Analysis of Reporting Trends of Serious Adverse Events Associated With Anti-Obesity Drugs

Concern over the side effects of anti-obesity medications, particularly if severe, has grown as their use has increased. Thus, the objective was to use trends in the reporting of suspected adverse events associated with anti-obesity medications that have been approved for sale in the European Union to attempt to uncover discrepancies in the safety of these medications. The study was designed as secondary research, based on data about the number of adverse drug reactions (both serious and non-serious) reported to the EudraVigilance database. Trends of the annual reporting rates for the six anti-obesity drugs were analyzed by the Joinpoint Trend Analysis Software that divides the trendline into an optimum number of segments connected by "joinpoints" and tests the significance of the trend within each segment. The trends of serious adverse drug events showed clear differences among the anti-obesity drugs: while all drugs had significant increasing trends during a few initial years after their appearance on the market, only the annual number of reports for semaglutide continued to grow ever since (annual change + 67.1%, p = 0.000). On the contrary, a continuous increase in the reporting rate of non-serious adverse drug events was observed only for liraglutide (annual change + 33.8%, p = 0.000) while for the other anti-obesity drugs, including semaglutide, the trends after the initial period were either negative or did not increase significantly. In conclusion, among the anti-obesity drugs currently approved, only semaglutide shows a continuously increasing trend in the annual reporting of serious adverse events, suggesting a need for further investigation of safety signals.

Association between the triglyceride glucose-body roundness index and the incidence of cardiovascular disease among Chinese middle and old-aged adults: a nationwide prospective cohort study

AIM

Previous studies have suggested that the triglyceride glucose (TyG) index and body roundness index (BRI) are indicators of insulin resistance (IR) and are associated with the incidence of cardiovascular disease (CVD) among middle and old-aged adults. BRI is considered a more accurate indicator of the proportion of body fat and visceral fat than body mass index (BMI). However, it remains unclear whether the combined use of the TyG index and BRI, specifically the triglyceride glucose-body roundness index (TyG-BRI), is associated with the incidence of CVD among Chinese middle and old-aged adults.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). The TyG-BRI index was computed using baseline measurements of triglycerides, fasting blood glucose, waist circumference, and height. Cox proportional hazards regression and restricted cubic spline (RCS) regression analyses were applied to assess the association between the TyG-BRI index and incident CVD (defined as cardiac events or stroke).

RESULTS

A total of 8,113 Chinese adults participated in this study, with a median age of 58 years, including 56.3% males. The fully adjusted Cox regression analysis revealed that individuals in the highest quartile (Q4) of the TyG-BRI index had a 59.1% increased risk of developing incident CVD compared to those in the lowest quartile (HR, 1.591 [95% CI, 1.330-1.902]). The TyG-BRI index showed a significant linear association with CVD incidence (P for nonlinearity = 0.447, P < 0.001). This association persisted after conducting subgroup and sensitivity analyses.

CONCLUSIONS

This study introduced a novel TyG-BRI index, which integrated IR and body roundness as a comprehensive indicator, demonstrating its strong and independent association with increased CVD risk in a Chinese nationwide cohort. Our findings provide new insights into the interaction between metabolic dysfunction and cardiovascular risk, suggesting that the TyG-BRI index could serve as a practical tool for targeted preventive interventions.

General and central obesity were significantly correlated with blood lead level in non-smoking, general population aged 30-50, without hypertension

INTRODUCTION

To investigate the association between obesity and blood lead level (BLL) in the general population after controlled for menopause, blood pressure, calcium, and smoking; we assessed the relationship between BMI, WC (Waist Circumference), and blood lead levels in the non-smoking middle-aged subjects without hypertension among 2018 KNHANES. All data were recategorized into S1 (BMI<25 kg/m2 & WC<90 cm), S2 (intermediate), and S3 (BMI>25 kg/m2 & WC>90 cm).

METHODS

We made the log transformation of blood lead levels to bring them closer to a normal distribution. Logarithmic transformed BLL was closely related to BMI (p=.010) and WC (p=.020) after adjusting for sociodemographic, energy, working factors, and cardiometabolic variables. The prevalence of ratios of S3, S2, and S1 was comparable according to the quarterly group of BLL.

RESULTS AND CONCLUSIONS

Blood lead levels might increase oxidative stress on triglycerides and low high-density lipoprotein (HDL)-cholesterol; consequently, lead exposure might form peroxynitrite, a reactive oxygen substrate (ROS) susceptible to destroying lipids. Consequently, obesity was significantly correlated with logarithmic blood lead levels irrespective of sociodemographic, energy, working, and cardiometabolic factors in the non-smoking middle-aged population without hypertension. Further controlled clinical trials would be considered.

Potato protein hydrolysate (PPH902) exerts anti-lipogenesis and lipolysis-promoting effect by inhibiting adipogenesis in 3T3-L1 adipocytes

Obesity is linked to cardiovascular disease, cerebrovascular disease, diabetes, and dyslipidemia, lowering quality of life, work productivity, and healthcare expenditures. The aim of this present study is to investigate the mechanism of potato protein (PP) post-treatment in regulating lipogenesis and lipolysis in 3T3-L1 adipocytes. 9% PP hydrolysed for 2 h (PPH902) shows high yield and better activity; thus, PPH902 was used in all other experiments. 3T3-L1 preadipocyte cells were used, the cell culture medium were changed every 2 days, IDH was added on Day 0. PPH902 was added on the 8th day, it was left for 72 h and then cells are collected. The relative triglyceride residual (RTR) content was quantified, and the expression of key lipid metabolism-related proteins was analyzed using Western blotting. PPH902 at concentrations of 400 ppm, 800 ppm, and 1600 ppm markedly decreases the RTR content. PPH902, at higher doses, modulates the expression of lipid production-associated transcription factors PPARγ, SREBP-1c, and FAS by activating AMPK, which inhibits lipogenesis and activates phosphorylated HSL to enhance lipolysis, so augmenting lipid metabolism. These findings suggest that PPH902 is an effective anti-lipogenic and lipolysis-promoting agent with potential applications in anti-obesity interventions.

Physical activity, sedentary behavior, and metabolic syndrome in adults with arthritis: cross-sectional and Mendelian randomization analysis

This study examined the relationship between moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and metabolic syndrome, employing both cross-sectional and Mendelian randomization methods to enhance causal inference. The cross-sectional analysis included adults aged 20 years and older with arthritis (n=4,227) from the National Health and Nutrition Examination Survey and assessed the associations between MVPA, SB, and metabolic syndrome. Mendelian randomization analysis used genome-wide association studies to validate causal relationships, employing instrumental variables selected from single nucleotide polymorphisms linked to accelerometer-based physical activity (fraction of time with accelerations >425 milli-gravities) and SB. The primary Mendelian randomization methods included inverse variance weighting and Bayesian Weighted Mendelian Randomization. Sensitivity analyses, including Mendelian Randomization-Egger intercept test, the weighted median method, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier, were conducted to ensure result robustness. Cross-sectional analysis revealed a significant association between higher levels of MVPA and reduced SB with a lower prevalence of metabolic syndrome. Participants in the high MVPA/low SB group demonstrated lower odds of metabolic syndrome (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.29-0.56), hypertension (OR, 0.55; 95% CI, 0.40-0.75), fasting glucose (OR, 0.52; 95% CI, 0.35-0.77), and waist circumference (OR, 0.34; 95% CI, 0.22-0.54). Mendelian randomization analysis confirmed a causal relationship, showing that physical activity decreases risk factors for metabolic syndrome, while SB exacerbates them. This study emphasizes the critical roles of regular physical activity and reduced SB in mitigating the risk of metabolic syndrome, especially among older adults with arthritis.

The Role of Cholesterol Metabolism and Its Regulation in Tumor Development

BACKGROUND

Within the tumor microenvironment, tumor cells undergo metabolic reprogramming of cholesterol due to intrinsic cellular alterations and changes in the extracellular milieu. Furthermore, cholesterol reprogramming within this microenvironment influences the immune landscape of tumors, facilitating immune evasion and consequently promoting tumorigenesis. These biological changes involve modifications in numerous enzymes associated with cholesterol uptake and synthesis, including NPC1L1, SREBP, HMGCR, SQLE, and PCSK9.

REVIEW

This review systematically summarizes the role of cholesterol metabolism and its associated enzymes in cancer progression, examines the mechanisms through which dysregulation of cholesterol metabolism affects immune cells within the tumor microenvironment, and discusses recent advancements in cancer therapies that target cholesterol metabolism.

