Clinical studies on anti-obesity medications in Arab countries

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Mendelian Randomization Assessment of the Genetic Effects of Lipid-Lowering Drugs on Digestive System Cancers

The relationship between lipid-lowering drugs and the risk of digestive system cancers remains unclear. This study aims to assess the risk association between lipid-lowering drugs and digestive system cancers through mendelian randomization (MR) analysis. We utilized genetic instruments to substitute for the exposure to lipid-lowering drugs, including expression quantitative trait loci (eQTL) for HMGCR, PCSK9, and NPC1L1, as well as genetic variants associated with low-density lipoprotein (LDL) from the Global Lipids Genetics Consortium's genome-wide association study (GWAS) data for target genes. We used MR and SMR methods to assess the risk estimates of lipid-lowering drug target genes on digestive system tumors. The MR analysis indicated a negative association between HMGCR-mediated LDL and hepatocellular carcinoma (OR = 0.06, 95% CI: 0.00-0.81, p = 0.03), and a positive association between NPC1L1-mediated LDL and gastric cancer risk (OR = 15.45, 95% CI: 5.96-40.56, p < 0.01). In the SMR analysis, it was observed that HMGCR expression decreased the risk of hepatocellular carcinoma (OR = 0.11, 95% CI: 0.02-0.68, p = 0.02), while NPC1L1 expression increased the risk of gastric cancer (OR = 1.33, 95% CI: 1.08-1.64, p < 0.01). Our study results suggested a potential risk association between HMGCR inhibitors and NPC1L1 with hepatocellular carcinoma and gastric cancer.

Cross-Sectional Associations between Clinical Biochemistry and Nutritional Biomarkers and Sarcopenic Indices of Skeletal Muscle in the Baltimore Longitudinal Study of Aging

BACKGROUND

Investigating relationships between nutritional and clinical biochemistry biomarkers and skeletal muscle mass, strength and function (sarcopenic indices) may 1) highlight micronutrients of interest for potential preventive or treatment strategies for sarcopenia, or 2) highlight biomarkers that may be useful for identifying individuals at risk of sarcopenia.

OBJECTIVES

Investigate associations between nutritional biomarkers (vitamin D, vitamin B12, folate, magnesium, potassium, calcium, and iron), clinical biomarkers (hemoglobin, ferritin, albumin, creatinine, and hemoglobin A1c: HbA1c), and sarcopenic indices (appendicular lean mass: ALM); height-adjusted ALM: ALMht; fat-free mass as a percentage of total body weight; extended short physical performance battery score: extSPPB; height-adjusted hand grip strength: HGSht; height-adjusted knee extension concentric strength, and; height-adjusted knee extension isometric strength) in males and females.

METHODS

Using multivariable linear regression analysis, we investigated cross-sectional associations between biomarkers and sarcopenic indices in data collected from 1761 participants (age 22-103 y) from the Baltimore Longitudinal Study of Aging.

RESULTS

Hemoglobin was positively associated with ALM (β = 0.20, P = 0.021), HGSht (β = 0.25, P = 0.001), and extSPPB (β = 0.13, P = 0.024) in males, and with extSPPB in females (β = 0.15, P = 0.019). In males, serum iron was positively associated with ALMht (β = 0.0021, P = 0.038) and extSPPB (β = 0.0043, P = 0.045). In females, ferritin was positively associated with knee-extension strength measurements. Serum creatinine was positively associated with lean mass measures in males and females and with muscle strength and function measures in males with normal renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m2). In males, high HbA1c was associated with lower ALMht (β = -0.21, P = 0.023), extSPPB (β = -0.40, P = 0.027), and HGSht (β = -0.56, P = 0.031). In males and females, magnesium was positively associated with extSPPB, and potassium was positively associated with measures of knee-extension strength.

CONCLUSIONS

The associations found between measures of iron status and creatinine and sarcopenic indices, in males in particular, indicate potential importance for muscle health. Future longitudinal and intervention studies are warranted to confirm these findings.

Estimates and trends in the global burden of glaucoma influenced by metabolic risk factors from Global Burden of Disease Study between 1990 to 2019

PurposeGlaucoma is an irreversible eye disease that causes blindness, which not only causes visual impairment and economic burden to patients, but also increases the social burden. This study aimed to estimate the global burden of glaucoma due to metabolic risk over the past 30 years.MethodsThe number and rate of deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) for metabolic risk factors-induced glaucoma were extracted. The estimated annual percentage changes (EAPCs) for ASRs were calculated using a generalized linear model with a Gaussian distribution to quantify the temporal trends in the global burden of metabolic risk factor-attributed glaucoma. The strength and direction of the association between the sociodemographic index (SDI) and the DALY rate were measured using Spearman's rank-order correlation.ResultsApproximately 0.07% of the global DALYs of glaucoma in 1990 were associated with metabolic risk factors, which increased to 0.1% in 2019. From 1990 to 2019, the global DALY cases of glaucoma caused by metabolic risk factors and the global burden of DALYs increased, whereas the DALY rate decreased with a higher SDI regional grade. The ASR of glaucoma disability loss years with a metabolic high risk increased with age, reaching the highest in the >85-year-old age group.ConclusionThe burden of glaucoma caused by metabolic risk factors has increased over the past three decades, especially in regions with a low SDI and in old-age groups.

Joint Association of Physical Activity and Sleep Quality With Blood Pressure Control in Patients With Hypertension in Douala, Cameroon

INTRODUCTION

Blood pressure (BP) control is necessary to prevent fatal events in patients with hypertension. Although physical activity (PA) and sleep quality (SQ) are known to reduce BP, their joint association is yet to be demonstrated. This study aimed to assess the joint association of PA and SQ on BP control among patients with hypertension in Cameroon.

METHODS

This was a hospital-based cross-sectional study carried out among outpatients attending Douala General Hospital in Cameroon diagnosed with hypertension. BP was considered to be controlled if it was lower than 140/90 mm Hg. PA and SQ have been assessed using the International Physical Activity Questionnaire and the Pittsburg Sleep Quality Index. Odds ratio and 95% CI have been calculated, and differences were considered significant at P < .05.

RESULTS

A total of 415 participants were recruited, the mean age was 61 (11) years, and 67% were women. Around 66.3% of participants had their BP uncontrolled. Patients with uncontrolled BP had a significantly higher proportion of overweight/obesity (87.3% vs 73.6, P = .001), sedentary time ≥ 2 hours per day (37.1% vs 27.1, P = .043), and low leisure-time PA level (39.6% vs 52.9%, P = .014). After adjustment for confounders, a poor SQ associated with a low PA level significantly increased the odds of having an uncontrolled BP (odds ratio: 2.66; 95% CI, 1.13-6.24; P = .025).

CONCLUSION

Cameroonian patients with hypertension exhibit a high rate of poor BP control which is significantly associated with poor SQ and low PA level. These 2 parameters should be considered simultaneously for a better prevention of cardiovascular complications.

Efficacy and safety of once-weekly semaglutide 2.4 mg for weight management in participants from China: A prespecified analysis of the STEP 7 randomized clinical trial

AIM

To evaluate the efficacy and safety of semaglutide 2.4 mg versus placebo for weight management in a population of Chinese adults with overweight or obesity.

MATERIALS AND METHODS

In STEP 7 (NCT04251156), a double-blind, phase 3a trial, adults from a predominantly East Asian population with overweight or obesity, with or without type 2 diabetes, were randomized 2:1 to once-weekly subcutaneous semaglutide 2.4 mg or placebo for 44 weeks as an adjunct to a reduced-calorie diet and increased physical activity. This prespecified analysis evaluated Chinese participants in STEP 7. The primary endpoints were percentage change in body weight from baseline to Week 44 and the proportion of participants who achieved ≥5% reduction in body weight from baseline.

RESULTS

Overall, 195 Chinese participants were randomized to semaglutide 2.4 mg and 105 to placebo. Estimated change in mean body weight from baseline to Week 44 was -11.8% with semaglutide 2.4 mg versus -3.5% with placebo (estimated treatment difference -8.3%; 95% confidence interval [CI] -10.2, -6.4; p < 0.0001). At Week 44, a greater proportion of participants treated with semaglutide 2.4 mg achieved ≥5% body weight loss versus placebo (85.4% vs. 26.8%): odds ratio 16.1; 95% CI 8.4, 30.9; p < 0.0001. Adverse events were reported by 92.3% of semaglutide-treated participants and 82.9% of placebo-treated participants, the most common of which were gastrointestinal disorders (126/195, 64.6% vs. 35/105, 33.3%).

CONCLUSIONS

These data demonstrate beneficial effects of semaglutide 2.4 mg versus placebo, supporting its use in an adult Chinese population with overweight or obesity.

Dietary Carbohydrate Intake, Carbohydrate Quality, and Healthy Aging in Women

Importance

Dietary carbohydrate quality is inversely associated with risks of chronic disease and all-cause mortality. However, limited evidence exists regarding the role of carbohydrate quality and dietary carbohydrate types in promoting healthy aging.

Objective

To evaluate the long-term role of dietary carbohydrate intake and carbohydrate quality in healthy aging.

Design, Setting, and Participants

This prospective cohort study used data from the Nurses' Health Study (NHS) from January 1984 to December 2016 and included participants aged younger than 60 years in 1984. Data were analyzed from January 2023 to February 2025.

Exposure

Intakes of total carbohydrates; refined carbohydrates; high-quality carbohydrates from whole grains, fruits, vegetables, and legumes; dietary fiber; and the dietary glycemic index (GI) and glycemic load (GL).

Main Outcomes and Measures

Nutrient intakes were derived from 1984 and 1986 food frequency questionnaires. The primary outcome was healthy aging, defined as the absence of major chronic diseases, lack of cognitive and physical function impairments, and having good mental health, according to 2014 or 2016 NHS questionnaire data. Multivariate logistic regression was used to calculate associations of each carbohydrate variable with healthy aging.

