The global obesity pandemic: shaped by global drivers and local environments

Understanding the dynamics driving obesity in socioeconomically deprived urban neighbourhoods: an expert-based systems map

BACKGROUND

Over the past decades, the prevalence of obesity among adults has rapidly increased, particularly in socioeconomically deprived urban neighbourhoods. To better understand the complex mechanisms behind this trend, we created a system map exposing the underlying system driving obesity prevalence in socioeconomically deprived urban neighbourhoods over the last three decades in the Netherlands.

METHODS

We conducted Group Model Building (GMB) sessions with a group of thirteen interdisciplinary experts to develop a Causal Loop Diagram (CLD) of the obesogenic system. Using system-based analysis, the underlying system dynamics were interpreted.

RESULTS

The CLD demonstrates the food environment, physical activity environment, socioeconomic environment and socio-political environment, and their interactions. We identified the following overarching reinforcing dynamics in the obesogenic system in socioeconomically deprived urban neighbourhoods: (1) adverse socioeconomic conditions and an unhealthy food environment reinforced each other, (2) increased social distance between social groups and adverse socioeconomic conditions reinforced each other and (3) increased social distance between institutions and communities and the normalisation of unhealthy behaviours reinforced each other. These deeper system dynamics further reinforced chronic stress, sedentary behaviour, sleeping problems, unhealthy diets and reduced physical activity over time. In turn, these dynamics led to the emergent result of rising obesity prevalence in socioeconomically deprived urban neighbourhoods over the past decades.

CONCLUSIONS

Our study sheds light on the system dynamics leading to neighbourhoods with an unhealthy food environment, challenging socioeconomic conditions, a widening distance between social groups and an infrastructure that discouraged physical activity while promoting sedentary behaviour. Our insights can form the basis for the development of an integrated approach aimed at reshaping the obesogenic system in socioeconomically deprived urban neighbourhoods.

Paracrine role of endothelial IGF-1 receptor in depot-specific adipose tissue adaptation in male mice

During recent decades, changes in lifestyle have led to widespread nutritional obesity and its related complications. Remodelling adipose tissue as a therapeutic goal for obesity and its complications has attracted much attention and continues to be actively explored. The endothelium lines all blood vessels and is close to all cells, including adipocytes. The endothelium has been suggested to act as a paracrine organ. We explore the role of endothelial insulin-like growth factor-1 receptor (IGF-1R), as a paracrine modulator of white adipose phenotype. We show that a reduction in endothelial IGF-1R expression in the presence of high-fat feeding in male mice leads to depot-specific beneficial white adipose tissue remodelling, increases whole-body energy expenditure and enhances insulin sensitivity via a non-cell-autonomous paracrine mechanism. We demonstrate that increased endothelial malonate may be contributory and that malonate prodrugs have potentially therapeutically relevant properties in the treatment of obesity-related metabolic disease.

Temptation at every corner: exploring public perceptions of food cues and policy support for governmental food cue regulation in outdoor public spaces

BACKGROUND

Unhealthy visual food cues in outdoor public spaces are external drivers of unhealthy diets. Food cues are visible situations associated with food-related memories. This study aimed to gain insight into the (un)healthy food cues residents notice in outdoor public spaces in Dutch municipalities. It also aimed to explore residents' perceptions of food cues' influence on eating behaviour to gain insight into the acceptability of food cues and support for governmental food cue regulation.

METHODS

An exploratory study was conducted among 101 adults who photographed outdoor visual food cues in their municipality and answered survey questions about the food cues using a bespoke app ('myfoodenvironment'). Participant and food cue characteristics were analysed. Associations between those characteristics, perceived influence on eating behaviour, acceptability of food cues and support for regulation were analysed.

RESULTS

Participants took 461 photographs of food cues. Most food cues visualised food (73.8%), 54.4% of which showed only unhealthy food. Food cues photographed by participants with a high level of education and those located near a food service outlet were more often perceived as stimulating others to eat compared to those photographed by participants with a middle education level and located near a food store or along the road (Fisher's exact test: p < 0.001 and p = 0.001, respectively). For most photographs, participants found the presence of food cues acceptable and were opposed to governmental cue regulation. However, when food cues visualised healthy food, they were more likely to be found acceptable than when visualising unhealthy food (χ2 (4; N = 333) = 16.955; p = 0.002). Besides, when food cues visualised unhealthy food, participants were less likely to oppose governmental regulation of those types of cues, than when visualising healthy food (Fisher's exact test: p = 0.002).

CONCLUSIONS

Unhealthy food cues in outdoor public spaces were predominantly photographed by the participants. Yet, for most photographs, participants found the food cues acceptable and opposed governmental food cue regulation, although acceptance was higher for healthy food cues and opposition was lower for unhealthy food cues. These findings can serve as input for policymakers to develop governmental food cue regulations that may gain public support.

Effectiveness of the etonogestrel subdermal implant in users with overweight and obesity: a systematic literature review

BACKGROUND

The etonogestrel (ENG) subdermal implant is considered a well-tolerated and effective contraception option to avoid unintended pregnancies. However, it is unclear whether being affected by overweight or obesity diminishes the effectiveness of the implant.

OBJECTIVES

To systematically assess the published evidence on implant contraceptive effectiveness in women with overweight or obesity, and in women who underwent bariatric surgery.

SEARCH STRATEGY

A systematic search of MEDLINE and Embase for publications reporting implant effectiveness since 2011.

SELECTION CRITERIA

Primary publications of randomised and non-randomised trials, observational studies and case reports were included.

DATA COLLECTION AND ANALYSIS

Two independent reviewers identified the Pearl Index, qualitative descriptions of contraceptive failure, implant exposure and potential bias, and assessed overall quality of evidence.

MAIN RESULTS

We found 12 publications meeting our criteria, consisting of nine observational studies and three case reports. Excluding case reports, the publications reported Pearl Indices from 0.0/100 women-years (WY) to 0.23/100WY for women with overweight and obesity, respectively. No studies met the eligibility criteria for the post-bariatric surgery population.

CONCLUSIONS

Observed implant effectiveness in women with overweight and obesity falls within the range of published data across all weight groups (0.0-1.4/100 WY) and does not suggest a reduced effectiveness associated with higher body mass index. Large, well-controlled studies designed to specifically assess the effectiveness of the ENG implant with respect to user weight, particularly in women following bariatric surgery, are warranted.

Understanding Adipose Tissue Dysfunction

Diseases affecting adipose tissue (AT) function include obesity, lipodystrophy, and lipedema, among others. Both a lack of and excess AT are associated with increased risk for developing diseases including type 2 diabetes mellitus, hypertension, obstructive sleep apnea, and some types of cancer. However, individual risk of developing cardiometabolic and other 'obesity-related' diseases is not entirely determined by fat mass. Rather than excess fat accumulation, AT dysfunction may represent the mechanistic link between obesity and comorbid diseases. There are people who remain metabolically healthy despite obesity, whereas people with normal weight or very low subcutaneous AT mass may develop typically obesity-related diseases. AT dysfunction is characterized by adipocyte hypertrophy, impaired subcutaneous AT expandability (ectopic fat deposition), hypoxia, a variety of stress, inflammatory processes, and the release of proinflammatory, diabetogenic, and atherogenic signals. Genetic and environmental factors might contribute to AT heterogeneity either alone or via interaction with intrinsic biological factors. However, many questions remain regarding the mechanisms of AT dysfunction initiation and whether and how it could be reversed. Do AT signatures define clinically relevant subtypes of obesity? Is the cellular composition of AT associated with variation in obesity phenotypes? What roles do environmental compounds play in the manifestation of AT dysfunction? Answers to these and other questions may explain AT disease mechanisms and help to define strategies for improving AT health. This review focuses on recent advances in our understanding of AT biology.

Effect of marriage on overweight and obesity: evidence from China

BACKGROUND

The number of overweight and obese people in China is showing a rapidly rising trend. Exploring the reasons behind this phenomenon is an urgent academic topic. This study aims to evaluate the effect of marriage on overweight and obesity in China.

METHODS

A total of 44,095 samples were analyzed Data came from China Family Panel Studies (CFPS), a national, large-scale, multidisciplinary social tracking survey. Four periods of panel data were used and fixed effects regression was performed. Overweight and obesity were defined as BMI ≥ 24 kg/m2 and BMI ≥ 28 kg/m2, respectively.

RESULTS

Marriage significantly increases the probability of being overweight (6.5%, p < 0.01) and obese (2.8%, p < 0.01). An important influencing factor is the reduction of exercise behavior after marriage; that is, marriage reduces exercise time but has no significant effect on drinking. Additionally, we see a greater impact on those aged between 20 and 30, but it has no significant effect on those aged between 40 and 50.

CONCLUSION

Marriage is an important socioeconomic factor that led to overweight and obesity. It is urgent to encourage married people to control their weight and government health departments should provide more convenient exercise facilities.

Integrated Insights into Metabolic and Bariatric Surgery: Improving Life Quality and Reducing Mortality in Obesity

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients' management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits.

An exploratory case study of food sharing practices in Caribbean countries through a transition lens using intergenerational dyad interviews

BACKGROUND

Caribbean populations face complex health issues related to diet and food security as they undergo a rapid nutrition transition, resulting in some of the world's highest number of premature deaths from noncommunicable diseases (NCDs). Despite policy efforts to promote local and regional food consumption, reliance on food imports remains high with many Caribbean countries importing more than 80% of their food from larger economies. Previous regional research revealed the importance of food sharing practices in the Caribbean, with implications for the consumption of local foods, food security, and community resilience against climate change. However, there is limited understanding of these practices and how they have evolved.