CONCLUSION

Targeting cholesterol metabolism-related enzymes can inhibit tumor growth, reshape immune landscapes, and rejuvenate antitumor immunity, offering potential therapeutic avenues in cancer treatment.

Causal Associations with Arterial Stiffness and Sarcopenia: A Mendelian Randomization Analysis

Observational studies and clinical trials indicate a link between arterial stiffness (AS) and sarcopenia (SAR), yet the causal relationship between these remains unclear. The study aims to investigate the causal connection from AS to SAR by Mendelian randomization (MR). We analyzed Genome-Wide Association Studies data for AS indicators: pulse wave arterial stiffness index (PWASI) and pulse wave peak-to-peak time (PPT), and SAR indicators: low hand grip strength (LHGS), usual walking pace (UWP), moderate-to-vigorous physical activity levels (MVPA), and walk or cycle unassisted for 10 minutes. The inverse variance-weighted, MR-Egger, weighted mode, and weighted median were applied to MR. There is a bidirectional causal relationship between the AS and SAR. The PWASI has a causation with UWP (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.94-0.99). The PPT has a causal association with MVPA (OR = 1.08, 95% CI = 1.002-1.144) and UWP (OR = 1.05, 95% CI = 1.017-1.096). The LHGS is causally associated with PPT (OR = 0.95, 95% CI = 0.91-0.98) and UWP has a causal association with PWASI (OR = 0.77, 95% CI = 0.65-0.90) and PPT (OR = 1.37, 95% CI = 1.17-1.60). The increased AS could reduce the motor ability slightly and the lower upper and lower limb strength could lead to the higher AS. This bidirectional causal relationship of the two may offer novel perspectives for advancing the understanding of the underlying mechanisms related to AS and muscle pathophysiology.

The promise of incretin-based pharmacotherapies for metabolic dysfunction-associated fatty liver disease

BACKGROUND

The presence of excess liver fat secondary to metabolic dysregulation represents the end-organ manifestation of a systemic disease that can progress to steatohepatitis, cirrhosis and its feared complications of clinical decompensation and hepatocellular cancer. Since metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent globally, there is a pressing need to augment lifestyle interventions with pharmacotherapies to ameliorate disease burden and reduce adverse liver-related events.

PURPOSE

This review summarises current evidence for the utility of incretin mimetics in the MAFLD/MASH arena.

METHODS

A literature review that encompassed multiple database searches to inform the evidence base for incretin drugs in MAFLD/MASH.

RESULTS

Incretin mimetics demonstrate multifarious benefits across the metabolic diseases spectrum with mounting evidence for their role in remitting steatohepatitis and liver fibrosis. Weight loss and insulin sensitisation contribute, but additional mechanisms may also be engaged. Gastrointestinal adverse effects are common but for most, can be managed while preserving the hepatic and cardiometabolic benefits.

CONCLUSION

The literature reveals benefits from incretin-based therapies for MASH, but data on whether they improve long-term hepatic outcomes are awaited to support their future incorporation into routine clinical care.

Association between body shape index and arterial stiffness: results of the EVasCu study and a meta-analysis

OBJECTIVE

The aim of this study was to analyse the association between body shape index (ABSI) and arterial stiffness in healthy subjects using data from the EVasCu study. In addition, a meta-analysis was performed to compare the association between ABSI and central, peripheral and systemic arterial stiffness in the general population.

METHODS

The EVasCu study included 390 healthy subjects. ABSI was calculated from waist circumference, body mass index and height, and arterial stiffness was assessed with aortic pulse wave velocity (a-PWv) and cardio-ankle vascular index (CAVI). A meta-analysis of previous studies, including data from the EVasCu study, was performed to obtain pooled estimates of correlation coefficients (r) and their respective 95% confidence intervals (95% CIs) for the association between ABSI and central, peripheral and systemic arterial stiffness. In addition, pooled OR estimates and their 95% CIs were calculated.

RESULTS

In the EVasCu study, the correlation coefficient estimate was 0.458 (p < 0.01) for the association of a-PWv and ABSI and 0.408 (p < 0.01) for the association of CAVI and ABSI. In the meta-analysis, the pooled correlation coefficient estimate was 0.22 (95% CIs: 0.16, 0.28) for central arterial stiffness and ABSI, 0.21 (95% CIs: 0.14, 0.28) for peripheral arterial stiffness and ABSI, and 0.28 (95% CI: 0.21, 0.3) for systemic arterial stiffness and ABSI. When pooled ORs were calculated, the pooled OR estimate was 2.12 (95% CIs: 1.68, 2.56) for central arterial stiffness and ABSI, 2.21 (95% CIs: 1.81, 2.60) for peripheral arterial stiffness and ABSI, and 2.99 (95% CIs: 2.14, 3.85) for systemic arterial stiffness and ABSI.

CONCLUSION

Based on both the results obtained in the EVasCu study and the meta-analysis, there is a positive association between ABSI and arterial stiffness, both in healthy subjects and in participants with comorbidities. For each unit of cm/kg/m²/m increase in ABSI, the risk of arterial stiffness increased by 112% for central arterial stiffness, 121% for peripheral arterial stiffness, and 199% for systemic arterial stiffness. However, further research is needed in this field of knowledge.

Glucagon-Like Peptide-1 Agonist Use in Adults With Congenital Heart Disease: Effect, Safety, and Outcomes

BACKGROUND

Obesity is prevalent among patients with adult congenital heart disease (ACHD) and contributes to adverse cardiovascular outcomes. There is a paucity of data regarding glucagon-like peptide-1 receptor agonists (GLP-1 RA) for weight loss in patients with ACHD.

OBJECTIVES

The purpose of this study was to assess the effect, safety, and outcomes of GLP-1 RA among patients with ACHD.

METHODS

This is a retrospective cohort study of patients with ACHD at Mayo Clinic (January 2013-January 2024) who were prescribed semaglutide or liraglutide. The primary endpoint was weight loss. Secondary endpoints were changes in NYHA functional class, hemoglobin A1c, estimated glomerular filtration rate, and safety endpoints of renal adverse event, hypoglycemia, hospitalization/drug discontinuation due to side effects.

RESULTS

Seventy patients received GLP-1 RA over a mean duration of 21 ± 20 months. Majority (85.7%) had moderate/severe complexity congenital heart disease. Weight loss >5% was achieved in 30 (42.9%) patients. Patients with body mass index ≥35 kg/m2 were more likely to achieve weight loss >5% [66.7% vs 40%, P = 0.027]. Younger age resulted in improved weight loss of 0.17 kg per 1-year age difference (P = 0.014). Hemoglobin A1c lowered by a mean of 0.6% (P = 0.054). There were no significant changes in NYHA functional class or estimated glomerular filtration rate. One-third of patients experienced side effects, mostly from gastrointestinal intolerance (20%); 11.4% discontinued the medication due to side effects.

CONCLUSIONS

GLP-1 RAs are safe and effective for weight loss in patients with ACHD with beneficial effects on glycemic control.

Development and validation of a diagnostic nomogram model for osteoporosis in the elderly using 3D multi-echo Dixon sequence combined with magnetization transfer imaging

OBJECTIVE

To develop a novel combined nomogram based on 3D multi-echo Dixon (qDixon), magnetization transfer imaging (MTI) and clinical risk factors for the diagnosis of osteoporosis.

MATERIALS AND METHODS

A total of 287 subjects who underwent MR examination with qDixon and MTI sequences participated in this study. These participants were randomly assigned to a training cohort and a validation cohort at a ratio of 7:3. We extracted and analyzed the bone marrow fat fraction (FF) and magnetization transfer ratio (MTR) of L1 ∼ 3 vertebrae, along with clinical data. Univariate and multivariate logistic regression analyses was used to assess independent predictors of OP in the training cohort. We established a diagnostic nomogram and evaluated its performance in terms of discrimination, calibration, and clinical value using the receiver operating characteristic curve (ROC) and calibration curve. Decision curve analysis (DCA) was performed to determine the clinical validity of the nomogram by measuring the net benefits at different threshold probabilities.

RESULTS

Gender, age, FF, and MTR (all P﹤0.05) emerged as independent indicators for diagnosing osteoporosis. The AUCs for the FF, MTR, FF + MTR, and nomogram models were 0.842, 0.903, 0.923, and 0.941, respectively, in the training cohort and 0.779, 0.872, 0.901, and 0.929, respectively, in the validation cohort. The nomogram model exhibited good calibration and discrimination. DCA revealed that the nomogram model yielded a higher net benefit than the FF and MTR models.

CONCLUSION

The nomogram model, integrating qDixon, MTI, and clinical parameters, could serve as a reliable tool for diagnosing the individual risk for the osteoporosis in the elderly.

