NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants

A novel human specific lncRNA MEK6-AS1 regulates adipogenesis and fatty acid biosynthesis by stabilizing MEK6 mRNA

BACKGROUND

Obesity is becoming one of the major non-communicable diseases with increasing incidence and risks that cannot be ignored. However effective and safe clinical treatment strategies still need to be deeply explored. Increased number and volume of adipocytes lead to overweight and obesity. The aim of our work is to identify lncRNAs that have important regulatory in differentiation of human mesenchymal stem cells (MSCs) into adipocytes, and to provide effective targets for clinical prevention and treatment of obesity and related metabolic disorders.

METHODS

We extracted primary MSCs from human adipose tissue, and conducted expression profile analysis of lncRNAs during adipogenic differentiation of MSCs to screen changed lncRNAs. Characteristics of lncRNA were revealed mainly by RACE and RNA FISH. Loss- and gain-of function experiments in vivo and in vitro were used to analyze effects of lncRNA. Targeted metabolomics was utilized to detect levels of free fatty acids. RNA pull-down, mRNA stability tests, etc. were employed to explore mechanisms of lncRNA.

RESULTS

Human-specific lncRNA, we named it MEK6-AS1, was the most up-regulated transcript during adipogenic differentiation of MSCs. MEK6-AS1 was highly expressed in adipose tissue samples from individuals with BMI ≥ 25 and positively correlated with adipogenic marker genes in these samples. Knocking down lncRNA inhibited expression of adipogenic differentiation markers and ectopic adipogenesis, reducing contents of various free fatty acids, as well as promoting osteogenic differentiation. Overexpression of lncRNA had the opposite effects to the above processes. We also found that MEK6-AS1 was elevated during hepatic steatosis organoid generation. Mechanistically, MEK6-AS1 worked partially through stabilization of MEK6 mRNA by NAT10.

CONCLUSIONS

We have identified a human-specific lncRNA (MEK6-AS1) with position information in the genomic database but has not been extensively reported. We demonstrated that MEK6-AS1 as a novel lncRNA involved in adipogenic differentiation and adipogenesis, fatty acid metabolism, and osteogenic differentiation. We found that MEK6-AS1 may exert its effect by enhancing MEK6 mRNA stability through NAT10. Our study may provide insights into implication of lncRNAs in stem cell biology and offer a new potential therapeutic target for the prevention and treatment of obesity and other related disease.

Age-period-cohort analysis of gallbladder and biliary diseases epidemiological trends from 1990 to 2021 and forecasts for 2035: a systematic analysis from the global burden of disease study 2021

BACKGROUND

Gallbladder and biliary diseases (GABD) represent prevalent disorders of the digestive system.

METHODS

Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) were extracted from the Global Burden of Disease (GBD) 2021 study. The estimated annual percentage change (EAPC) was utilized to quantify temporal trends in GABD. Age-period-cohort analysis was conducted to determine the effects attributable to age, period, and birth cohort. Additionally, we projected global trends to 2035.

RESULTS

Globally, GABD incident cases, mortality cases, and DALYs increased by 60.11%, 71.71%, and 56.90%, respectively. However, all corresponding age-standardized rates (ASRs) demonstrated overall downward trends with estimated annual percentage changes (EAPC) of -0.32 (-0.38 to -0.26), -0.95 (-1.08 to -0.83), and - 0.69 (-0.74 to -0.65), respectively. The number of incident cases was higher in females than in males across all age groups. The age effect indicated that older individuals had higher age-specific incidence and death rates. Both period and cohort effects showed declining risk across incidence and mortality. The ASIR and ASMR of GABD are projected to continue decreasing over the next 15 years.

CONCLUSION

GABD continue to pose a significant global public health challenge, particularly affecting women and the elderly population. Consequently, the implementation of effective interventions to mitigate the GABD burden is of paramount importance.

Guidance on Energy Intake Based on Resting Energy Expenditure and Physical Activity: Effective for Reducing Body Weight in Patients with Obesity

OBJECTIVE

In treating obesity, energy intake control is essential to avoid exceeding energy expenditure. However, excessive restriction of energy intake often leads to resting energy expenditure (REE) reduction, increasing hunger and making weight loss difficult. This study aimed to investigate whether providing nutritional guidance that considers energy expenditure based on the regular evaluation of REE and physical activity could effectively reduce body weight (BW) in patients with obesity.

METHODS

A single-arm, prospective interventional study was conducted on 20 patients with obesity (body mass index ≥ 25 kg/m2) at the Nagoya University Hospital for 24 weeks. REE and physical activity were regularly assessed, and the recommended energy intake was adjusted based on the values. The primary outcome was the change in BW, and the secondary outcomes included changes in REE and hunger ratings, which were assessed using a visual analog scale.

RESULTS

Eighteen participants completed the study, demonstrating a significant reduction in BW after 24 weeks (-5.34 ± 6.76%, p < 0.0001). No significant changes were observed in REE or hunger ratings. No adverse events were reported throughout the study period.

CONCLUSIONS

Guidance on energy intake based on REE and physical activity was effective for reducing BW in patients with obesity without decreasing REE or increasing hunger. This approach may reduce the burden on patients with obesity while losing BW.

Association of body mass index with disability in activities of daily living in older adults: a systematic review of the literature based on longitudinal data

BACKGROUND

The influence of Body Mass Index (BMI) on the functional capacity for daily activities in older adults is a significant concern. Our study is designed to delineate the longitudinal relationship between BMI and the ability of daily living activities among older adults.

METHODS

Two researchers conducted a comprehensive literature search and independent screening of articles in PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), the Database for Chinese Technical Periodicals (VIP), and Wanfang, covering the period from January 2000 to May 2024. Studies were selected based on predefined inclusion and exclusion criteria, and relevant data were extracted for subsequent meta-analysis using the Cochrane Collaboration's Review Manager 5.3 software.

RESULTS

After rigorous selection, four longitudinal studies were incorporated into our meta-analysis. The findings indicated that underweight older adults exhibited a higher likelihood of experiencing difficulties with basic activities of daily living (BADL) (odds ratio [OR] = 1.33, 95% confidence interval [CI]: [1.03, 1.72]; P = 0.03). Conversely, overweight older adults were found to have a reduced likelihood of BADL (odds ratio [OR] = 0.81, 95% confidence interval [CI]: [0.79, 0.83]; P < 0.001). However, overweight and obese older adults demonstrated an increased likelihood of challenges with Instrumental Activities of Daily Living (IADL) (odds ratio [OR] = 1.58, 95% confidence interval [CI]: [1.25, 2.00]; P < 0.01).

CONCLUSIONS

Our longitudinal meta-analysis substantiates the correlation between underweight status and the impairment of BADL in older adults, irrespective of gender. It also reveals that overweight older adults have a lower risk of BADL difficulties, yet a higher risk of IADL challenges, which is further exacerbated in obesity. The early identification and management of BMI in this population could be instrumental in preventing a decline in ADL. Recognizing the role of BMI categories in this context is essential for developing targeted preventative strategies for the elderly, while also accounting for other modifiable risk factors such as pain and depression.

Low-intensity pulsed ultrasound improves metabolic dysregulation in obese mice by suppressing inflammation and extracellular matrix remodeling

Chronic inflammation in white adipose tissue is crucial in obesity and related metabolic disorders. Low-intensity pulsed ultrasound (LIPUS) is renowned for its anti-inflammatory effects as a non-invasive treatment, yet its precise role in obesity has been uncertain. Our study investigates the therapeutic effect of LIPUS and its underlying mechanism on obesity in mice, thereby offering a novel approach for non-invasive treatment of obesity and associated metabolic disorders for human. Male C57BL/6J mice aged 10 weeks were fed a high-fat diet (HFD) for 8 weeks to establish obesity model, then underwent 8 weeks of LIPUS (frequency: 1.0 MHz, duty cycle: 20 %, Isata: 58-61 mW/cm2, 20 min per day) stimulation of the epididymal white adipose tissue. Fat and lean mass were measured using nuclear magnetic resonance (NMR), while energy homeostasis was evaluated using metabolic cages. Insulin resistance was assessed using glucose tolerance tests (GTT) and insulin tolerance tests (ITT). Regulatory mechanisms were explored using RNA sequencing. Results showed that LIPUS significantly reduced obesity markers in obese mice, including body and adipose tissue weight, and improved insulin resistance, without affecting food intake. RNA sequencing showed 250 up-regulated and 351 down-regulated genes between HFD-LIPUS group and HFD-Sham group, suggesting anti-inflammatory action. Quantitative PCR confirmed reduced pro-inflammatory gene expression and macrophage infiltration in eWAT. Gene set enrichment analysis showed decreased NF-κB signaling and extracellular matrix-receptor interactions in LIPUS-treated mice. Thus, LIPUS effectively mitigates metabolic dysregulation in HFD-induced obesity through inflammation suppression and extracellular matrix remodeling, which provides a potential physical therapy for metabolic syndrome in clinic.

A Bayesian network analysis of the probabilistic relationships between metabolically healthy obesity and cardiovascular disease risk under new diagnostic criteria

BACKGROUND

The relationship between metabolically healthy obesity (MHO) and cardiovascular disease (CVD) risk remains debated. The critical point may be the lack of consensus on MHO's definition and diagnostic criteria.

OBJECTIVE

This study aimed to investigate the association of MHO status with arteriosclerosis-CVD (ASCVD) risk in Chinese under new diagnostic criteria.

METHODS

Participants aged 35-79 in the 2009 China Health and Nutrition Survey cohort were included. The 10-year ASCVD risk was predicted by the prediction for ASCVD risk in China, and participants with a predicted risk of ⩾ 10% were classified into the high-risk group. The Bayesian network (BN) models were constructed to characterize the multivariable probabilistic connections between metabolically obesity phenotypes and ASCVD risk.

