Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old

Epicardial adipose tissue, obesity and the occurrence of atrial fibrillation: an overview of pathophysiology and treatment methods

INTRODUCTION

Obesity is a chronic disease, which has significant health consequences and is a staggering burden to health care systems. Obesity can have harmful effects on the cardiovascular system, including heart failure, hypertension, coronary heart disease, and atrial fibrillation (AF). One of the possible substrates might be epicardial adipose tissue (EAT), which can be the link between AF and obesity. EAT is a fat deposit located between the myocardium and the visceral pericardium. Numerous studies have demonstrated that EAT plays a pivotal role in this relationship regarding atrial fibrillation.

AREAS COVERED

This review will focus on the role of obesity and the occurrence of atrial fibrillation (AF) and examine the connection between these and epicardial adipose tissue (EAT). The first part of this review will explain the pathophysiology of EAT and its association with the occurrence of AF. Secondly, we will review bariatric and metabolic surgery and its effects on EAT and AF.

EXPERT COMMENTARY

In this review, the epidemiology, pathophysiology, and treatments methods of AF are explained. Secondly the effects on EAT were elucidated. Due to the complex pathophysiological link between EAT, AF, and obesity, it is still uncertain which treatment strategy is superior.

Aerobic Dance on an Air Dissipation Platform Improves Cardiorespiratory, Muscular and Cellular Fitness in the Overweight and Obese Elderly

Background: Obesity is a global health problem associated with a high number of comorbidities that decrease functional capacity, especially in elderly people. Aerobic dance is considered a viable strategy to prevent the effects of aging, mainly in obese and overweight elderly people. This study aimed to evaluate the effects of aerobic dance on an air dissipation platform (ADP) on body composition, oxidative stress and muscular and cardiorespiratory fitness in elderly people. Methods: In total, 32 elderly adults (67.1 ± 3.6) were divided into 3 groups based on body mass index: healthy (HG), overweight (OWG) and obese (OG). Training program of aerobic dance on an ADP was carried out twice a week for 12 weeks. Results: OWG (p = 0.016) and OG decreased their weight (p < 0.001). There was a significant decrease in malondialdehyde concentrations in all experimental groups (p < 0.05). OWG and OG significantly improved their peak oxygen uptake (p < 0.01). HG increased the vertical jump height (p < 0.05), and HG and OG improved the power output of the lower extremities (p < 0.05). Conclusions: The aerobic dance on an ADP may be an effective alternative to lose weight, prevent oxidative stress and improve cardiorespiratory fitness in obese and overweight elderly people.

Body mass index and all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus in South Korea: a retrospective cohort study

OBJECTIVES

The lower risk of death in overweight or obese patients, compared with normal-weight individuals, has caused confusion for patients with diabetes and healthcare providers. This study investigated the relationship between body mass index (BMI) and mortality in patients with type 2 diabetes.

DESIGN

A retrospective cohort study.

SETTING

We established a national population database by merging the Korea National Health Insurance (KNHI) claims database, the National Health Check-ups Database and the KNHI Qualification Database of South Korea.

PARTICIPANTS

A total of 53 988 patients who were newly diagnosed with type 2 diabetes (E11 in International Classification of Diseases, 10th Edition) in 2007, had available BMI data, lacked a history of any serious comorbidity, received diabetes medication and did not die during the first 2 years were followed up for a median of 8.6 years.

PRIMARY OUTCOME MEASURES

All-cause mortality.

RESULTS

The mean BMI was 25.2 (SD 3.24) kg/m², and the largest proportion of patients (29.4%) had a BMI of 25-27.4 kg/m². Compared with a BMI of 27.5-29.9 kg/m² (the reference), mortality risk continuously increased as BMI decreased while the BMI score was under 25 (BMI <18.5 kg/m²: adjusted HR (aHR) 2.71, 95% CI 2.24 to 3.27; BMI 18.5-20.9 kg/m²: aHR 1.94, 95% CI 1.70 to 2.22; BMI 21-22.9 kg/m²: aHR 1.51, 95% CI 1.34 to 1.70; and BMI 23-24.9 kg/m²: aHR 1.14, 95% CI 1.01 to 1.28). For patients aged ≥65 years, the inverse association was connected up to a BMI ≥30 kg/m² group (aHR 0.76, 95% CI 0.59 to 0.98). However, the associations for men, patients aged <65 years and ever smokers resembled a reverse J curve, with a significantly greater risk of death in patients with a BMI ≥30 kg/m².

CONCLUSIONS

This study suggests that, for patients with type 2 diabetes at a normal weight, distinct approaches are needed in terms of promoting muscle mass improvement or cardiorespiratory fitness, rather than maintaining weight status. Improved early diagnosis considering the inverse association between BMI and mortality is also needed.