METHODS

Using a transition lens, we explored the generational, life course, and sociocultural factors influencing food sharing practices in the Caribbean. We conducted semistructured online interviews with 10 intergenerational dyads involved in food sharing recruited from the virtual campus of the University of West Indies. Our study sample included 20 participants, ranging from 18 to 83 years old, from five English-speaking Caribbean countries (6 different islands).

RESULTS

Food sharing practices had a central role within the social fabric of all participants, contributing to their mental health and well-being. They represented a fundamental aspect of participants' culture and traditions, driving a sense of belonging and connection among Caribbean communities. However, contemporary food sharing practices indicated a move towards more convenience-oriented and processed foods, with reduced time spent cooking and a decline in the use of food sources such as backyard gardens, fishing, and marketplaces, with a preference for supermarkets. These trends, particularly observed among younger generations, aligned with the ongoing nutrition transition in the Caribbean and were influenced by various sociopolitical and environmental factors such as climate events, economic fluctuations, urbanisation, and changing family structures.

CONCLUSIONS

The evolving landscape of food sharing practices in the Caribbean has linkages with various domains of nutrition, health, society, culture, environment and globalisation. While a transition towards less healthy diets will increase the risk of many NCDs, the intrinsic cultural, social, and emotional benefits of food sharing could also positively impact health outcomes in the Caribbean region.

Reallocating Time Between 24-h Movement Behaviors for Obesity Management Across the Lifespan: A Pooled Data Meta-Analysis of More Than 9800 Participants from Seven Countries

BACKGROUND

The distribution of time across physical activity, sedentary behaviors, and sleep appears to be essential for the management of obesity. However, the impact of reallocating time among these behaviors, collectively known as 24-h movement behaviors, remains underexplored.

OBJECTIVE

This study examines the theoretical effects of reallocating time between 24-h movement behaviors on obesity indicators across different age groups.

METHODS

We performed a pooled data meta-analysis of 9818 participants from 11 observational and experimental studies. To estimate the time spent in movement behaviors, we reprocessed and harmonized individual-level raw accelerometer-derived data. Isotemporal substitution models estimated theoretical changes in body mass index (BMI) and waist circumference (WC) associated with time reallocation between movement behaviors. We performed the analysis separately for children, adolescents, adults, and older adults.

RESULTS

Even minor reallocations of 10 min led to significant changes in obesity indicators, with pronounced effects observed when 30 min were reallocated. The most substantial adverse effects on BMI and WC occurred when moderate-to-vigorous physical activity (MVPA) was reallocated to other movement behaviors. For 30-min reallocations, the largest increase in BMI (or BMI z-score for children) occurred when MVPA was reallocated to light-intensity physical activity (LPA) in children (0.26 units, 95% confidence interval [CI] 0.15, 0.37) and to sedentary behavior (SB) in adults (0.72 kg/m2, 95% CI 0.47, 0.96) and older adults (0.73 kg/m2, 95% CI 0.59, 0.87). The largest increase in WC was observed when MVPA was substituted with LPA in adults (2.66 cm, 95% CI 1.42, 3.90) and with SB in older adults (2.43 cm, 95% CI 2.07, 2.79). Conversely, the highest magnitude of the decrease in obesity indicators was observed when SB was substituted with MVPA. Specifically, substituting 30 min of SB with MVPA was associated with a decrease in BMI z-score by - 0.15 units (95% CI - 0.21, - 0.10) in children and lower BMI by - 0.56 kg/m2 (95% CI - 0.74, - 0.39) in adults and by - 0.52 kg/m2 (95% CI - 0.61, - 0.43) in older adults. Reallocating time away from sleep and LPA showed several significant changes but lacked a consistent pattern. While the predicted changes in obesity indicators were generally consistent across age groups, inconsistent findings were observed in adolescents, particularly for reallocations between MVPA and other behaviors.

CONCLUSIONS

This investigation emphasizes the crucial role of MVPA in mitigating obesity risk across the lifespan, and the benefit of substituting SB with low-intensity movement behaviors. The distinct patterns observed in adolescents suggest a need for age-specific lifestyle interventions to effectively address obesity. Emphasizing manageable shifts, such as 10-min reallocations, could have significant public health implications, promoting sustainable lifestyle changes that accommodate individuals with diverse needs, including those with severe obesity.

National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990-2021, and forecasts up to 2050

BACKGROUND

Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5-24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15-24 years) and adults for all 50 states and Washington, DC.

METHODS

In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources, which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m2 to less than 30 kg/m2 and obesity was defined as a BMI of 30 kg/m2 or higher, and for individuals younger than 18 years definitions were based on International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates were calculated by age and sex at the national level, with estimates for older adolescents (aged 15-24 years) and adults aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.

FINDINGS

In 2021, an estimated 15·1 million (95% UI 13·5-16·8) children and young adolescents (aged 5-14 years), 21·4 million (20·2-22·6) older adolescents (aged 15-24 years), and 172 million (169-174) adults (aged ≥25 years) had overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male adolescents (aged 15-24 years), at 52·4% (47·4-57·6), whereas Mississippi had the highest for female adolescents (aged 15-24 years), at 63·0% (57·0-68·5). Among adults, the prevalence of overweight or obesity was highest in North Dakota for males, estimated at 80·6% (78·5-82·6), and in Mississippi for females at 79·9% (77·8-81·8). The prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between 1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9-197·4) among male adolescents and 185·9% (139·4-237·1) among female adolescents (15-24 years). For adults, the percentage change in prevalence of obesity was 123·6% (112·4-136·4) in males and 99·9% (88·8-111·1) in females. Forecast results suggest that if past trends and patterns continue, an additional 3·33 million children and young adolescents (aged 5-14 years), 3·41 million older adolescents (aged 15-24 years), and 41·4 million adults (aged ≥25 years) will have overweight or obesity by 2050. By 2050, the total number of children and adolescents with overweight and obesity will reach 43·1 million (37·2-47·4) and the total number of adults with overweight and obesity will reach 213 million (202-221). In 2050, in most states, a projected one in three adolescents (aged 15-24 years) and two in three adults (≥25 years) will have obesity. Although southern states, such as Oklahoma, Mississippi, Alabama, Arkansas, West Virginia, and Kentucky, are forecast to continue to have a high prevalence of obesity, the highest percentage changes from 2021 are projected in states such as Utah for adolescents and Colorado for adults.

INTERPRETATION

Existing policies have failed to address overweight and obesity. Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate. Stronger governance is needed to support and implement a multifaceted whole-system approach to disrupt the structural drivers of overweight and obesity at both national and local levels. Although clinical innovations should be leveraged to treat and manage existing obesity equitably, population-level prevention remains central to any intervention strategies, particularly for children and adolescents.

FUNDING

Bill & Melinda Gates Foundation.

Sudden Death in Obesity: Mechanisms and Management

In recent decades, the prevalence of obesity has increased significantly, leading to an epidemic at the global level. Obesity is associated with various metabolic alterations and increases the risk of cardiovascular disease. The most devastating manifestation of cardiovascular disease is sudden cardiac death (SCD), leading to substantial years of potential life lost worldwide. Obesity-related SCD is an increasingly important public health problem and warrants a specific investigative focus on improved risk stratification and prevention. In this review, we summarize the current evidence regarding management of SCD in obesity and discuss knowledge gaps as well as future directions in this field.

Obesity prevention across the lifespan: assessing the efficacy of intervention studies and discussing future challenges

INTRODUCTION

Obesity is intricately linked with metabolic conditions that disrupt hormones and metabolism, often resulting in weight-related challenges. Given the heightened mortality rates associated with cardiovascular and metabolic disorders linked to obesity, there is a pressing call to mobilize medical professionals, researchers, and policymakers towards advocating for healthy lifestyles and preventing obesity. Traditionally, obesity prevention and treatment have been viewed as separate endeavors, with prevention primarily falling under public health initiatives and treatment within the purview of clinicians. However, this division has led to significant healthcare costs without a substantial reduction in obesity rates.

EVIDENCE ACQUISITION

Our search encompassed published articles focused on prevention, excluding any mention of "treatment". Data was gathered from diverse sources including academic databases, government health agency websites like the CDC, research organizations, clinical trials registries, and public health campaigns.

EVIDENCE SYNTHESIS

Due to the diverse range of interventions (encompassing dietary modifications, physical activity promotion, policy initiatives, education, and community-based programs, either independently or in combination), and the variability in study design and population demographics, we conducted a narrative review to systematically present and critically analyze evidence on preventing overweight and obesity across different age groups.

CONCLUSIONS

Effectively addressing obesity prevention necessitates a comprehensive, multidisciplinary approach that establishes an environment where healthier choices are accessible and viable for all. This requires collaborative efforts between individuals, communities, healthcare providers, policymakers, and industries to institute enduring change. Furthermore, there remains a critical need for national and international guidelines tailored to age-related risk factors, paving the way for innovative precision medicine approaches centered on salutogenesis rather than pathogenesis.

Inflammation and Physical Performance in Overweight and Obese Schoolchildren

Obesity represents a critical public health concern, often linked to low-grade chronic inflammation starting in childhood. This study aimed to evaluate the impact of a 12-week kinesiotherapy program on physical performance and levels of leptin and C-reactive protein (CRP) in overweight and obese children.

METHODS

Conducted at the Filantropia Municipal Clinical Hospital, 160 children aged 6 to 15 were randomly assigned to a study group (SG, n = 80) and a control group (CG, n = 80). The SG engaged in a tailored kinesiotherapy program, while the CG maintained their usual activities. All children and their families learned five key principles for preventing and managing obesity.