Results

Among 47 513 participants (mean [SD] baseline age, 48.5 [6.2] years), 3706 (7.8%) met our healthy aging definition. Every 10%-calorie increment in intakes of total carbohydrates (odds ratio [OR], 1.17; 95% CI, 1.10-1.25) and high-quality carbohydrates (OR, 1.31; 95% CI, 1.22-1.41) was positively associated with healthy aging. Refined carbohydrates were associated with lower odds of healthy aging (OR, 0.87; 95% CI, 0.80-0.95). Intakes of carbohydrates from fruits, vegetables, and whole grains were positively associated with odds of healthy aging (ORs ranging from 1.11; 95% CI, 1.07-1.15 to 1.37; 95% CI, 1.20-1.57 per 5% energy increment). Additionally, intakes of total dietary fiber and fiber from fruits, vegetables, and cereals were associated with higher odds of healthy aging (ORs ranging from 1.07; 95% CI, 1.03-1.11 to 1.17; 95% CI, 1.13-1.22 per 1-SD increment). GL was positively associated with healthy aging, which was attenuated by dietary fiber adjustment. A higher GI (OR, 0.76; 95% CI, 0.67-0.87) and carbohydrate-to-fiber ratio (OR, 0.71; 95% CI, 0.62-0.81) were inversely associated with healthy aging when comparing extreme quintiles. There were positive associations for isocaloric replacements of refined carbohydrates, animal protein, total fat, or trans fats with high-quality carbohydrates (ORs ranging from 1.08; 95% CI, 1.01-1.16 to 1.16; 95% CI, 1.11-1.21).

Conclusions and Relevance

In this cohort study of women, intakes of high-quality carbohydrates and dietary fiber were associated with positive health status in older adulthood, suggesting that dietary carbohydrate quality may be an important determinant of healthy aging.

Causal Associations Between Lipids, NPC1L1, and Liver Cancer Risk: Insights From Mendelian Randomization and Bioinformatics

BACKGROUND AND AIM

The study aims to investigate the potential causal effects of lipids on liver cancer risk and to analyze the possible impact of lipid-lowering drug targets on liver cancer.

METHODS

Genetic variants linked to lipid traits and drug targets were obtained from the Global Lipids Genetics Consortium and DrugBank. Liver cancer data were sourced from FinnGen. Mendelian randomization (MR) was used to assess causal relationships between lipid traits and liver cancer. Functional analyses included protein-protein interaction (PPI), KEGG pathway enrichment, transcription factor (TF) network analysis, and survival analysis. NPC1L1 expression, DNA methylation, and immune infiltration were analyzed using UALCAN, TCGA-LIHC, and TIMER, respectively.

RESULTS

MR analysis showed higher genetically predicted LDL-C levels reduced liver cancer risk (OR = 0.5981, p = 0.034). Drug target MR indicated that NPC1L1 inhibition (OR = 1.0638, p = 0.0311) and elevated PPARɑ levels (OR = 1.1339, p < 0.01) increased liver cancer risk. Functional analysis revealed NPC1L1 was highly expressed in liver cancer tissues due to hypomethylation and linked to immune cell infiltration, indicating its role in immune evasion and tumor progression.

CONCLUSION

The study demonstrates that elevated LDL-C levels are associated with a reduced risk of liver cancer and NPC1L1 plays a key role in regulating lipid metabolism and influencing immune evasion.

New horizons for promising influences of sulforaphane in the management of metabolic syndrome: a mechanistic review

The disorder known as metabolic syndrome (MetS) represents a substantial threat to society since it is linked to a higher risk of heart disease, diabetes, stroke, and other health issues. Although there is no known cure for metabolic syndrome, lifestyle changes in diet and physical activity can help. Sulforaphane (SFN), a compound in cruciferous vegetables, has been recognized as a promising treatment for addressing metabolic syndrome. The information was compiled after a thorough search of four databases, PubMed, Scopus, Web of Sciences, and Google Scholar. This analysis includes 86 studies that include clinical and nonclinical SFN investigations in diseases connected to metabolic syndrome. Research has shown that sulforaphane is a prospective treatment option for obesity, type 2 diabetes mellitus (T2-DM), and associated metabolic disorders due to its capacity to regulate fatty acid production and glucose management. Many molecular processes have been investigated, including activating nuclear factor erythroid 2-related factor 2(Nrf2), activating nuclear factor erythroid 2(NF-E2), reducing reactive oxygen species, and upregulating insulin receptor substrate 1(IRS-1) and other suggested mechanisms. The current review established many facts in favor of SFN's prospective benefits in metabolic syndrome. More studies in this field involving human studies are necessary to determine whether SFN may effectively treat metabolic syndrome.

Hyaluronic acid-based hesperidin nanostructured lipid carriers loaded dissolving microneedles: A localized delivery approach loaded for the management of obesity

Obesity, a persistent imbalance of calories, has become one of the major clinical factors that result in many metabolic disorders. Despite excellent anti-obesity properties, the poor aqueous solubility of hesperidin (HES), a flavonoid, hampers its applicability. To resolve this issue and conquer oral administration's drawbacks, our study has concentrated on encapsulating HES in nanostructured lipid carriers (NLCs) and incorporating the NLCs into microneedles (MNs). By developing HES-loaded NLCs (HES-NLCs) with hyaluronic acid (HA) as a base design to form a microneedle patch (HES-NLCMNP), the study aimed to increase the stability and bioavailability of HES and provide an innovative way for the management of obesity. HES-NLCs were loaded to the microneedle, to promote anti-obesity activity. The microneedle tip, which has been composed of HA, will act as a biodegradable polymer that could effectively deliver the activity of HES-NLC to the blood stream. Furthermore, the base of the microneedle patch composed of polyvinyl alcohol (PVA) offered excellent flexibility, releasing HES and providing resistance to any adverse effects. Analysis revealed that the prepared HES-NLCs have desirable physical characteristics with an extended-release profile. The optimised NLC formulation (F3F) was later incorporated into HA-base-designed MNs that demonstrated mechanical solid integrity and effective skin penetration. In vivo pharmacokinetics significantly improved all parameters with a reduced elimination rate. Physiological, haematological, and antioxidant markers improved in treated rats, with histopathological analysis showing significant tissue alterations. The results suggest that HES-NLCMNP is a promising platform to improve drug effectiveness, patient compliance, and treatment outcomes for obesity.

Exploring the Link Between Thyroid Disorders and Obesity: Mechanisms, Impacts, and Clinical Implications

OBJECTIVE

Obesity and thyroid dysfunction are among the most significant challenges in endocrinology, frequently overlapping to create complexities in weight management. Even after achieving euthyroidism, weight variations persist, significantly affecting patients' quality of life. This review explores the mechanisms linking hypothyroidism and hyperthyroidism to weight fluctuations, emphasizing their impact on basal metabolic rate, appetite regulation, glucose and lipid metabolism, and thermogenesis.

METHODS

We conducted a comprehensive review using PubMed and Google Scholar, applying the search criteria: (obesity OR overweight) AND (Hashimoto's thyroiditis OR hyperthyroidism OR hypothyroidism OR Thyroid Cancer). From this search, we reviewed 500 publications and finally included 71 publications, focusing on broad clinical questions regarding the role of thyroid hormones in weight regulation and metabolism, the impact of thyroid disorders and their treatments on obesity, and approaches for managing obesity in the context of thyroid dysfunction.

RESULTS

In hypothyroidism, the impact of levothyroxine therapy on weight changes is discussed, along with the potential role of T3 supplementation. For hyperthyroid patients, the effects of antithyroid medications, radioactive iodine therapy, and thyroidectomy on weight regulation are explored. Pharmacological and nonpharmacological strategies for managing obesity in thyroid disorders are reviewed. Lifestyle interventions and pharmacotherapies are evaluated for their efficacy and potential effects on thyroid function. Lastly, the implications of bariatric surgery are explored, including its effects on thyroid function, medication absorption, and postsurgical management of thyroid disorders.

CONCLUSION

This review underscores the importance of an integrated, multidisciplinary approach to managing obesity in the context of thyroid dysfunction to optimize patient outcomes.

Liposomal formulation co-encapsulating α-tocopheryl succinate and α-tocopherol ameliorates high-fat diet-induced obesity

Lipid accumulation inhibition is a pivotal focus for anti-obesity drugs. α-Tocopheryl succinate (TS) is a derivative of α-tocopherol (T) that inhibits lipid accumulation, making it a propitious candidate for an anti-obesity agent. However, cytotoxicity of TS limits its application. Reactive oxygen species produced by TS are responsible for the cytotoxicity, which can be mitigated by T. Herein, we evaluated the effect of a liposomal formulation co-encapsulating TS and T (TS/T-lipo) on obesity. We prepared TS/T-lipo and evaluated the resultant cytotoxicity and lipid accumulation inhibition effect in vitro. TS/T-lipo showed a significant inhibitory effect on lipid accumulation without cytotoxicity. The inhibitory effect on lipid accumulation is likely due to upregulation of Uncoupling Protein 1, which causes lipid consumption. Moreover, we evaluated the effect of TS/T-lipo on a high-fat diet-induced obese mouse model and found that body weight significantly decreased in the TS/T-lipo group without elevation of liver toxicity or blood glucose levels. Additionally, increased glycerol serum levels are suggestive of increased lipolysis upon treatment with TS/T-lipo. Histological analysis supports inhibition of lipid accumulation by treatment with TS/T-lipo. Taken together, this evidence demonstrates that co-administration of TS/T can reduce cytotoxicity and may be a promising candidate for an anti-obesity drug.

Efficacy and safety of once-weekly tirzepatide in Japanese patients with obesity disease (SURMOUNT-J): a multicentre, randomised, double-blind, placebo-controlled phase 3 trial

BACKGROUND

Data on tirzepatide in Asian patients with obesity are limited. This study aimed to gain a better understanding of tirzepatide for treatment of Japanese patients with obesity disease (BMI ≥25 kg/m2 with excessive fat accumulation) as defined by the Japanese Society for the Study of Obesity.

METHODS

This was a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial of the efficacy and safety of tirzepatide as an adjunct to lifestyle modifications. Japanese adults with obesity disease (BMI ≥27 kg/m2 accompanied by ≥2 obesity-related health disorders or ≥35 kg/m2 accompanied by ≥1 obesity-related health disorders), excluding diabetes, were assigned 1:1:1 via computer-generated random sequence to receive once weekly subcutaneous tirzepatide (10 mg or 15 mg) or placebo. Coprimary endpoints were the mean percent change in bodyweight and the proportion of participants achieving at least 5% bodyweight reduction at week 72, using the efficacy estimand. Efficacy and safety were assessed in the modified intention-to-treat (mITT) population. This study is registered with ClinicalTrials.gov, NCT04844918.

