediated 25.4% of the association between hsCRP and diabetes, and hsCRP simultaneously mediated 5.7% of the association between AIP and diabetes.

CONCLUSIONS

This cohort suggests combined effects and mutual mediation between the AIP and hsCRP on incident diabetes in China. Our findings provide clinical implications for monitoring and managing AIP and hsCRP levels to mitigate the development of diabetes.

Roles of Gut Microbiota Metabolites and Circadian Genes in the Improvement of Glucose and Lipid Metabolism in KKAy Mice by Theabrownin

Theabrownin (TB), a prominent pigment in fermented dark tea, exhibits beneficial effects on adiposity reduction. Our study revealed that TB derived from Fu brick tea significantly lowered fasting blood glucose levels and insulin resistance in obese/diabetic KKAy mice. Furthermore, TB demonstrated potent anti-inflammatory effects in the liver, adipose tissue, and intestines, as well as enhancing intestinal integrity. Additionally, TB was found to inhibit hepatic gluconeogenesis and promote fatty acid oxidation. Notably, TB altered gut metabolites, particularly l-palmitoylcarnitine, which showed an elevation in serum, liver, and adipose tissue following TB intervention. l-Palmitoylcarnitine reduced gluconeogenesis in primary hepatocytes and decreased lipid deposition in both primary hepatocytes and 3T3-L1 adipocytes in vitro. However, these effects were abolished when the circadian gene Period 3 (Per3) was knocked down. Our findings suggest that l-palmitoylcarnitine may play a crucial role in improving TB-mediated glucose homeostasis and lipid metabolism by regulating Per3.

Exploring the genetic contribution in obesity: An overview of dopaminergic system genes

Obesity is a widespread global health concern that affects a significant portion of the population and is associated with reduced quality of life, morbidity, and mortality. It is considered a pandemic, with its prevalence constantly rising in Western countries. As a result, numerous studies have focused on understanding the elements that contribute to obesity. Researchers have focused on neurotransmitters in the brain to develop weight management drugs that regulate food intake. This review explores the literature on genetic influences on dopaminergic processes to determine whether genetic variation has an association with obesity in reward-responsive regions, including mesolimbic efferent and mesocortical areas. Various neurotransmitters play an essential role in regulating food intake, such as dopamine which controls through mesolimbic circuits in the brain that modulate food reward. Appetite stimulation, including primary reinforcers such as food, leads to an increase in dopamine release in the reward centers of the brain. This release is related to motivation and reinforcement, which determines the motivational weighting of the reinforcer. Changes in dopamine expression can lead to hedonic eating behaviors and contribute to the development of obesity. Genetic polymorphisms have been investigated due to their potential role in modulating the risk of obesity and eating behaviors. Therefore, it is crucial to assess the impact of genetic alterations that disrupt this pathway on the obesity phenotype.

Advances in the diagnosis of early biomarkers for acute kidney injury: a literature review

Acute kidney injury (AKI) is a critical condition with diverse manifestations and variable outcomes. Its diagnosis traditionally relies on delayed indicators such as serum creatinine and urine output, making early detection challenging. Early identification is essential to improving patient outcomes, driving the need for novel biomarkers. Recent advancements have identified promising biomarkers across various biological processes. Tubular injury markers, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), N-acetyl-β-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP), offer insights into early tubular damage. Inflammatory and repair-associated biomarkers, such as interleukin-18 (IL-18), monocyte chemotactic protein-1 (MCP-1), osteopontin (OPN), and C-C motif chemokine ligand 14 (CCL14), reflect ongoing injury and recovery processes. Additionally, stress and repair markers like tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein-7 (IGFBP-7), alongside filtration markers such as cystatin C (CysC) and proenkephalin (PenKid®) e.tal, further enhance diagnostic precision. Oxidative stress-related markers, including Superoxide Dismutase 1 (SOD1), also contribute valuable information. Emerging candidates, such as microRNAs, soluble urokinase plasminogen activator receptor (SuPAR), and chitinase-3-like protein 1 (CHI3L1), hold substantial promise for AKI detection and prognosis. This review summarizes the progress in AKI biomarker research, highlighting their clinical utility and exploring their potential to refine early diagnosis and management strategies. These findings offer a new perspective for integrating novel biomarkers into routine clinical practice, ultimately improving AKI care.