RESULTS

Results indicated significant improvements in the SG, with enhancements in the 6 min walking distance, Timed Up and Go test, and walking cadence (all p-values < 0.001). Notably, leptin and CRP levels (23.02 ± 7.17 to 16.62 ± 7.83, 4.13 ± 1.00 to 3.90 ± 0.95 mg/l, respectively) decreased significantly in the SG, contrasting with no significant changes in the CG. Regression analysis revealed a positive correlation between leptin levels and physical activity in the SG (coefficient: 0.5642, R-squared: 0.266).

CONCLUSIONS

These findings suggest that targeted exercise programs can effectively enhance physical performance and reduce inflammation markers in overweight children, highlighting the importance of tailored interventions in managing obesity.

Small molecule modulation of insulin receptor-insulin like growth factor-1 receptor heterodimers in human endothelial cells

OBJECTIVES

The insulin receptor (IR) and insulin like growth factor-1 receptor (IGF-1R) are heterodimers consisting of two extracellular α-subunits and two transmembrane β -subunits. Insulin αβ and insulin like growth factor-1 αβ hemi-receptors can heterodimerize to form hybrids composed of one IR αβ and one IGF-1R αβ. The function of hybrids in the endothelium is unclear. We sought insight by developing a small molecule capable of reducing hybrid formation in endothelial cells.

METHODS

We performed a high-throughput small molecule screening, based on a homology model of the apo hybrid structure. Endothelial cells were studied using western blotting and qPCR to determine the effects of small molecules that reduced hybrid formation.

RESULTS

Our studies unveil a first-in-class quinoline-containing heterocyclic small molecule that reduces hybrids by >50% in human umbilical vein endothelial cells (HUVECs) with no effects on IR or IGF-1R. This small molecule reduced expression of the negative regulatory p85α subunit of phosphatidylinositol 3-kinase, increased basal phosphorylation of the downstream target Akt and enhanced insulin/insulin-like growth factor-1 and shear stress-induced serine phosphorylation of Akt. In primary saphenous vein endothelial cells (SVEC) from patients with type 2 diabetes mellitus undergoing coronary artery bypass (CABG) surgery, hybrid receptor expression was greater than in patients without type 2 diabetes mellitus. The small molecule significantly reduced hybrid expression in SVEC from patients with type 2 diabetes mellitus.

CONCLUSIONS

We identified a small molecule that decreases the formation of IR: IGF-1R hybrid receptors in human endothelial cells, without significant impact on the overall expression of IR or IGF-1R. In HUVECs, reduction of IR: IGF-1R hybrid receptors leads to an increase in insulin-induced serine phosphorylation of the critical downstream signalling kinase, Akt. The underpinning mechanism appears, at least in part to involve the attenuation of the inhibitory effect of IR: IGF-1R hybrid receptors on PI3-kinase signalling.

The use of contracts to implement and manage healthy vending: best practice recommendations for effective and sustained interventions

BACKGROUND

Contracts can be an effective lever to implement and manage health-enabling food retail environments. However, guidance for the effective use of contracts in food retail settings is limited. The use of contracts to create healthy food vending environments is one area where policy attention has been focussed in high income countries. We applied a public health regulatory framework to publicly available guidance documents on healthy vending to develop best practice recommendations for using contracts to create healthy food vending environments.

METHODS

Document analysis involved i) snowball sampling to identify eligible publicly available healthy vending guidance documents from an identified seed paper; ii) application of a public health regulatory framework to extract data across three domains of form, substance and governance of healthy vending initiatives; and iii) synthesis of data to form best practice recommendations. Eligible documents were those aimed at implementing healthier vending; published from 2000 onwards; accessible online; and included recommendations beyond nutrition standards alone, including a reference to at least one regulatory governance process (administration, implementation, monitoring, enforcement or review).

RESULTS

Twelve of 92 documents identified were eligible and all were from the United States (US). All noted that products need to comply with nutrition standards. Other aspects of regulatory substance (i.e., pricing, promotion, placement, labelling and contract length) were less well considered as were elements of regulatory governance (regulatory rules, administration, implementation, monitoring, enforcement and review). Our adapted framework covers three regulatory domains with nine components, and a further 20 recommendations for best practice application in healthy vending.

CONCLUSIONS

To be effective, contracts used to manage healthy food vending should include more than the nutrition standards for healthy food and drinks. Clearly stating the contract objectives, operative terms and conditions, and defining responsibilities for monitoring, review and enforcement within the contract, in addition to the nutrition standards, will assist practitioners in creating effective and sustained contract-based initiatives aimed at improving the healthiness of vending, or potentially other food retail environments.

Common biological processes and mutual crosstalk mechanisms between cardiovascular disease and cancer

Cancer and cardiovascular disease (CVD) are leading causes of mortality and thus represent major health challenges worldwide. Clinical data suggest that cancer patients have an increased likelihood of developing cardiovascular disease, while epidemiologic studies have shown that patients with cardiovascular disease are also more likely to develop cancer. These observations underscore the increasing importance of studies exploring the mechanisms underlying the interaction between the two diseases. We review their common physiological processes and potential pathophysiological links. We explore the effects of chronic inflammation, oxidative stress, and disorders of fatty acid metabolism in CVD and cancer, and also provide insights into how cancer and its treatments affect heart health, as well as present recent advances in reverse cardio-oncology using a new classification approach.

Oct-B: A derivative of L-BAIBA significantly alleviating high-fat diet-induced obesity in mice

The rising prevalence of obesity is a global health concern. Supplementation with (S)-β-aminoisobutyric acid (L-BAIBA) has shown potential in preventing obesity and related metabolic disorders induced by high-fat diets. However, developing effective and low-toxicity BAIBA derivatives remains a challenging yet promising field. In this study, we introduce Oct-B, a novel BAIBA ester compound, which exhibits 80-fold greater efficacy than L-BAIBA in alleviating obesity in high-fat diet-fed mice. Our results demonstrate that Oct-B significantly reduces serum TG, TC, LDL-C, and the activities of ALT and AST, and also reduces TG and TC in liver, surpassing the effects of L-BAIBA. Histological analysis shows that Oct-B significantly decreases lipid accumulation in liver tissues, normalizes mast cells in white adipose tissue, and upregulates the expression of UCP1 protein in white adipose tissue. The qRT-PCR results indicated Oct-B alleviates obesity by downregulating lipogenic genes (PPARγ, ACC1, FAS), upregulating lipolysis related genes (PPARα, HSL) and thermogenic gene UCP1. Additionally, quantitative mass spectrometry reveals a marked increase in L-BAIBA levels in white fat, brown fat, serum, and muscle following Oct-B administration. These findings suggest that Oct-B is an efficient L-BAIBA substitute, offering a promising therapeutic approach for preventing and treating high-fat diet-induced obesity.

Offline to online: a systematic mapping review of evidence to inform nutrition-related policies applicable to online food delivery platforms

BACKGROUND

Online food delivery (OFD) platforms offer easy access to an abundance of energy-dense and nutrient-poor takeaway foods and may exacerbate existing unhealthy food environments. Efforts to improve population diets include a range of policy recommendations focused on improving the healthiness of food environments; however, the way in which such policies may apply to OFD platforms is not clear. This paper aimed to synthesise the existing evidence to inform nutrition-related policies applicable to OFD platforms for population health and well-being. A secondary aim was to scan existing nutrition-related policies in Australia and internationally, which have the potential to be applicable to OFD platforms.

METHODS

Seven electronic databases including Medline, Embase, CINAHL, Business Source Ultimate, Scopus, Web of Science, and Proquest were searched from January 2010 to October 2023. Evidence from studies was mapped to five existing policy domains outlined by the Healthy Food Environment Policy Index (Food-EPI) including (i) food labelling; (ii) food promotion; (iii) food composition and nutritional quality; (iv) food retail; and (v) food pricing. Relevant data sources were searched for currently implemented nutrition-related government policies that may have relevance to OFD platforms.

RESULTS

A total of 2012 records were screened, and 43 studies were included. There were 70 relevant study outcomes across the included studies, which addressed one or more of the 5 domains. Of these, 21 were relevant to 'Food Promotion' (30%), 18 to 'Food Retail' (26%), 15 to 'Food Composition (21%), 11 to 'Food Prices' (16%), and six to 'Food Labelling' (9%). Three existing policies from international jurisdictions (England, Singapore, EU) included OFD platforms, of which one was a voluntary measure. Several existing policies under food labelling have the potential to be amended to include OFD platforms under regulatory definitions.

CONCLUSION

OFD platforms have emerged as a disruptor to how people acquire their food and have yet to be widely included in existing nutrition-related policies. Advancing the evidence base to support the design of effective policy actions and mitigate the potential negative health impacts of OFD platforms will support efforts to improve population diets.

Unraveling the Role of the Human Gut Microbiome in Health and Diseases

The human gut is a complex ecosystem that supports billions of living species, including bacteria, viruses, archaea, phages, fungi, and unicellular eukaryotes. Bacteria give genes and enzymes for microbial and host-produced compounds, establishing a symbiotic link between the external environment and the host at both the gut and systemic levels. The gut microbiome, which is primarily made up of commensal bacteria, is critical for maintaining the healthy host's immune system, aiding digestion, synthesizing essential nutrients, and protecting against pathogenic bacteria, as well as influencing endocrine, neural, humoral, and immunological functions and metabolic pathways. Qualitative, quantitative, and/or topographic shifts can alter the gut microbiome, resulting in dysbiosis and microbial dysfunction, which can contribute to a variety of noncommunicable illnesses, including hypertension, cardiovascular disease, obesity, diabetes, inflammatory bowel disease, cancer, and irritable bowel syndrome. While most evidence to date is observational and does not establish direct causation, ongoing clinical trials and advanced genomic techniques are steadily enhancing our understanding of these intricate interactions. This review will explore key aspects of the relationship between gut microbiota, eubiosis, and dysbiosis in human health and disease, highlighting emerging strategies for microbiome engineering as potential therapeutic approaches for various conditions.