RESULTS

The 10-year ASCVD risk score and the proportion of individuals at ASCVD high risk were significantly different between metabolically obesity phenotypes (P< 0.001). BN reasoning results showed that MHO individuals were not significantly associated with a 10-year ASCVD risk. Among metabolically unhealthy individuals, the conditional probability of high ASCVD risk increased with the Body Mass Index (BMI), with the conditional probability of high ASCVD risk was 24.63% (95% CI: 22.81-26.55%), 32.97% (95% CI: 30.75-35.27%) and 40.2% (95% CI: 36.64-43.86%) for metabolically unhealthy normal weight (MUNW), metabolically healthy overweight weight (MHOW), and metabolically unhealthy obesity (MUO) group, respectively. Subgroup analysis showed that MHO individuals were at increased risk of CVD compared with metabolically healthy normal weight (MHNW) individuals only in females.

CONCLUSION

These results showed that there was no significant increase in ASCVD risk of MHO phenotype based on the new diagnostic criteria, suggesting that MHO is in a relatively healthy state.

Integrating Genetic Insights, Technological Advancements, Screening, and Personalized Pharmacological Interventions in Childhood Obesity

Childhood obesity is a significant global health challenge with rising prevalence over the past 50 years, affecting both immediate and long-term health outcomes. The increase in prevalence from 0.7% to 5.6% in girls and 0.9% to 7.8% in boys highlights the urgency of addressing this epidemic. By 2025, it is estimated that 206 million children and adolescents aged 5-19 years will be living with obesity. This review explores the complex interplay of genomics and genetics in pediatric obesity, transitioning from monogenic and polygenic obesity to epigenetics, and incorporating advancements in omics technologies. The evolutionary purpose of adiposity, systemic evaluation of hyperphagia, and the role of various genetic factors are discussed. Technological advancements in genotyping offer new insights and interventions. The integration of genetic screening into clinical practice for early identification and personalized treatment strategies is emphasized.

Risk of biliary diseases in patients with type 2 diabetes or obesity treated with tirzepatide: A meta-analysis

OBJECTIVE

To investigate the risk of biliary diseases in patients with type 2 diabetes mellitus (T2DM) or obesity treated with tirzepatide.

METHODS

Literature searches were performed using the PubMed, Web of Science, Cochrane Library, and CNKI databases until 20 May 2024. Randomized controlled studies (RCTs) investigating the safety of tirzepatide vs placebo/other hypoglycemic drugs in patients with T2DM or obesity were included. The safety outcomes mainly included the incidence of cholelithiasis, pancreatitis, cholecystitis, and gallbladder/biliary diseases. Cochrane Collaboration's tool for assessing the risk of bias was used to assess the quality of literature. Heterogeneity was evaluated using I2 statistics.

RESULTS

A total of 12 high-quality RCTs (involving 12,351 patients) were included. The results of meta-analysis showed that tirzepatide was associated with gallbladder/biliary diseases (RR = 1.52; 95%CI: 1.17-1.98; I2 = 0%, P = 0.76) and cholelithiasis (RR = 1.67; 95%CI: 1.14-2.44; I2 = 0%, P = 0.95). Subgroup analysis based on the dose of tirzepatide found no dose-response relationship between different doses of tirzepatide and the risk of gallbladder/biliary diseases and cholelithiasis.

CONCLUSIONS

Based on the data currently available, tirzepatide is associated with the development of cholelithiasis in patients. However, the findings from RCTs still need to be further investigated in many post-marketing safety surveillance programs.

Lipid-lowering therapies and long-term stroke prevention in East Asians: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Stroke prevention is a pressing global health priority, with reducing elevated lipids recognized as a key strategy. East Asians, constituting more than 1.6 billion individuals and the largest racial group worldwide, are a key demographic in this effort. Yet, the effectiveness of lipid-lowering therapies for stroke prevention in this population remains uncertain.

AIMS AND METHODS

We conducted a systematic review and meta-analysis of large-scale randomized controlled trials (RCTs) with at least 3 years of follow-up to evaluate the long-term impact of lipid-lowering therapies on stroke incidence in East Asians. We systematically searched four electronic databases up to 11 January 2024. The association was quantified using relative risk (RR) with a 95% confidence interval (CI), and between-study heterogeneity was evaluated using the I2 statistic. In addition, we utilized the Cochrane Risk of Bias Tool to assess the risk of bias in each included RCT and applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to evaluate the certainty of the evidence.

RESULTS

This study incorporated data from nine large-scale RCTs involving 54,354 participants. Our findings of overall analyses revealed that lipid-lowering therapies did not significantly affect the long-term incidence of all strokes (9 RCTs; 54,354 participants; RR = 0.98 (95% CI = 0.87-1.10); P = 0.75), ischemic stroke (7 RCTs; 52,059 participants; RR = 0.91 (95% CI, = 0.79-1.04); P = 0.16), or hemorrhage stroke (7 RCTs; 52,059 participants; RR = 1.24 (95% CI = 0.97-1.59); P = 0.09) in East Asians. Notably, there was no evidence of heterogeneity or publication bias, and the quality of evidence assessed using GRADE methodologies was rated as high. Sensitivity analyses confirmed the robustness of our results, with no single study significantly affecting the overall findings. Furthermore, subgroup analyses consistently supported the conclusions, further bolstering the reliability of our study.

CONCLUSIONS

Lipid-lowering therapies did not demonstrate any beneficial effects on long-term stroke prevention among East Asians.

Changes in the prevalence of maternal chronic conditions during pregnancy: A nationwide age-period-cohort analysis

OBJECTIVE

To estimate temporal changes in the prevalence of pre-existing chronic conditions among pregnant women in Sweden and evaluate the extent to which secular changes in maternal age, birth cohorts and obesity are associated with these trends.

DESIGN

Population-based cross-sectional study.

SETTING

Sweden, 2002-2019.

POPULATION

All women (aged 15-49 years) who delivered in Sweden (2002-2019).

METHODS

An age-period-cohort analysis was used to evaluate the effects of age, calendar periods, and birth cohorts on the observed temporal trends.

MAIN OUTCOME MEASURES

Pre-existing chronic conditions, including 17 disease categories of physical and psychiatric health conditions recorded within 5 years before childbirth, presented as prevalence rates and rate ratios (RRs) with 95% confidence intervals (CIs). Temporal trends were also adjusted for pre-pregnancy body mass index (BMI) and the mother's country of birth.

RESULTS

The overall prevalence of at least one pre-existing chronic condition was 8.7% (147 458 of 1 703 731 women). The rates of pre-existing chronic conditions in pregnancy increased threefold between 2002-2006 and 2016-2019 (RR 2.82, 95% CI 2.77-2.87). Rates of psychiatric (RR 3.80, 95% CI 3.71-3.89), circulatory/metabolic (RR 1.62, 95% CI 1.55-1.71), autoimmune/neurological (RR 1.69, 95% CI 1.61-1.78) and other (RR 2.10, 95% CI 1.99-2.22) conditions increased substantially from 2002-2006 to 2016-2019. However, these increasing rates were less pronounced between 2012-2015 and 2016-2019. No birth cohort effect was evident for any of the pre-existing chronic conditions. Adjusting for secular changes in obesity and the mother's country of birth did not affect these associations.

CONCLUSIONS

The burden of pre-existing chronic conditions in pregnancy in Sweden increased from 2002 to 2019. This increase may be associated with the improved reporting of diagnoses and advancements in chronic condition treatment among women, potentially enhancing their fecundity.

Body Mass Index and Weight Change as Predictors of Hypertension Development: A Sex-Specific Analysis

Background/Objectives: Obesity is associated with food intake, drinking, and nutrition. It is necessary to examine the association between body mass index (BMI), body weight changes, and the incidence of hypertension, focusing on potential sex differences. Methods: A retrospective two-point cohort study was conducted using data from the Japanese Specific Health Checkup program from 2011 to 2013. Multivariable logistic regression analyses were employed to assess associations between BMI, weight change, and hypertension onset, adjusting for age, sex, and lifestyle factors, including smoking, drinking, and exercise. Results: In total, 397,181 participants were analyzed. A higher BMI was linked to a higher risk of hypertension, with an odds ratio (OR) of 1.11 (95% confidence interval [CI]: 1.11-1.12) for both sexes. Women aged 40-65 showed higher ORs than men. Weight gain was associated with developing hypertension, with an OR (95% CI) of 1.09 (1.09-1.10) in men and 1.08 (1.07-1.08) in women. This association held across all BMI levels, even among individuals without obesity, with the effect being generally stronger in men. Conclusions: Both BMI and weight change contribute to the development of hypertension among the Japanese healthy population, with differences based on sex. Weight reduction may reduce the risk of hypertension for individuals with and without obesity, emphasizing the importance of weight stability through food and nutrition control, particularly for women.

Deciphering the Psychological Characteristics of Takotsubo Cardiomyopathy and Acute Myocardial Infarction

Background/Objectives: Takotsubo syndrome (TTS) shares many clinical features with acute myocardial infarction (AMI); however, its underlying pathophysiology remains elusive due to specific characteristics (i.e., reversibility, presence of stressors, and low mortality rate). Emerging evidence suggests that TTS often emerges following significant somatic, emotional, or psychological stressors. Several studies have investigated the biological factors that may contribute to the onset of TTS, including the release of stress hormones. However, the psychological characteristics associated with TTS, which may be useful for differentiating TTS from other cardiovascular conditions, remain poorly explored. This study aims to overcome these limitations by evaluating whether certain psychological features may allow this specific clinical condition to be differentiated from other cardiovascular conditions. Methods: This study compared three groups of individuals: patients with TTS (N = 56), patients with AMI (N = 52), and individuals without a history of cardiovascular disease (N = 56). Patients were examined three months after the acute phases. The objective was to identify and examine multiple psychological factors involved in TTS, including state and trait anxiety, symptoms of depression, psychological symptoms, distress, perceived social support, and health locus of control. Results: The results indicate that patients with TTS exhibited higher levels of somatization, trait anxiety, obsessive-compulsiveness, and overall psychological distress than patients with AMI and control groups. These findings were associated with an internal health locus of control and low-risk lifestyles. Conclusions: This psychological exploration of TTS reveals a multifaceted relationship between the mind and the heart, challenging traditional notions of cardiovascular pathophysiology and suggesting the importance of considering the cardio-psychological health of patients in both preventive and intervention programs.