Multi-omics insights into the molecular signature and prognosis of hypopharyngeal squamous cell carcinoma

Approximately two-thirds of hypopharyngeal squamous cell carcinoma (HPSCC) cases are diagnosed at advanced stages, with the worst prognosis among head and neck squamous cell carcinomas (HNSCCs). Identifying biomarkers for high-risk patients requiring aggressive treatment is crucial. We present mutational, transcriptomic, and proteomic studies of 103 Chinese HPSCC patients and observe a higher prevalence and poorer prognosis in males. Estrogen response pathways are up-regulated, and proteins phosphorylated by protein kinase C (PKC) and cyclin-dependent kinases (CDKs) are aberrantly regulated in HPSCC. We identify aberrant copy number regions including SOX2(3q26.33), FGFR(8p11.23), CCND1(11q13.3), CDKN2A/2B(9p21.3), and MYC(8q24.21). Human papillomavirus (HPV) status combined with highly mutated genes, such as SYNE1 in HPV(-) and MUC4 in HPV(+) patients, were assessed as prognosis markers. A predictive model involving clinical factors and expression of six genes was established and cross-site validated. These findings open new opportunities for stratifying high-risk patients and molecular targets for personalized therapeutic strategies.

Factors driving adolescent tuberculosis incidence by age and sex in 30 high-tuberculosis burden countries: a mathematical modelling study

INTRODUCTION

During adolescence, tuberculosis incidence rises, with a greater increase in males compared with females. Tuberculosis notifications and estimates infrequently disaggregate adolescent age groups. Moreover, the factors that drive the increases in overall incidence and the male-to-female (MF) ratio remain unclear.

METHODS

We constructed a mechanistic model to estimate cumulative Mycobacterium tuberculosis infection and tuberculosis disease incidence in the WHO's 30 high-tuberculosis burden countries (HBCs), which represent 86%-90% of global tuberculosis incidence. We derived infection risk from tuberculosis prevalence and assortative social mixing based on sex and age (10-14 years vs 15-19 years old). We adjusted age subgroup-specific risks of disease progression by age- and sex-specific risks of low body mass index (BMI), pregnancy and postpartum period (PPP) and HIV coinfection. We calculated population attributable fractions (PAFs) to these factors.

RESULTS

In 2019, 91.2 million (95% uncertainty interval (UI) 83.9 to 99.3 million) adolescents in the 30 HBCs had been infected with M. tuberculosis, and an estimated 1.0 million (95% UI 0.8 to 1.2 million) developed tuberculosis disease. The median PAF of tuberculosis disease to HIV, modified by antiretroviral therapy, was 1% and highest in Southern Africa. The median PAF for PPP among older adolescents of both sexes was 2.6%. The median PAF to low BMI was 16% and highest in South Asia. The MF risk ratio of tuberculosis disease was 1.2-fold higher among older adolescents, relative to young adolescents. The widening MF risk ratio was attributable mostly to low BMI, with a smaller contribution from sex-assortative social mixing.

CONCLUSION

Globally, large numbers of adolescents have been infected by M. tuberculosis and develop tuberculosis disease. Low BMI is the most important contributor to the overall incidence of tuberculosis disease, as well as to the sex difference that widens with age.

Brazilian guideline for screening and diagnosis of type 2 diabetes: a position statement from the Brazilian Diabetes Society

BACKGROUND

Patients with type 2 diabetes (T2D) often experience prolonged periods of asymptomatic hyperglycemia, which significantly increases the risk of developing chronic complications related to diabetes. Screening programs for individuals at high risk for T2D provide valuable opportunities not only for early diagnosis but also for detecting intermediate hyperglycemic states, commonly referred to as prediabetes. Interventions aimed at preventing diabetes in this group can successfully delay or even avoid the onset of the disease and its associated burdens. This review is an update of the Brazilian Diabetes Society (Sociedade Brasileira de Diabetes [SBD]) evidence-based guideline for diagnosing diabetes and screening T2D.

METHODS

The methodology was previously published and defined by the internal institutional steering committee. The working group drafted the manuscript by selecting vital clinical questions for a narrative review, utilizing MEDLINE via PubMed to identify relevant studies. The review assessed the best available evidence, including randomized clinical trials (RCTs), meta-analyses, and high-quality observational studies related to the diagnosis of diabetes.