Behavioral Determinants of Childhood Obesity in the United States: An Exploratory Study

Childhood obesity is a complex and multifactorial phenomenon. Understanding these factors is crucial in developing effective interventions to prevent and treat childhood obesity. The purpose of this study is to provide an update on factors related to childhood obesity in the United States. This cross-sectional study analyzed data from the 2021 Youth Risk Behavior Surveillance System (YRBSS) survey to assess factors associated with childhood obesity among US children aged 12 to 17 years. Logistic regression analysis was used to identify the sociodemographic factors associated with overweight and obesity. Data were analyzed using R studio (4.3.2). A total of 12,836 respondents were enrolled in this study. Among them, the prevalence of overweight, obesity, and morbid obesity was found to be 17.66%, 11.21%, and 1.76%, respectively. Respondents with a BMI over 25 were mostly male (17.63%) and of White race (32.77%). The main sociodemographic factors associated with overweight and obesity were being 14 or 15 years old, male, non-White, having a history of alcohol or marijuana consumption, and not practicing physical activity. These findings can inform targeted interventions for prevention and management. This research sheds light on critical sociodemographic factors related to childhood obesity in the U.S., highlighting its complexity. The findings emphasize the influence of age, gender, ethnicity, and lifestyle behaviors, such as substance use and physical inactivity, on obesity rates among youth. These insights are crucial for developing targeted interventions. Addressing these factors offers a real chance to enhance future health outcomes, and underscoring the need for comprehensive strategies that include both health education and broader community support to instill healthy habits early on. In addition, unexpected results concerning vegetable consumption and the omission of genetic and familial data suggest areas for further research.

Did socioeconomic inequalities in overweight and obesity in South African women of childbearing age improve between 1998 and 2016? A decomposition analysis

Overweight and obesity in adult women contribute to deaths and disability from non-communicable diseases (NCDs) and obesity-related health problems in their offspring. Globally, overweight and obesity prevalence among women of childbearing age (WCBA) has increased, but associated socioeconomic inequality remains unclear. This study, therefore, assesses the changing patterns in the socioeconomic inequality in overweight and obesity among South African non-pregnant WCBA between 1998 and 2016. It uses data from the 1998 and 2016 Demographic and Health Surveys. Socioeconomic inequality in overweight and obesity was assessed using the concentration index (C). The index was decomposed to identify contributing factors to obesity and overweight inequalities. Factors contributing to changes in inequalities between 1998 and 2016 were assessed using the Oaxaca-type decomposition approach. Socioeconomic inequalities in overweight and obesity among WCBA in South Africa increased between 1998 (C of 0.02 and 0.06, respectively) and 2016 (C of 0.04 and 0.08, respectively). Socioeconomic status was the biggest contributor to overweight and obesity inequalities for both years. The Oaxaca-type decomposition showed that race and urban residence are major contributors to changes in overweight and obesity inequalities. Policies such as the current tax on sugar-sweetened beverages and subsidising fruits and vegetables, among others, are needed to prioritise WCBA, especially for those from disadvantaged socioeconomic backgrounds, in addressing inequalities in overweight and obesity in South Africa.

Mechanisms by which obesity regulates inflammation and anti-tumor immunity in cancer

Obesity is associated with an increased risk for 13 different cancers. The increased risk for cancer in obesity is mediated by obesity-associated changes in the immune system. Obesity has distinct effects on different types of inflammation that are tied to tumorigenesis. For example, obesity promotes chronic inflammation in adipose tissue that is tumor-promoting in peripheral tissues. Conversely, obesity inhibits acute inflammation that rejects tumors. Obesity therefore promotes cancer by differentially regulating chronic versus acute inflammation. Given that obesity is chronic, the initial inflammation in adipose tissue will lead to systemic inflammation that could induce compensatory anti-inflammatory reactions in peripheral tissues to suppress chronic inflammation. The overall effect of obesity in peripheral tissues is therefore dependent on the duration and severity of obesity. Adipose tissue is a complex tissue that is composed of many cell types in addition to adipocytes. Further, adipose tissue cellularity is different at different anatomical sites throughout the body. Consequently, the sensitivity of adipose tissue to obesity is dependent on the anatomical location of the adipose depot. For example, obesity induces more inflammation in visceral than subcutaneous adipose tissue. Based on these studies, the mechanisms by which obesity promotes tumorigenesis are multifactorial and immune cell type-specific. The objective of our paper is to discuss the cellular mechanisms by which obesity promotes tumorigenesis by regulating distinct types of inflammation in adipose tissue and the tumor microenvironment.

Effectiveness of Three Front-of-Pack Food Labels in Guiding Consumer Identification of Nutrients of Concern and Purchase Intentions in Kenya: A Randomized Controlled Trial

Background: Front-of-pack-labels (FOPLs) on packaged foods provide essential information to help consumers make informed dietary choices. However, evidence on their effectiveness, particularly in low- and middle-income countries like Kenya, is limited. Objective: This study assessed the effectiveness of three FOPLs in helping consumers identify nutrients of concern in packaged food products and influencing their purchase intention in Kenya. Methods: A total of 2198 shoppers from supermarkets in Nairobi, Mombasa, Kisumu, and Garissa were randomized into three groups: Red and Green Octagon label (RG), Red and Green Octagon with icons (RGI), and Black Octagon Warning label (WL). In the control phase, participants were shown unlabeled images of packaged foods, followed by questions. In the experimental phase, the same images were presented with one assigned FOPL, and participants responded again to the same set of questions. Differences in correct identification of nutrients of concern and changes in purchase intention were analyzed using frequency tables and Chi-Square tests, while modified Poisson regression assessed FOPL effectiveness. Results: FOPLs significantly improved correct nutrient identification and reduced the intention to purchase unhealthy foods, with the WL proving most effective. Conclusions: These findings highlight the potential of FOPLs, particularly the WL, as an effective regulatory tool for promoting healthier food choices in Kenya.

Association between cardiometabolic index (CMI) and periodontitis in US adults: analysis of NHANES data (2009-2014)

BACKGROUND

The cardiometabolic index (CMI) is a new predictor of obesity-related diseases, but its link to periodontitis is under-researched. This study aims to examine the potential association between the CMI and periodontitis.

METHODS

We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009-2014) to examine the potential association between CMI and periodontitis. The study utilized a weighted multivariate logistic model to assess the association between TG, HDL-C, TG/HDL-C, obesity indices (BMI, WC, WHtR, CMI), and periodontitis, employing the area under the receiver operating characteristic curves (ROC) to estimate areas under the curve (AUC). Furthermore, generalized smooth curve fitting was conducted to examine the relationship between CMI and periodontitis. Finally, the study incorporated subgroup analysis and interaction tests to examine consistency across different populations.

RESULTS

TG/HDL-C, WHtR, and CMI were positively associated with periodontitis in the fully adjusted classification model. It was observed that for each unit increase in CMI, there was a corresponding 17.8% increase in the prevalence of periodontitis [1.178 (1.049, 1.322) 0.00562] and 18.7% increase in the prevalence of moderate/severe [1.187 (1.057, 1.334) 0.00376] in the fully adjusted model. When CMI was used as a categorical variable, the adjusted OR for periodontitis prevalence increased significantly with increasing CMI after adjusting for all potential covariates (T3 vs. T1: OR, 1.28 [1.06, 1.55], p < 0.05). The ROC analysis indicated that a larger area under the curve was found in the CMI [0.554 (0.538-0.570)] than in the WC [0.544 (0.528-0.560)] and WHtR [0.544 (0.528-0.561)]. Nonetheless, the discrepancy observed did not reach statistical significance (all p > 0.05). Further generalized smooth curve fitting and threshold effect models indicated a positive linear correlation between CMI and periodontitis. Moreover, there is no interactive association between TG/HDL-C, WHtR, CMI, and periodontitis.

CONCLUSIONS

This cross-sectional study revealed a positive relationship between CMI and periodontitis. Further prospective studies are warranted to validate our findings.

Visceral fat distribution: Interracial studies

Visceral adipose tissue, a type of abdominal adipose tissue, is highly involved in lipolysis. Because increased visceral adiposity is strongly associated with the metabolic complications related with obesity, such as type 2 diabetes and cardiovascular disease, there is a need for precise, targeted, personalized and site-specific measures clinically. Existing studies showed that ectopic fat accumulation may be characterized differently among different populations due to complex genetic architecture and non-genetic or epigenetic components, ie, Asians have more and Africans have less visceral fat vs Europeans. In this review, we summarize the effects of multiple non-genetic and genetic factors on visceral fat distribution across races. Non-genetic factors include diet, socioeconomic status, sex hormones and psychological factors, etc. We examine genetic factors of racial differences in visceral fat content as well as possible regulatory pathways associated with interracial visceral fat distribution. A comprehensive understanding of both genetic and non-genetic factors that influence the distribution of visceral fat among races, leads us to predict risk of abdominal obesity and metabolic diseases in ethnic groups that enables targeted interventions through accurate diagnosis and treatment as well as reduced risk of obesity-associated complications.