Evaluating the Role of School-Based Physical Activity in Mitigating Cardiometabolic Risk Factors in Children and Adolescents with Overweight or Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Overweight or obese children and adolescents have a higher risk of developing cardiometabolic health problems compared with their healthy-weight peers, which are likely to progress to cardiovascular disease and are associated with a range of negative impacts.

OBJECTIVES

To evaluate the effects of school-based physical activity (PA) interventions on cardiometabolic risk factors in children and adolescents with overweight or obesity.

METHOD

A search of online databases was conducted to identify relevant studies up to 31 January 2025.

RESULTS

Eleven studies were included, involving 963 participants aged 7 to 18 years. School-based PA interventions have a significant effect size (ES) in reducing body fat percentage (ES = -0.43, p < 0.01), diastolic blood pressure (ES = -0.27, p < 0.05), triglycerides (ES = -0.38, p < 0.01), fasting blood glucose (ES = -0.60, p < 0.01), blood insulin (ES = -0.62, p < 0.01), and homeostatic model assessment-insulin resistance (ES = -0.58, p < 0.01) in overweight or obese students. However, no significant improvements were observed in body mass index, body mass index z-score, waist circumference, waist-to-height ratio, maximal oxygen consumption, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol.

CONCLUSION

School-based PA interventions lasting 6 weeks longer, twice a week or more, can significantly mitigate some cardiometabolic risks of overweight or obese children and adolescents. Effective, targeted PA programs should be considered in the school setting to promote the cardiometabolic health of this vulnerable group.

Relationship between tobacco smoking and metabolic syndrome: a Mendelian randomization analysis

BACKGROUND

Numerous epidemiologic observational studies have demonstrated that smokers have an increased risk of developing cardiovascular-related diseases. However, less is known about the causal relationship between tobacco smoking and the metabolic syndrome. This study aimed to determine whether genetically predicted smoking is associated with metabolic syndrome using the Mendelian randomization (MR) approach.

METHODS

This paper used individual-level genetic and personal data from the Taiwan Biobank dataset, including 80,072 Han Chinese individuals (15,773 cases of metabolic and 64,299 controls; 21,399 smokers and 58,673 nonsmokers). The literature was searched for smoking-associated single nucleotide polymorphisms (SNPs), and 14 SNPs satisfying MR assumptions were identified and used as instrumental variables. Weighted and unweighted genetic risk scores (GRSs) based on these significant SNPs were derived. MR analyses were performed using the two-stage approach of regression models.

RESULTS

Genetically predicted smoking is associated with a higher risk of metabolic syndrome (odds ratio [OR]: 1.49, 95% CI: 1.47-1.52 per 1 standard deviation increase) for weighted and unweighted GRSs. When Q1 was used as the reference group, the adjusted ORs of metabolic syndrome for Q2, Q3, and Q4 were 1.15 (1.08, 1.22), 2.17 (2.05, 2.30), and 4.23 (3.98, 4.49), respectively, for the weighted GRS. The corresponding ORs for Q2, Q3, and Q4 were 1.16 (1.09, 1.24), 2.17 (2.05, 2.30), and 4.26 (4.02, 4.53), respectively, for the unweighted GRS.

CONCLUSIONS

Genetic predisposition toward tobacco smoking is strongly associated with a higher likelihood of metabolic syndrome. Further work is warranted to clarify the underlying mechanism of smoking in the development of metabolic syndrome.

Impact of medical versus surgical weight loss on cardiovascular outcomes

Obesity contributes to cardiovascular disease in two ways - directly, as an independent risk factor, and indirectly, through its contribution to comorbidities such as hypertension, diabetes, dyslipidemia. This cascade of multiplicative effects means that early management of obesity is instrumental in risk reduction and prevention of adverse cardiovascular outcomes. The amount and sustainability of weight loss has been extensively studied and stratified by medical versus surgical weight loss. Medical weight loss has historically been inferior by both parameters; however, new therapies targeting glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) receptors have demonstrated very promising results independently for both weight loss and cardiovascular disease. In this review, we compare cardiovascular outcomes between bariatric surgical approaches and novel GLP-1/GIP medications. We aim to answer the following question: In this era of new pharmacological weight loss options, does the method of weight loss-surgical or medical-impact cardiovascular risk mitigation, or is the key factor the maintenance of a healthier weight, regardless of the method?

Critical Review on Anti-Obesity Effects of Anthocyanins Through PI3K/Akt Signaling Pathways

Obesity is a global health crisis and is one of the major reasons for the rising prevalence of metabolic disorders such as type 2 diabetes, cardiovascular diseases, and certain cancers. There has been growing interest in the search for natural molecules with potential anti-obesity effects; among the phytochemicals of interest are anthocyanins, which are flavonoid pigments present in many fruits and vegetables. Anthocyanins influence obesity via several signaling pathways. The PI3K/Akt signaling pathway plays a major role with a focus on downstream targets such as GLUT4, FOXO, GSK3β, and mTOR, which play a central role in the regulation of glucose metabolism, lipid storage, and adipogenesis. The influence of critical factors such as oxidative stress and inflammation also affect the pathophysiology of obesity. However, the studies reviewed have certain limitations, including variations in experimental models, bioavailability challenges, and a lack of extensive clinical validation. While anthocyanin shows tremendous potential, challenges such as poor bioavailability, stability, and regulatory matters must be overcome for successful functional food inclusion of anthocyanins. The future of anthocyanin-derived functional foods lies in their ability to overcome hurdles. Therefore, this review highlights the molecular mechanisms of obesity through the PI3K/Akt signaling pathways and explores how anthocyanins can modulate these signaling pathways to address obesity and related metabolic disorders. It also addresses some ways to solve the challenges, like bioavailability and stability, while emphasizing future possibilities for anthocyanin-based functional foods in obesity management.

The effect of fiber intake on the association of pesticide exposure and hypertension: a population-level study

The association between pesticide exposure and the risk of hypertension is inconsistent. Moreover, little is known about the effects of dietary fiber intake on the association between pesticide exposure and the risk of hypertension. This study aimed to assess whether fiber intake alters the relationship between pesticide exposure and hypertension. The study included 14,218 American adult patients. Multivariate logistic regression analysis was used to assess the relationship between pesticide exposure and the risk of hypertension. We also examined the relationship between pesticide metabolites in urine specimens and hypertension. Participants were stratified based on their mean fiber intake (low fiber intake: <17 gm and high fiber intake: ≥17 gm). An interaction test between dietary fiber intake, pesticide exposure, and risk of hypertension was conducted. Exposure to pesticides increased the risk of hypertension in the crude and full-adjusted models, and their odds ratio (ORs) [95% Confidence Interval (CI)] were 1.40 (1.26-1.56) and 1.19 (1.05-1.34), respectively. The analysis of pesticide metabolites indicated that dimethyldithiophosphate was statistically associated with hypertension (OR = 1.01, 95% CI = 1.01-1.02). The association between pesticide exposure and hypertension was opposite among participants in low and high fiber intake groups, OR = 1.34, 95% CI: 1.14-1.58 vs. OR = 0.98, 95% CI: 0.80-1.20, respectively, which implied that a high fiber intake may decrease the risk of hypertension (interaction likelihood ratio test: p = 0.031). We are the first to report the role of fiber intake in pesticide exposure and the risk of hypertension.

Influenza Vaccination Trends and Associated Factors Among Middle-aged Working Adults With an Elevated Cardiovascular Risk in Korea

BACKGROUND AND OBJECTIVES

The development of atherosclerotic cardiovascular disease (ASCVD) in middle-aged working groups can be a major contributor to disability-adjusted life years. However, information regarding the current trends in influenza vaccination within this demographic group remains scarce. Thus, we aimed to investigate the recent 11-year trends in influenza vaccination and related factors among these populations in Korea.

METHODS

Of 42,879 individuals aged 40-64 years enrolled in the Korea National Health and Nutrition Examination Survey between 2010 and 2021, 35,323 were included. We investigated the yearly trend of influenza vaccination rate according to ASCVD risk and factors associated with being unvaccinated in the elevated ASCVD risk group (ASCVD risk score: ≥7.5%).

RESULTS

Among the 35,323 participants, 20,392 (57.7%) were classified into the elevated ASCVD risk group. Over the 11 years, the vaccination rate was significantly higher in the elevated ASCVD risk group than in the low ASCVD risk group (33.8% vs. 25.3%, p<0.001). Factors associated with the unvaccinated status in the elevated ASCVD risk group included younger age (<50 years; adjusted odds ratio, 1.61; 95% confidence interval, 1.31-1.98), male sex (1.43; 1.16-1.76), current smoker status (1.41; 1.13-1.76), residence in an urban area (1.19; 1.01-1.41), and having higher education (1.3; 1.04-1.64).