The Impact of Economic Income on BMI Trajectory Groups in Chinese Elderly Individuals: A Population-Based Longitudinal Study

OBJECTIVE

The objective of this study is to gain insights into the influence of income on the body mass index (BMI) locus in the elderly population.

METHODS

The Chinese Longitudinal Healthy Longevity and Happy Family Study (CLHLS-HF) was included at baseline (2008) for participants aged 65 years and older. The total number of participants analyzed in this study was 7555. A population-based trajectory model (GBTM) was used. The economic income level was an independent variable and adjusted for age, gender, ethnicity, education, marriage, and physical activity (Model 1), and the baseline BMI value was added in Model 2, with a quadratic of the income added in Model 3. A sensitivity analysis was adopted.

RESULTS

Three BMI trajectory groups were identified using GBTM and were labeled as "overweight", "normal", and "obesity". After adjusting for covariates (Model 1), with the increase in economic income, the risk of the elderly transitioning into the overweight trajectory group and the obesity trajectory group was relatively increased. When the baseline BMI values were adjusted for Model 2, the effect of economic income on the overweight and obesity trajectories was enhanced. A sensitivity analysis was performed, and it was found that the result of the positive impact of economic income on the BMI trajectory group was robust.

CONCLUSIONS

The higher the income, the greater the risk of Chinese elderly individuals developing the overweight or obesity trajectory. It is suggested that elderly individuals with higher economic income especially need interventions and nutrition education to help them acquire nutrition knowledge for a healthy lifestyle. The positive impact of economic income on the BMI trajectories of the elderly provides further directions for preventing and controlling obesity in the elderly.

Understanding the complex function of gut microbiota: its impact on the pathogenesis of obesity and beyond: a comprehensive review

Obesity is a multifactorial condition influenced by genetic, environmental, and microbiome-related factors. The gut microbiome plays a vital role in maintaining intestinal health, increasing mucus creation, helping the intestinal epithelium mend, and regulating short-chain fatty acid (SCFA) production. These tasks are vital for managing metabolism and maintaining energy balance. Dysbiosis-an imbalance in the microbiome-leads to increased appetite and the rise of metabolic disorders, both fuel obesity and its issues. Furthermore, childhood obesity connects with unique shifts in gut microbiota makeup. For instance, there is a surge in pro-inflammatory bacteria compared to children who are not obese. Considering the intricate nature and variety of the gut microbiota, additional investigations are necessary to clarify its exact involvement in the beginnings and advancement of obesity and related metabolic dilemmas. Currently, therapeutic methods like probiotics, prebiotics, synbiotics, fecal microbiota transplantation (FMT), dietary interventions like Mediterranean and ketogenic diets, and physical activity show potential in adjusting the gut microbiome to fight obesity and aid weight loss. Furthermore, the review underscores the integration of microbial metabolites with pharmacological agents such as orlistat and semaglutide in restoring microbial homeostasis. However, more clinical tests are essential to refine the doses, frequency, and lasting effectiveness of these treatments. This narrative overview compiles the existing knowledge on the multifaceted role of gut microbiota in obesity and much more, showcasing possible treatment strategies for addressing these health challenges.

Individual, household, and community-level determinants of undernutrition among pregnant women in the northern zone of the Sidama region, Ethiopia: A multi-level modified Poisson regression analysis

INTRODUCTION

In Ethiopia, maternal undernutrition is a major public health concern. However, comprehensive evidence is lacking in the southern part of Ethiopia, specifically the household and community-level related determinants of undernutrition. Besides, the evidence about the prevalence and determinants of undernutrition is not yet documented in the current study setting. Thus, this study aimed to determine the prevalence of undernutrition and identify its determinants among pregnant women in Hawela Lida district of the Sidama region, Ethiopia.

METHODS

A community-based cross-sectional study was conducted on a sample of 515 pregnant women from June 1-25, 2024. A multi-stage sampling method was utilized to select eligible pregnant women. We collected data using a structured and pretested interviewer-administrated questionnaire and an anthropometric measurement. Data were collected using the Open Data Kit smart phone device and exported it to Stata version 17 for further processing and analysis. A multi-level mixed-effects modified Poisson regression analysis with robust variance was used to account for confounders and between and with cluster effects.

RESULT

The prevalence of undernutrition among pregnant women was 41.7% (95% CI: 37.3-45.6). The prevalence of undernutrition was associated with planned pregnancy (adjusted prevalence ratio [APR]: 0.80; 95% CI: 0.66-0.98), household food insecurity (APR: 1.64; 95% CI: 1.26-2.13), inadequate dietary diversity (APR: 1.79; 95% CI: 1.43-2.25), and women's poor knowledge of nutrition (APR: 1.68; 95% CI: 1.32-2.12) at individual levels. The identified determinants of undernutrition at the community level were low community literacy rates (APR: 4.62; 95% CI: 1.13-18.79) and low community wealth status (APR: 1.91; 95% CI: 1.10-3.31).

CONCLUSION

Two in five pregnant women had an undernutrition problem in the study setting. Individual and community-level determinants contributed to the high prevalence of undernutrition. Thus, any prevention and control approaches to undernutrition should consider inter-sectorial collaboration to account for determinants at various levels. Besides, any program must emphasize the delivery of nutrition education about dietary diversity, particularly targeting pregnant mothers who have poor knowledge of nutrition and unplanned pregnancy at the individual level. Moreover, creating a small business reform for the community with low wealth status using agricultural extension workers must be considered.

Global adherence to a healthy and sustainable diet and potential reduction in premature death

The Planetary Health Diet (PHD), also known as the EAT-Lancet reference diet, was developed to optimize global dietary quality while keeping the environmental impacts of food production within sustainable planetary boundaries. We calculated current national and global adherence to the PHD using the Planetary Health Dietary Index (PHDI). In addition, we used data on diet and mortality from three large US cohorts (n = 206,404 men and women, 54,536 deaths) to estimate the total and cause-specific mortality among adults 20 y of age and older that could be prevented by shifting from current diets to the reference PHD. The PHDI varied substantially across countries, although adherence was universally far from optimal (mean PHDI = 85 out of 140). By improving the global PHDI to 120, approximately 15 million deaths (27% of total deaths) could be prevented annually. Estimates of preventable deaths due to this shift ranged from 2.5 million for cardiovascular diseases to 0.7 million for neurodegenerative diseases. Our analysis suggests that adopting healthy and sustainable diets would have major direct health benefits by reducing mortality due to multiple diseases and could contribute substantially to achieving the United Nations Sustainable Development Goals. These numbers of preventable deaths are based on evidence that human biology is similar across racial and ethnic groups, but the exact numerical estimates should be interpreted with caution because some assumptions used for the calculations build on limited data. Refinement of these estimates will be possible when additional regional data on diet and mortality become available.

Impact of Obesity on Clinical Presentation and Surgical Outcomes in Patients with Benign Prostate Hyperplasia Receiving Greenlight Laser Prostatectomy

Objective

To investigate the impact of body mass index (BMI) on preoperative characteristics, lower urinary tract symptoms (LUTS), intraoperative variables, surgical outcomes and postoperative complications.

Methods

This is a retrospective observational study including 891 benign prostate hyperplasia (BPH) patients who underwent GreenLight Laser photoselective vaporization of the prostate (PVP) between 2014 and 2020. Clinical characteristics, uroflowmetry parameters, and surgery related parameters were extracted from electronic health records. Patients were categorized into different weight groups based on Taiwanese populations' BMI criteria. Statistical analyses, involving descriptive statistics, correlation analyses, and independent t-tests, were employed to examine associations between BMI and relevant variables.

Results

Pearson's correlation analysis indicated a negative correlation between BMI (r = -0.172, p < 0.001) and age, and positive correlations with total prostate volume (TPV) (r = 0.123, p < 0.001) and transition zone volume (TZV) (r = 0.083, p = 0.017). Obese patients were found to be younger (p=0.007) and have larger TPVs (p=0.010) but showed no significant differences in International Prostate Symptom Scores (IPSS) scores when compared to non-obese patients. Notably, obese patients had lower preoperative and postoperative post-void residual (PVR), whereas non-obese patients exhibited a more significant PVR reduction post-surgery. BMI did not significantly affect surgical parameters or postoperative complications.

Conclusion

In BPH patients treated with PVP, obese individuals were younger with larger prostates but had similar IPSS scores compared to non-obese patients. Obese patients had lower pre and post-surgery PVR, while non-obese patients saw greater PVR improvements. BMI plays a nuanced role BPH patients' characteristics.

The association between weight-adjusted-waist index and psoriasis: A cross-sectional study based on NHANES 2009 to 2014

Weight-adjusted-waist index (WWI) is an anthropometric indicator of central obesity, which is calculated by dividing the waist circumference (WC) by the squared weight. The purpose of this study was to investigate the association between WWI and psoriasis in adults. Multivariate logistic regression and smoothing curve fitting were used to investigate the relationship between WWI and psoriasis based on data from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. Subgroup analysis and interaction tests were employed to examine the population-level stability of this connection. There was a positive association between WWI and psoriasis in 15,932 participants > 20 years of age. In the fully adjusted model, each 1-unit increase in WWI was associated with a 14% increase in the risk of developing psoriasis [1.14 (1.01, 1.32)]. Participants in the highest quartile of WWI had a 38% higher risk of developing psoriasis than those in the lowest quartile [1.38 (1.01, 1.94)]. This positive association was more pronounced in males. WWI is positively associated with psoriasis in US adults. Our findings imply that WWI has the potential to improve psoriasis prevention in the general population.

The prevalence of obesity and overweight among Iranian population: an umbrella systematic review and meta-analysis

BACKGROUND

The present umbrella systematic reviews and meta-analyses aim to determine the comprehensive prevalence of obesity and overweight across different age subgroups in Iran.

METHODS

We conducted a comprehensive search across many databases, including Science Direct, Web of Science, Scopus, PubMed, and Google Scholar, to retrieve papers published until November 2023. The meta-analyses included in this study examined the prevalence of obesity and overweight in Iran. The current umbrella meta-analysis finally contained 24 meta-analyses. We evaluated the scientific reliability of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR2).