RESULTS AND CONCLUSIONS

Fifteen specific recommendations were formulated. Screening is recommended for adults aged 35 and older or younger individuals with obesity and additional risk factors. For children and adolescents, screening is recommended starting at age ten or the onset of puberty if they are overweight or obese and have additional risk factors. Fasting plasma glucose (FPG) and HbA1c are recommended as initial screening tests. The oral glucose tolerance test (OGTT) is recommended for high-risk individuals with normal HbA1c and FPG or those with prediabetes. The 1-h OGTT is preferred over the 2-h OGTT, as it is both more practical and a superior test. A structured approach to reevaluation intervals is provided.

Association of sarcopenia index, based on serum creatinine and cystatin C, with incident diabetes mellitus

BACKGROUND

Sarcopenia, characterized by loss of muscle mass and strength, has been linked to various health outcomes, including diabetes mellitus. This study aims to investigate the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident diabetes mellitus in middle-aged and older adults in China.

METHODS

This study extracted data from 2015 to 2020 China Health and Retirement Longitudinal Study (CHARLS), including age ≥ 45-year adults without diabetes mellitus at baseline. Sarcopenia index was calculated based on serum creatinine and cystatin C levels, and incident diabetes mellitus was assessed through follow-up surveys. Cox proportional hazards regression models were used to analyze the association between sarcopenia index and incident diabetes mellitus, adjusting for potential confounders, with hazard ratio (HR) with 95% confidence interval (95% CI) reported.

RESULTS

During a mean follow-up period of 5.0 years, a total of 501 new cases of diabetes were recorded. A total of 7718 participants were included in the analysis. The median age was 60 years, and 46.2% were male. During a mean follow-up period of 5.0 years, 501 cases of incident diabetes mellitus were identified. After adjusting for covariates, Compared with participants in the lowest quartile, the corresponding diabetes HRs (95% CIs) for participants in the second, third, and fourth quartiles were 0.930 (95% CI 0.724-1.193; P = 0.567); 0.892 (95% CI 0.685-1.162; P = 0.398), 0.869 (95% CI 0.657-1.150; P = 0.327). Restricted cubic spline curves revealed that incident rate decreased with increase in sarcopenia index.

CONCLUSIONS

This study provides national longitudinal evidence in China on the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident diabetes mellitus in middle-aged and older adults. Our findings suggest that sarcopenia index may be a useful biomarker for predicting the risk of diabetes mellitus in this population.

GLP-1 Receptor Agonists in Pediatric and Adolescent Obesity

Obesity remains highly prevalent among children in the United States and is associated with an ever-increasing burden of obesity-related diseases. Effective pediatric obesity prevention and treatment will require both societal interventions and health care system innovation. One recent advancement is the approval of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for use in adolescents. GLP-1RAs are notable for their effectiveness in weight management and in their ability to ameliorate obesity-related diseases. GLP-1RAs can be an important part of a comprehensive treatment plan for pediatric patients seeking obesity care, and we will review the pediatric clinician's considerations for their effective use. We discuss the history of obesity pharmacology and development of GLP-1RAs. We review the indications for use and common adverse reactions. We highlight the importance of mental health care for obesity treatment, with a focus on disordered eating behaviors and their intersection with obesity and pharmacologic treatment of obesity. Nutrition remains an important issue for obesity prevention and management, and we highlight nutritional concerns during GLP-1RA therapy. Finally, we discuss health inequities in obesity, the dangers of perpetuating these inequities if GLP-1RA access remains biased, and the opportunities for improvement.

Equity of National Essential Public Health Services (NEPHS) in Mainland China, 2019: a cross-sectional study based on the NEPHS database

BACKGROUND

China's National Essential Public Health Service (NEPHS) Program was launched in 2009 to deliver population-based public health and individual health management services to all residents at 800,000 primary health-care centers nationwide. This study assessed NEPHS utilization data and evaluated usage inequities using comprehensive nationwide data.

METHODS

A cross-sectional study was conducted, selecting 16 indicators (out of 18) from 12 service packages to evaluate inequity. These included 4 indicators for services provided to all residents and 12 for pregnant women, new mothers, children aged 0-6 years, and patients with hypertension, diabetes, severe mental disorders, or tuberculosis. Data on service utilization and target populations for these indicators across the 31 provinces and 453 cities in mainland China were obtained from the NEPHS database and management platform for the period January 1 to December 31, 2019. Service utilization rates and bias-corrected bootstrap confidence intervals (CIs) were calculated to determine utilization. Inequities were assessed using the Gini coefficient and Sitthiyot-Holasut composite inequality index at the national and provincial levels, and the Theil index was employed to decompose overall inequity into within-region and between-region subgroups.