CONCLUSIONS

One in 3 middle-aged working adults with an elevated risk of ASCVD received the influenza vaccination. Although the influenza vaccination rate was higher in participants with an elevated ASCVD risk than in those with low ASCVD risk, the vaccination rate was relatively unsatisfactory.

Efficacy of intragastric botulinum toxin A injection on patients with side effects caused by intragastric balloon placement intolerance: A case series study

RATIONALE

Obesity is a global health concern, with intragastric balloon (IGB) placement serving as a nonsurgical intervention for weight management. However, intolerance due to severe gastrointestinal side effects often leads to premature removal, limiting its effectiveness. Botulinum toxin A (BTX-A) injection has been proposed as a potential strategy to improve IGB tolerance by modulating gastric motility.

PATIENT CONCERNS

This study reports a case series of patients who developed severe intolerance to IGB placement, including persistent nausea, vomiting, fluid intolerance, dehydration, and reduced urine output, necessitating medical intervention.

DIAGNOSES

Patients were diagnosed with IGB intolerance due to obstructive gastric effects, characterized by impaired gastric emptying and intolerance to oral fluids, leading to dehydration and electrolyte imbalances.

INTERVENTIONS

A total of 14 patients with IGB intolerance were treated with 500 U of BTX-A injected around the pyloric canal. Prokinetic drugs were also administered to support gastric motility. Patients were monitored for 6 months following the intervention.

OUTCOMES

Among the 14 patients, 11 (78.57%) showed a significant improvement in fluid tolerance within 12 hours of BTX-A injection and were able to retain the IGB without additional complications. Three patients (21.43%) did not improve and required early IGB removal. No major adverse effects related to BTX-A injection were observed.

LESSONS

BTX-A injection appears to be a promising adjunctive therapy to improve IGB tolerance in patients experiencing severe intolerance. These findings suggest a potential role for BTX-A in reducing the need for premature balloon removal, thereby enhancing weight loss outcomes. However, further randomized controlled trials with larger sample sizes are needed to confirm its efficacy, optimize dosage, and establish standardized treatment protocols.

Joint association of sleep duration and depression with new-onset hearing loss: a national cohort study

Background

Hearing loss, a global health burden, is closely associated with depression and sleep disorders. However, the combined effects of sleep duration and depression on hearing loss risk remain unclear.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed, including 6,374 adults aged 45 and older. Cox proportional hazards models assessed the relationship between depression, sleep duration, and hearing loss. Mediation analysis explored the potential mediating roles of CESD-10 score and sleep duration on new-onset hearing loss. Subgroup analyses by age, sex, and BMI were also conducted.

Results

Over a 7-year follow-up, 1,422 participants developed hearing loss. Both short sleep duration and high CESD-10 scores were independently associated with increased risk of hearing loss. Participants with long sleep duration but depression had a hazards ratio (HR) of 1.59 (95% CI: 1.35, 1.87) for hearing loss. Mediation analysis showed that sleep duration mediated 10.1% of the association between CESD-10 score and hearing loss, while CESD-10 score mediated 70.8% of the relationship between sleep duration and hearing loss.

Conclusion

This study highlights the significant and interconnected roles of sleep duration and depression in the development of hearing loss. Interventions addressing both sleep and depression may offer more effective strategies for preventing and managing hearing loss.

Estimation of the Burden of Ischemic Heart Disease in the Tabasco Population, Mexico, 2013-2021

INTRODUCTION

The burden of disease measures the total impact of diseases on a population, considering incidence, prevalence, disability, and premature mortality. This study analyzes the burden of ischemic heart disease (IHD) in Tabasco, Mexico, from 2013 to 2021. Ischemic heart disease has a significant incidence of 21,203,479 cases worldwide, and nationally (inside Mexico) a total of 221,747 cases, with more than 9,137,791 deaths due to this pathology globally.

OBJECTIVE

To analyze the burden of ischemic heart disease in Tabasco, Mexico, during the 2013-2021 period.

METHODS

An observational, descriptive, longitudinal, and retrospective study was conducted in Tabasco. The study population consisted of 2,402,598 people according to INEGI, with a sample of 927,000 adults (462,000 men and 465,000 women). Data were used from the General Directorate of Health Information, IHME, and the World Bank. Analyses were performed in Microsoft Excel, calculating measures of central tendency, dispersion, and Disability-Adjusted Life Years (DALYs).

RESULTS

The DALYs in the adult population of Tabasco were: 2013-23,932; 2014-28,132; 2015-30,197; 2016-30,683; 2017-31,839; 2018-38,599; 2019-40,046; 2020-42,307; and 2021-55,723, totaling 297,576 DALYs from 2013 to 2021.

DISCUSSION

Ischemic heart disease increased in incidence and mortality in both men and women during the years analyzed. The increase in DALYs indicates a greater impact of ischemic heart disease in Tabasco compared to countries like Costa Rica.

CONCLUSION

The burden of ischemic heart disease from 2013 to 2021 represents a significant loss of quality and years of life in the population of Tabasco, Mexico.

The role of tetrahydrocannabivarin (THCV) in metabolic disorders: A promising cannabinoid for diabetes and weight management

Disorders of the metabolism, including obesity and type 2 diabetes, represent significant global health challenges due to their rising prevalence and associated complications. Despite existing therapeutic strategies, including lifestyle interventions, pharmacological treatments, and surgical options, limitations such as poor adherence, side effects, and accessibility issues call attention to the need for novel solutions. Tetrahydrocannabivarin (THCV), a non-psychoactive cannabinoid derived from Cannabis sativa, has emerged as a promising agent to manage metabolic disorders. Unlike tetrahydrocannabinol (THC), THCV exhibits an antagonistic function on the CB1 receptor and a partial agonist function on the CB2 receptor, thus enabling appetite suppression, enhanced glucose regulation, and increased energy expenditure. Preclinical studies demonstrated that THCV improves insulin sensitivity, promotes glucose uptake, and restores insulin signaling in metabolic tissues. Additionally, THCV reduces lipid accumulation and improves the mitochondrial activity in adipocytes and hepatocytes, shown through both cell-based and animal research. Animal models further revealed THCV's potential to suppress appetite, prevent hepatosteatosis, and improve metabolic homeostasis. Preliminary human trials support these findings, thereby showing that THCV may modulate appetite and glycemic control, though larger-scale studies are necessary to confirm its clinical efficacy and safety. THCV's unique pharmacological profile positions it as a possible therapeutic candidate to address the multifaceted challenges of obesity and diabetes. Continued research should concentrate on optimizing formulations, undertaking well-designed clinical studies, and addressing regulatory hurdles to unlock its full potential.

Semaglutide as a GLP-1 Agonist: A Breakthrough in Obesity Treatment

This review addresses the role of semaglutide (SMG), a GLP-1 receptor agonist, in the treatment of obesity and its related comorbidities. Originally developed for type 2 diabetes (DM2), SMG has shown significant efficacy in weight reduction, with superior results compared to other treatments in the same class. Its effects include appetite suppression, increased satiety, and improvements in cardiovascular, renal, and metabolic parameters. Studies such as SUSTAIN, PIONEER, and STEP highlight its superiority compared to other GLP-1 receptor agonists and anti-obesity drugs. The oral formulation showed promising initial results, with higher doses (50 mg) showing weight losses comparable to those of subcutaneous administration. Despite its benefits, there are challenges, such as weight regain after cessation of treatment, gastrointestinal adverse effects, and variability of response. Future studies should explore strategies to mitigate these effects, identify predictive factors of efficacy, and expand therapeutic indications to other conditions related to obesity and insulin resistance. The constant innovation in this class of drugs reinforces the potential of SMG to transform treatment protocols for chronic weight-related diseases.