RESULTS

The overall prevalence of overweight and obesity among the Iranian population was 18.38% (95% CI: 10.267, 26.496) and 10.91% (95% CI: 9.654, 12.177), respectively. The overall obesity prevalence in males was 9.93 (95%CI: 8.483, 11.388), and in females was 9.67% (95%CI: 8.317, 11.033). The prevalence of overweight and obesity among children and adolescents was 12.43% (95% CI: 10.184, 14.683) and 6.51% (95% CI: 5.866, 7.157), and in adults, it was 27.39% (95% CI: 14.878, 39.914) and 17.20% (95% CI: 13.483, 20.919), respectively. Male children and adolescents had a higher prevalence of overweight and obesity than females, but adult males had a lower prevalence than females.

CONCLUSION

This study presents the trend of obesity and overweight among the Iranian population. Since the trend of increasing overweight and obesity is alarming, policymakers and healthcare providers at the national and regional levels should design and implement preventive programs and interventions.

Whole Exome Sequencing Revealed Paternal Inheritance of Obesity-related Genetic Variants in a Family with an Exclusively Breastfed Infant

Objective

Obesity is a serious health problem that progressively affects individuals’ lives with comorbidities, such as heart disease, stroke, and diabetes mellitus. Since its prevalence has increased, particularly in children less than five years old, its genetic and environmental causes should be determined for prevention and control of the disease. The aim of this study was to detect underlying genetic risk factors in a family with an exclusively breastfed obese infant.

Methods

A three-generation family was recruited to be evaluated for obesity. Detailed examinations along with body mass index (BMI) calculations were performed on available family members. Whole exome sequencing (WES) was performed on a 7-month-old obese infant. Bioinformatic analyses were performed on the Genomize SEQ platform with variant filtering at minor allele frequencies <1% for all normal populations. Sanger sequencing was applied in variant confirmation and family segregation.

Results

Neuro-motor developmental features were normal and genetic syndromes were excluded from the index. Early-onset severe obesity (+4.25 standard deviation score weight-for-height) was evident in index case; his father and grandmother were also obese (BMIs 38.1 kg/m2 and 31.3 kg/m2, respectively). WES analysis revealed deleterious variants in SH2B1, PDE11A, ADCY3, and CAPN10 genes previously associated with obesity. All variants were evaluated as novel candidates for obesity, except PDE11A, and family segregation confirmed paternal inheritance.

Conclusion

This study confirmed the paternal inheritance of all potentially deleterious obesity-related variants. The cumulative effect of individual variants might explain the obesity phenotype in this family. The infant is recommended to be followed up periodically due to increased risk for later childhood obesity.

Safety and Efficacy of Brachytherapy in Inoperable Endometrial Cancer

Background/Objectives: Radiotherapy represents the only treatment option for patients with inoperable endometrial cancer (EC). The aim of our study was to evaluate the efficacy and safety of brachytherapy (BT) in this selected patient population. Methods: Between 1990 and 2019, 18 patients with inoperable EC in stage FIGO I-IV were treated with intracavitary brachytherapy using the "Heyman Packing technique". BT was performed either as sole PDR- or HDR-brachytherapy with a median cumulative dose up to 60.0 Gy (67.9 Gy EQD2 α/β = 3Gy) and 34.0 Gy (75.6 Gy EQD2 α/β = 3Gy), respectively. Results: The median follow-up was 46 months (6-219). The mean age was 71 years. The 5-year cumulative local recurrence rate (CLRR) for the whole cohort was 27.3%. The 5-year overall survival (OS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were 51%, 79%, and 69%. The 5-year DFS for low-, intermediate-, and high-risk EC was 89%, 50%, and 44% (p = 0.51). No significant difference in DFS was observed in patients over 70 (p = 0.526). No late side effects of grade > 1 were documented. Conclusions: Brachytherapy for inoperable EC is a safe and effective treatment option, offering good local control and OS with minimal toxicity. Moreover, brachytherapy effectively controls hemoglobin-relevant bleeding. Therefore, BT should be considered a viable alternative to non-curative treatment strategies in gynecological multidisciplinary conferences.

Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 7 September 2022 retrieved 1131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Fifty-five papers were included, spanning thirty-two countries. All thirteen sociodemographic variables identified were significantly associated with UPF intake in one or more studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10–20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5·7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

Epidemiology of cardiometabolic health in Latin America and strategies to address disparities

In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.

Effects of sleeve gastrectomy and Roux-en-Y gastric bypass on pharmacokinetics of lamotrigine and valproate: A cohort study

BACKGROUND

Bariatric surgeries may affect the pharmacokinetics of medications through alterations of the gastrointestinal physiology. Pharmacokinetic changes of first-line antiseizure medications such as lamotrigine and valproate following bariatric treatment have received little research attention so far.

METHODS

In our prospective case study we included lamotrigine- or valproate-treated patients undergoing bariatric surgery at hospitals in Central Norway. Lamotrigine and valproate concentrations were assessed using serial blood samples over a dose interval, before and one, six and twelve months following surgery. Primary outcomes included changes in area under the time-concentration curve (AUC) with secondary outcomes comprising full pharmacokinetic profiling.

RESULTS

Six lamotrigine-treated obese patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 3) and sleeve gastrectomy (SG) (n = 3), as well as two valproate-treated patients (one undergoing RYGB and one SG) were included. Largest changes for dose-adjusted AUC values after surgery were seen in RYGB-treated patients on lamotrigine (average increases of 38 % one month and 32 % 12 months postoperatively). In the patients on valproate, AUC values were decreased by 22 % after 6 months and by 30 % after 12 months. The interindividual variation was high. Formal statistical testing was not done due to few cases.

CONCLUSION

Postoperative pharmacokinetic changes for lamotrigine and valproate were modest, but for lamotrigine changes may be larger in patients undergoing RYGB than in those undergoing SG. Given the substantial interindividual variation, therapeutic drug monitoring should be used to capture pharmacokinetic changes and guide dose adjustments after bariatric surgery.

High-fat and High-sucrose Diet-induced Hypothalamic Inflammation Shows Sex Specific Features in Mice

Hypothalamic inflammation underlies diet-induced obesity and diabetes in rodent models. While diet normalization largely allows for recovery from metabolic impairment, it remains unknown whether long-term hypothalamic inflammation induced by obesogenic diets is a reversible process. In this study, we aimed at determining sex specificity of hypothalamic neuroinflammation and gliosis in mice fed a fat- and sugar-rich diet, and their reversibility upon diet normalization. Mice were fed a 60%-fat diet complemented by a 20% sucrose drink (HFHSD) for 3 days or 24 weeks, followed by a third group that had their diet normalized for the last 8 weeks of the study (reverse diet group, RevD). We determined the expression of pro- and anti-inflammatory cytokines, and of the inflammatory cell markers IBA1, CD68, GFAP and EMR1 in the hypothalamus, and analyzed morphology of microglia (IBA-1+ cells) and astrocytes (GFAP+ cells) in the arcuate nucleus. After 3 days of HFHSD feeding, male mice showed over-expression of IL-13, IL-18, IFN-γ, CD68 and EMR1 and reduced expression of IL-10, while females showed increased IL-6 and IBA1 and reduced IL-13, compared to controls. After 24 weeks of HFHSD exposure, male mice showed a general depression in the expression of cytokines, with prominent reduction of TNF-α, IL-6 and IL-13, but increased TGF-β, while female mice showed over-expression of IFN-γ and IL-18. Furthermore, both female and male mice showed some degree of gliosis after HFHSD feeding for 24 weeks. In mice of both sexes, diet normalization after prolonged HFHSD feeding resulted in partial neuroinflammation recovery in the hypothalamus, but gliosis was only recovered in females. In sum, HFHSD-fed mice display sex-specific inflammatory processes in the hypothalamus that are not fully reversible after diet normalization.

Body mass index and the prevalence of high-risk colorectal adenomas in a population undergoing screening colonoscopy in Alberta, Canada

PURPOSE

There is limited evidence regarding body mass index (BMI) as an early marker of high-risk adenoma (HRA) at the time of screening colonoscopy. Because high-risk adenomas (HRA) can develop into colorectal cancer (CRC), BMI could serve as an important clinical predictor of future risk of CRC.

METHODS

We examined data from 1831 adults undergoing screening colonoscopy at the Forzani & MacPhail Colon Cancer Screening Center in Alberta, Canada. We fit multivariable logistic regression models to examine the association between BMI and HRA. Non-linear relationships for BMI on HRA were also evaluated using restricted cubic splines.

RESULTS

The mean BMI in patients with HRA was 28.2 kg/m2 compared to 27.4 kg/m2 in patients without adenomas (t test: p = 0.003). In the adjusted models, those with a BMI over 30 kg/m2 had 1.45 (95% CI 1.05-2.00) times the odds of HRA detected during colonoscopy compared to those with a BMI below 25 kg/m2. Examining BMI as continuous, the odds of HRA were 1.20 (95% CI 1.04-1.37) times higher for every 5 kg/m2 increase in BMI.

CONCLUSION

The findings of this study suggest that excess body mass is associated with higher risk of HRA among a screening population and may be useful an early marker of future disease.

Higher Prevalence of Tooth Loss in People With Abdominal Obesity but Normal Weight: Findings From the United States and Scottish Populations

OBJECTIVES

Previous research has shown that people with obesity are at a higher risk of tooth loss; however, it is unclear whether abdominal obesity (e.g., high waist circumference) is associated with tooth loss among individuals without obesity. This study aims to investigate the association between abdominal obesity and tooth loss among people who are not obese.

MATERIAL AND METHODS

Two cross-sectional surveys were used: the United States' National Health and Nutrition Examination Survey (NHANES) 1999-2012 (n = 19,436) and the Scottish Health Survey (SHeS) 2008-2014 (n = 4243). Tooth loss was measured by the number of remaining teeth: 20 and over, 1-19, and edentulous. Abdominal obesity was defined by categorizing waist circumference into three levels: normal, high, and very high. Ordinal logistic regression was used to model the association between tooth loss and abdominal obesity.