Transcriptomic Analysis of the Protective Effect of Piperine on Orlistat Hepatotoxicity in Obese Male Wistar Rats

Obesity is a risk factor for the development of noncommunicable diseases that impair the quality of life. Orlistat is one of the most widely used drugs in the management of obesity due to its accessibility and low cost. However, cases of hepatotoxicity have been reported due to the consumption of this drug. On the other hand, piperine is an alkaloid found in black pepper that has demonstrated antiobesity, antihyperlipidemic, antioxidant, prebiotic, and hepatoprotective effects. The aim of this study was to evaluate the protective effect of piperine on the toxicity of orlistat in liver tissue. Obese male rats were administered piperine (30 mg/kg), orlistat (60 mg/kg), and the orlistat-piperine combination (30 mg/kg + 60 mg/kg) daily for 6 weeks. It was observed that the orlistat-piperine treatment resulted in greater weight loss, decreased biochemical markers (lipid profile, liver enzymes, pancreatic lipase activity), and histopathological analysis showed decreased hepatic steatosis and reduction of duodenal inflammation. Transcriptomic analysis revealed that the administration of piperine with orlistat increased the expression of genes related to the beta-oxidation of fatty acids, carbohydrate metabolism, detoxification of xenobiotics, and response to oxidative stress. Therefore, the results suggest that the administration of orlistat-piperine activates signaling pathways that confer a hepatoprotective effect, reducing the toxic impact of this drug.

Dietary fat content and absorption shape standard diet devaluation through hunger circuits

OBJECTIVE

Exposure to 60% high fat diet (HFD) leads to a robust consummatory preference over well-balanced chow standard diet (SD) when mice are presented with a choice. This passive HFD-induced SD devaluation following HFD challenge and withdrawal is highlighted by the significant reduction in SD food intake even in states of caloric deprivation. The elements of HFD that lead to this SD depreciation remains unclear. Possibly important factors include the amount and type of fat contained in a diet as well as past eating experiences dependent on sensory properties including taste and post ingestive feedback. We aimed to explore the role of these components to HFD-induced SD devaluation.

METHODS

Wildtype mice were longitudinally presented discrete HFDs in conjunction with SD and feeding and metabolic parameters were analyzed. A separate cohort of animals were assessed for acute HFD preference in 3 conditions: 1) ad libitum fed (sated), 2) overnight fasted (physiologically hungry), and 3) ad libitum fed (artificially hungry), elicited through chemogenetic Agouti-related peptide (AgRP) neuron activation. Population dynamics of AgRP neurons were recorded to distinct inaccessible and accessible diets both before and after consummatory experience. Transient receptor potential channel type M5 (TRPM5) knockout mice were used to investigate the role of fat taste perception and preference to HFD-induced SD devaluation. The clinically approved lipase inhibitor orlistat was used to test the contribution of fat absorption to HFD-induced SD devaluation.

RESULTS

HFD-induced SD devaluation is dependent on fat content, composition, and preference. This effect scaled both in strength and latency with higher percentages of animal fat. 60% HFD was preferred and almost exclusively consumed in preference to other diets across hours and days, but this was not as evident upon initial introduction over seconds and minutes, suggesting ingestive experience is critical. Optical fiber photometry recordings of AgRP activity supported this notion as neuronal suppression by the different diets was contingent on prior intake. While taste transduced via TRPM5 influenced HFD-evoked weight gain, it failed to impact either HFD preference or HFD-induced SD devaluation. Perturbation of post ingestive feedback through orlistat-mediated diminishment of fat absorption prevented HFD-evoked weight gain and abolished HFD-induced SD devaluation.

CONCLUSIONS

Post ingestive feedback via fat digestion is vital for expression of HFD-induced SD devaluation.

The healthiness of Australian food outlets available through online delivery platforms, by level of socioeconomic disadvantage and remoteness

Online food delivery platforms are an emerging but poorly understood aspect of food retail environments. We collected data via web scraping methods from the two leading online food delivery platforms in Victoria, Australia, identifying 11,154 food outlets from Menulog, and 12,939 from Uber Eats (with 21,733 unique outlets available across both platforms). Outlets were classified according to their healthiness using a tool developed with Australian dietitians and public health nutritionists, and assigned a food environment score. Area level (suburb/neighbourhood) socioeconomic disadvantage was determined using the Socio-Economic Indexes for Areas Index of Relative Socio-economic Disadvantage, and relative remoteness was determined using both the Accessibility/Remoteness Index of Australia and the Modified Monash Model. Across both food delivery platforms, approximately 15% of food outlets were classified as "unhealthy", 82% were classified as "less healthy", and 3% were classified as "healthy". More food outlets were available in areas of socioeconomic advantage, and in metropolitan areas. Food environment scores indicated that unhealthy outlets were significantly more available in areas with higher socioeconomic disadvantage and greater relative remoteness. Disparities in the healthiness of food outlets available through online food delivery platforms may have a negative influence on the purchasing and dietary behaviours of residents in these areas, thereby widening diet related health inequalities. Further research is required to understand the potential influence of online food delivery platforms on inequities in population diets and health.

Inequalities in Research on Food Environment Policies: An Evidence Map of Global Evidence from 2010-2020

There has been increasing pressure to implement policies for promoting healthy food environments worldwide. We conducted an evidence map to critically explore the breadth and nature of primary research from 2010-2020 that evaluated the effectiveness, cost-effectiveness, development, and implementation of mandatory and voluntary food environment policies. Fourteen databases and 2 websites were searched for "real-world" evaluations of international, national, and state level policies promoting healthy food environments. We documented the policy and evaluation characteristics, including the World Cancer Research Fund International NOURISHING framework's policy categories and 10 equity characteristics using the PROGRESS-Plus framework. Data were synthesized using descriptive statistics and visuals. We screened 27,958 records, of which 482 were included. Although these covered 70 countries, 81% of publications focused on only 12 countries (United States, United Kingdom, Australia, Canada, Mexico, Brazil, Chile, France, Spain, Denmark, New Zealand, and South Africa). Studies from these countries employed more robust quantitative methods and included most of the evaluations of policy development, implementation, and cost-effectiveness. Few publications reported on Africa (n = 12), Central and South Asia (n = 5), and the Middle East (n = 6) regions. Few also assessed public-private partnerships (PPPs, n = 31, 6%) compared to voluntary approaches by the private sector (n = 96, 20%), the public sector (n = 90, 19%), and mandatory approaches (n = 288, 60%). Most evaluations of PPPs reported on the same 2 partnerships. Only 50% of publications assessing policy effectiveness compared outcomes between population groups stratified by an equity characteristic, and this proportion has decreased over time. There are striking inequities in the origin, scope, and design of these studies, suggesting that research capacity and funding lies in the hands of a few expert teams worldwide. The small number of studies on PPPs questions the evidence base underlying the international push for PPPs to promote health. Policy evaluations should consider impacts on equity more consistently. This study was registered at PROSPERO as CRD42020170963.

Using interpretable machine learning methods to identify the relative importance of lifestyle factors for overweight and obesity in adults: pooled evidence from CHNS and NHANES

BACKGROUND

Overweight and obesity pose a huge burden on individuals and society. While the relationship between lifestyle factors and overweight and obesity is well-established, the relative contribution of specific lifestyle factors remains unclear. To address this gap in the literature, this study utilizes interpretable machine learning methods to identify the relative importance of specific lifestyle factors as predictors of overweight and obesity in adults.

METHODS

Data were obtained from 46,057 adults in the China Health and Nutrition Survey (2004-2011) and the National Health and Nutrition Examination Survey (2007-2014). Basic demographic information, self-reported lifestyle factors, including physical activity, macronutrient intake, tobacco and alcohol consumption, and body weight status were collected. Three machine learning models, namely decision tree, random forest, and gradient-boosting decision tree, were employed to predict body weight status from lifestyle factors. The SHapley Additive exPlanation (SHAP) method was used to interpret the prediction results of the best-performing model by determining the contributions of specific lifestyle factors to the development of overweight and obesity in adults.

RESULTS

The performance of the gradient-boosting decision tree model outperformed the decision tree and random forest models. Analysis based on the SHAP method indicates that sedentary behavior, alcohol consumption, and protein intake were important lifestyle factors predicting the development of overweight and obesity in adults. The amount of alcohol consumption and time spent sedentary were the strongest predictors of overweight and obesity, respectively. Specifically, sedentary behavior exceeding 28-35 h/week, alcohol consumption of more than 7 cups/week, and protein intake exceeding 80 g/day increased the risk of being predicted as overweight and obese.

CONCLUSION

Pooled evidence from two nationally representative studies suggests that recognizing demographic differences and emphasizing the relative importance of sedentary behavior, alcohol consumption, and protein intake are beneficial for managing body weight status in adults. The specific risk thresholds for lifestyle factors observed in this study can help inform and guide future research and public health actions.

Amino Acid Compound 2 (AAC2) Treatment Counteracts Insulin-Induced Synaptic Gene Expression and Seizure-Related Mortality in a Mouse Model of Alzheimer's Disease

Diabetes is a major risk factor for Alzheimer's disease (AD). Amino acid compound 2 (AAC2) improves glycemic and cognitive functions in diabetic mouse models through mechanisms distinct from insulin. Our goal was to compare the effects of AAC2, insulin, and their nanofiber-forming combination on early asymptomatic AD pathogenesis in APP/PS1 mice. Insulin, but not AAC2 or the combination treatment (administered intraperitoneally every 48 h for 120 days), increased seizure-related mortality, altered the brain fat-to-lean mass ratio, and improved specific cognitive functions in APP/PS1 mice. NanoString and pathway analysis of cerebral gene expression revealed dysregulated synaptic mechanisms, with upregulation of Bdnf and downregulation of Slc1a6 in insulin-treated mice, correlating with insulin-induced seizures. In contrast, AAC2 promoted the expression of Syn2 and Syp synaptic genes, preserved brain composition, and improved survival. The combination of AAC2 and insulin counteracted free insulin's effects. None of the treatments influenced canonical amyloidogenic pathways. This study highlights AAC2's potential in regulating synaptic gene expression in AD and insulin-induced contexts related to seizure activity.