Obesity Class and Severity of Metabolic Emergencies: A Single-Center Retrospective Five-Year Study

Background/Objectives: This study aims to investigate the impact of obesity severity on the prevalence and outcomes of acute metabolic emergencies in the emergency department (ED) setting, with a specific focus on obesity class stratification and associated metabolic complications. Methods: This retrospective, single-center study analyzed data from 433 patients admitted to the ED of the Timisoara Municipal Emergency Hospital between January 2019 and March 2024. Patients were classified according to WHO obesity grades (Class I: BMI 30.0-34.9 kg/m2, Class II: 35.0-39.9 kg/m2, Class III: ≥ 40.0 kg/m2). The prevalence and severity of metabolic emergencies, including hyperglycemic crises, acute kidney injury (AKI), and severe electrolyte imbalances, were compared across obesity classes. Results: Obese patients (37.2%) exhibited a significantly higher prevalence of metabolic emergencies than non-obese individuals (p < 0.001). Hyperglycemia was present in 27.9% of obese patients vs. 11.0% of non-obese patients (p < 0.001). AKI incidence nearly doubled in obese patients (12.4% vs. 5.5%, p = 0.01). Logistic regression identified Class III obesity as an independent risk factor for metabolic emergencies (adjusted OR = 3.2, 95% CI: 2.1-4.9, p < 0.001). Conclusions: The severity of metabolic emergencies increases with increasing obesity class, emphasizing the need for obesity-specific risk stratification in ED settings. Routine monitoring of metabolic markers and early intervention strategies should be prioritized for high-risk obese patients.

The Effect of Eating Speed on Sarcopenia, Obesity, and Sarcopenic Obesity in Older Adults: A 16-Year Cohort Study Using the Korean Genome and Epidemiology Study (KoGES) Data

Background: Sarcopenia and obesity are age-related conditions associated with dietary habits. However, the relationship between eating speed and sarcopenia, particularly in older adults >65 years of age remains unclear. Methods: To investigate the effect of eating speed on the occurrence of sarcopenia, obesity, and sarcopenic obesity, we examined eating speed, socioeconomic factors, and disease history of 6202 patients at baseline and their changes over a 16-year follow-up period. Results: A fast eating speed was significantly associated with a higher risk of developing sarcopenia (normal eating: HR 1.284, 95% CI 1.107-1.490; slow eating: HR 1.583, 95% CI 1.279-1.958). Slower eating was associated with a reduced risk of obesity (normal eating: HR 0.865, 95% CI 0.786-0.952; slow eating: HR 0.680, 95% CI 0.577-0.802). These trends were consistent among participants aged <65 years. Among participants aged ≥65 years, fast eating was associated with a higher incidence of sarcopenia (HR 1.603, 95% CI 1.119-2.298), but no significant relationship existed with obesity (normal eating: HR 0.846, 95% CI 0.623-1.150; slow eating: HR 0.792, 95% CI 0.537-1.168). Conclusions: Slow eating speed decreased the incidence of obesity but increased that of sarcopenia in adults aged <65 years. However, in adults aged ≥65 years, slow eating speeds increased the incidence of sarcopenia but did not reduce the incidence of obesity.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

Bill & Melinda Gates Foundation.

The effects of personalized video feedback of basic cardiac life support on knowledge and skills levels in undergraduate nursing students: a randomized controlled trial

BACKGROUND

Cardiopulmonary cerebral resuscitation is the first-line treatment for cardiopulmonary arrest, documented as one of the most common medical emergencies and the leading causes of death globally. The aim of this study was to investigate the effects of the personalized video feedback of Basic Cardiac Life Support (BCLS) on knowledge and skill levels among undergraduate nursing students.

METHODS

This randomized controlled trial was conducted at a nursing school in Tehran, Iran, in 2023. Forty incoming students were chosen through the census method and divided into experimental and control groups by simple randomization. The students of both groups were taught about BCLS through lectures and simulation-based techniques in two 120-minute sessions. Then, the students performed BCLS on the mannequin and recorded it with a digital camera, then immediate personalized feedback was given in both groups. Next, the recorded video with personalized feedback from the experimental group was made available to them that it was the only difference between the two groups. One week and one month after retraining, the BCLS knowledge and skills levels of both groups were examined. To collect the data, the personal profile form, the BCLS knowledge questionnaire, and the BCLS skills Checklist were utilized.

RESULTS

There was no significant difference in the individual characteristics (p > 0.05) and the mean scores of BCLS knowledge (p = 0.762) and skills (p = 0.715) in both groups before training. There was no significant difference in the mean scores of BCLS knowledge in both groups immediately (p = 0.467), one week (p = 0.904), and one month (p = 0.626) after training. No significant difference was observed in the mean scores of BCLS skills in both groups immediately after training (p = 0.303), while one week (p < 0.0001) and one month (p < 0.0001) later, the mean skills scores in the experimental group were higher than those in the control group.

CONCLUSIONS

Providing feedback to students via personalized video appears to have a greater impact on students' knowledge and skills regarding BCLS than providing in-person feedback alone. So, it was recommended to apply this student-centered and self-directed training in undergraduate nursing students after more studies in larger groups.

TRIAL REGISTRATION

The study has been registered in the Iranian Registry of Clinical Trials (No. IRCT20230911059402N1, Date: 12/10/2023).

COVID-19 related complications

The COVID-19 pandemic has significantly impacted global healthcare systems, revealed vulnerabilities and prompted a re-evaluation of medical practices. Acute complications from the virus, including cardiovascular and neurological issues, have underscored the necessity for timely medical interventions. Advances in diagnostic methods and personalized therapies have been pivotal in mitigating severe outcomes. Additionally, Long COVID has emerged as a complex challenge, affecting various body systems and leading to respiratory, cardiovascular, neurological, psychological, and musculoskeletal problems. This broad spectrum of complications highlights the importance of multidisciplinary management approaches that prioritize therapy, rehabilitation, and patient-centered care. Vulnerable populations such as paediatric patients, pregnant women, and immunocompromised individuals face unique risks and complications, necessitating continuous monitoring and tailored management strategies to reduce morbidity and mortality associated with COVID-19.

Hawthorn leaf and its extract alleviate high-fat diet-induced obesity and modulate gut microbiome in mice

Obesity has emerged as a global health issue with its prevalence continuously increasing and being associated with multiple comorbidities. Although existing medications are effective, they often come with significant side effects, making dietary therapy an advantageous alternative. Hawthorn leaves and their active component, vitexin, have shown potential in regulating lipid metabolism and improving gut microbiota imbalance. This study utilized a high-fat diet-induced obese mouse model, administering different doses of hawthorn leaves and vitexin for 13 weeks, and employed 16S rRNA sequencing and metabolomics to analyze the composition of gut microbiota and metabolites. The results demonstrated that hawthorn leaves and vitexin significantly slowed body weight gain, improved glucose tolerance, regulated blood lipid levels, and downregulated the expression of obesity-related gene in mice (ppar-α, ppar-γ, fas). Additionally, the treatment groups showed a significant improvement in gut microbiota diversity. Both vitexin and hawthorn leaves increased the abundance of Kineothrix, Paramuribaculum, Lawsonibacter (which belong to the Bacillota phylum) and Olsenella (Actinobacteria phylum), while reducing the abundance of Anaerotignum (Bacillota phylum). Moreover, the hawthorn leaves and vitexin treatments may alleviate obesity-related symptoms by increasing the fecal content of testosterone propionate, formoterol, and isoleucyl-prolyl-proline, and decreasing the content of Trolox. These findings highlight the potential of hawthorn leaves and vitexin as functional foods for obesity management by modulating gut microbiota pathways, offering a promising dietary therapy approach.

Ferroptosis in adipose tissue: A promising pathway for treating obesity?

Using a high-fat-diet (HFD) mouse model and clinical samples, Wang et al.1 in this issue of Cell Metabolism report that ferroptotic signaling is involved in the expansion of adipose tissue and promotes adaptive thermogenesis in beige adipocytes. This finding may represent a promising new avenue for treating obesity.

ACTION Malaysia-perception and barriers to obesity management among people with obesity and healthcare professionals in Malaysia

BACKGROUND

Timely weight loss conversations between healthcare professionals (HCPs) and people with obesity (PwO) can help in effective obesity management. The Awareness, Care, and Treatment in Obesity maNagement in the Asia Pacific region (ACTION APAC) studied the attitudes, perceptions, and behaviours toward obesity among PwO and HCPs in nine countries of South and Southeast Asia. The current study is a subgroup analysis based on the Malaysian population, known as ACTION Malaysia (ACTION-MY), and aims to explore the attitudes, perceptions, behaviours, and barriers to effective obesity management among both PwO and HCPs.

METHODOLOGY

An online survey in dual languages (Malay and English) was conducted between April 2022 and May 2022 among 1001 adult PwO and 200 HCPs (general practitioners, endocrinologists, obstetricians/gynaecologists, cardiologists, and other appropriate specialities).

RESULTS

The findings highlighted significant gaps in obesity awareness, with 57% of PwO misclassifying their weight status as normal or overweight. While 68% of PwO valued discussing weight management with HCPs, success rates remained low. On average, patients made three weight loss attempts in adulthood, with 63% regaining weight even after maintaining weight loss for six months or more. Key barriers included insufficient exercise, motivation deficits, and poor hunger control. Although 88% of HCPs recognised obesity as a chronic disease affecting overall health, patient disinterest, limited awareness of treatment options, and time constraints hindered effective intervention. Despite 70% of PwO trusting HCPs' medication recommendations, only 10% received weight loss prescriptions.