FINDINGS

Between May 10, 2021, and June 24, 2023, 413 participants were screened, and 267 were randomly assigned. Due to exclusion of one study site, the mITT population was 225 participants (133 [59%] men and 92 [41%] women, mean age 50·8 [SD 10·7] years), with 73 in the tirzepatide 10 mg group, 77 in the tirzepatide 15 mg group, and 75 in the placebo group, of whom 192 (85%) completed both study and treatment. Estimated treatment differences relative to placebo in change in bodyweight at week 72 were -16·1% (95% CI -18·7 to -13·5; p<0·0001) and -21·1% (95% CI -23·6 to -18·5; p<0·0001) following tirzepatide 10 mg and 15 mg, respectively. At week 72, a higher proportion of participants achieved at least 5% bodyweight reduction with tirzepatide 10 mg (67 [94%] of 71) and 15 mg (73 [96%] of 76) compared with placebo (15 [20%] of 75; both p<0·0001). Cardiometabolic and body composition indices were also improved with tirzepatide. Participants treated with tirzepatide experienced treatment-emergent adverse events more frequently (10 mg: n=61 [84%]; 15 mg: n=66 [86%]) than those who received placebo (52 [69%]), most commonly gastrointestinal symptoms. Study discontinuations due to adverse events were infrequent (placebo: n=3 [4%]; tirzepatide 10 mg: n=1 [1%]; tirzepatide 15 mg: n=0).

INTERPRETATION

In Japanese adults with obesity disease, tirzepatide provided clinically a meaningful reduction in bodyweight compared with placebo over 72 weeks, with a safety profile consistent with that observed in global populations.

FUNDING

Eli Lilly and Company.

TRANSLATION

For the Japanese translation of the abstract see Supplementary Materials section.

Assessing the association of multi-environmental chemical exposures on metabolic syndrome: A machine learning approach

Metabolic syndrome (MetS) is a major global public health concern due to its rising prevalence and association with increased risks of cardiovascular disease and type 2 diabetes. Emerging evidence suggests that environmental chemical exposures may play a significant role in the development of MetS by disrupting metabolic pathways. This study used data from 2,960 participants in the Korean National Environmental Health Survey (KoNEHS) cycle 4 (2018-2020) to examine associations between environmental exposures and MetS risk through machine learning (ML) approaches. Eight ML algorithms were applied, with the multilayer perceptron (MLP) and random forest (RF) models identified as optimal predictors. The MLP achieved an AUC of 0.79, and the RF achieved the highest F1 score of 0.82. Both models highlighted PFOA and PFOS, alongside age and BMI, as key predictors. SHapley Additive exPlanations (SHAP) and partial dependence plots (PDP) revealed both linear and nonlinear exposure-response patterns, suggesting threshold effects for key chemicals. These findings underscore the importance of incorporating environmental exposures into MetS risk assessments. The ML models provided robust predictive performance and novel insights into chemical and metabolic interactions, advocating for regulatory measures to reduce harmful exposures and integrate environmental factors into MetS prevention strategies.

Determining whether weight status mediates the association between number of cigarettes smoked per day and all-cause mortality among US adults who smoke cigarettes

INTRODUCTION

While there is evidence demonstrating the association between cigarette smoking and weight status, and mortality and weight status, it has not been examined whether weight status is a mediator between number of cigarettes smoked per day (CPD) and all-cause mortality, limiting our knowledge of this association and potential novel approaches to reduce all-cause mortality due to cigarette smoking. We aimed to evaluate whether weight status mediated the association between CPD and mortality.

METHODS

We harnessed the 2003-2018 NHANES and the Linkage Mortality Files, which included adults who smoked ≥ 100 lifetime cigarettes (unweighted n = 5,676). A generalized linear model estimated the association between cigarettes smoked per day (CPD) and weight status (e.g., Body Mass Index (BMI) or Waist Circumference (WC)). An Accelerated Failure Time model with a Weibull distribution estimated the association between CPD and all-cause mortality with weight status as a mediator, adjusting for age, SES, alcohol consumption, race/ethnicity, sex/gender, blood pressure, total cholesterol, and physical activity.

RESULTS

Between 2003-2018, the sample's mean BMI was 27.97 kg/m2, sample's mean WC was 97.58 cm and mean CPD was 13.21. The total effect in the mediation analysis of WC adjusted by BMI levels in the association between CPD and all-cause mortality was -0.44 (95% CI =  -2.00, -0.20; p =  0.016), the average direct effect was -0.35 (95% CI =  -1.86, -0.10; p =  0.036), and the average indirect effect was -0.10 (95% CI =  -0.23, -0.05; p < 0.001).

CONCLUSION

WC, as a surrogate measure of weight status, when adjusted by BMI levels, was a partial mediator between CPD and all-cause mortality. Public health interventions aimed to reduce mortality due to cigarette smoking at the population level should consider weight management programs as a harm reduction strategy to reduce mortality.

Exploring Generative Artificial Intelligence to Enhance Reflective Writing in Pharmacy Education

The integration of generative artificial intelligence (AI) holds the potential to impact teaching and learning. In this commentary, we explore the opportunity for AI to enhance reflective writing (RW) among student pharmacists. AI-guided RW has the potential to strengthen students' reflective capacity, deepen their autobiographical memory, and develop their self-confidence. This commentary presents examples of how AI can be utilized to enrich RW and includes a sample prompt aimed at facilitating student self-reflection. We explore how integrating AI-facilitated RW assignments into the pharmacy curriculum can help students develop detailed examples for self-reflection and gain exposure to the potential uses of AI in their professional development and career advancement.

Analysis of Adherence Status and Influencing Factors Among Middle-Aged and Elderly Hypertension Patients in Rural Areas of Northeast China

Hypertension remains a major public health challenge globally, with suboptimal adherence to treatment and lifestyle modifications exacerbating cardiovascular risks. This study evaluates multidimensional adherence (medication, diet, and behavior) and its determinants among hypertensive patients in rural Northeast China. A cross-sectional study enrolled 6352 adults aged ≥ 40 years with diagnosed and poorly controlled hypertension from rural villages across five cities (Benxi, Chaoyang, Dandong, Donggang, and Fuxin) in Liaoning Province, Northeast China, using multistage cluster sampling. Adherence was assessed via standardized questionnaires, with logistic regression analyzing sociodemographic, clinical, and behavioral predictors. Medication adherence was reported by 73.7% of participants, while dietary and behavioral adherence rates were 10.5% and 29.3%, respectively. Ethnic disparities emerged, with Han Chinese exhibiting lower medication adherence (aOR = 0.485, 95% CI: 0.377-0.624). Cohabiting with children enhanced dietary adherence (aOR = 2.184, 95% CI: 1.854-2.573), whereas widowed status reduced both dietary (aOR = 0.698, 95% CI: 0.528-0.924) and behavioral adherence (aOR = 0.726, 95% CI: 0.595-0.887). Higher hypertension knowledge scores positively influenced all adherence domains (p < 0.05). Adherence among rural hypertensive patients is multidimensional, shaped by cultural, socioeconomic, and behavioral factors. Targeted interventions addressing dietary sodium reduction, family-based support, and health literacy improvement are urgently needed. This study underscores the importance of integrating region-specific strategies into hypertension management programs to mitigate cardiovascular morbidity in high-risk populations.

Cancer risk according to lifestyle risk score trajectories: a population-based cohort study

BACKGROUND

While individual lifestyle behaviors have been associated with cancer risk, combined impact of these factors remains understudied. This research explores relationships between lifestyle risk score trajectories and cancer risk within the Korean population.

METHODS

A cohort of 3,451,189 cancer-free men and women who participated in a health examination between 2002 and 2003, provided by the National Health Insurance, was studied. Lifestyle risk score trajectories were determined using group-based trajectory modeling based on total score of four modifiable unhealthy behaviors: current smoking, heavy alcohol drinking, excess body weight, and physical inactivity repeatedly observed three times between 2002 and 2007. Scores ranged between 0 (low risk) and 8 (high risk). The Cox proportional hazards model was applied to examine the association between these trajectories and cancer incidence.

RESULTS

During the follow-up time (2008-2019), 312,075 cancer cases were identified. Among men, seven trajectories were identified, and trajectories of high lifestyle risk scores increased cancer risk of all cancer combined, cancer subgroupings, upper aero-digestive, stomach, colorectal, liver, gallbladder, pancreatic, lung, and bladder cancer, but inverse relation was observed for prostate cancer. Among women, four trajectory groups showed similar trends.

CONCLUSIONS

Maintaining a healthy lifestyle and avoiding unhealthy behaviors are essential for cancer prevention.

Association between dietary folate and hyperuricemia based on inflammation and cardiovascular disease status

BACKGROUND AND AIMS

The impact of dietary folate intake on serum uric acid is not yet conclusive. This study aims to investigate the association between dietary folate intake and the risk of hyperuricemia according to inflammatory status and comorbidities in Korean adults.

METHODS AND RESULTS

The cross-sectional analysis was conducted on 14,445 subjects aged ≥19 years enrolled in the Korea National Health and Nutrition Examination Survey (KNHNES) from 2016 to 2021. Dietary folate intake was assessed using the 24-h recall method. Dietary folate consumption was positively associated with the intake of beans, vegetables, and fruits, and negatively associated with cereals and meat intake. After adjusting for potential confounders, increased folate intake was found to be associated with a decreased risk of hyperuricemia (odds ratio for the highest tertile compared to the lowest tertile = 0.71 (95 % CI: 0.62-0.82)). The protective effect of folate intake against hyperuricemia was higher in individuals with normal inflammatory status compared to those with low-grade inflammation. Furthermore, the protective effect was greater in individuals without hypertension, dyslipidemia, and cardiovascular disease compared to those with these conditions.

CONCLUSION

These results suggest that dietary intake may help mitigate hyperuricemia, and individuals with inflammatory condition or cardiovascular diseases may require higher intake levels to achieve similar protective effects compared to healthy individuals.