RESULTS

The NEPHS collected health records for 88.25% of China's permanent residents (95% CI: 79.23%-98.82%). The nationwide vaccination coverage rate was 97.44% (95% CI: 91.33%-99.91%). Newborn visit and child health management rates for children aged 0-6 years were 92.08% (95% CI: 74.85%-98.34%) and 90.87% (95% CI: 82.49%-98.47%), respectively. At the national level, NEPHS service utilization in 2019 was generally equitable, with Gini coefficients below 0.4 for the 15 indicators. Potential large equity gaps were observed in the provision of health education services in Shanghai [Gini coefficient = 0.358 (95% CI: 0.219, 0.444)], Inner Mongolia [Gini coefficient = 0.370 (95% CI: 0.073, 0.440)] and Xinjiang [Gini coefficient = 0.457 (95% CI: 0.217, 0.502)]. Additionally, the utilization of family planning education and sanitation inspection services also indicated potential large and severe equity gap in 13 provinces. The Theil indices revealed that inequities primarily existed within rather than between regions. Province-level results indicated perfect equity in health record management and vaccination coverage, while several provinces showed potential equity gaps in health education and family planning services. Potential equity gaps were also observed in health management services for patients with hypertension and diabetes, particularly in Beijing, Hunan and Xinjiang.

CONCLUSIONS

This study provides evidence for health planning in China's primary health sector and guidance for analyzing equity in national health programs similar to the NEPHS Program.

Global food retail environments are increasingly dominated by large chains and linked to the rising prevalence of obesity

Retail food environments influence food purchasing and dietary patterns. A global analysis of the food retail landscape allowing comparisons across geographical regions is therefore needed to tackle diet-related non-communicable diseases. Here we examine trends in retail food environments from 2009 to 2023 across 97 countries, exploring associations with changes in obesity prevalence. Increases were observed in the density of chain outlets, grocery sales from chain retailers, unhealthy food sales per capita and digital grocery sales; non-chain outlet density and the ratio of non-chain to chain outlets declined over time. South Asia and low- and middle-income countries overall experienced the most rapid transformation. Changes in retail environments and the prevalence of obesity were found to be positively correlated. As retail environments become increasingly digital and dominated by large chains, important implications for diets and health should be expected, particularly in lower-income countries.

The G allele of the rs4344 polymorphism of the angiotensin-converting enzyme gene is associated with alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) in Brazilian hypertensive patients

BACKGROUND

The association of genetic variants and environmental factors contribute to increased susceptibility to arterial hypertension (AH). Polymorphisms of the angiotensin-converting enzyme (ACE) gene have been identified as a genetic risk factor related to blood pressure (BP) levels and liver function, since they influence the renin-angiotensin-aldosterone system (RAAS).

OBJECTIVE

To evaluate the influence of the rs4344 polymorphism of the ACE gene on AH and biochemical parameters of liver function (ALT, AST, GGT and ALP) in normotensive and hypertensive patients.

METHOD AND RESULTS

The identification of the polymorphism was performed by qPCR, using the TaqMan® system, in 811 individuals (484 normotensive and 327 hypertensive) and biochemical dosages (AST, ALT, GGT and ALP) were performed by UV/Vis spectrophotometry. A univariate logistic regression model was used to identify factors associated with hypertension and Pearson's chi-square test to assess allele frequency between groups. A multivariate logistic regression model was used to correct confounding factors and assess the association of the variant with hypertension. Data normality was assessed using the Shapiro-Wilk test. Continuous nonparametric variables were expressed as median and interquartile range and analyzed using the Mann-Whitney test and parametric data were expressed as mean and standard deviation and analyzed by unpaired Student's t test. The rs4344 variant was not linked to hypertension in the individuals examined. However, concerning liver function marker enzymes, the G allele was associated with increased levels of GGT and ALT in hypertensive patients.

CONCLUSIONS

Our findings indicated that the rs4344 variant of the ACE gene is linked to impaired liver function in hypertensive individuals.