Associations of body mass index and hospital-acquired disability with post-discharge mortality in older patients with acute heart failure

OBJECTIVES

To investigate the effect of hospital-acquired disability (HAD) on all-cause mortality after discharge according to the body mass index (BMI) in older patients with acute decompensated heart failure.

METHODS

We included 408 patients aged ≥ 65 years who were hospitalized for acute decompensated heart failure and had undergone an acute phase of cardiac rehabilitation at the Sakakibara Heart Institute between April 2013 and September 2015 (median age: 82 years, interquartile range (IQR): 76-86; 52% male). Patients were divided into three groups based on BMI at hospital admission: underweight (< 18.5 kg/m²), normal weight (18.5 to 25 kg/m²), and overweight (≥ 25 kg/m²). HAD was defined as a decrease of at least five points at discharge compared to before hospitalization according to the Barthel Index.

RESULTS

The median follow-up period was 475 (IQR: 292-730) days, and all-cause mortality during the follow-up period was 84 deaths (21%). According to multivariate Cox regression analysis, being underweight (HR: 1.941, 95% CI: 1.134-3.321,P = 0.016) or overweight (HR: 0.371, 95% CI: 0.171-0.803,P = 0.012), with normal BMI as the reference, and HAD (HR: 1.857, 95% CI: 1.062-3.250,P = 0.030) were independently associated with all-cause mortality. Patients with HAD exhibited a significantly lower cumulative survival rate in the underweight group (P = 0.001) and tended to have a lower cumulative survival rate in the normal weight group (P = 0.072). HAD was not significantly associated with cumulative survival in the overweight group (P = 0.392).

CONCLUSIONS

BMI and HAD independently predicted all-cause mortality after discharge in older patients with acute decompensated heart failure. Furthermore, HAD was significantly associated with higher all-cause mortality after discharge, especially in the underweight group.

Association of Body Mass Index in Midlife With Morbidity Burden in Older Adulthood and Longevity

Importance

Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures.

Objective

To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older.

Design, Setting, and Participants

Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 and January 1973 linked with Medicare follow-up between January 1985 and December 2015. Participants included 29 621 adults who were at least age 65 years in follow-up and enrolled in Medicare. Data were analyzed from January 2020 to December 2021.

Exposures

Standard BMI categories.

Main Outcomes and Measures

(1) Morbidity burden at 65 years and older assessed with the Gagne combined comorbidity score (ranging from -2 to 26, with higher score associated with higher mortality), which is a well-validated index based on International Classification of Diseases, Ninth Revision codes for use in administrative data sets; (2) longevity (age at death); and (3) health care costs based on Medicare linkage in older adulthood (aged ≥65 years).

Results

Among 29 621 participants, mean (SD) age was 40 (12) years, 57.1% were men, and 9.1% were Black; 46.0% had normal BMI, 39.6% were overweight, and 11.9% had classes I and II obesity at baseline. Higher cumulative morbidity burden in older adulthood was observed among those who were overweight (7.22 morbidity-years) and those with classes I and II obesity (9.80) compared with those with a normal BMI (6.10) in midlife (P < .001). Mean age at death was similar between those who were overweight (82.1 years [95% CI, 81.9-82.2 years]) and those who had normal BMI (82.3 years [95% CI, 82.1-82.5 years]) but shorter in those who with classes I and II obesity (80.8 years [95% CI, 80.5-81.1 years]). The proportion (SE) of life-years lived in older adulthood with Gagne score of at least 1 was 0.38% (0.00%) in those with a normal BMI, 0.41% (0.00%) in those with overweight, and 0.43% (0.01%) in those with classes I and II obesity. Cumulative median per-person health care costs in older adulthood were significantly higher among overweight participants ($12 390 [95% CI, $10 427 to $14 354]) and those with classes I and II obesity ($23 396 [95% CI, $18 474 to $28 319]) participants compared with those with a normal BMI (P < .001).

Conclusions and Relevance

In this cohort study, overweight in midlife, compared with normal BMI, was associated with higher cumulative burden of morbidity and greater proportion of life lived with morbidity in the context of similar longevity. These findings translated to higher total health care expenditures in older adulthood for those who were overweight in midlife.