Increased risk of young-onset ovarian cancer in women with non-alcoholic fatty liver disease: A nationwide cohort study of 2.3 million women aged 20-39 years

Little is known about modifiable risk factors for young-onset ovarian cancer, except for obesity and nulliparity. We investigated the association between non-alcoholic fatty liver disease (NAFLD) and the risk of young-onset ovarian cancer. A total of 2,376,482 women aged 20-39 years who underwent national health screening under the Korean National Health Insurance Service between 2009 and 2012 were included in this nationwide cohort study and followed-up until December 2022. The fatty liver index was used as a diagnostic biomarker for NAFLD. The risk was estimated using multivariable Cox proportional hazards models after adjusting for potential confounders. During 26.8 million person-years of follow-up (median: 11.5 years), 6,319 young women were newly diagnosed with young-onset ovarian cancer. The cumulative incidence probability was significantly higher for those with NAFLD than for those without (log-rank P < 0.01). NAFLD was associated with an increased risk of young-onset ovarian cancer (adjusted hazard ratio [aHR], 95% confidence interval [CI]: 1.30, 1.16-1.45). As the severity of NAFLD increased, the risk of young-onset ovarian cancer tended to increase (aHR, 95% CI: Moderate and severe NAFLD; 1.26, 1.12-1.41 and 1.45, 1.22-1.72, respectively; P for trend < 0.01). NAFLD was independently associated with an increased risk of young-onset ovarian cancer. As NAFLD is modifiable, our findings may benefit the next generation by reducing premature morbidity and mortality associated with young-onset ovarian cancer.

Effects of exercise on glycolipid metabolism in adolescents with overweight and obesity: a systematic review and meta-analysis of 26 randomized controlled trials

Objective

The aim of this meta-analysis was to investigate the effect of exercise intervention on glycolipid metabolism in overweight and obese adolescents.

Methods

A systematic review and meta-analysis of randomized trials were conducted. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered (ID: CRD42024623686). Electronic searches were performed using the following databases: Web of Science, PubMed, Scopus, Cochrane and Embase. Randomized controlled trials of exercise interventions were included. Data on fasting blood glucose (FBG), fasting insulin (FINS), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) before and after exercise interventions were extracted for overweight and obese adolescents. Risk of bias was assessed using the Cochrane risk of bias tool. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the quality of the evidence. Standardized mean differences (SMDs) were calculated to compare differences between exercise and conventional control groups. Subgroup analyses were performed to assess whether effects differed by exercise type, intervention duration, supervision, and intervention frequency.

Results

A total of 984 participants (576 in experimental groups and 408 in control groups) were included across 26 studies. The analysis revealed that exercise interventions significantly improved key metabolic parameters: FBG (SMD: -0.42 95% CI [-0.73 to -0.12]), FINS (SMD: -0.81 95% CI [-1.13 to -0.49]), TC (SMD: -0.18 95% CI [-0.34 to -0.01]), TG (SMD: -0.46 95% CI [-0.56 to -0.25]), LDL-C (SMD: -0.28 95% CI [-0.44 to -0.12]), and HDL-C (SMD: 0.26 95% CI [0.11-0.40]). Subgroup analysis indicated that exercise type, supervision and intervention frequency influenced the effectiveness.

Conclusion

The analysis suggests that exercise interventions improve glycolipid metabolism in adolescents with overweight and obesity. Continuous endurance training demonstrated greater efficacy in improving blood glucose parameters, whereas hybrid-type exercise showed advantages in improving lipid metabolism. Engaging in three supervised training sessions weekly may be the optimal approach to enhance glycolipid metabolism in obese adolescents. These findings provide evidence for clinicians and healthcare professionals (e.g., exercise physiologists, physical therapists) to guide exercise prescriptions for obese adolescents, thereby preventing worsening metabolic imbalances.

Significant Impacts of the Body-Mass Index, Blood Pressure, Blood Glucose, and Ankle-Brachial Index on Peripheral Neuropathy Risk in Indonesian With Type 2 Diabetes: A Cross-Sectional Study

Background: Diabetic peripheral neuropathy is associated with morbidity and mortality in people with diabetes mellitus. Aims: In this study, we determined relationships of the body-mass index (BMI), systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, and ankle-brachial index (ABI) with diabetic peripheral neuropathy risk. Methods: A cross-sectional study was conducted with 1088 Indonesians and data collected using self-reported questionnaires, laboratory examinations, and physical examinations. Instruments included a digital scale, height measurement device, digital sphygmomanometer, Doppler ultrasound, 10-g monofilament, and a 128-Hz tuning fork. Data analysis used the Chi-square test, Fisher Exact, and multiple logistic regression test with significance p < .05. Results: The BMI (p < .001), blood pressure (p < .001), ABI (p < .001), fasting blood glucose (p = .016), and HbA1c (p < .001) were significantly related to peripheral neuropathy risk. The conditions of obesity, hypertension, high ABI, high fasting blood glucose, and high HbA1c significantly increased the risk of peripheral neuropathy. Moreover, participants with ≥4 co-occurring abnormal levels of the BMI, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, and ABI had significantly synergistically increased risks of peripheral neuropathy, and the more abnormal conditions there were, the higher the risk of peripheral neuropathy. Conclusions: Abnormalities of the BMI, blood pressure, fasting blood glucose, HbA1c, and ABI significantly and synergistically increased the risk of peripheral neuropathy and can be considered predictors of peripheral neuropathy. Nurses are expected to be aware of these predictors so that they can immediately take appropriate steps if they encounter abnormal conditions by optimizing their role as educators.

Incidence and Associated Risk Factors for Falls in Adults Following Critical Illness: An Observational Study

OBJECTIVE

To explore the incidence of falls and associated risk factors in the first year after hospital discharge in survivors of critical illness.

DESIGN

Prospective single-site observational study.

SETTING

University-affiliated mixed ICU.

PATIENTS

One hundred ICU adults who required invasive ventilation for 48 hours and in an ICU for at least 4 days.

INTERVENTIONS

Not applicable.

MEASUREMENTS AND MAIN RESULTS

Falls were monitored prospectively for 1 year with completion of monthly falls calendars. Falls data included the number of people who had falls/no falls/recurrent falls, falls rate per person per year, and time to first fall. Fall severity was classified according to the Schwenck classification scheme to examine injurious falls requiring medical intervention. Other outcomes considered included assessments of balance, strength, function, cognition, psychologic health, and health-related quality of life. One hundred participants (31% female) were recruited with a mean age of 58.3 ± 16.2 years, and a median ventilation duration of 6.3 days [4.0-9.1]. Sixty-one percent fell at least once in the first year with the majority sustaining two or more falls (81.4%) and one in four sustained an injurious fall requiring medical attention. The falls incidence rate was 4.4 falls per person-year (95% CI, 3.2-5.9), with the highest incidence occurring less than 3 months after hospital discharge (5.9 falls/person-year [95% CI, 4.4-7.8]). Time to first fall or injurious fall was 36 [11-66] and 95 (95% CI, 40-155) days, respectively. Key risk factors for falls at the time of hospital discharge include comorbidities, higher discharge medications, balance, and muscle strength.

CONCLUSIONS

There was a high falls incidence in ICU survivors. The study findings suggest a critical window may exist within the first 3 months after hospital discharge and the need for screening, pharmacological optimization, and exercise training in this patient group.

Effect of intensive nutritional support on functional recovery in subacute stroke: A randomized, multicenter, single-blinded trial

BACKGROUND

Nutrition in the subacute phase of stroke may be a critical factor in functional recovery and post-stroke mortality. Nevertheless, the issue of intensive nutritional support for people with subacute stroke remains insufficiently explored.

OBJECTIVES

This study investigated the effects of intensive nutritional support during rehabilitation on functional recovery in the subacute phase of participants with a first-ever stroke.

METHODS

This randomized, single-blinded, parallel-designed study is part of the Korean Stroke Cohort for Functioning and Rehabilitation, a 10-year long-term follow-up of stroke participants. A total of 91 first-ever stroke participants were recruited from 5 hospitals and randomly allocated to the intensive nutrition (IN) group (n = 43) or the conventional nutrition (CN) group (n = 48). All participants received the same comprehensive inpatient stroke rehabilitation. During the three-week intervention period, the IN group received an additional 500 kcal daily by intravenous nutritional infusion, while both groups received usual nutrition. Functional assessments and nutritional status were evaluated at baseline, post-intervention, and 6 months after stroke onset. Repeated measures ANOVA and post-hoc analyses were used for intention-to-treat analysis.

RESULTS

Baseline characteristics were not significantly different between the groups. The dropout rate was significantly higher in the IN group (20 %) than in the CN group (2 %). A repeated measures ANOVA demonstrated significant interactions between time and intervention for the modified Barthel index (P = 0.02, η² = 0.05, small) and nutrition risk screening 2002 (P = 0.03, η² = 0.03, small), indicating significant improvements in the IN group. The modified Barthel Index, Nutrition Risk Screening 2002, and Functional Ambulation Category demonstrated significantly higher changes in the IN group compared to the CN group between time points.

CONCLUSIONS

Intensive nutritional support during comprehensive rehabilitation could provide additional functional improvement in subacute stroke participants. However, alternative methods of intensive nutrition should be explored, as intravenous nutritional infusions were not well-tolerated by some participants.

CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT04259307.

The Efficacy and Safety of GLP-1 RAs in the Modification of Cardiovascular Morbidity in Patients with Obesity Without Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials Involving 32,884 Patients

BACKGROUND

Although the cardioprotective effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are well documented in patients with diabetes mellitus, their impact on cardiovascular outcomes in patients with obesity without diabetes remains under debate. Therefore, we conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effects of GLP-1 RAs on cardiovascular outcomes in patients with obesity without diabetes.

METHODS

We systematically searched PubMed, Web of Science, SCOPUS, and Cochrane databases through December 26, 2023. We pooled dichotomous data using risk ratios (RRs) and continuous data using mean differences with 95% confidence intervals (CIs). We evaluated the quality of each study using the Cochrane RoB2 method, and the study protocol was registered on PROSPERO ID: CRD42024498538.