CONCLUSIONS

This study emphasises the need for enhanced communication between HCPs and PwO, along with comprehensive support that includes mental health services. Addressing the perception gap regarding weight management responsibility is crucial. The results suggest that culturally contextualised approaches to obesity management in Malaysia are essential. Our findings highlight the urgent need for developing treatment strategies and policies targeting identified barriers and establishing collaborative frameworks to enhance obesity management within Malaysia's healthcare system.

What is the evidence regarding the safety of new obesity pharmacotherapies

The use of gut-hormone receptors agonists as new therapeutic options for obesity and some of its related comorbidities, such as type 2 diabetes, has resulted in an unprecedented efficacy in the medical management of people living with obesity (PLWO). Appraisal of the safety of these drugs is of utmost importance considering the large number of PLWO, and the potentially long exposure to these pharmacotherapies. In this narrative review we summarize the evidence on the safety of liraglutide, semaglutide, and tirzepatide as derived from randomized clinical trials conducted in adults living with obesity. Additionally, the safety of these drugs is put into perspective with that of other drugs currently approved for the treatment of PLWO. Overall, the available data support a favorable efficacy versus safety balance for gut-hormone hormone receptor analogues in the treatment of these subjects. Nonetheless, it should be acknowledged that in the context of a chronic disease that has reached epidemic proportions, data from randomized clinical trials aimed primarily at proving the efficacy of these drugs may have been insufficient to unveil all the safety issues. Thus, continuous surveillance on the adverse effects of liraglutide, semaglutide, and tirzepatide is required as we use these drugs in a broader population than that represented in currently available clinical trials.

Role of Incretin Mimetics in Cardiovascular Outcomes and Other Classical Cardiovascular Risk Factors beyond Obesity and Diabetes Mellitus in Nondiabetic Adults with Obesity: a Meta-analysis of Randomized Controlled Trials

BACKGROUND

Emerging data on cardiovascular outcomes, specifically major adverse cardiovascular events (MACE), are being reported from various trials involving incretin mimetics, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and glucose-dependent insulinotropic polypeptide (GIP), especially among patients with obesity and diabetes. Our aim was to evaluate this matter, while also involving various traditional cardiovascular risk factors [e.g., several body weight (BW) parameters, blood pressure (BP), lipid profile].

METHODS

A search of PubMed, Europe PMC, ScienceDirect, Cochrane, and ClinicalTrials.gov up to September 2024 was performed to identify GLP-1 RA and GIP trials in MACE risk reduction as a primary endpoint. Our secondary endpoints included a reduction in BW, waist circumference (WC), body mass index (BMI), BP changes, and lipid modifying effects, while also yielding safety concerns surrounding the use of these pharmaceutical agents. Mean differences (MD) and risk ratios (RR) were summarized using random-effects model.

RESULTS

A total of 11 eligible randomized controlled trials (RCTs) comprising 8 GLP-1 RA trials and 3 dual GLP-1 RA/GIP (tirzepatide) trials were included. Compared with control groups, GLP-1 RA significantly reduced the MACE risk by 32% [RR 0.68 (95% CI 0.53-0.87); P = 0.002; I2 = 73%, P-heterogeneity < 0.001] and 59% for tirzepatide [RR 0.41 (95% CI 0.18-0.92); P = 0.03; I2 = 0%, P-heterogeneity = 0.96]. Incretin mimetics also substantially reduced BW, BP, and improved lipid panel measures. However, there was an increased risk of adverse events, specifically gastrointestinal disorders within the incretin mimetics subset.

CONCLUSIONS

Incretin mimetics have shown promise in reducing MACE risk while also enhancing cardiovascular risk factors, including blood pressure and lipid profile, in adults with obesity without diabetes.

Effect of once-weekly subcutaneous semaglutide on abdominal visceral fat area in Japanese adults with overweight and obesity: A post hoc analysis of the STEP 6 trial

OBJECTIVE

A post hoc analysis of a subset of participants with visceral fat area (VFA) measurements in the STEP 6 trial was conducted to examine both the correlation between VFA and clinical parameters and the effect of semaglutide on VFA in key subgroups.

METHODS

Participants were Japanese adults aged ≥ 20 years with obesity disease, randomized to once-weekly subcutaneous semaglutide 2.4 mg, semaglutide 1.7 mg, or placebo, plus lifestyle recommendations, for 68 weeks. Correlation between baseline VFA (and change in VFA from baseline to week 68) and clinical parameters (body weight, body mass index [BMI], waist circumference, hepatic parameters, glycated hemoglobin, blood pressure, lipids, high-sensitivity C-reactive protein, and plasminogen activator inhibitor-1 [PAI-1]) was evaluated. Percentage change in VFA between semaglutide and placebo was compared across subgroups.

RESULTS

Among 180 participants (semaglutide 2.4 mg, n = 89; semaglutide 1.7 mg, n = 46; placebo, n = 45), mean VFA was 170.0 cm2 across subgroups. A positive correlation (Pearson's correlation coefficient [r] ≥0.3) was observed between baseline VFA and body weight (r = 0.415), BMI (r = 0.374), and both JASSO and WHO criterion waist circumference (r = 0.458 and r = 0.555). Correlation between changes in VFA and body weight, waist circumference, high-density and very low-density lipoprotein cholesterol, triglycerides, PAI-1, aspartate aminotransferase, and alanine transaminase were observed in ≥ 1 treatment arm. Semaglutide 2.4 mg and 1.7 mg reduced VFA compared with placebo in all subgroups.

CONCLUSIONS

VFA partially correlated with clinical parameters in Japanese adults with obesity disease. Subcutaneous semaglutide was an efficacious treatment option for the reduction of VFA, regardless of clinical characteristics.

TRIAL REGISTRY NAME

CT.gov TRIAL REGISTRATION IDENTIFICATION NUMBER: NCT03811574.

Association between brachial-ankle pulse wave velocity, obesity-related indices, and the 10-year incident risk score of atherosclerotic cardiovascular disease: The rural Chinese cohort study

BACKGROUND AND AIMS

Although existing evidence suggests that arterial stiffness and obesity impact cardiovascular health, limited studies have been conducted to explore the association between brachial-ankle pulse wave velocity (baPWV), obesity-related indices, and the risk of atherosclerotic cardiovascular disease (ASCVD).

METHODS AND RESULTS

The study participants were among those who completed the baPWV measurement at the second follow-up examination (during 2018-2020) of the Rural Chinese Cohort Study. Logistic regression models were employed to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) of the 10-year incident risk score of ASCVD associated with baPWV and obesity-related indices. Mediation analysis was applied to investigate the role of baPWV in the obesity-induced 10-year incident risk score of ASCVD. A total of 1589 individuals, including 573 men and 1016 women, were included in the study. In logistic regression analyses, the highest quartile levels of baPWV and obesity-related indices all significantly increased the 10-year incident risk score of ASCVD compared to their corresponding lowest quartiles. The ORs (95%CIs) of ASCVD 10-year incident risk score risk were 4.21(2.55-6.94) for baPWV, 4.43(2.69-7.29) for METS-VF, 7.20(4.09-12.66) for CVAI, 3.38(2.12-5.38) for CI, and 2.40(1.54-3.75) for ABSI. The indirect effect of baPWV accounted for 5.85 %, 7.92 %, 14.56 %, and 5.08 % of the total effects for METS-VF, CVAI, CI, and ABSI, respectively.

CONCLUSION

This study found that elevated levels of both baPWV and obesity-related indices were associated with a higher 10-year incident risk score of ASCVD. Additionally, baPWV partially mediated the obesity-related increase in 10-year incident risk score of ASCVD.

Structured lifestyle modification as an adjunct to obesity pharmacotherapy: there is much to learn

We are at the start of an exciting new era of very effective pharmacotherapy for patients with obesity, with the latest generation of drugs approaching the efficacy of obesity surgery. Clinical trials of obesity drugs tend to emphasise the importance of participation in some form of structured lifestyle intervention for all trial participants. This usually consists of advice to reduce calorie intake and increase moderate to vigorous physical activity. There is strong evidence that structured lifestyle modification programmes improve health in patients with obesity and related disorders. However, there is no specific evidence that they improve the response to obesity medications. This is because of the way that drug trials for patients with obesity have traditionally been designed, with participants in the active drug treatment group being compared to participants on placebo drug treatment, but with both groups always receiving the same structured lifestyle intervention. While this approach is entirely reasonable, it makes it impossible to draw any inferences about the efficacy of structured lifestyle modification to augment the response to drug therapy. Given this genuine equipoise, a critical step in ensuring that our treatment of patients with obesity is robustly evidence-based is to determine whether "drug plus lifestyle" offer any advantage over "drug plus placebo" in large, well-designed and adequately powered clinical trials. We also need to determine the cost-effectiveness of these programmes.