RESULTS

For people living without obesity, abdominal obesity is associated with a higher prevalence of tooth loss, and the effect is different between women and men. For women, abdominal obesity increased the chance of tooth loss by 64% (odds ratio [OR]: 1.64, 95% confidence interval [CI]: 1.16-2.34) in the NHANES and 196% (OR: 2.96, 95% CI: 1.47-5.97) in the SHeS. For men, abdominal obesity increased the chance of tooth loss by 41% (OR: 1.41, 95% CI: 1.06-1.87) in the NHANES and 65% (OR: 1.65, 95% CI: 1.02-2.73) in the SHeS.

CONCLUSIONS

This study indicated that the prevalence of tooth loss is substantially higher in people with abdominal obesity, and this association is distinctively different between men and women. These findings suggest that those who are not obese but have abdominal obesity may be an important target population for oral health prevention strategies.

Overnutrition and associated factors among women of reproductive age in Sub-Saharan Africa: A hierarchical analysis of 2019-2023 standard demographic and health survey data

OBJECTIVES

Overnutrition, a leading cause of global mortality, has seen a significant rise in low- and middle-income countries, including sub-Saharan Africa. Despite emerging evidence linking overnutrition to non-communicable diseases, limited action has been taken to address this issue. While undernutrition studies have received more attention, research on overnutrition and women's health remains scarce in sub-Saharan Africa. Our study aims to assess the prevalence and associated factors of overnutrition among reproductive women in this region METHODS: We conducted a secondary analysis of 2019-2023 Demographic and Health Survey datasets in sub-Saharan Africa. Our study included a weighted sample of 65,161 women aged 15-49 y. Using a multilevel mixed-effects logistic regression model, we identified factors associated with overnutrition. The adjusted odds ratio, along with a 95% confidence interval and a significance level of p < 0.05, determined the statistical significance of the explanatory variables.

RESULTS

The pooled prevalence of overnutrition among women of reproductive age in sub-Saharan Africa was 34.79% (95% CI: 34.42-35.16). Specifically, the prevalence of overweight and obesity was 21.81% and 12.99%, respectively. Women's educational status, age, media use, household wealth, urbanization, community poverty, and country income level were significantly associated with higher odds of overnutrition.

CONCLUSIONS

The prevalence of overnutrition among women of reproductive age in sub-Saharan Africa is relatively high. Key factors associated with this issue include women's educational status, age, media utilization, household wealth, place of residence, community poverty level, and national income status. These multilevel determinants highlight the need for a comprehensive, evidence-based approach to address overnutrition in this population. Effective strategies should target individual behaviors while considering broader social, economic, and environmental contexts. Integrating overnutrition prevention into maternal and reproductive health services, as well as strengthening social protection measures, are recommended steps to tackle this growing challenge in sub-Saharan Africa.

10-Gingerol reduces cytoplasmic lipid droplets and induces lipolysis in 3T3-L1 adipocytes

Obesity is a globally prevalent metabolic disorder characterized by an increased number of adipose cells and excessive fat in adipocytes. Herbal medicines, such as ginger, have shown potential in treating obesity by inhibiting adipogenesis and reducing adipocyte hypertrophy. Ginger contains bioactive compounds, particularly gingerols, which have demonstrated anti-adipogenic and/or lipolytic effects. However, research on the effects of 10-gingerol on adipose tissue remains limited. This study aimed to evaluate the effect of 10-gingerol on lipid content, lipolysis markers, and the expression of genes related to lipid metabolism in 3T3-L1 adipocytes. Three groups were analyzed: a negative control (preadipocytes), a positive control (mature adipocytes), and a group treated with 10-gingerol (10-G). Results showed that 10-G reduced lipid accumulation by 42.16% in mature adipocytes compared to the control, without affecting cell viability. Additionally, 10-G increased glycerol release and downregulated lipogenic genes such as Pparγ, Acaca, Fabp4, and Mtor, while upregulating genes related to fatty acid oxidation, including Cebpα, Cpt1a, Lipe, and Prkaa1. In conclusion, 10-gingerol reduces lipid content in mature adipocytes by downregulating lipogenesis, increasing lipolysis, and enhancing fatty acid oxidation.

Assessing the prevalence of obesity in a Russian adult population by six indices and their associations with hypertension, diabetes mellitus and hypercholesterolaemia

The anthropometric index that best predicts cardiometabolic risk remains inconclusive. This study therefore assessed the prevalence of obesity using six indices and compared their associations with obesity-related cardiometabolic disorders. We determined obesity prevalence according to body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio (WHtR), body fat percentage and fat mass index (FMI) using data from the Know Your Heart study (n = 4495, 35-69 years). The areas under the receiver operating characteristic curves (AUCs) provided predictive values of each index for detecting the presence of hypertension, hypercholesterolaemia and diabetes. Age-standardised obesity prevalence significantly varied according to anthropometric index: from 17.2% (FMI) to 75.8% (WHtR) among men and from 23.6% (FMI) to 65.0% (WHtR) among women. WHtR had the strongest association with hypertension (AUC = 0.784; p < 0.001) and with a combination of disorders (AUC = 0.779; p < 0.001) in women. In women, WHtR also had the largest AUCs for hypercholesterolaemia, in men - for hypertension, diabetes and a combination of disorders, although not all the differences from other obesity indices were significant. WHtR exhibited the closest association between hypertension and a combination of disorders in women and was non-inferior compared to other indices in men.

The change of epicardial adipose tissue characteristics and vulnerability for atrial fibrillation upon drastic weight loss

BACKGROUND

Obesity increases the risk of atrial fibrillation (AF). We hypothesize that 'obese' epicardial adipose tissue (EAT) is, regardless of comorbidities, associated with markers of AF vulnerability.

METHODS

Patients >40y of age undergoing bariatric surgery and using <2 antihypertensive drugs and no insulin were prospectively included. Study investigations were conducted before and 1y after surgery. Heart rhythm and p-wave duration were measured through ECGs and 7-d-holters. EAT-volume and attenuation were determined on non-enhanced CT scans. Serum markers were quantified by ELISA.

RESULTS

Thirty-seven patients underwent surgery (age: 52.1 ± 5.9y; 27 women; no AF). Increased p-wave duration correlated with higher BMI, larger EAT volumes, and lower EAT attenuations (p < 0.05). Post-surgery, p-wave duration decreased from 109 ± 11 to 102 ± 11ms. Concurrently, EAT volume decreased from 132 ± 49 to 87 ± 52ml, BMI from 43.2 ± 5.2 to 28.9 ± 4.6kg/m2, and EAT attenuation increased from -76.1 ± 4.0 to -71.7 ± 4.4HU (p <0.001). Adiponectin increased from 8.7 ± 0.8 to 14.2 ± 1.0 μg/ml (p <0.001). However, decreased p-wave durations were not related to changed EAT characteristics, BMI or adiponectin.

CONCLUSION

In this explorative study, longer p-wave durations related to higher BMIs, larger EAT volume, and lower EAT attenuations. P-wave duration and EAT volume decreased, and EAT attenuation increased upon drastic weightloss. However, there was no relation between decreased p-wave duration and changed BMI or EAT characteristics.

Excess weight by degree and duration and cancer risk (ABACus2 consortium): a cohort study and individual participant data meta-analysis

Background

Elevated body mass index (BMI) ≥25 kg/m2 is a major preventable cause of cancer. A single BMI measure does not capture the degree and duration of exposure to excess BMI. We investigate associations between adulthood overweight-years, incorporating exposure time to BMI ≥25 kg/m2, and cancer incidence, and compare this with single BMI.

Methods

In this cohort study and individual participant data meta-analysis, we obtained data from the ABACus 2 Consortium, consisting of four US cohorts: Atherosclerosis Risk in Communities (ARIC) study (1987-2015), Women's Health Initiative (WHI; 1991 to 2005 [main study], to 2010 [Extension 1], and to 2020 [Extension 2]), Prostate, Lung, Colorectal, Ovarian Cancer Screening (PLCO) Trial (1993-2009), NIH-AARP Diet and Health Study (1996-2011), and one European cohort, the European Prospective Investigation into Cancer and Nutrition (EPIC; participants enrolled in 1990 and administrative censoring was centre-specific). Participants with at least 3 BMI measurements and complete cancer follow-up data were included. We calculated overweight-years: degree of overweight (BMI ≥25 kg/m2) multiplied by the duration of overweight (years). Using random effects two-stage individual participant data meta-analyses, associations between cancer and overweight-years, single BMI, cumulative overweight degree and duration, measured at the same time and captured over a median of 41 years in men and 39 years in women, were evaluated with Cox proportional hazards models. Models were age-adjusted or multivariable (MV) adjusted for baseline age, ethnicity, alcohol, smoking and hormone replacement therapy (HRT). Harrell's C-statistic of metrics were compared. This study is registered at PROSPERO, CRD42021238270.

Findings

720,210 participants, including 312,132 men and 408,078 women, were followed up for cancer incidence over a median 9.85 years (interquartile range (IQR) 8.03, 11.67) in men and 10.80 years (IQR 6.05, 15.55) in women. 12,959 men (4.15%) and 36,509 women (8.95%) were diagnosed with obesity-related cancer. Hazard ratios for obesity-related cancers in men, per 1 standard deviation (SD) overweight-years were 1.15 (95% CI: 1.14, 1.16, I2: 0) age-adjusted and 1.15 (95% CI: 1.13, 1.17, I2: 0%) MV-adjusted and per 1SD increment in single BMI were 1.17 (95% CI: 1.16, 1.18, I2: 0) age-adjusted and 1.16 (95% CI: 1.15, 1.18, I2: 0%) MV-adjusted. The HR for overweight-years in women per 1 SD increment was 1.08 (95% CI: 1.04, 1.13, I2: 82%) age-adjusted and 1.08 (95% CI: 1.04, 1.13, I2: 83%) MV-adjusted and per 1SD increment in single BMI was 1.10 (95% CI: 1.07, 1.14, I2: 72%) age-adjusted and 1.11 (95% CI: 1.07, 1.15, I2: 79%) MV-adjusted. C-statistics for overweight-years and single BMI for obesity-related cancers were 0.612 (95% CI: 0.578, 0.646) and 0.611 (95% CI: 0.578, 0.644) respectively for men and 0.566 (95% CI: 0.534, 0.598) and 0.573 (95% CI: 0.546, 0.600) for women.