RESULTS

We included 19 RCTs with a total of 32,884 patients. Of these, 15 had a low overall risk of bias, two raised concerns, and two had a high risk of bias. There was no difference between GLP-1 RAs and placebo regarding cardiovascular mortality (RR 0.85; 95% CI 0.71-1.01; p = 0.07). However, compared with placebo, GLP-1 RAs significantly decreased the incidence of all-cause mortality (RR 0.82; 95% CI 0.72-0.93; p < 0.0001), non-cardiovascular mortality (RR 0.77; 95% CI 0.63-0.95; p = 0.01), and myocardial infarction (RR 0.73; 95% CI 0.62-0.86; p < 0.0001). Additionally, patients receiving GLP-1 RAs experienced significant overall weight loss (- 8.53 kg; 95% CI - 12.38 to - 4.68; p < 0.0001) and improvements in lipid profiles, including lower levels of total cholesterol (- 0.77 %; 95% CI - 1.03 to - 0.50; p < 0.0001), triglycerides (- 6.78 %; 95% CI - 8.11 to - 5.46; p < 0.0001), low-density lipoproteins (- 2.85 %; 95% CI - 3.74 to - 1.96; p < 0.0001), and very low-density lipoproteins (- 4.47 %; 95% CI - 5.56 to - 3.38; p < 0.0001). GLP-1 RAs also significantly increased the incidence of any adverse events (RR 1.11; 95% CI 1.05-1.16; p < 0.0001), with no difference regarding the incidence of serious adverse events. However, gastrointestinal adverse events were significantly more frequent in patients receiving GLP-1 RAs, with a higher risk of any gastrointestinal adverse events (RR 2.83; 95% CI 1.86-4.3; p < 0.001), nausea (RR 2.70; 95% CI 2.18-3.33; p < 0.001), diarrhea (RR 1.97; 95% CI 1.68-2.31; p < 0.001), vomiting (RR 3.85; 95% CI 3.32-4.48; p < 0.001), and constipation (RR 2.35; 95% CI 1.94-2.85; p < 0.001) than in those receiving placebo.

CONCLUSION

In obese patients without diabetes, GLP-1 RAs demonstrated substantial benefits in reducing cardiovascular risks, including all-cause mortality and myocardial infarction, and effectively promoted weight loss and improved lipid profiles and blood pressure control. However, their use is accompanied by a higher incidence of gastrointestinal adverse effects and heterogeneity in outcomes, highlighting the need for individualized treatment approaches.

REGISTRATION

PROSPERO identifier number: CRD42024498538.

Increased Risk of Early-Onset Endometrial Cancer in Women Aged 20-39 Years with Non-Alcoholic Fatty Liver Disease: A Nationwide Cohort Study

Background/Objectives: Given the rising incidence of early-onset endometrial cancer diagnosed before the age of 50 years, this study examined whether non-alcoholic fatty liver disease (NAFLD) served as an independent risk factor for early-onset endometrial cancer, irrespective of obesity status. Methods: This nationwide cohort study included 2,311,949 Korean women aged 20-39 years who underwent health screenings from 2009 to 2012. NAFLD severity was classified based on the fatty liver index: none (<30), moderate (30-59), and severe (≥60). Multivariable-adjusted Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) for early-onset endometrial cancer. Results: During a median follow-up of 7.6 years, 1289 women developed early-onset endometrial cancer. The cumulative incidence of early-onset endometrial cancer was significantly higher in women with NAFLD than in those without (log-rank p < 0.001). A dose-dependent association was observed, with increased risk corresponding to greater NAFLD severity (aHR [95% confidence interval (CI)]: moderate NAFLD, 2.38 [1.99-2.85]; severe NAFLD, 5.39 [4.44-6.53]; p for trend < 0.01). Compared with non-obese women without NAFLD, the aHRs for early-onset endometrial cancer were 2.53 [2.11-3.05] in non-obese women with NAFLD, 1.66 [1.10-2.52] in obese women without NAFLD, and 4.30 [3.60-5.13] in obese women with NAFLD (synergy index = 1.50, p < 0.01). Conclusions: NAFLD was independently associated with increased risk of early-onset endometrial cancer in both non-obese and obese women. Furthermore, young women with both NAFLD and obesity exhibited a synergistically elevated risk. Early identification and management of NAFLD may help mitigate the rapidly growing burden of early-onset endometrial cancer.

Impact on Metabolism Generated by Surgical and Pharmacological Interventions for Weight Loss in Women with Infertility

Obesity increases the risk of anovulation, insulin resistance, hyperandrogenism, and endometrial dysfunction, resulting in women with infertility and increasing preconceptional and pregnancy complications. Bariatric surgery has been described as the most effective intervention for obesity, with improved fertility outcomes. However, its invasive nature increases the potential of nutritional deficiencies and the need for a delayed conception post-surgery. On the other hand, pharmacological treatments such as glucagon-like-peptide 1 receptor agonists offer non-invasive alternatives with promising results in body weight, improving insulin sensitivity and restoring ovarian function. However, their use must be discontinued before conception due to potential fetal risks. Other available pharmacological treatment options encompass topiramate, phentermine, and Orlistat. The choice of treatment must be individualized considering cost-effectiveness, accessibility, obesity severity, reproductive goals, and associated risks within each patient. A multidisciplinary approach is essential to optimize metabolic and reproductive health in obesity and infertility. This review will examine the impact on metabolism when comparing surgical and pharmacological interventions for weight loss in women with infertility.

Knowledge, attitudes, and practices regarding intrinsic capacity in the elderly population: A cross-sectional study in Shanghai, China

To investigate the knowledge, attitudes, and practices (KAP) of the elderly population regarding their intrinsic capacity, as defined by the World Health Organization as a marker of healthy aging. A cross-sectional study was conducted at the Shanghai Traditional Chinese Medicine Hospital from July to November 2023. Participants' socio-demographic information and KAP scores were collected through a self-designed questionnaire. A total of 507 elderly individuals participated, with 53.25% being male and a mean age of 70.76 ± 7.63 years. The mean knowledge, attitude, and practice scores were 19.58 ± 8.85, 30.07 ± 4.81, and 34.71 ± 7.77, respectively. Pearson's correlation analysis showed significant positive correlations among the KAP scores (all P < 0.001). Multivariate logistic regression indicated that knowledge scores (OR = 1.127, P < 0.001), attitude scores (OR = 1.189, P < 0.001), and current employment status (OR = 2.759, P = 0.009) were associated with proactive practices. Structural equation modeling demonstrated that knowledge had a direct influence on attitude (β = 0.572, P < 0.001) and practice (β = 0.776, P < 0.001), while attitude directly impacted practice (β = 0.412, P < 0.001). The study reveals that the elderly lack knowledge but have positive attitudes and proactive behaviors about intrinsic capacity. Enhancing education and attitudes is vital for healthy aging and well-being.

Positive Association Between the Cardiometabolic Index and the Risk of Male Biochemical Androgen Deficiency in Adults

Metabolic disorders are associated with testosterone deficiency, and the cardiometabolic index (CMI) is a recently identified metabolic indicator. The relationship between male biochemical androgen deficiency (MBAD), a precursor to testosterone deficiency, and CMI remains unclear. In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 to investigate the relationship between MBAD and CMI in men. This study included 1229 participants; among which, 209 participants had MBAD. Machine learning models identified that the importance of CMI on MBAD was in the top three. After adjusting for all covariates, we found a positive association between CMI and MBAD. Restricted cubic spline (RCS) curves validated this association both in age and body mass index subgroups. Trend regression showed that participants with a higher CMI tended to have a higher risk of MBAD. The positive association between CMI and MBAD persisted after multiple interpolations, validating the robustness of the results. Altogether, this study suggests that CMI exhibits a stable positive relationship with MBAD.

Monofilament testing to identify insensate regions of the residual limb of individuals with transtibial amputation

INTRODUCTION

Living with a lower limb amputation is a life-altering complication. This condition is often associated with a high prevalence of pressure ulcers and skin breakdown at the interface between the prosthetic socket and the residual limb. The purpose of this study was to describe a monofilament test method for identifying areas that lack protective sensation in individuals with transtibial amputation (TTA).

METHODS

Fifteen males and 5 females with TTA were evaluated using a standard 5.07/10 g monofilament test, which was adapted to test sensation at 10 locations on the residual limb.

RESULTS

Thirty-five percent of the participants experienced loss of protective sensation on their distal anterior tibial crest, 50% of the participants had absent sensation along their incision line, and 20% of the participants experienced loss of sensation at the center of the distal end of the limb. The test method showed excellent intrarater reliability (Kappa = 1).

CONCLUSIONS

Implementing a monofilament test is a reliable and practical option for practitioners to use in testing for loss of protective sensation in TTA because of the ease and speed of the test, as well as its low cost and potential for standardization.

A comprehensive review of Schisandra chinensis lignans: pharmacokinetics, pharmacological mechanisms, and future prospects in disease prevention and treatment

Lignans derived from Schisandra chinensis have attracted significant attention for their diverse pharmacological activities and clinical potential. This review presents a comprehensive analysis of the pharmacological properties of Schisandra chinensis lignans, including their antioxidant, anti-inflammatory, neuroprotective, hepatoprotective, antibacterial/viral, antidiabetic and anticancer effects. Their multifaceted mechanisms of action hold promise for therapeutic areas such as cancer, neurodegenerative diseases and metabolic disorders, aligning with urgent clinical needs. Additionally, this review explores the pharmacokinetics of these bioactive compounds, highlighting challenges in their absorption, distribution, metabolism and excretion, which impact their bioavailability. Recent advancements in drug delivery systems are discussed, highlighting their potential to enhance therapeutic efficacy in clinical settings. Furthermore, the synergistic effects of combining these lignans with other therapeutic agents are considered a strategy to increase their efficacy. Future research is imperative to identify additional active components and elucidate novel mechanisms of action, paving the way for expanded therapeutic applications and unlocking the full clinical potential of Schisandra chinensis in disease prevention and treatment.

A Comparative Evaluation of Adiposity Indices for Predicting Visceral Adipose Tissue Magnitude: Insights from NHANES 2011-2018

Background and Aims: Visceral adipose tissue (VAT) is a key cardiometabolic risk factor. This study evaluates the association between VAT and adiposity indices and identifies reliable predictors of increased VAT. Methods: This cross-sectional study utilized data from 4696 participants in the National Health and Nutrition Examination Survey 2011-2018. VAT was measured via dual-energy X-ray absorptiometry. Adiposity indices included body mass index (BMI), waist circumference (WC), lipid accumulation product, visceral adiposity index, body shape index, body roundness index, and metabolic score for visceral fat (METS-VF). Correlation analysis, receiver operating characteristic curve analysis, and multivariate adaptive regression splines (MARS) modeling evaluated the performance of indices and identified key predictors of VAT. Results: All adiposity indices were significantly correlated with VAT (P < 0.001). Among them, METS-VF demonstrated the highest predictive performance for increased VAT (>130 cm2) followed by WC. Optimal cutoff values for METS-VF were 7.1 [areas under the curve (AUC): 0.887, 95% confidence interval (CI): 0.873-0.899] in men and 7.5 (AUC: 0.904, 95% CI: 0.891-0.916) in women. For WC, the cutoff values were 99.5 cm (AUC: 0.866, 95% CI: 0.851-0.879) in men and 96 cm (AUC: 0.883, 95% CI: 0.869-0.896) in women. MARS modeling identified race, age, WC, BMI, glucose, high-density lipoprotein cholesterol, and triglycerides as significant predictors of VAT, achieving an R2 of 75.2%. Conclusion: METS-VF demonstrated the highest predictive value among the indices evaluated for predicting increased VAT. It may serve as a valuable tool in assessing visceral obesity and associated cardiometabolic risks.