Comparative efficacy and safety of semaglutide 2.4 mg and tirzepatide 5-15 mg in obesity with or without type 2 diabetes: A systematic review of Phase 3 clinical trials

BACKGROUND AND AIMS

Both semaglutide 2.4 mg and tirzepatide have been recently approved for chronic use in obesity. There is a lack of literature comparing the efficacy and safety of both these agents in people with obesity/overweight with or without type 2 diabetes (T2D). We systematically reviewed Phase 3 randomized controlled trials (RCTs) conducted with two agents to synthesize the comparative efficacy and safety outcomes.

METHODS

We systematically searched PubMed electronic databases until December 15, 2024, using selected keywords and Boolean "AND." Subsequently, we compared the most closely matched trials conducted with semaglutide 2.4 mg and tirzepatide through an adjusted (if baseline imbalance in treatment outcome modifiers present) or unadjusted (in the absence of baseline imbalance) indirect treatment comparison method.

RESULTS

We identified one trial each of semaglutide 2.4 mg (STEP-1) and tirzepatide 5, 10, and 15 mg (SURMOUNT-1) in obese or overweight people without T2D and one trial each of semaglutide 2.4 mg (STEP-2) and tirzepatide 10 and 15 mg (SURMOUNT-2) in overweight people with T2D that were almost entirely comparable concerning baseline outcome modifier characteristics. Our unadjusted analysis without individual patients' data found relatively higher (4 and 5.4 % additional) weight loss, HbA1c (-0.4 % additional) reduction, and fewer gastrointestinal side effects (GI S/E) with tirzepatide 10 and 15 mg, respectively, than with semaglutide 2.4 mg, in the intention-to-treat analysis.

CONCLUSION

Tirzepatide 10 and 15 mg are more effective and have fewer GI S/E than semaglutide 2.4 mg. A well-powered head-to-head RCT is currently needed to confirm these findings.

The Evolving Role of Weight Loss Pharmacotherapy

Obesity is a complex disease, afflicting millions of individuals worldwide. Multiple treatment options exist, including dietary and lifestyle modifications, pharmacotherapy, endobariatrics, and surgery. Although diet and exercise remain crucial to the long-term management of obesity, their effectiveness as monotherapy is limited. Adjunctive therapy, therefore, has become a tool associated with more durable weight loss results. This article serves to explore the expanding pharmacologic options available for the treatment of obesity. Traditional pharmacotherapy includes phentermine/topiramate and bupropion/naltrexone, both of which have been shown to aid in weight loss. More recent novel therapies include glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists, which have shown even more marked weight loss and improvement in obesity-associated comorbid conditions compared with alternative medications. Despite their effectiveness, barriers to widespread use include their cost, insurance approval, and side effect profile. Further studies are underway examining the role of pharmacotherapy in conjunction with endoscopic bariatric therapies as well as bariatric surgery.

Crosstalk between lipocalin-2 and IL-6 in traumatic brain injury: Closely related biomarkers

Clinical biomarkers are crucial for diagnosing and predicting outcomes in patients with traumatic brain injury (TBI). In this study, we performed an unbiased analysis of plasma proteins in acute TBI patients using bead-based multiplex assays and identified a strong positive correlation between LCN2 and IL-6 levels. Based on these findings, we hypothesized that LCN2 and IL-6 are closely related circulating biomarkers for TBI. Our previous and current studies demonstrate that the expression of LCN2, IL-6, and its receptors is upregulated in patients with chronic traumatic encephalopathy, in mouse models of traumatic and ischemic injury, and in an in vitro scratch injury model. Lcn2-deficiency reduced the injury-induced expression of IL-6 and its receptors in both animal and scratch injury models. These results suggest an augmented LCN2-dependent IL-6 signaling in the injured brain. As both LCN2 and IL-6 are secreted proinflammatory mediators, we further explored the possibility of cross-regulation between LCN2 and IL-6. In cultured glial cells, treatment with recombinant LCN2 protein enhanced the microglial expression of IL-6, while IL-6 protein treatment increased astrocytic LCN2 expression. Moreover, IL-6 expression and release were elevated in LCN2-overexpressing transgenic mice. Mechanistically, IL-6 enhanced astrocytic LCN2 expression through STAT3 signaling, while LCN2 upregulated microglial IL-6 expression through the NF-κB pathway. Taken together, our results suggest an important role of the LCN2-IL-6 axis in amplifying neuroinflammation through a positive feedback loop in secondary brain injury conditions. Finally, this study implies the utility of LCN2 and IL-6 as closely related biomarkers for TBI diagnosis and prognosis.

Role of pancreatic lipase inhibition in obesity treatment: mechanisms and challenges towards current insights and future directions

The worldwide health emergency of obesity is closely connected to how dietary fats are metabolized, whereas the process is significantly influenced by pancreatic lipase (PL), an enzyme critical for lipid hydrolysis into fatty acids. This narrative review employs a methodological approach utilizing literature searches of PubMed data up to March 2024. The search term criteria encompasses keywords related to the role, mechanism, challenges, and current and future treatments of pancreatic lipase in obesity with an overall references is 106. This paper offers a comprehensive explanation of the role of PL, underlining its significance in the digestive process and lipid imbalances that contribute to obesity and by extension, its impact on obesity development and progression. Additionally, it delves into the dual functionality of the pancreas, emphasizing its impact on metabolism and energy utilization which, when dysregulated, promotes obesity. A focal point of this review is the investigation into the efficacy, challenges, and adverse effects of current pancreatic lipase inhibitors, with orlistat being highlighted as a primary current drug delivery. By discussing advanced obesity treatments, including the exploration of novel anti-obesity medications that target specific biological pathways, this review underscores the complexity of obesity treatment and the necessity for a multifaceted approach. In conclusion, this paper emphasizing the importance of understanding the role of enzymes like pancreatic lipase mechanistic and adopting a multidisciplinary approach to treatment and side effects of current obesity drugs and explore new emerging therapeutic strategies for more effective obesity management.

Association between mothers' working hours and metabolic syndrome in children and adolescents: data from the Korea National Health and Nutrition Examination Survey, 2016-2020

BACKGROUND

Prevention and management of metabolic syndrome (MetS) during childhood are crucial. Recently, obesity among children and adolescents has increased with an increase in mothers' working hours. The present study was conducted to determine the relationship between mothers' working hours and MetS in their children.

METHODS

Data from the 2016-2020 National Health and Nutrition Examination Survey were used, and 2,598 children and adolescents aged 10-18 years were included. Logistic regression analysis was conducted to confirm the association between MetS and mothers' working hours for each risk factor. Linear regression analysis was conducted to confirm the association between mothers' working hours and the number of risk factors for MetS.

RESULTS

Abdominal obesity in children was higher when the mothers' working hours were 53 hours or more (odds ratio [OR], 2.267; 95% confidence interval [CI], 1.21-4.25). In the trend analysis, the OR of children's abdominal obesity increased significantly as mothers' working hours increased (P-value <0.05). Additionally, sex-stratified analysis revealed a significant trend between maternal work hours and the presence of MetS in female children (P=0.016). The adjusted OR of the presence of MetS in female children with mothers working 53 hours or more weekly was 6.065 (95% CI, 1.954-18.822).

CONCLUSION

Mothers' working hours were highly correlated with the risk of abdominal obesity in their children. The OR of the presence of MetS significantly increased in female children with mothers having longer working hours compared with those with stay-at-home mothers.

Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results

BACKGROUND

The ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring.

METHODS

All consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications.

RESULTS

In total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09-5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38-0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation.

CONCLUSIONS

At 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.

Beyond BMI: Exploring obesity trends in the south Asian region

Background

Obesity is a global health challenge affecting individuals across all demographics. In South Asia, the traditional method of assessing obesity using Body Mass Index (BMI), may not account for factors such as fat distribution, muscle mass, or ethnic variations.

Objective

This narrative review explores the multifaceted nature of obesity in South Asia, focusing on the region's demographic profiles and the socio-cultural and economic determinants shaping obesity trends. Additionally, the review critiques the limitations of BMI as an accurate measure of obesity in this diverse population.

Methods

A comprehensive literature search was conducted to identify studies that address obesity trends in South Asia, with a focus on regional variations, influencing factors, and the limitations of BMI.