Interpretation

Adulthood degree and duration of excess BMI were associated with cancer risk. Both factors should be considered in cancer prevention strategies and policies. This study only focused on adulthood exposure to excess BMI, so the minimal differences in the predictive performance between adiposity metrics may be due to underestimation of cumulative excess BMI exposure.

Funding

Cancer Research UK, the Manchester NIHR Biomedical Research Centre, the National Cancer Institute, the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, U.S. Department of Health and Human Services, the Intramural Research Program of the National Cancer Institute, the International Agency for Research on Cancer, Imperial College London, European Commission (DG-SANCO), the Danish Cancer Society, Ligue Contre le Cancer, Institut Gustave-Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale, Deutsche Krebshilfe, Deutsches Krebsforschungszentrum, German Federal Ministry of Education and Research, the Hellenic Health Foundation, Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council, Dutch Ministry of Public Health, Welfare, and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch Zorg Onderzoek Nederland, World Cancer Research Fund, Statistics Netherlands, Health Research Fund, Instituto de Salud Carlos III, regional Spanish governments of Andalucía, Asturias, Basque Country, Murcia, and Navarra, the Catalan Institute of Oncology, Swedish Cancer Society, Swedish Scientific Council, and Region Skåne and Region Västerbotten, and the Medical Research Council.

Safety and effectiveness of laparoscopic renal biopsy: a single-center review and meta-analysis

BACKGROUND

While renal biopsy remains the preferred diagnostic method for assessing proteinuria, hematuria, or renal failure, laparoscopic renal biopsy (LRB) can serve as an alternative for high-risk patients when percutaneous kidney biopsy (PKB) is not recommended. This study was aimed to evaluate the safety of LRB.

METHODS

In study 1, Fourteen patients from January 2021 to January 2023 had a LRB taken for various indications, such as morbid obesity, abnormal kidney construction, uncontrolled hypertension, and coagulopathy. We also conducted a Meta-analysis of the success rate and complication rate of previous LRB in study 2.

RESULTS

All the patients completed biopsies and adequate renal tissues were obtained. The success rate was 100%. The median number of glomeruli obtained was 22.5 (range:12.0, 45.0). The complication rate was 7.1% (urinary tract infection). There were no significant differences between levels of hemoglobin, serum creatinine, and urinary NAGL before and after surgery. In the meta-analysis, the success rate of operation, satisfactory rate of sample, and complication rate of surgery were 99.9%, 99.1%, and 2.6% respectively.

CONCLUSION

LRB can achieve a good success rate and specimen retrieval and does not increase the risk of complications for high-risk patients. It can present as one of the alternative methods for patients with glomerular diseases.

The gut microbiota as a link between Alzheimer's disease and obesity

Alzheimer's disease (AD) is a degenerative disease that causes a progressive decline in memory and thinking skills. Over the past few years, diverse studies have shown that there is no single cause of AD; instead, it has been reported that factors such as genetics, lifestyle, and environment contribute to the pathogenesis of the disease. In this sense, it has been shown that obesity during middle age is one of the most prominent modifiable risk factors for AD. Of the multiple potential mechanisms linking obesity and AD, the gut microbiota (GM) has gained increasing attention in recent years. However, the underlying mechanisms that connect the GM with the process of neurodegeneration remain unclear. Through this narrative review, we present a comprehensive understanding of how alterations in the GM of people with obesity may result in systemic inflammation and affect pathways related to the pathogenesis of AD. We conclude with an analysis of the relationship between GM and insulin resistance, a risk factor for AD that is highly prevalent in people with obesity. Understanding the crosstalk between obesity, GM, and the pathogenesis of AD will help to design new strategies aimed at preventing neurodegeneration.

The Impact of Orthodontic Treatment on Body Weight Due to Change in Dietary Habits

Background Orthodontic treatment, while primarily focusing on correcting dental alignment and occlusion, has been increasingly validated for its potential impact on broader aspects of oral health and general well-being: its potential influence on body weight. While the mechanical effects of orthodontic appliances are well documented in the literature, their potential behavioral impact on weight loss remains underexplored. Beyond its primary role in correcting dental alignment, our study has unveiled a lesser-known benefit: its potential to aid in weight reduction among individuals who have already struggled through conventional methods. Orthodontic treatment is a surprising yet successful intervention in the field of weight management. Often known only for its use in correcting dental malalignments, our research has revealed an additional benefit: it can help people who have struggled to do so with other conventional methods lose weight. Orthodontic treatment accomplishes the same goals more quickly and with few side effects. In addition to highlighting the aesthetic and functional benefits of orthodontics, this growing body of knowledge also presents orthodontics as a novel solution for individuals struggling with weight issues. In exploring the mutually beneficial relationship between orthodontic care and weight loss, we looked at a way to achieve both improved overall health and fitness along with dental alignment. Since obesity is associated with a notably higher risk of negative health outcomes, losing weight not only helps you feel better about yourself but also improves your general health and wellness. This study explores the relationship between orthodontic treatment and reduction in weight among patients undergoing treatment at Sardar Begum Dental College. Its primary objective is to assess and compare changes in body weight among the said patients. Methodology This observational prospective study was carried out at the Department of Orthodontics and Dentofacial Orthopaedics, Sardar Begum Dental College, Peshawar. Every patient gave their informed consent and expressed their willingness for participation in the study. An online sample size calculator (OpenEpi) was used. The confidence level was set to 95% with a margin of error of ±5%, and the sample size calculated was 150. The patients were chosen using a convenient sampling technique. The patients' weights were recorded on the days of bonding (T0) and one month (T1), two months (T2), and three months (T3) following bonding. Data was processed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Since the data was not normally distributed, the Wilcoxon signed-rank test was applied. Results The Wilcoxon signed-rank test revealed that body weight was significantly reduced one month, two months, and three months after bonding. The body weight on the day of bonding (median=48.200; n=150) was compared to the body weight after one month (median=47.800; n=150), resulting in a statistically significant decrease (z=-9.480; p=0.000) with a large effect size (r=-0.547). The analysis shows a significant decrease in body weight after one month of orthodontic bonding, with a large effect size indicating a substantial impact of the orthodontic treatment on body weight. Conclusion Fixed orthodontic treatment appears to have an impact on body weight, i.e., weight is reduced after the first, second, and third months of bonding.

Burden of non-communicable diseases in Iran: past, present, and future

Iran, as an in-transition country, tackled communicable diseases and now is confronting emerging challenges of non-communicable diseases (NCDs) in the path to reach health for everyone at all ages by 2030. Across Iran, death-averting treatments of NCDs have been expanded recently which might cause a shift toward a greater share of years lived with disability (YLDs) compared to years of life lost (YLLs) in the disability-adjusted life years of NCDs. Since the management of disability differs from the reduction of mortality in terms of public health policies, depicting the current picture of the burden of NCDs is principal for policymakers in achieving health for all. In this communication, we briefly reviewed our current knowledge about the burden of NCDs in Iran and found that burdens of cardiovascular diseases and asthma are shifting toward greater YLDs than YLLs. In addition to expanding preventive measures and maintenance of the current system, this profile calls policymakers for the development of more rehabilitation centers for patients with ischemic heart disease, stroke, and respiratory diseases to mitigate their disabilities. The consistent increase in the age-standardized YLD rate of neoplasms necessitates providing rehabilitation centers as well. Morbidity and mortality of diabetes have increased robustly which warrant extensive preventive and control measures. It should be noted that the estimates of the Global Burden of Disease study offer us invaluable insights on the burden of diseases in Iran; nonetheless, efforts for gathering nationally-representative data, e.g., National and Subnational Burden of Diseases, Injuries, and Risk Factors study, are strongly encouraged in the future.

Silybin restores glucose uptake after tumour necrosis factor-alpha and lipopolysaccharide stimulation in 3T3-L1 adipocytes

Obesity is associated with a low-grade chronic inflammatory process characterized by higher circulating TNFα levels, thus contributing to insulin resistance. This study evaluated the effect of silybin, the main bioactive component of silymarin, which has anti-inflammatory properties, on TNFα levels and its impact on glucose uptake in the adipocyte cell line 3T3-L1 challenged with two different inflammatory stimuli, TNFα or lipopolysaccharide (LPS). Silybin's pre-treatment effect was evaluated in adipocytes pre-incubated with silybin (30 or 80 µM) before challenging with the inflammatory stimuli (TNFα or LPS). For the post-treatment effect, the adipocytes were first challenged with the inflammatory stimuli and then post-treated with silybin. After treatments, TNFα production, glucose uptake, and GLUT4 protein expression were determined. Both inflammatory stimuli increased TNFα secretion, diminished GLUT4 expression, and significantly decreased glucose uptake. Silybin 30 µM only reduced TNFα secretion after the LPS challenge. Silybin 80 µM as post-treatment or pre-treatment decreased TNFα levels, improving glucose uptake. However, glucose uptake enhancement induced by silybin did not depend on GLUT4 protein expression. These results show that silybin importantly reduced TNFα levels and upregulates glucose uptake, independently of GLUT4 protein expression.

An internet-based platform with a low-calorie dietary intervention improves cardiometabolic risk factors in overweight and obese people in China: Half-year follow-up results of a randomized controlled trial

AIM

To explore the effectiveness of the Metawell programme on cardiometabolic risk factors in China, which combines meal replacement biscuits, a wireless scale, and a mobile phone application.

METHODS

In this two-arm, parallel-design randomized study, 220 participants were randomly assigned to an intervention (n = 110) and a control (n = 110) group. Participants in the intervention group were instructed to use meal replacement products and scales for weight loss and monitoring, whereas participants in the control group received printed materials containing a sample diet and face-to-face weight loss education at enrolment. The trial lasted 6 months, including a weight loss period in Months 1-3 and a weight maintenance period in Months 3-6. Generalized estimating equations were used to compare differences between the two groups.