Recent Advances in Drug Development for Hair Loss

Hair loss disorders pose a substantial global health burden, affecting millions of individuals and significantly impacting quality of life. Despite the widespread use of approved therapeutics like minoxidil and finasteride, their clinical efficacy remains limited. These challenges underscore the pressing need for more targeted and effective therapeutic solutions. This review examines the latest innovations in hair loss drug discovery, with a focus on small-molecule inhibitors, biologics, and stem cell-based therapies. By integrating insights from molecular mechanisms and leveraging advancements in research methods, the development of next-generation therapeutics holds the potential to transform the clinical management of hair loss disorders. Future drug development for hair loss disorders should prioritize antibody therapy and cell-based treatments, as these approaches offer unprecedented opportunities to address the limitations of existing options. Antibody therapies enable precise targeting of key molecular pathways involved in hair follicle regulation, providing highly specific and effective interventions. Similarly, cell-based therapies, including stem cell transplantation and dermal papilla cell regeneration, directly address the regenerative capacity of hair follicles, offering transformative potential for hair restoration.

Trends of hospice utilization in Korea before and after the COVID- 19 pandemic in patients with cancer: an interrupted time series analysis using nationwide data

PURPOSE

The coronavirus disease (COVID- 19) outbreak has impacted hospice care. This study investigated the impact of the pandemic on the rate and average length of hospice utilization in patients with end-stage cancer.

METHODS

Data from the 2017 to 2022 National Hospice and Palliative Care registry and the cause-of-death statistics were used. The study population included patients with end-stage cancer who received hospice care. Outcome measures were the monthly utilization rate and length of hospice care. An interrupted time series analysis was performed to compare outcome measures before and after the pandemic, set at January 2020. The pre-intervention period was set from August 2017 to December 2019, and the post-intervention period was set from February 2020 to December 2022.

RESULTS

The study population included 88,753 individuals. Total hospice utilization rate showed an increasing pre-intervention trend, at a rate of 0.2500 per month (p < 0.0001). The post-intervention trend decreased at a rate of - 0.2634 per month (p < 0.0001). However, the post-intervention slope did not show a significant trend. Total length of utilization showed a decreasing pre-intervention trend, at a rate of - 2.2160 days (p = 0.0001). The post-intervention trend decreased at a rate of - 0.0003 (p < 0.0001), and the post-intervention slope also decreased at a rate of - 0.0001 (p < 0.0001).

CONCLUSION

The pandemic has led to a general decrease in total hospice utilization and average length of utilization. Policies on end-of-life care should be strengthened to ensure adequate provision of hospice care.

The pharmacodynamics-based prophylactic benefits of GLP-1 receptor agonists and SGLT2 inhibitors on neurodegenerative diseases: evidence from a network meta-analysis

BACKGROUND

Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a new generation of antihyperglycemic agents that operate through mechanisms distinct from conventional diabetes treatments. Beyond their metabolic effects, these medications have demonstrated neuroprotective properties in preclinical studies. While clinical trials have explored their therapeutic potential in established neurodegenerative conditions, their role in disease prevention remains unclear. We conducted a network meta-analysis (NMA) to comprehensively evaluate the prophylactic benefits of these agents across multiple neurodegenerative diseases and identify the most promising preventive strategies.

METHODS

We systematically searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov through October 24th, 2024, for randomized controlled trials (RCTs) of GLP-1 receptor agonists or SGLT2 inhibitors. Our primary outcome was the incidence of seven major neurodegenerative diseases: Parkinson's disease, Alzheimer's disease, Lewy body dementia, multiple sclerosis, amyotrophic lateral sclerosis, frontotemporal dementia, and Huntington's disease. Secondary outcomes included safety profiles assessed through dropout rates. We performed a frequentist-based NMA and evaluated risk of bias with Risk of Bias tool. The main result of the primary outcome in the current study would be re-affirmed via sensitivity test with Bayesian-based NMA.

RESULTS

Our analysis encompassed 22 RCTs involving 138,282 participants (mean age 64.8 years, 36.4% female). Among all investigated medications, only dapagliflozin demonstrated significant prophylactic benefits, specifically in preventing Parkinson's disease (odds ratio = 0.28, 95% confidence intervals = 0.09 to 0.93) compared to controls. Neither GLP-1 receptor agonists nor other SGLT2 inhibitors showed significant preventive effects for any of the investigated neurodegenerative conditions. Drop-out rates were comparable across all treatments.

CONCLUSIONS

This comprehensive NMA reveals a novel and specific prophylactic effect of dapagliflozin against Parkinson's disease, representing a potential breakthrough in preventive neurology. The specificity of dapagliflozin's protective effect to Parkinson's disease might rely on its highly selective inhibition to SGLT2. These findings provide important direction for future research and could inform preventive strategies for populations at risk of Parkinson's disease.

TRIAL REGISTRATION

PROSPERO CRD42021252381.

The association between visceral adiposity index and long-term all-cause mortality shows age-related disparities: a nationwide cohort study

BACKGROUND

The prevalence of obesity has increased rapidly worldwide over the past few decades and remains a recognized public health concern. However, studies exploring visceral adiposity index (VAI), a sex-specific indicator reflecting visceral fat distribution and function, and long-term mortality are limited. This study aimed to investigate the association of VAI with long-term all-cause mortality among general adults in the United States.

METHODS

This cohort study used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Participants were linked to National Death Index mortality data through December 31, 2019. Weighted Cox proportional hazards regression model was used to calculate hazard ratios (HRs) and 95% CIs, and restricted cubic spline (RCS) was also conducted.

RESULTS

A total of 21,943 US adults (weighted mean age, 46.9 years; 10,921 males [weighted, 49.1%]) were included. During 211,473 person-years of follow-up (median follow‑up: 9.3 years), 3326 total deaths occurred. After multivariable adjustments, compared with the 3rd quintile (Q3) of VAI, participants in the 2nd (Q2) and 5th (Q5) quintiles were at a significantly higher risk of all-cause mortality (HR 1.16 [95% CI, 1.00-1.34] and HR 1.15 [95% CI, 1.01-1.31], respectively). RCS revealed a U-shaped relationship of log2-transformed VAI to all-cause mortality (P for nonlinearity < 0.001), with an inflection point of 0.824. Subgroup analysis indicated that there was a significant interaction of VAI with age on all-cause mortality (P for interaction = 0.005). Higher VAI levels were associated with higher all-cause mortality in younger adults (Q5 vs. Q3, HR 1.56 [95% CI, 1.12-2.18], P = 0.009) rather than older adults (Q5 vs. Q3, HR 1.05 [95% CI, 0.91-1.22], P = 0.497).

CONCLUSIONS

In the nationally representative cohort of US adults, VAI was nonlinearly associated with long-term all-cause mortality and the association showed age-related disparities. A higher VAI was related to a higher mortality risk in younger adults. These findings underscore the importance of appropriate VAI for long-term health outcomes, especially for young adults.

The prevalence of metabolic syndrome in patients with non-alcoholic fatty liver disease in primary care clinics at King Saud University Medical City, Riyadh, Saudi Arabia

Background

Metabolic syndrome is present in a subset of individuals harboring a constellation of metabolic risk factors that heightens their likelihood of developing coronary artery disease. Non-alcoholic fatty liver disease (NAFLD) manifests through the incremental accumulation of fat within liver cells in the absence of secondary causes. NAFLD has long been recognized as the hepatic manifestation of metabolic syndrome. Our study seeks to ascertain the prevalence of metabolic syndrome among NAFLD patients at King Khalid University Hospital and to explore the factors associated with metabolic syndrome.

Method and design

We conducted a retrospective study targeting 1,173 patients diagnosed with NAFLD at King Khalid University Hospital in Riyadh, Saudi Arabia, from March 2020 to March 2021. NAFLD diagnosis was made based on ultrasonographic evidence of a fatty liver, excluding other liver ailments and alcohol intake. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria, which require at least three of five metabolic risk factors to be present. Statistical analysis was performed using chi-square tests for categorical variables and independent t-tests for continuous variables, with a significance level set at p < 0.05.

Results

Out of 1173 NAFLD participants evaluated, 38.2% met the NCEP/ATPIII criteria for metabolic syndrome. Additionally, 23.8% had at least one metabolic syndrome component coinciding with their ultrasonographically confirmed NAFLD diagnosis. The incidence of NAFLD was not linked to gender. Married individuals constituted a higher percentage (42.8%) of the NAFLD cohort. Elevated blood glucose and triglyceride levels, along with reduced HDL levels, were predominantly observed among the metabolic syndrome components in NAFLD patients.

Conclusion

A significant portion of the NAFLD patient population was concurrently affected by metabolic syndrome. There exists a marked interrelationship between NAFLD and the components of metabolic syndrome. Regular metabolic disorder screenings are recommended for this patient group.

Blood pressure can be seriously elevated during botulinum toxin A detrusor injection

INTRODUCTION

Botulinum toxin A detrusor injection (BoNT/A-DI) is used in patients with overactive bladder (OAB) or neurogenic bladder due to multiple sclerosis (MS) or after spinal cord injury. The procedure is generally performed under local anaesthesia. We examined the influence of BoNT/A-DI on blood pressure, the most important autonomic parameter in awake patients, as a potential risk factor for cardiovascular events.

MATERIAL & METHODS

Patients with OAB or spontaneous voiding with neurogenic detrusor overactivity (NDO) due to MS in whom BoNT/A-DI was planned under local anaesthesia, vital parameters (systolic, diastolic, and mean blood pressure; heart rate; and rate pressure product [RPP]) were recorded before, during, and after the procedure. Participants with and without previously known hypertension were compared, along with those with initial versus repeat injections, with a focus on the high-risk group, which comprised the 20% of patients with the highest baseline blood pressure values.