Postgenomic understandings of fatness and metabolism

'Obesity' has, for decades, been a subject of intense scientific and public interest, and remains a key target for postgenomic science. I examine the emergence of determinism in research into 'obesity' in the postgenomic field of metabolomics. I argue that determinism appears in metabolomics research in two ways: firstly, fragmentation and narrow construal of the environment is evident in metabolomics studies on weight loss interventions, resulting in particular features of the environment (notably, dietary intake) having outsized influence while the wider social environment is neglected. Secondly, studies aiming to characterize the metabolic signature of 'obesity' are guided by a commitment to a deterministic connection between 'obesity' and dysfunction, leading to a neglect or distortion of metabolic heterogeneity across individuals regardless of body size.

Psychological Theoretical Frameworks of Healthy and Sustainable Food Choices: A Systematic Review of the Literature

BACKGROUND

Non-sustainable diets are associated with several environmental and health-related problems. Psychology research is interested in the study of food choice determinants, and several theoretical frameworks have been applied to study mechanisms underlying behavioral change and to develop theory-based interventions. The present systematic review is aimed at reviewing the existing literature on the psychological theoretical frameworks used to study sustainable and/or healthy food choices and their application for the development of interventions promoting such food choices, both in general and clinical populations.

METHODS

A systematic search of PubMed, PsycInfo, and Scopus was conducted according to PRISMA criteria.

RESULTS

Forty-five articles met the inclusion criteria and thirty-five theoretical frameworks emerged, mostly pertaining to social psychology and with the most widely used being the Theory of Planned Behavior. The majority of studies had a cross-sectional design, were conducted in general populations, and focused on healthy food choices. Only a few studies tested theory-based interventions. Internal (i.e., self-efficacy, personal values, and motivation) and external (i.e., peers, family, and social media influence) factors emerged as relevant healthy and sustainable eating determinants.

CONCLUSIONS

The current review underlines that an integrative perspective combining prompts from different psychology fields is needed in order to identify the psychological factors influencing food choices and to develop psychological interventions for the promotion of more sustainable diets.

Body Mass Index and Prevalence of Obesity in Brazilian Adult Women: Temporal Comparison of Repeated Population-Based Cross-Sectional Surveys

Background: Obesity is a complex multifactorial disease that has been associated with higher morbidity and mortality. Objectives: This study aimed to compare changes in body mass index (BMI) and obesity prevalence between two cross-sectional samples of Brazilian women. Furthermore, retrospective assessments of lifetime body weight changes were explored. Methods: Two independent population-based cross-sectional surveys were conducted in 2003 (first survey) and 2015 (second survey) with women living in the urban area city in southern Brazil. Both surveys had a similar design and included 981 women aged 20-60 years. Mean BMI and the presence of obesity (BMI ≥ 30 kg/m2) were estimated. Additionally, lifetime body weight change was obtained for the retrospective longitudinal assessment. Results: After 12 years, there was a significant increase from 25.9 ± 5.3 kg/m2 to 28.1 ± 6.2 kg/m2 in mean BMI. Between 2003 and 2015, the prevalence of obesity increased by 73% (18.0%; 95% CI: 15.8-20.6 vs. 31.2%; 95% CI: 28.3-34.1; p < 0.001). The means of estimated cumulative body weight gain from 15 to 50 years were 15.2 kg (95% CI: 13.3-17.1) and 17.2 kg (95% CI: 15.5-18.9) in 2003 and 2015, respectively; the greater cumulative difference between the two periods was observed at 40 years of age (3.3 kg). Conclusions: There was a significant increase in the mean BMI and prevalence of obesity between 2003 and 2015. Moreover, women experienced higher body weight gain during their lives in both survey periods, mainly in early adulthood.

Dietary Patterns of Healthy Underweight Individuals Compared to Normal-BMI Individuals Using Photographic Food Diaries

BACKGROUND

Previously, we found that healthy underweight (HU) subjects, with BMI < 18.5, eat about 12% less food (by calories) each day. It is presently unclear whether this lower intake is associated with them making food choices that provide high satiation and satiety.

METHODS

Using 7-day photographic records of food intake, we analyzed 52 HU and 50 normal-weight participants.

RESULTS

We included 52 HU and 50 normal-weight participants in the final analysis. HU individuals ate 25% fewer calories than normal-weight individuals. Their intake included a higher % of rice (p = 0.0013) and vegetables (p = 0.0006) and a lower % of livestock meat (p = 0.0007), poultry meat (p < 0.0001), and starchy roots (p = 0.0015), compared with the normal-weight population. The percent energy from carbohydrates was significantly higher (p = 0.0234), and the % energy from fat was significantly lower (p < 0.0001) in the HU group, with no difference in the % energy from protein. HU individuals sourced more of their protein from plants. Dietary patterns were grouped into three clusters, with 24 individuals grouped into cluster 1 (87.5% normal-weight population), 28 individuals into cluster 2 (64.3% normal-weight group), and 50 individuals into cluster 3 (78% HU group).

CONCLUSIONS

The HU group ate less overall and had proportionally more rice and vegetables and less poultry and livestock meat, starchy roots, and drinks. With respect to macronutrients, they also ate a greater % carbohydrates and less % fat, and they sourced more of their protein intake from plant sources. HU individuals did not follow a low-carbohydrate lifestyle.

Elucidating macrophage scavenger receptor 1's mechanistic contribution as a shared molecular mediator in obesity and thyroid cancer pathogenesis via bioinformatics analysis

Introduction

Obesity is a disease characterized by the excessive accumulation of fat. Concurrently, thyroid carcinoma (THCA) stands as the foremost endocrine malignancy. Despite the observed escalation in concurrent prevalence of both conditions, the underlying interconnections remain elusive. This indicates the need to identify potential biomarkers to predict the pathways through which obesity and THCA coexist.

Methods

The study employed a variety of methods, including differential gene expression analysis, Weighted Gene Co-expression Network Analysis (WGCNA), and gene enrichment analysis. It was also supplemented with immunohistochemical data from the Human Protein Atlas (HPA), advanced machine learning techniques, and related experiments such as qPCR, to identify important pathways and key genes shared between obesity and THCA.

Results

Through differential gene expression analysis, WGCNA, and machine learning methods, we identified three biomarkers (IL6R, GZMB, and MSR1) associated with obesity. After validation analysis using THCA-related datasets and biological experiments, we selected Macrophage Scavenger Receptor 1 (MSR1) as a key gene for THCA analysis. The final analysis revealed that MSR1 is closely related to the degree of immune cell infiltration in patients with obesity and THCA, suggesting that this gene may be a potential intervention target for both obesity and THCA.

Discussion

Our research indicates that MSR1 may influence the occurrence and development of obesity and THCA by regulating the infiltration level of immune cells. This lays the foundation for future research on targeted therapies based on their shared mechanisms.

Explaining socioeconomic inequality in food consumption patterns among households with women of childbearing age in South Africa

The changing food environment shifts peoples' eating behaviour toward unhealthy food, including ultra-processed food (UPF), leading to detrimental health outcomes like obesity. This study examines changes in socioeconomic inequalities in food consumption spending between 2005/06 and 2010/11 in South African households with women of childbearing age (15 to 49) (WCBA). Data come from the 2005/06 and 2010/11 Income and Expenditure Surveys. The distribution of spending according to the NOVA food classification system groupings (unprocessed or minimally processed foods, processed culinary ingredients, processed and UPF products) was analysed using standard methodologies. Changes in spending inequalities between 2005/06 and 2010/11 were assessed using the concentration index (C), while the factors explaining the changes in spending inequalities were identified using the Oaxaca decomposition approach. The Kakwani index (K) was used to assess progressivity. Results show that average real spending on all food categories, including UPF, increased between 2005/06 and 2010/11. Socioeconomic inequality in UPF consumption spending decreased (C = 0.498 in 2005/06 and C = 0.432 in 2010/11), and spending on processed foods (C = 0.248 in 2005/06 and C = 0.209 in 2010/11). Socioeconomic status, race, and urban residence contributed to overall socioeconomic inequality and changes in UPF consumption inequality between 2005/06 and 2010/11. Spending on all food categories was regressive in 2005/06 (K = -0.173 for UPF and -0.425 for processed foods) and 2010/11 (K = -0.192 for UPF and -0.418 for processed foods) because such spending comprises a larger share of poorer household's income than their wealthier counterparts. The government should address these contributors to inequality to mitigate the risks associated with UPF consumption, especially among less affluent households.

Association Between Ultraprocessed Food Consumption and Metabolic Disorders in Children and Adolescents with Obesity

BACKGROUND/OBJECTIVES

We investigated the effects of ultraprocessed food (UPF) consumption on metabolic disorders (e.g., adiposity, metabolic associated steatotic liver disease [MASLD], and insulin resistance) in children and adolescents with obesity to improve dietary guidelines and public health strategies.