RESULTS

The median (interquartile range) ages of the intervention and control groups were 32.00 (28.00, 39.00) years and 33.00 (28.25, 41.00) years, with body mass indices of 28.20 (26.30, 30.95) kg/m2 and 27.70 (26.02, 29.70) kg/m2, respectively. Participants in the intervention group experienced significantly greater decreases in waist circumference, hip circumference, triglycerides, total cholesterol: high-density lipoprotein cholesterol ratio, fasting blood glucose, fasting insulin, and homeostatic model assessment of insulin resistance index compared to the control group (p < 0.01). Among participants who did not regain weight during the maintenance period after weight loss, the reductions in systolic and diastolic blood pressure were significantly greater in the intervention group than in the control group (p < 0.05).

CONCLUSIONS

The Metawell programme of caloric restriction and remote monitoring can be adapted to overweight and obese people in China to reduce their cardiometabolic risk factors. Furthermore, there was a better improvement in blood pressure in participants who maintained the effects of weight loss.

Neck circumference, waist-to-height ratio, Chinese visceral adiposity index and incident heart failure

BACKGROUND

The indicators of abdominal obesity have shown to be associated with a high risk of cardiovascular diseases (CVDs), even adjusted for body mass index (BMI). We aimed to investigate the association between neck circumference, waist-to-height ratio (WHtR), Chinese visceral adiposity index (CVAI) and incident heart failure (HF) in Chinese adults.

METHODS

The current study included 86,546 participants from two independent cohorts: the Kailuan I study established in 2006 and the Kailuan study II established in 2008. Participants aged 18-80 years who were free of CVDs or cancer were recruited at baseline. The values of neck circumference, WHtR and CVAI were available in 2014. The trajectory analysis was conducted using repeated measures of WHtR and CVAI in the 2008, 2010, 2012 and 2014 surveys. The incident HF cases were identified via reviewing medical records by cardiologists.

RESULTS

During a mean follow-up of 5.62 years, 724 incident HF cases were documented. The highest quartiles of neck circumference, WHtR and CVAI respectively, were significantly associated with a high risk of HF compared to the lowest quartiles of adiposity measures (neck circumference: HR:1.30, 95%CI: 1.03-1.65; WHtR: HR:1.49, 95%CI: 1.16-1.92; and CVAI: HR:1.98, 95%CI: 1.48-2.65). The combination of adiposity measures with BMI or metabolic abnormalities jointly predicted incident HF. Presence of hypertension and diabetes appeared to be the major mediators, accounting for ∼ 8.11-24.7% of the associations between three indicators of abdominal obesity and HF risk.

CONCLUSION

The new indices of abdominal adiposity could help to identify those who were at a high risk of HF, especially in the presence of high BMI or metabolic abnormalities.

BMI Interacts with the Genome to Regulate Gene Expression Globally, with Emphasis in the Brain and Gut

Genome-wide association studies identify common genomic variants associated with disease across a population. Individual environmental effects are often not included, despite evidence that environment mediates genomic regulation of higher order biology. Body mass index (BMI) is associated with complex disorders across clinical specialties, yet has not been modeled as a genomic environment. Here, we tested for expression quantitative trait (eQTL) loci that contextually regulate gene expression across the BMI spectrum using an interaction approach. We parsed the impact of cell type, enhancer interactions, and created novel BMI-dynamic gene expression predictor models. We found that BMI main effects associated with endocrine gene expression, while interactive variant-by-BMI effects impacted gene expression in the brain and gut. Cortical BMI-dynamic loci were experimentally dysregulated by inflammatory cytokines in an in vitro system. Using BMI-dynamic models, we identify novel genes in nitric oxide signaling pathways in the nucleus accumbens significantly associated with depression and smoking. While neither genetics nor BMI are sufficient as standalone measures to capture the complexity of downstream cellular consequences, including environment powers disease gene discovery.

Cardiorespiratory Fitness in Adolescence and Risk of Type 2 Diabetes in Late Adulthood: A Nationwide Sibling-Controlled Cohort Study

Background

The importance of adolescent cardiorespiratory fitness for long-term risk of type 2 diabetes (T2D) remains poorly investigated, and whether the association is influenced by unobserved familial confounding is unknown.

Methods

We conducted a sibling-controlled cohort study based on all Swedish men who participated in mandatory military conscription examinations from 1972 to 1995 around the age of 18, and who completed standardized cardiorespiratory fitness testing. The outcome was T2D, defined as a composite endpoint of diagnosis in inpatient or specialist outpatient care, or dispensation of antidiabetic medication, until 31 December 2023.

Findings

1 124 049 men, of which 477 453 were full siblings, with a mean age of 18.3 years at baseline were included. During follow-up, 115 958 men (48 089 full siblings) experienced a first T2D event at a median age of 53.4 years. Compared to the first decile of fitness, higher fitness levels were associated with a progressively lower risk of T2D. In cohort analysis, the hazard ratio (HR) in the second decile was 0.83 (95% CI, 0.81 to 0.85), with a difference in the standardized cumulative incidence at age 65 of 4.3 (3.8 to 4.8) percentage points, dropping to a HR of 0.38 (0.36 to 0.39; incidence difference 17.8 [17.3 to 18.3] percentage points) in the tenth decile. When comparing full siblings, and thus controlling for all unobserved behavioral, environmental, and genetic confounders that they share, the association replicated, although with attenuation in magnitude. The HR in the second decile was 0.89 (0.85 to 0.94; incidence difference 2.3 [1.3 to 3.3] percentage points), and in the tenth decile it was 0.53 (0.50 to 0.57; incidence difference 10.9 [9.7 to 12.1] percentage points). Hypothetically shifting everyone in the first decile of fitness to the second decile was estimated to prevent 7.2% (6.4 to 8.0) of cases at age 65 in cohort vs. 4.6% (2.6 to 6.5) in full-sibling analysis. The association was similar in those with overweight as in those without.

Interpretation

Higher levels of adolescent cardiorespiratory fitness are associated with lower risk of T2D in late adulthood, with clinically relevant associations starting already from very low levels of fitness, and similarly in those with overweight compared to those without. The association replicates, but becomes weaker, after adjusting for unobserved familial confounders shared between full siblings. This suggests that adolescent cardiorespiratory fitness is a robust marker of long-term T2D risk, but that conventional observational analysis may yield biased estimates.

Funding

None.

Research in context

Evidence before this study: Type 2 diabetes is a growing public health issue, affecting at least half a billion people globally. Modifiable factors such as physical activity and the closely related trait cardiorespiratory fitness, which are inversely associated with type 2 diabetes, are declining, particularly among youth. Since these traits track from youth into adulthood, early-life interventions might have important implications for prevention. However, previous studies have typically focused on middle-aged individuals, leaving gaps in understanding whether fitness in youth is associated with type 2 diabetes in the long-term. Moreover, they have not been designed to adequately account for unobserved confounders. Triangulating the evidence across different methods, such as using sibling comparison analysis, would be important to obtain more accurate and reliable estimates of the causal relationship.Added value of this study: In this nationwide sibling-controlled cohort study encompassing more than 1 million young men, of which half a million were full siblings, higher levels of adolescent cardiorespiratory fitness were associated with a substantially lower risk of developing type 2 diabetes up to five decades later. The association was clinically relevant already from low levels of fitness, and it appeared similar in those with overweight as in those without overweight. While the association replicated after adjusting for unobserved familial confounders shared between full siblings, the magnitude of association attenuated by an amount that appeared clinically relevant. For example, the incidence differences between deciles of fitness were about 40% smaller in sibling-comparison analyses as compared to cohort analysis, and the preventable share of type 2 diabetes associated with hypothetical interventions shifting the population-level of fitness was reduced by about one-third.Implications of all the available evidence: Adolescent cardiorespiratory fitness is a strong marker of long-term risk of type 2 diabetes, both in those with and without overweight. These findings render support to large-scale surveillance of fitness from a prevention perspective, and if the findings are confirmed using other lines of causal analysis, they may render support to interventions targeting fitness already from a young age. Yet, these findings also highlight the importance of triangulation for obtaining more reliable evidence of the magnitude of association, and shed light on the pitfalls of conventional observational analysis which may yield biased estimates.

Body Composition Trend in Slovene Adults: A Two-Year Follow-Up

This research re-evaluates the prevalence of obesity in a cohort of 432 Slovenian adults two years after an initial population-based cross-sectional examination, utilizing the World Health Organization's body mass index (BMI) and total body fat percentage (FAT%) classifications. Herein, a medically approved electrical bioimpedance monitor was used to analyse body composition, and the results revealed a significant increase in the percentage of individuals classified as having overweight or obesity on the basis of BMI, from 40.7% initially to 45.2% at follow-up (FU); however, these percentages were notably higher in males than in females. The increases in body mass, BMI, fat mass, and FAT% were observed mainly in adult females, whereas in adult males, the increases in BM and BMI were attributed to fat-free mass (FFM) rather than fat mass. In this study, BMI was also compared with the FAT% obesity classification, and the BMI classification was shown to result in significantly fewer participants with obesity in both measures. However, the proportion of participants with obesity based on the two classifications did not differ substantially between the initial and FU measurements. In this study, mixed linear models were used to analyse overall trends and subgroup variations and highlight the importance of considering sex, age, and time of measurement when assessing body composition metrics. These findings emphasize the need for personalized health assessments and the importance of measuring body composition to evaluate adult obesity more accurately for both clinical assessments and public health policies. The state, in collaboration with social initiatives and industrial stakeholders, should prioritize these data and advance public health through innovative educational and awareness initiatives that are founded on robust scientific principles and that empower and promote the adoption of a healthy, active lifestyle.