Grape pomace extract attenuates high fat diet-induced endotoxemia and liver steatosis in mice

Obesity is a prominent global health concern associated with chronic inflammation and metabolic disorders, such as insulin resistance, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD). Excessive consumption of saturated fats exacerbates these conditions by increasing intestinal barrier permeability and circulating endotoxins. This study aims to investigate, in a murine model of high-fat diet (HFD)-induced obesity, the potential beneficial effects of a grape pomace extract (GPE), rich in phenolic compounds, at mitigating endotoxemia, and liver steatosis. Underlying mechanisms were characterized in an in vitro model of intestinal inflammation and permeabilization, as induced by tumor necrosis factor alpha (TNFα) in Caco-2 cell monolayers. Consumption of a HFD (60% calories from fat) for 13 weeks induced obesity, insulin resistance, and liver damage, evidenced by higher levels of plasma alanine aminotransferase (ALT), hepatic triglycerides content, and steatosis. In addition, HFD caused metabolic endotoxemia, hepatic toll-like receptor 4 (TLR4) upregulation and inflammation. GPE supplementation significantly reduced body weight and subcutaneous and visceral adipose tissue weight, and attenuated metabolic dysregulation. Furthermore, GPE decreased circulating LPS levels and mitigated HFD-mediated hepatic TLR4 upregulation, nuclear factor kappa B (NF-κB) activation, and downstream expression of proteins involved in oxidative stress and inflammation (NOX4, TNFα, and F4/80). In Caco-2 cells, GPE mitigated TNFα-induced monolayer permeabilization, decreased tight junction (TJ) protein levels, enhanced cellular oxidant production, activated redox-sensitive signaling, i.e., NF-κB and ERK1/2, and increased NOX1 and MLCK mRNA levels, the latter being a key regulator of monolayer permeability. The above findings suggest that GPE may protect against HFD-induced obesity and associated metabolic dysfunction (insulin resistance and NAFLD) by modulating intestinal barrier integrity and related endotoxemia.

A study of trends in body morphology, overweight, and obesity in Chinese adults aged 40-59 years

OBJECTIVE

To reveal the changing pattern of anthropometry of middle-aged adults aged 40-59 in China from 2000-2020, and to predict the development trend in the next decade, to provide a reference basis for curbing the prevalence of overweight and obesity in them.

METHODS

A grey GM(1,1) prediction model was established for the cross-sectional data on anthropometric measures of 422,851 adults obtained from five series of national physical fitness surveillance in China.

RESULTS

1) From 2000 to 2020, all anthropometric indicators of middle-aged people aged 40-59 years in China maintained growth, with waist circumference increasing at the highest rate, weight at the second highest rate, and height at the slowest rate; 2) Overweight and obesity rates are increasing rapidly, with an average annual increase of 0.37 percentage points and 0.30 percentage points, with a greater increase for men than for women.

CONCLUSION

Without stronger interventions, overweight and obesity rates among middle-aged adults are likely to continue to increase in the future, and coordinated efforts are needed to slow down the obesity epidemic and improve the physical health of middle-aged adults.

Usefulness of body and visceral fat determined by bioimpedancemetry versus body mass index and waist circumference in the identification of elevated values of different atherogenesis risk scales

INTRODUCTION

Obesity and atherogenesis are two highly prevalent pathological processes worldwide that also share several pathophysiological mechanisms.

OBJECTIVES

Descriptive and cross-sectional study in 8,590 Spanish workers (4,104 men and 4,486 women) with an average age of 41.5years, in which the usefulness of four scales of overweight and obesity such as body mass index (BMI), waist circumference and percentages of body and visceral fat determined by bioimpedance measurement to identify high levels of atherogenic risk determined by atherogenic dyslipidemia (AD), lipid triad (LT) and several atherogenic indices is assessed.

RESULTS

All the overweight and obesity scales show a predictive value between moderate and good, determined by the AUC of the ROC curves, with values ranging from 0.727 to 0.886 in women and 0.676 to 0.885 in men. Of all of them, the one with the highest AUC is visceral fat with values exceeding 0.800 and the lowest are for BMI. In all cases, the AUC is higher in women.

CONCLUSIONS

The overweight and obesity scales analysed (BMI, waist circumference and percentage of body and visceral fat) show AUCs for predicting atherogenic risk between moderate and high, with visceral fat being the most useful of all.