METHODS

The dietary intake of 149 participants (aged 8-17 years) was assessed with food diaries. The NOVA classification system was used to classify food according to the degree of processing. Metabolic outcomes, including the fat mass index (FMI), hepatic fat percentage, and insulin resistance, were measured via dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging proton density fat fraction (MRI-PDFF), and biochemical analysis, respectively.

RESULTS

Greater UPF consumption from baseline to the 6-month follow-up was significantly associated with increased insulin and decreased total cholesterol and LDL-cholesterol. UPF consumption was positively associated with the prevalence of MASLD (liver MRI-PDFF ≥ 5%; odds ratio T3 vs. T1 = 1.75; 95% confidence interval [CI] 1.03, 3.00), moderate-to-severe MASLD (liver MRI-PDFF ≥ 10%; OR T3 vs. T1 = 4.19; 95% CI 1.72, 10.22), and insulin resistance (OR T3 vs. T1 = 2.44; 95% CI 1.33, 4.48), after adjusting for covariates. A linear dose-response relationship was observed between UPF consumption and the odds of moderate-to-severe MASLD and insulin resistance.

CONCLUSIONS

Greater UPF consumption was strongly associated with MASLD and insulin resistance in children and adolescents with obesity, underscoring the importance of reducing UPF consumption through dietary guidelines and public health interventions to mitigate the risk of obesity-related metabolic conditions in young populations.

Waist circumference as a parameter in school-based interventions to prevent overweight and obesity - a systematic review and meta-analysis

BACKGROUND

Preventing childhood obesity remains an important public health issue worldwide. Since visceral fat in particular is understood as an important risk factor for many chronic diseases, waist circumference is recommended as a measurement parameter for global obesity surveillance. This systematic review and meta-analysis focused on waist circumference as an outcome parameter for studies of school-based interventions to prevent overweight and obesity.

METHODS

A systematic literature search was conducted at the end of 2019 in nine data bases, including Medline and Embase, in order to identify relevant studies evaluating interventions in schools aimed at preventing obesity. Eligibility criteria admitted randomised and non-randomised controlled trials. After screening titles, abstracts and full texts, the data of the identified studies were systematically extracted. Risk of bias was assessed according to study type with the appropriate Cochrane Risk of Bias Tool. The review gives a qualitative overview over all included studies structured by extracted data. Separate meta-analyses were done for the outcome mean difference in change in waist circumference, measured in cm or reported as z-score value, using an inverse variance random-effects model due to study design.

RESULTS

A total of 2421 publications were screened based on titles, abstracts and full texts. Complemented by results of a former systematic literature search 44 studies were identified for inclusion, comprising a total of 39.837 participants (age range: 6 to 18 years). Nearly half of the studies were conducted in Europe, two-thirds combined diet and exercise-based interventions. Likewise two thirds of the studies were conducted as cluster-randomised trials. Most of the reported effects favoured the experimental groups, indicating the basic effectiveness of school-based measures. Based on reported data, only one third of the studies could be included in the meta-analyses. For the difference in mean change of the outcome parameter waist circumference measured in cm (95% CI), we found a pooled effect estimate of -0.95 (-1.87; -0.46). For the difference in mean change of the outcome parameter waist circumference reported as z-score value (95% CI), the pooled effect estimate was -0.10 (-0.15; -0.05). Both effect estimates were in favour of the experimental group. The overall effect sizes were small with a p-value < 0.05.

CONCLUSIONS

Pooled effect estimates were small but in favour of the experimental groups. The same applies to the majority of the effects reported in the included studies. The included cluster of randomised controlled trials demonstrated an especially sound methodological standard. The possibility of achieving larger effects in studies of preventive interventions and health promotion is limited. Schools can only realise their full potential in preventing overweight and obesity in children and adolescents if they are accompanied by measures in other areas of the obesogenic environment.

A cross-sectional study on online food delivery applications (OFDAs) in the United Arab Emirates: use and perceptions of healthy food availability among university students

Online food delivery applications (OFDAs) have seen a surge in popularity during the COVID-19 Pandemic, particularly among young adults. This study aimed to assess the use of OFDAs and the perception of food healthiness and safety among university students in the United Arab Emirates (UAE). A web-based cross-sectional study was conducted among university students in the UAE via snowball sampling (n = 1096). Sociodemographic characteristics, OFDAs usage, and perceptions toward food healthiness and safety were investigated. Chi-square analysis was used to determine the association between categorical variables and healthy food choices. Mann-Whitney U and Kruskal-Wallis H tests were used to determine differences between different groups and perception statements. Over half (52%) of the students were frequent users of OFDAs with fast food being the most popular choice (88.4%). Older participants, those living in the university dorms, and those with higher allowances used the OFDAs more frequently (P < 0.05). Price (78.0%) and food appearance (65.7%) had the highest impact on food selection. Most subjects (69.3%) reported looking for healthy food but were worried about affordability (43.1%) and taste (27.1%). Most participants (57.8%) agreed that OFDAs increased their appetite and food intake. Participants believed that having a hygiene rating system in OFDAs would give them the chance to make informed decisions (82.3%). Unhealthy food options were popular among university students. The study highlights the need to provide more affordable and appealing healthy food options and suggests that improved nutrition information and hygiene standards could help to promote healthy food choices among university students.

Development of the Local Food Systems Policy Index (Local Food-EPI+) tool and assessment process to benchmark the implementation of local government policies for creating healthy, equitable and environmentally sustainable food systems

OBJECTIVE

Local governments have an important role to play in creating healthy, equitable and environmentally sustainable food systems. This study aimed to develop and pilot a tool and process for local governments in Australia to benchmark their policies for creating healthy, equitable and environmentally sustainable food systems.

DESIGN

The Healthy Food Environment Policy Index (Food-EPI), developed in 2013 for national governments, was tailored to develop the Local Food Systems Policy Index (Local Food-EPI+) tool for local governments. To incorporate environmental sustainability and the local government context, this process involved a literature review and collaboration with an international and domestic expert advisory committee (n 35) and local government officials.

SETTING

Local governments.

RESULTS

The tool consists of sixty-one indicators across ten food policy domains (weighted based on relative importance): leadership; governance; funding and resources; monitoring and intelligence; food production and supply chain; food promotion; food provision and retail in public facilities and spaces; supermarkets and food sources in the community; food waste reuse, redistribution and reduction; and support for communities. Pilot implementation of the tool in one local government demonstrated that the assessment process was feasible and likely to be helpful in guiding policy implementation.

CONCLUSION

The Local Food-EPI+ tool and assessment process offer a comprehensive mechanism to assist local governments in benchmarking their actions to improve the healthiness, equity and environmental sustainability of food systems and prioritise action areas. Broad use of this tool will identify and promote leading practices, increase accountability for action and build capacity and collaborations.

Clinical Impact of Obesity on Postoperative Outcomes of Patients With Thyroid Cancer Undergoing Thyroidectomy: A 5-Year Retrospective Analysis From the US National Inpatient Sample

BACKGROUND

The clinical impact of obesity on postoperative outcomes of patients undergoing thyroidectomy remains controversial.

METHODS

Patients aged ≥ 18 years who were diagnosed with thyroid malignancy and underwent thyroidectomy between 2016 and 2020 were included, and divided into two groups: patients with body mass index (BMI) < 30 kg/m2 and those with BMI ≥ 30 kg/m2. Patients in the obese group were then subdivided into four groups: Group 1 (BMI 30.0-34.9 kg/m2), Group 2 (BMI 35.0-39.9 kg/m2), Group 3 (BMI 40.0-44.9 kg/m2), and Group 4 (BMI ≥ 45.0 kg/m2) to evaluate the association between degree of obesity and clinical outcomes. We performed propensity score matching, compared outcome variables between the groups, and conducted adjusted multivariate logistic regression analyses of postoperative outcomes.

RESULTS

A total of 6778 patients diagnosed with thyroid cancer who underwent thyroidectomy were screened, of whom 1299 (19.2%) patients were obese. Patients in the obese group had higher total hospital charges (p < 0.001) and an increased risk of overall postoperative complications (34.7% vs. 30.5%, p = 0.023). Specifically, patients in the obese group had increased odds of respiratory complication (adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) [1.26-2.19]), acute renal failure (aOR 1.87, 95% CI [1.13-3.09]), and wound complication (aOR 2.77, 95% CI [1.21-6.37]) than those in the non-obese group. Moreover, trend tests showed that the risks of unfavorable discharge, infection, acute renal failure, and respiratory complication all exhibited an upward trend with increased BMI.

CONCLUSION

Obesity is associated with an increased risk of postoperative complications in patients with thyroid cancer undergoing thyroidectomy. This finding suggests that obese patients should be treated with more caution during postoperative recovery.

Descriptive analysis of MC4R gene variants associated with obesity listed on ClinVar

OBJECTIVES

The most recent version of ClinVar was utilized to filter variants of the MC4R gene based on location, condition, and clinical significance with the goal of obtaining benign and disease-associated variants of the MC4R gene. MC4R gene variants can lead to dysregulation of energy expenditure and appetite control, which prompted this study to delineate the distinctive features of MC4R gene variants submitted to the ClinVar repository regarding their association with obesity and related phenotypes.

METHOD

A thorough search was conducted in the ClinVar repository for clinically significant MC4R variants through the utilization of the gene name MC4R[gene] and MeSH terms "MC4R[gene]" and "single gene"[properties]" in the search box. Leading to the identification of clinically significant genetic variants associated with obesity.