Obesity alters the macrophages' response to Leishmania major in C57BL/6 mice

Obesity is a global pandemic associated with several comorbidities, such as cardiovascular diseases and type 2 diabetes. It is also a predisposing factor for infectious diseases, increasing mortality rates. Moreover, diet-induced obesity can cause metabolic fluctuations that affect macrophage differentiation in various organs. In this sense, we investigated how bone marrow-derived macrophages and tissue-resident macrophages in the skin, which have been differentiated in a host with metabolic syndrome and with previous inflammatory burden, respond to Leishmania major infection. Our findings suggest that bone marrow-derived macrophages from obese C57BL/6 mice, even when cultivated in vitro with inflammatory stimuli, are more susceptible to L. major. These macrophages produce less tumor necrosing factor (TNF) and nitric oxide (NO) and show higher arginase activity. Furthermore, obese mice infected with an intermediate dose of L. major in the skin had more severe lesions when analyzed for ulceration, diameter, thickness, and parasite burden. The increase in lesion severity in obese mice was associated with a higher frequency of tissue-resident macrophages, which are less efficient in killing parasites. We also used CCR2-/- mice, which predominantly have tissue-resident macrophages, and found that lesion resolution was delayed in association with CCR2 deficiency. Additionally, obesity potentiated tissue damage, resulting in higher frequency of tissue-resident macrophages. Our results demonstrate that obesity can alter macrophage responses to infection, leading to increased susceptibility to L. major and more severe cutaneous leishmaniasis. These findings may have important implications for managing obesity-related infections and the development of new therapies for cutaneous leishmaniasis.

Effect of synbiotic supplementation on obesity and gut microbiota in obese adults: a double-blind randomized controlled trial

BACKGROUND

Synbiotics, combining specific probiotics and selected prebiotics, may benefit health issues like obesity, but evidence remains inconsistent.

OBJECTIVE

This study aimed to verify the effect of a pre-screened synbiotics combination [containing Bifidobacterium animalis subsp. lactis MN-Gup (MN-Gup), galacto-oligosaccharides (GOS) and xylo-oligosaccharides (XOS)] on obesity in the population.

METHODS

In a randomized, double-blind, placebo-controlled trial, 80 individuals with obesity consumed daily synbiotics (containing MN-Gup 1 × 1011 CFU/day, GOS 0.7 g/day, and XOS 0.7 g/day) or placebo for 12 weeks. Body composition, blood lipids, serum hormone, bile acids, and gut microbiota were measured pre-and post-intervention.

RESULTS

Synbiotics supplementation significantly decreased body fat percentage, waist, and serum low-density lipoprotein cholesterol (LDL-C), increased peptide YY, cholecystokinin, oxyntomodulin, GSH (glutathione peroxidase) in individuals with obesity. Additionally, synbiotic supplementation led to an enrichment of beneficial bacteria and bile acids chenodeoxycholic acid (CDCA). Bifidobacterium and Romboutsia were significantly positively correlated with CDCA. A more favorable effect was observed in individuals with obesity and abnormal LDL-C compared to those without dyslipidemia.

CONCLUSION

Twelve-week synbiotics intervention reduced body fat percentage, waist, and serum LDL-C, especially in individuals with obesity and abnormal LDL-C. The possible mechanisms may be related to changes in gut microbiota, bile acids and gut hormones.

CLINICAL TRIAL REGISTRATION

Chictr.org.cn, identifier ChiCTR2200064156.

Comparative analysis of dietary vs. non-dietary approaches in obesity and disordered eating behaviors: a narrative review of the literature

PURPOSE

This narrative review aims to conduct a comparative analysis of dietary and non-dietary approaches in the management of weight and disordered eating behaviors (DEBs) in adults with obesity.

METHODS

Studies were identified from Medline (PubMed), including only English-language manuscripts published from 1998 to 2024. To be included in the review the studies had to be RCTs that compared the effect of dietary and non-dietary approaches on weight loss and DEBs in adults with obesity not being treated with pharmacological treatments.

RESULTS

Seven randomized controlled trials (RCTs) reported in 8 manuscripts published between 1998 and 2024 met the inclusion criteria. The sample size ranged from a minimum of 16 subjects to a maximum of 219. All studies involved adult subjects, mainly women, with first-, second-, or third-degree obesity and most subjects had cognitive restriction and/or uncontrolled eating. Dietary approaches were characterized by moderate caloric restriction (CR) and restriction of fat intake. In contrast, non-dietary approaches focused on mindful eating (ME), intuitive eating (IE) and weight neutral (WN) approaches. Of the 7 RCTs included, 5 reported greater weight loss in the diet group compared to the non-diet group; however, only one of these sustained the result at follow-up. In contrast, 4 studies demonstrated greater improvements in DEBs in the non-diet group.

CONCLUSION

CR is essential for weight loss in individuals with obesity, but long-term weight management also hinges on their relationship with food. The psychological improvements reported in non-dietary versus dietary approaches should not be overlooked and can be a starting point for the development of multidisciplinary interventions involving synergistic actions between diet, exercise, and practices to improve DEBs with the goal of reducing the obesity epidemic. Level of evidence Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.

The Frequency and Main Characteristics of Obesity in Undocumented Migrants Receiving Medical Assistance from a Charitable Organisation in Italy

BACKGROUND

Obesity is continually growing not only in medium- and high-income countries but also in low-income countries, from where increasing numbers of migrants arrive in Western countries. We aimed to investigate the frequency and characteristics of obesity in a sample of undocumented migrants, a population for which official health data are not available.

METHODS

We collected demographic and socio-economic data and information on medical diagnoses and pharmacologic treatments for 341 undocumented migrants consecutively attending the outpatient clinic of a big non-governmental organisation in Milan, Italy, from March to July 2023. To measure obesity, we used both body mass index (BMI) and waist circumference (WC). We used multivariate robust Poisson regression models to calculate prevalence ratios (PRs) and 95% Confidence Intervals (CIs) of overweight or obesity according to socio-demographic conditions and other risk factors.

RESULTS

Using BMI, the proportion of migrants with obesity was 28.7% (95% CI 24.0-33.0%) and those with overweight represented 32.3% (95% CI 27.3-37.5%). Obesity was more frequent among Asians (53.9%, 95% CI 37.2-69.9%), followed by Latinos (38.7%, 95% CI 29.6-48.5%) and Eastern Europeans (38.2%, 95% CI 25.4-52.3%). Using WC, 68.3% (95% CI 63.1-73.2%) of migrants had values suggestive of overweight or obesity. In the multivariate analyses, overweight and obesity were more frequent in migrants with older age, with a stable employment, and who had been present in Italy for a long time, as well as in those with CV diseases. Moreover, individuals with obesity needed more medications for the cardiovascular system and for the alimentary tract and metabolism.

CONCLUSIONS

In our sample of undocumented migrants, overweight and obesity were frequent, representing an important public health issue, considering the difficulty experienced by such individuals in finding access to both prevention and healthcare services.

Development of a habit-based intervention to support healthy eating and physical activity behaviours for pregnant women with overweight or obesity: Healthy Habits in Pregnancy and Beyond (HHIPBe)

BACKGROUND

The number of women entering pregnancy with overweight or obesity is increasing. This can increase the risk for excessive gestational weight gain (GWG) which is associated with health complications for mother and baby. There are limited evidence-based interventions within antenatal care settings to encourage healthy eating and physical activity behaviours and support women with managing GWG.

METHODS

A previous habit-based intervention 'Ten Top Tips for a Healthy Weight' (10TT) was adapted and made suitable for pregnancy in line with the Medical Research Council's (MRC) complex intervention development guidelines. It involved three key activities: (1) identifying the evidence base; (2) identifying appropriate theory; and, (3) modelling processes. A core element was integrating lived experience via personal and public involvement (PPI).

RESULTS

The original 10TTs were adapted with PPI in line with current advice on nutrition and physical activity in pregnancy. New intervention materials were devised, including a leaflet and a logbook and app for self-monitoring to be delivered alongside a brief 1:1 conversation. Behaviour change techniques (BCTs) included in the new materials were coded using a number of behavioural taxonomies. An E-learning resource was created to help standardise the approach to delivery of the intervention and avoid stigmatising conversations.

CONCLUSION

Following MRC guidance for the development of complex interventions alongside significant PPI allowed for the adaption of 10TT habit-based weight management intervention into the 'Healthy Habits in Pregnancy and Beyond' (HHIPBe) intervention. The feasibility and acceptability of implementing this intervention in the antenatal setting will be explored in a feasibility randomised controlled trial.

TRIAL REGISTRATION

This study was registered on Clinical Trials as 'Healthy Habits in Pregnancy and Beyond (HHIPBe)' ClinicalTrials.gov Identifier: NCT04336878. The study was registered on 07/04/2020.

A Guideline-Directed Approach to Obesity Treatment

This article summarizes and compares 18 sets of guidelines for adult obesity treatment, highlighting key recommendations for patient evaluation, lifestyle intervention, anti-obesity medications (AOMs), and metabolic and bariatric surgery. Guidelines are consistent in many regards, although there is divergence regarding preferred AOMs. Metabolic and bariatric surgery is still recognized as the most durable form of obesity treatment, and newer guidelines suggest these procedures at lower BMI thresholds for people with uncontrolled type 2 diabetes. Overall, guidelines for obesity treatment show a high degree of agreement, although updates are needed to incorporate new treatment innovations.

The Relationship Between Psychological Factors and Nutritional Status in Adolescence

BACKGROUND

The aim of the research is to explore the relationship between psychological factors and nutritional status in adolescence. The issue of adolescent nutrition is related to several psychological problems, as well as to developmental changes during this period. Research on body image dissatisfaction has confirmed that most adolescents are dissatisfied with their bodies. Developmentally oriented scientists are unique in their approach to explaining the problem of body image, focusing on multiple aspects and attempting to understand the intrapersonal and interpersonal factors that are important for the formation of body image.

METHODS

The sample included 260 adolescents aged 11 to 15. The assessment of sociodemographic factors, emotional states, physical activity levels, and eating habits was included in the questionnaires filled out by the parents (DASS-21 and the Physical Activity & Nutrition Behaviors Monitoring Form questionnaire). Body Mass Index (BMI) was calculated based on information about the height and weight of the adolescents.

RESULTS

The results of the correlation between psychological characteristics and BMI indicate a negative low correlation with all psychological aspects: depression (r = -0.25; p < 0.05), anxiety (r = -0.30; p < 0.05), and stress (r = -0.28; p < 0.05). Over 70% of adolescents are classified in the category of normal BMI.

CONCLUSIONS

The results indicate that subjects who are of normal weight experience less pronounced depression, anxiety, and stress.