RESULTS

Seventy patients were included (mean age: 64.0, median age: 66, range: 27-86 years), and two were excluded because their initial blood pressure values were too high. Sixty patients had OAB, and eight had NDO due to MS; twenty-two patients had a history of hypertension. A total of 40 patients received the first injection, and 28 received a repeat injection. Systolic blood pressure increased significantly by an average of 9.8 mmHg. However, in the hypertensive patients, systolic blood pressure rose by an average of 19.4 mmHg; isolated peak systolic values rose by up to 232 mmHg, and peak diastolic values rose by up to 128 mmHg. Cardiac stress (measured by rate pressure product [RPP]) in these patients increased significantly (RPP = 17.6 versus 7.2 in the non-hypertensive group). In the 20% of patients with the highest resting blood pressure values, systolic blood pressure rose to an average of 187.4 mmHg (15.1 mmHg compared with resting blood pressure), and cardiac workload increased by 17. No significant differences were observed between patients who received initial and repeat injections.

CONCLUSIONS

Clinicians who administer BoNT/A-DI should monitor blood pressure during the procedure and be aware of the risk of potentially significantly elevated blood pressure values during BoNT/A DI, especially in patients with a medical history of hypertension. Significantly elevated pre-interventional blood pressure values should receive an internal medicine consultation timely before the intervention to prevent cardiovascular risks.

Association between physical activity and quality of life in Japanese adults aged 85 to 89 years: a cross-sectional study

BACKGROUND

Associations between physical activity (PA) and quality of life (QOL) have usually been studied in people in their 60s and 70s, however little is known about these associations in older age groups. We aimed to examine the association between PA and QOL in Japanese adults aged 85-89 years and investigate the types of exercises/sports in this population.

METHODS

This cross-sectional study (n = 914) used baseline data from the Kawasaki Aging and Well-being Project (KAWP), a longitudinal cohort study of older adults aged 85-89 years. Health-related QOL and psychological well-being were assessed using the EuroQoL 5D-5L (EQ-5D-5L) and the WHO Five Well-Being Index (WHO-5), respectively. PA was objectively and subjectively measured using a triaxial accelerometer and modified Zutphen Physical Activity Questionnaire, respectively. Associations were analyzed using multivariable regression analysis.

RESULTS

Higher PA was significantly associated with a higher EQ-5D-5L index score (coefficient, 0.004; 95%CI [0.001, 0.008], standardized coefficient, 0.142). In contrast, no association was observed between PA and the WHO-5 total score (coefficient, 0.103; 95%CI [-0.066, 0.271], standardized coefficient, 0.068). Calisthenics were the most commonly performed sports or exercises (27.4% of male and 47.6% of female participants). The subgroup of participants with > median PA had a longer walking duration than their counterparts, and the following sports/exercises were more frequently performed in addition to calisthenics; resistance training and others among male participants: stretching/yoga among female participants.

CONCLUSIONS

Our findings suggest that PA is associated with a better health-related QOL. However, no association was observed between PA and psychological well-being in this population. We found that calisthenics were the most commonly performed and that more physically active older adults performed several types of exercises/sports in addition to calisthenics and walking for longer durations. Since few studies have investigated the types of exercises/sports in this age group, these findings would be helpful for interventions to maintain PA and QOL in this age group.

TRIAL REGISTRATION

UMIN000026053.

MicroRNAs as Epigenetic Biomarkers of Pathogenetic Mechanisms of the Metabolic Syndrome Induced by Antiseizure Medications: Systematic Review

Antiseizure medication (ASM) induced metabolic syndrome (AIMetS) is a common adverse drug reaction (ADR) of pharmacotherapy for epilepsy and psychiatric disorders. However, the sensitivity and specificity of blood biomarkers may be insufficient due to the influence of combined pathology, concomitant diseases, and the peculiarities of the metabolism of ASMs in patients with epilepsy. Methods: The presented results of experimental and clinical studies of microRNAs (miRs) as epigenetic biomarkers of MetS and AIMetS, which were entered into the different databases, were analyzed for the last decade (2014-2024). Results: A systematic review demonstrated that miRs can act as promising epigenetic biomarkers of key AIMetS domains. However, the results of the review demonstrated the variable role of various miRs and their paralogs in the pathogenesis of AIMetS. Therefore, as part of this study, an miRs signature was proposed that allows us to assess the risk of developing and the severity of AIMetS as low risk, medium risk, and high risk. Conclusions: The mechanisms of development and biomarkers of AIMetS are an actual problem of epileptology, which is still far from being resolved. The development of panels (signatures) of epigenetic biomarkers of this widespread ADR may help to increase the safety of pharmacotherapy of epilepsy. However, to increase the sensitivity and specificity of circulating miRs in the blood as biomarkers of AIMetS, it is necessary to conduct "bridge" studies in order to replicate the results of preclinical and clinical studies into real clinical practice.

Optimization of Cardiovascular Care: Beyond the Guidelines

Scientific cardiac and vascular societies provide essential guidelines tailored to broad patient populations [...].

Semaglutide 2.4 mg long-term clinical outcomes in patients with obesity or overweight: a real-world retrospective cohort study in the United States (SCOPE 12 months)

OBJECTIVES

To evaluate the effectiveness of semaglutide 2.4 mg for weight reduction and improvement in cardiometabolic biomarkers at 52 and 68 weeks in a real-world setting in the United States.

METHODS

This noninterventional, retrospective cohort study used the Komodo Health database and included adults with obesity or overweight with ≥1 weight-related condition who initiated treatment with semaglutide 2.4 mg between June 2021 and August 2022 and remained on treatment for 1 year. A paired t-test was used to assess changes in weight, body mass index (BMI), and cardiometabolic biomarkers (systolic blood pressure [SBP], diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], HDL [high-density lipoprotein] cholesterol, LDL [low-density lipoprotein] cholesterol, and triglycerides) from baseline to 52-week and 68-week follow-up.

RESULTS

Among 4,424 eligible patients, 77% were women and the mean (SD) age was 46.7 (10.0) years and BMI was 36.6 (3.6) kg/m2. Dyslipidemia and hypertension were the most common obesity-related comorbidities at baseline. The mean (%) change in weight from baseline was -15.5 kg (-14.5%; p < 0.001; n = 594) at 52 weeks and -15.9 kg (-14.8%; p < 0.001; n = 391) at 68 weeks. The mean change in BMI from baseline was - 4.8 kg/m2 (n = 1124) at 52 weeks and - 4.9 kg/m2 (n = 700) at 68 weeks. At 52weeks, statistically significant improvements in mean values were observed for SBP (-6.3 mmHg), DBP (-3.1 mmHg), HbA1c (-0.4%), LDL cholesterol (-8.1 mg/dL), and triglycerides (-38.4 mg/dL) (all p < 0.001). Mean change at 52 weeks for HDL cholesterol was 1.0 mg/dL; p = 0.109. Results at 68 weeks were similar.

CONCLUSIONS

In this retrospective cohort study, the real-world effectiveness of semaglutide 2.4 mg was demonstrated by reductions in weight and BMI along with improvements in BP, HbA1c, and lipid panel among patients with obesity or overweight.

Development of a sex-specific visceral fat area estimation using discrete multi-wavelength near-infrared spectroscopy measurements in Korean individuals

BACKGROUND/OBJECTIVES

A high level of visceral fat area (VFA) is associated with obesity and cardiometabolic risk factors. VFA measured by computer tomography (CT) scan is accurate but has limitations for everyday use. Meanwhile, near-infrared (NIR) light penetrates the superficial layers of the human body so that fat content can be measured just as CT imaging measures fat accumulation.

SUBJECTS/METHODS

This study evaluated whether discrete multi-wavelength NIR spectroscopy (DMW-NIRS) can be used to measure abdominal fat as a satisfactory alternative to a CT scan. 290 subjects were enrolled in this study, and each subject underwent DMW-NIRS NIR measurement and CT scan. A sex-specific DMW-NIRS-based VFA estimation formula was developed by multiple linear regression, including lipid density, age, and body mass index (BMI).

RESULTS

The model of DMW-NIRS estimated VFA gave the least Akaike Information Criterions (AIC), Root Mean Squared Errors (RMSE), and the greatest Coefficient of determination (R2) to predict VFA (1199, 29.5, 0.544 in female, and 1714, 41.3, 0.504 in male, respectively). Also, the DMW-NIRS estimated that VFA was highly performed to determine visceral obesity, which is comparable with other obesity surrogates.

CONCLUSIONS

This study suggested that lipid density can be used as a valid, noninvasive method to determine visceral obesity.

Vestibular neurons link motion sickness, behavioural thermoregulation and metabolic balance in mice

Motion sickness is associated with thermoregulation and metabolic control, but the underlying neural circuitry remains largely unknown. Here we show that neurons in the medial vestibular nuclei parvocellular part (MVePC) mediate the hypothermic responses induced by motion. Reactivation of motion-sensitive MVePC neurons recapitulates motion sickness in mice. We show that motion-activated neurons in the MVePC are glutamatergic (MVePCGlu), and that optogenetic stimulation of MVePCGlu neurons mimics motion-induced hypothermia by signalling to the lateral parabrachial nucleus (LPBN). Acute inhibition of MVePC-LPBN circuitry abrogates motion-induced hypothermia. Finally, we show that chronic inhibition of MVePCGlu neurons prevents diet-induced obesity and improves glucose homeostasis without suppressing food intake. Overall, these findings highlight MVePCGlu neurons as a potential target for motion-sickness treatment and obesity control.