Results

The review identifies significant variations in obesity prevalence across South Asian countries, influenced by cultural norms, economic disparities, and urbanization. The limitations of BMI as a tool for assessing obesity are highlighted, particularly in its inability to capture fat distribution and muscle mass variations specific to South Asian populations.

Conclusions

Obesity in South Asia is shaped by complex demographic, cultural, and economic factors. While BMI is commonly used, it is insufficient for accurately assessing obesity in this population. More refined, context-specific measures are needed to better understand and address the growing obesity epidemic in South Asia.

The Close Link Between Obesity and Cardiovascular Disease: Current Insights and Remaining Challenges

Obesity is a global public health crisis, contributing to chronic disease development and poor prognosis. A large body of evidence consistently demonstrates that increased adiposity leads to many cardiovascular diseases (CVDs) and complications, such as coronary artery disease, heart failure, and arrhythmias, via direct and indirect mechanisms. Therefore, weight management is crucial to reduce and prevent cardiovascular risk. The recent emergence of glucose-like peptide-1 receptor agonists shows remarkable weight reduction and cardiovascular prevention. Despite the clear benefits, controversies and challenges on obesity-related CVD remain. This review aims to provide a comprehensive understanding of obesity-related CVD and explore current remaining tasks.

The exposome impact on hair health: non-pharmacological management. Part II⋆

Hair holds a significance that surpasses mere aesthetics, as it plays a pivotal role in our social interactions and contributes significantly to the definition of our self-esteem. Central to this understanding is the concept of the exposome, which encompasses intrinsic elements like genetics and physiological changes, as well as extrinsic factors such as UV radiation, pollution, lifestyle choices, and chemical treatments. These factors may significantly impact hair health and hair aging. Expanding upon the groundwork laid by the first part of this research (Cedirian et al., 2024), this study aims to deepen our understanding of exposome influence on hair. Specifically, through a narrative review of current literature, this second part endeavors to provide non-pharmacological treatment solutions and effective strategies to mitigate the negative impact of the exposome on hair health.

Obesity and the gut microbiota: implications of neuroendocrine and immune signaling

Obesity is a major health challenge due to its high prevalence and associated comorbidities. The excessive intake of a diet rich in fat and sugars leads to a persistent imbalance between energy intake and energy expenditure, which increases adiposity. Here, we provide an update on relevant diet-microbe-host interactions contributing to or protecting from obesity. In particular, we focus on how unhealthy diets shape the gut microbiota and thus impact crucial intestinal neuroendocrine and immune system functions. We describe how these interactions promote dysfunction in gut-to-brain neuroendocrine pathways involved in food intake control and postprandial metabolism and elevate the intestinal proinflammatory tone, promoting obesity and metabolic complications. In addition, we provide examples of how this knowledge may inspire microbiome-based interventions, such as fecal microbiota transplants, probiotics, and biotherapeutics, to effectively combat obesity-related disorders. We also discuss the current limitations and gaps in knowledge of gut microbiota research in obesity.

Cholesterol metabolism in pancreatic cancer and associated therapeutic strategies

Pancreatic cancer remains one of the most lethal cancers due to late diagnosis and high chemoresistance. Despite recent progression in the development of chemotherapies, immunotherapies, and potential nanoparticles-based approaches, the success rate of therapeutic response is limited which is further compounded by cancer drug resistance. Understanding of emerging biological and molecular pathways causative of pancreatic cancer's aggressive and chemoresistance is vital to improve the effectiveness of existing therapeutics and to develop new therapies. One such under-investigated and relatively less explored area of research is documenting the effect that lipids, specifically cholesterol, and its metabolism, impose on pancreatic cancer. Dysregulated cholesterol metabolism has a profound role in supporting cellular proliferation, survival, and promoting chemoresistance and this has been well established in various other cancers. Thus, we aimed to provide an in-depth review focusing on the significance of cholesterol metabolism in pancreatic cancer and relevant genes at play, molecular processes contributing to cellular cholesterol homeostasis, and current research efforts to develop new cholesterol-targeting therapeutics. We highlight the caveats, weigh in different experimental therapeutic strategies, and provide possible suggestions for future research highlighting cholesterol's importance as a therapeutic target against pancreatic cancer resistance and cancer progression.

Sex-specific impact of the COVID-19 outbreak on the incidence of metabolic syndrome: a comparative study of 2018-2019 and 2020-2021

BACKGROUND/AIMS

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted global health, exacerbated metabolic health issues, and altered lifestyle behaviors. This study examined the sex-specific impact of the COVID-19 outbreak on the incidence of metabolic syndrome using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

Data from the KNHANES VII (2018) and VIII (2019-2021), including 15,499 participants, were analyzed. The study population was stratified by sex, and further subdivisions were conducted based on the timeframe relative to the COVID-19 outbreak. Variables such as age, education level, household income, smoking status, and high-risk drinking were analyzed to assess their influence on the prevalence of metabolic syndrome.

RESULTS

The overall prevalence of metabolic syndrome significantly increased from 28.11% before the outbreak to 29.69% after the outbreak. Both males and females reported significant increases in waist circumference and fasting glucose levels. Age and education level differentially influenced the prevalence of metabolic syndrome between the sex. Smoking was significantly associated with increased prevalence in males, whereas high-risk drinking was associated with increased prevalence in males and decreased prevalence in females.

CONCLUSION

The COVID-19 pandemic has significantly increased the prevalence of metabolic syndrome with notable sex-specific differences. These findings highlight the need for sex-specific public health interventions to mitigate the impact of the pandemic on metabolic health.

The promise of glucagon-like peptide 1 receptor agonists (GLP-1RA) for the treatment of obesity: a look at phase 2 and 3 pipelines

INTRODUCTION

GLP-1-based therapies have changed the treatment of overweight/obesity. Liraglutide 3.0 mg daily, the first GLP-1 RA approved for treatment of overweight, induced a weight loss of 6-8%, Semaglutide 2.4 mg once weekly improved weight loss to about 12-15%, while the dual GIP/GLP-1 receptor agonist tirzepatide once weekly has induced a weight loss of about 20% in obese people without diabetes.

AREAS COVERED

This review describes results obtained with GLP-1 mono-agonists, GLP-1/GIP dual agonists, GLP-1/glucagon co-agonists, and the triple agonist retatrutide (GIP/GLP-1/glucagon), which have shown beneficial effect both on body weight and steatotic liver disease. A combination of semaglutide (a GLP-1 agonist) and cagrilintide (a long-acting amylin analogue) for weekly administration is currently in phase III development, and so is oral semaglutide and several non-peptide small molecule GLP-1 agonists for oral administration. The adverse events with the GLP-1-based therapies are primarily gastrointestinal and include nausea, vomiting, obstipation, or diarrhea, which often can be mitigated by slow up titration.

EXPERT OPINION

The GLP-1-based therapies will change the treatment of obesity and its comorbidities including steatotic liver disease in the future. Outstanding question is maintenance of the weight loss, possibly pharmacological treatment needs to be life-long.

Exploring Visceral Fat as a Screening Marker for Cardiometabolic Risk in Children and Adolescents

Objective: To establish and validate age- and sex-specific visceral fat area (VFA) cutoff values for the effective identification of cardiometabolic risk (CMR) in children and adolescents. Methods: A cross-sectional study involving 8133 participants was conducted to derive age- and sex-specific VFA cutoffs, which were validated in a longitudinal cohort comprising 10,805 individuals. The predictive performance of the derived VFA cutoffs for CMR was evaluated using the area under the receiver operating characteristic curve (AUC). Additionally, logistic regression models were utilized to calculate the relative risk (RR) of CMR associated with elevated VFA levels. Results: The 75th percentile of the VFA was identified as the optimal cutoff for screening for hypertension, hyperglycemia, dyslipidemia, and CMR clustering in boys. In girls, the 75th percentile was optimal for screening hypertension, dyslipidemia, and CMR clustering, while the 80th percentile proved best for hyperglycemia. No significant difference in predicative performance was observed between the optimal and simplified VFA cutoffs. Longitudinal validation demonstrated that individuals exceeding the VFA cutoff had a significantly higher risk for CMR, with RRs ranging from 1.33 to 3.89 (all p < 0.001) for boys and from 1.63 to 3.16 (all p < 0.001) for girls. Notably, normal-weight boys with VFA above the cutoff had a significantly higher CMR risk compared to their peers in other weight status categories. Conclusions: Both the optimal and simplified VFA cutoffs are robust tools for screening CMR in Chinese children and adolescents, with significant implications for early intervention strategies.