RESULTS

Utilizing the ClinVar clinical significance ranking system, the MC4R variants were categorized into six groups based on ClinVar/ClinGen's ranking system: pathogenic (P), likely pathogenic (LP), variant of uncertain significance (VUS), benign (B), likely benign (LB), and conflicting classifications (CC). A total of 103 pathogenic variants were observed. These variants have different clinical significance that are associated with monogenic obesity, monogenic diabetes, and body mass index quantitative traits. It was observed that over 80% of the mutations were single nucleotide variants, with nearly half being missense mutations spread throughout the topological and transmembrane domains. Furthermore, TM7 had the highest number of single nucleotide missense mutations.

CONCLUSION

Further analysis of the relationships between monogenic obesity and diabetes requires additional investigation to discover the underlying causes of these conditions. The study findings imply that mutations in MC4R's topological and transmembrane regions may significantly influence receptor activation and signaling. As more MC4R variants are discovered and their correlation with obesity is established, there is potential to definitively establish a strong connection between MC4R pathogenic variants and the development of obesity.

Burden of disease attributable to high body mass index: an analysis of data from the Global Burden of Disease Study 2021

Background

Obesity represents a major global health challenge with important clinical implications. Despite its recognized importance, the global disease burden attributable to high body mass index (BMI) remains less well understood.

Methods

We systematically analyzed global deaths and disability-adjusted life years (DALYs) attributable to high BMI using the methodology and analytical approaches of the Global Burden of Disease Study (GBD) 2021. High BMI was defined as a BMI over 25 kg/m2 for individuals aged ≥20 years. The Socio-Demographic Index (SDI) was used as a composite measure to assess the level of socio-economic development across different regions. Subgroup analyses considered age, sex, year, geographical location, and SDI.

Findings

From 1990 to 2021, the global deaths and DALYs attributable to high BMI increased more than 2.5-fold for females and males. However, the age-standardized death rates remained stable for females and increased by 15.0% for males. Similarly, the age-standardized DALY rates increased by 21.7% for females and 31.2% for males. In 2021, the six leading causes of high BMI-attributable DALYs were diabetes mellitus, ischemic heart disease, hypertensive heart disease, chronic kidney disease, low back pain and stroke. From 1990 to 2021, low-middle SDI countries exhibited the highest annual percentage changes in age-standardized DALY rates, whereas high SDI countries showed the lowest.

Interpretation

The worldwide health burden attributable to high BMI has grown significantly between 1990 and 2021. The increasing global rates of high BMI and the associated disease burden highlight the urgent need for regular surveillance and monitoring of BMI.

Funding

National Natural Science Foundation of China and National Key R&D Program of China.

Children and their being "carnivorous": is visceral adiposity protection or promotion?

BACKGROUND

Environmental factors and, in particular, diet, could represent potentially modifiable risk factors for the treatment of childhood obesity. The association between red meat consumption and obesity is demonstrated in adulthood. On the other hand, the association between red meat consumption and obesity is not as clear in children and adolescents. The aim of this study is to test the hypothesis that children and adolescents with obesity are consuming higher quantities of red meat, while still taking into account the appropriate consumption and the overall benefits of red meat itself.

METHODS

A cross-sectional study was conducted by using a sample including 41 children and adolescent affected by obesity. Anthropometric measures and eating habits, including red meat consumption, were collected at baseline using a structured and detailed questionnaire. The amount of red meat intake was estimated in portions per week (for clarity, the term portion is equivalent to about 150 grams of red meat).

RESULTS

Red meat consumption correlates with Body Mass Index (BMI) (P<0.01). Waist circumference (WC) values are also directly proportional to the consumption of red meat (P<0.05).

CONCLUSIONS

This study demonstrates that red meat consumption correlates with BMI and WC in pediatric age. Considering the opposite results from other study, the association between red meat consumption and obesity seems less clear in pediatric age rather than adulthood. On the other hand, the current state of art emphasizes that there should be more attention in obese and overweight children and adolescents in conjunction with appropriate lifestyle changes in order to achieve adequate waist circumference, BMI and related cardiovascular health. Benefits and risks associated with red meat consumption would seem balanced if consumed in moderate quantities as part of balanced diets with a high intake of vegetables and fruits. Even for the topic "red meat," the right balance would seem to lie in the middle.

Exploring the multifaceted role of ginkgolides and bilobalide from Ginkgo biloba in mitigating metabolic disorders

The ancient Ginkgo biloba tree grows across various regions, with distinctive leaves emitting a unique fragrance. Its extract contains flavonoids, organic acids, and terpenoids. Ginkgolide and bilobalide, which are G. biloba leaf extracts, offer diverse pharmaceutical benefits, including antioxidant, anti-inflammatory, and neuroprotective properties. The antioxidant and anti-inflammatory properties of these compounds are crucial for mitigating neurodegeneration, particularly in diseases such as Alzheimer's disease. Additionally, their effectiveness in countering oxidative stress and inflammation highlights their potential to prevent cardiovascular ailments. This study also suggests that these compounds have a promising impact on lipid metabolism, suggesting their significance in addressing obesity-related metabolic disorders. In conclusion, ginkgolides and bilobalide exhibit promising effects in sustaining the integrity of the nervous and endocrine systems, along with the modulation of lipid metabolism. The diverse health benefits suggest that these compounds could serve as promising therapeutic interventions for various conditions, including neurological, cardiovascular, and metabolic diseases.

From menus to misbeliefs: Absolute frequencies of healthy and tasty dishes predict the unhealthy = tasty belief in restaurants

We examine whether the prevalence of healthy and tasty food options in restaurant menus leads to the formation of beliefs about the relationship between healthiness and taste that deviate from the correlation of healthiness and taste ratings. Participants (N = 195) rated the healthiness and taste of twelve dishes from two different restaurant types (American and vegetarian restaurants), estimated the frequencies of healthy and tasty options, and reported their health-taste beliefs. Results show that ratings of perceived healthiness and expected taste are uncorrelated in both restaurant types, but participants formed the misbelief that unhealthy dishes taste better than healthy dishes to a greater extent in American than in vegetarian restaurants. Regression analyses revealed that the absolute frequencies of food options were significantly related to participants' health-taste beliefs while controlling for the correlation between healthiness and taste ratings in both restaurant types. Participants were more likely to believe that healthy food tastes better than unhealthy food when they perceived that healthy and tasty food were both frequent (or infrequent) in the respective restaurant type. Our results provide evidence that relying on absolute frequencies, rather than covariation, to infer the relationship between healthiness and taste may lead to misbeliefs that do not reflect the health-taste correlation of individual food items.

Assessing Knowledge, Attitudes and Behaviours toward Salt and Sugar Consumption in the Central Division of Fiji

OBJECTIVES

This study aimed to assess salt and sugar-related knowledge, attitudes and behaviours (KAB) of adults in the Central Division of Fiji.

METHODS

A randomised stratified sample of 700 adults were selected. Questions on salt and sugar-related KABs were developed. The survey took place from March to June 2022. For analyses, population and sample weights were applied, and differences between predefined subgroups (sex, age, ethnicity and area) were compared using weighted chi-square tests.

RESULTS

534 adults participated (response rate 76%). Over 80% of participants (82% (95% CI 78.5 to 84.9%)) identified that consuming too much salt or salty sauce can lead to hypertension. More than 90% recognised that consuming too much sugar can lead to diabetes (92.3% (89.7 to 94.3%)). Approximately 80% of participants thought it was somewhat or very important to lower salt and sugar intake in their diet (79.8% (76.1 to 83.0) and 84.2% (80.8 to 87.1%), respectively). However, almost 40% reported adding salt or salty sauces when cooking (37.3% (32.7 to 42.2%)) and 65% (60.6 to 68.5%) adding sugar to drinks daily.

CONCLUSIONS

Despite having positive knowledge and attitudes, many people reported behaviours likely to contribute to excess salt and sugar intake, highlighting the need for interventions that support behaviour change and the creation of healthier food environments.

Trends in body mass index for people with and without HIV: Pooled analysis of nationally-representative health surveys from 10 countries and 173,800 adults in Africa

It remains unclear if and how body mass index (BMI) levels have changed over time in HIV endemic regions. We described trends in mean BMI and prevalence of overweight between 2003-2019 in 10 countries in Africa including people living with (PLWH) and without (PLWoH) HIV. We pooled Demographic and Health Surveys (DHS) from countries where ≥2 surveys >4 years apart were available with height/weight measurements and HIV tests. HIV status was ascertained with a finger-prick dried blood spot (DBS) specimen tested in a laboratory. The DBS is taken as part of the regular DHS procedures. We summarized age and socioeconomic status standardized sex-specific mean BMI (kg/m2) and prevalence of overweight (BMI ≥25 kg/m2) by HIV status. We fitted country-level meta-regressions to ascertain if changes in ART coverage were correlated with changes in BMI. Before 2011, women LWH (22.9 [95% CI: 22.2-23.6]) and LWoH (22.6 [95% CI: 22.3-22.8]) had similar mean BMI. Over time, mean BMI increased more in women LWH (+0.8 [95% CI: 0.7-0.8] BMI units) than LWoH (+0.2 [95% CI: 0.2-0.3]). Before 2013, the mean BMI was similar between men LWH (21.1 (95% CI: 20.3-21.9)) and LWoH (20.8 (95% CI: 20.6-21.1)). Over time, mean BMI increased more in men LWoH (+0.3 [95% CI: 0.3-0.3]) than LWH (+0.1 [95% CI: 0.1-0.1]). The same profile was observed for prevalence of overweight. ART coverage was not strongly associated with BMI changes. Mean BMI and prevalence of overweight were similar in PLWH and PLWoH, yet in some cases the estimates for PWLH were on track to catch up with those for PLWoH. BMI monitoring programs are warranted in PLWH to address the rising BMI trends.