Novel pharmacotherapies for weight loss: Understanding the role of incretins to enable weight loss and improved health outcomes

Obesity and type 2 diabetes mellitus (T2D) are widespread diseases that significantly impact cardiovascular and renal morbidity and mortality. In the recent years, intensive research has been performed to assess the role of adipose tissue and body fat distribution in the development of metabolic and non-metabolic complications in individuals with obesity. In addition to lifestyle modifications, glucagon-like peptide-1 receptor agonists (GLP-1-RA) have become a meaningful treatment expansion for the management of both disorders. In addition to improving metabolic control and reducing body weight, treatment with GLP-1-RAs reduces cardiovascular and renal events in individuals with obesity with and without diabetes. These important benefits of GLP-1-RAs have triggered new interest in other enteroendocrine and enteropancreatic peptides for treating obesity and its metabolic and non-metabolic consequences. The first peptide dual-agonist targeting glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors has been approved for the treatment of T2D and obesity. GIP/GLP-1 dual-agonism appear to provide better metabolic control and greater weight reduction compared with GLP-1-R mono-agonism. Other peptide and non-peptide co-agonists are in clinical development for obesity, T2D, metabolic dysfunction-associated steatotic liver disease (MASLD) and other metabolic disorders. This narrative review aims to summarize the available data on approved and emerging enteroendocrine and enteropancreatic based treatment approaches for obesity and metabolic disorders. In addition to available clinical efficacy measures, side effects, limitations and open challenges will also be addressed.

The methyl-CpG-binding protein 2 (Mecp2) regulates the hypothalamic mitochondrial function and white adipose tissue lipid metabolism

OBJECTIVE

The neuroepigenetic factor Mecp2 regulates gene expression and is thought to play a crucial role in energy homeostasis. Body weight is regulated at the hypothalamic level, where mitochondrial energy metabolism is necessary for its proper functioning, allowing the hypothalamus to respond to peripheral signals to maintain energy balance and modulate energy expenditure through the sympathetic nervous system. Since the mechanism by which genetic and environmental factors contribute to regulating energy balance is unclear, this study aims to understand the contribution of gene-environment interaction to maintaining energy balance and how its disruption alters hypothalamic cellular energy production, impacting the control of systemic metabolism.

METHODS

We used a mouse model of epigenetic disruption (Mecp2-null) to evaluate the impact of Mecp2 deletion on systemic and hypothalamic metabolism using physiological and cellular approaches.

RESULTS

Our study shows that the previously reported body weight gain in mice lacking the expression of Mecp2 is preceded by a hypothalamic mitochondrial dysfunction that disrupts hypothalamic function, leading to a dysfunctional communication between the hypothalamus and adipose tissue, thus impairing lipid metabolism. Our study has revealed three crucial aspects of the contribution of this critical epigenetic factor pivotal for a proper gene-environment interaction: i) Mecp2 drives a molecular mechanism to maintain cellular energy homeostasis, which is necessary for the proper functioning of the hypothalamus. ii) Mecp2 is necessary to maintain lipid metabolism in adipose tissue. iii) Mecp2 is a molecular bridge linking hypothalamic cellular energy metabolism and adipose tissue lipid metabolism.

CONCLUSIONS

Our results show that Mecp2 regulates the hypothalamic mitochondrial function and white adipose tissue lipid metabolism and probably alters the communication between these two tissues, which is critical for corporal energy homeostasis maintenance.

Exploring Glucagon-Like Peptide-1 Receptor Agonists Usage Among Non-Diabetic Healthcare Providers: A Cross-Sectional Multi-Country Study

Background and Aim

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) were initially developed for type 2 diabetes but have gained widespread use for weight management, including among non-diabetic individuals. This study aimed to estimate the prevalence of GLP-1RA use, describe usage patterns, and explore healthcare providers' (HCPs) perceptions of their efficacy and safety.

Methods

A cross-sectional study was conducted among 657 HCPs from 10 countries using a structured online survey between September and December 2023. Convenience sampling was employed, statistical analyses were performed using STATA 17. Associations between demographic characteristics and perceptions of GLP-1RAs were analyzed using the chi-square test.

Results

Among 657 HCPs, 59.2% were female and 40.8% were male, with a median age of 36.0 years (IQR: 29.0-44.0) and a median BMI of 26.7 (IQR: 23.8-30.7). Among professional groups, nurses accounted for 44.7%, followed by physicians (36.2%) and allied health professionals (18.7%). Semaglutide (45.7%, 95% CI: 41.8%-49.5%) was the most commonly used GLP-1RA, followed by Liraglutide (36.9%, 95% CI: 33.2%-40.8%). Other GLP-1RAs were used less frequently, including Dulaglutide (17.0%, 95% CI: 14.2%-20.1%), Exenatide (14.1%, 95% CI: 11.5%-17.0%), Albiglutide (7.0%, 95% CI: 5.1%-9.2%), and Lixisenatide (8.5%, 95% CI: 6.5%-10.9%. Regarding perceived safety, 68.6% considered GLP-1RAs safe. Safety perceptions were significantly associated with educational level (p = 0.022), with participants holding higher degrees being more likely to perceive GLP-1RAs as unsafe (18.3%) compared to those with a bachelor's degree or lower (10.8%). No associations were found with age (p = 0.487), sex (p = 0.729), or BMI (p = 0.089). Similarly, 73.5% of participants considered GLP-1RAs effective for perceived efficacy. No associations were found with sex (p = 0.663) or BMI (p = 0.446). Older participants (p = 0.011) and those with higher education (p = 0.006) were more likely to perceive GLP-1RAs as ineffective.

Conclusion

This study provides the first prevalence estimate of GLP-1RA use among HCPs and GLP1-Ras users and explores the associations between demographic characteristics and perceptions of safety and efficacy. The findings highlight the self-prescribing practices of these medications for weight management and underscore the need for appropriate monitoring to avoid potential health risks.

Efficacy of Oral Medication in Weight Loss Management: A Systematic Review and Network Meta-Analysis

PURPOSE

This systematic review was conducted to determine which type of oral medication for obesity provides the best weight loss effect.

METHODS

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline. For this systematic review, we used 3 databases for journal searches: PubMed, ScienceDirect, and Scopus. This study only included randomized controlled trials or open-label clinical trials. There was no year limit used in the journal search for this systematic review.

FINDINGS

Eighteen randomized controlled trials, with a total population of 12,259 patients, were included. Of 18 studies, 15 were used for network meta-analysis. Based on the results of the network meta-analysis, weight loss was found in phentermine/topiramate (mean difference [MD], -3.28; 95% CI, -4.47 to -2.09), semaglutide (MD, -2.92; 95% CI, -4.38 to -1.46), phentermine (MD, -2.31; 95% CI, -3.82 to -0.81), naltrexone/bupropion (MD, -1.68; 95% CI, -2.87 to -0.49), topiramate (MD, -1.67; 95% CI, -2.86 to -0.48), and orlistat (MD, -1.44; 95% CI, -2.32 to -0.55). There were no significant differences among the groups. However, compared with placebo, all oral obesity therapies provide better benefits in weight loss (MD, -2.12; 95% CI, -2.64 to -1.59; P ≤ 0.00001).

IMPLICATIONS

Oral antiobesity drugs provide better weight loss than placebo. However, some side effects can be incurred by utilizing the drug for weight loss, especially related to the gastrointestinal system. Nonetheless, in clinical settings, consideration should be given to particular patients to reduce risk of side effects.

Real-world cross-sectional study evaluating patient characteristics, disease burden, and treatment approaches in people with obesity disease in Japan

AIM

To describe clinical characteristics, disease burden, and treatment patterns among people with obesity disease (PwOD) in Japan, using data from the Adelphi Real World Obesity Disease Specific Programme™ (DSP).

METHODS

Secondary data from the Japanese DSP cohort (July to December 2022) were analyzed. PwOD had a BMI ≥25 kg/m2 and ≥1 obesity-related complications (ORCs). Outcomes were summarized for all PwOD or stratified by obesity class (BMI ≥25-<35 or ≥35 kg/m2 [high-degree obesity disease]) and use of anti-obesity medications (AOMs).

RESULTS

The study included 442 PwOD (mean age: 52.8 years; 54.8% males; BMI ≥25-<35 kg/m2: 64.5%; BMI ≥35 kg/m2: 35.5%; AOM users: n = 228; non-AOM users: n = 214). High-degree obesity disease was associated with worsened SF-36v2 scores (Physical Component Summary, Physical Functioning, Bodily Pain, and General Health), greater activity impairment, and reduced work productivity. Common weight management approaches were diet (79.9%) and exercise (51.1%). Common prescription AOMs included traditional herbal medicine (67.5%) and mazindol (21.1%). People with high-degree obesity disease (BMI ≥35 vs. ≥25-<35 kg/m2) used more prescription AOMs (57.3 vs. 48.4%), behavioral therapy (9.6 vs. 1.8%), and weight loss surgery (2.6 vs. 0.4%). The difference in weight reduction between AOM and non-AOM users was modest.

CONCLUSIONS

People with high-degree obesity disease experienced greater disease burden. Diet and exercise are common for weight management, while behavioral therapy is less frequently implemented. These findings highlight the challenges and unmet medical needs in treating obesity in Japan and could inform better treatment strategies in Japan and globally among the Asian population.

Evaluating the Effects of Sensorimotor Training on the Physical Capacities of Older People

BACKGROUND

Physical activity (PA) plays a crucial role in improving the quality of life (QoL) in older people, particularly by enhancing their balance and movement coordination.

OBJECTIVE

This study aimed to assess the effects of sensorimotor training intervention in older adults.

METHODS

A total of 90 participants, divided into a Control Group (n = 44) and Experimental Group (n = 46) were involved in a 24-week sensorimotor training program. The physical capacities of the participants were assessed both before and after the intervention program. Strength and flexibility were measured using the "Rikli and Jones" protocol (1999), while agility and speed were assessed through "Timed-up-and-go" tests. Taking into account the participants' gender, a descriptive analysis of the sample was conducted to describe the data using the mean and standard deviation. Student's T test was performed to compare the differences between the groups according to the first and second data collection moments (before and after the intervention). Jamovi software (v. 2.5.2.0) was used to develop the statistical analysis, using a p-value of less than 0.05 to assess the statistical significance.

RESULTS

The Experimental Group showed significant improvements across all the analyzed variables following the intervention (p < 0.005), indicating substantial gains in physical capacities. In contrast, the Control Group in the "sitting and reaching" test did not show a significant difference between the groups highlighting the lack of improvement without intervention. According to the effect size of the sample, it was observed that the parameters "reach behind your back (right)" and "reach behind your back (left)" showed the highest effect size comparing the Control Group and Experimental Group (ES: 0.60, 0.71).

CONCLUSIONS

The findings highlight the practical clinical impact of implementing tailored physical activity programs for older adults. Such interventions are critical for enhancing QoL, reducing the risk of falls, injuries, and chronic illnesses, and promoting overall health, independence, and well-being. Integrating sensorimotor training into the routine care for older people can support healthy aging and functional independence.