Effects of Exergaming on College Students' Situational Interest, Self-Efficacy, and Motion Sickness

Objective: Given the low levels of physical activity (PA) among U.S. college students, the use of exergaming as a supplement to traditional exercise may promote higher levels of motivation and PA. Therefore, this study’s purpose was to examine the effect of two different exergames on college students’ situational interest (SI), self-efficacy (SE), and equilibrium change (EQC) compared to traditional treadmill walking. Methods: Sixty college students (30 female; Mage = 23.6 ± 4.1 years; MBMI = 23.9 ± 4.0 kg/m2) participated in three separate 20 min exercise sessions: (1) Xbox 360 Kinect Just Dance; (2) Xbox 360 Kinect Reflex Ridge; and (3) traditional treadmill walking at 4.0 mph. Participants’ SI, SE, and EQC were measured after each session using a series of validated surveys. Results: A mixed model analysis of covariance (ANCOVA) with repeated measures evaluated mean differences between exercise sessions for all outcomes. Significant main effects were observed between the three exercise sessions (all p < 0.01). Specifically, Just Dance and Reflex Ridge sessions yielded significantly higher SI scores than treadmill exercise, F (10, 49) = 54.61, p < 0.01, η2 = 0.92. In addition, participants experienced significantly lower EQC in Reflex Ridge than in treadmill exercise, F (2, 58) = 4.26, p = 0.02, η2 = 0.13. No differences were identified for SE. Conclusion: The integration of exergaming into traditional exercise routines may help to promote higher levels of SI but not SE amongst college students. RR exergaming also demonstrated low EQC as compared to traditional exercise. Experimental study designs are warranted to provide additional evidence on the efficacy of exergaming.

Slowdown in Mortality Improvement in the Past Decade: A US/UK Comparison

OBJECTIVES

To investigate the slowdown in mortality improvement in the United States, United Kingdom, and comparator countries observed in the first decade of the twenty-first century and critically evaluate proposed explanations.

METHODS

Change-point analysis to identify the year of change in comparison of national mortality trends and linear spline models in the investigation of subnational differences using data from the Human Mortality Database, Global Burden of Disease cause-specific data, and, for the United Kingdom, national statistics data. Consideration of the impact of using different methods to estimate overall mortality is also concluded together with a review of methodological assumptions made in previous studies.

RESULTS

The results confirm the slowdown in mortality improvement observed in the early twenty-first century but indicate that proposed explanations for this are inadequate on a range of counts.

DISCUSSION

Mortality improvement slowed down in the early twenty-first century but the explanations advanced, such as opioid use in the United States or influenza epidemics and austerity programs in the United Kingdom, seem unlikely to account for this. Further research considering longer-term life course and cohort influences is needed.

Time-varying association between body mass index and all-cause mortality in patients with hypertension

BACKGROUND

Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality.

METHODS

This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m²), normal weight (18.5-22.9 kg/m²), overweight (23-24.9 kg/m²), class I obesity (25-29.9 kg/m²) and class II obesity (BMI ≥ 30 kg/m²). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline.

RESULTS

Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39-1.65], and 1.27 (1.15-1.41) for underweight, respectively; 1.08 (0.96-1.21), and 1.16 (1.03-1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81-0.90), and 0.96 (0.91-1.02) for overweight, respectively; 0.80 (0.76-0.84), and 1.04 (0.99-1.10) for class I obesity, respectively).

CONCLUSIONS

We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.

Effects of fresh mango consumption on cardiometabolic risk factors in overweight and obese adults

BACKGROUND & AIMS

In vitro and animal studies show antidiabetic, anti-inflammatory, and cardioprotective properties of mangos. The objective of this study was to examine the effects of fresh mango consumption compared to an isocaloric control snack on body weight, glucose, insulin, lipid profiles, liver function enzymes, inflammation, and antioxidant activity in overweight and obese adults (BMI ≥26 kg/m²).

METHODS AND RESULTS

In a crossover design, 27 participants consumed 100 kcal/d of fresh mangos or isocaloric low-fat cookies daily for 12 weeks each, separated by a four-week washout period. Blood glucose, C-reactive protein (CRP), and aspartate transaminase activity significantly decreased while total antioxidant capacity significantly increased following mango consumption. There were no significant changes in body weight, body fat %, blood pressure, insulin, or lipid profile following mango consumption. Cookie consumption significantly increased body weight, insulin, CRP, and triglycerides.

CONCLUSION

These results suggest that relative to the control snack, mangos may improve certain risk factors associated with overweight and obesity including improved glycemic control and reduced inflammation.

CLINICAL TRIALS REGISTER

NCT03957928.

Risk associations of long-term HbA1c variability and obesity on cancer events and cancer-specific death in 15,286 patients with diabetes - A prospective cohort study

Background

Obesity, cancer and diabetes frequently coexist. The association of glycaemic variability (GV) and obesity with cancer events had not been explored in diabetes.

Methods

In the prospective Hong Kong Diabetes Register cohort (1995-2019), we used cox proportional hazards models to examine the risk associations of GV with all-site cancer (primary outcome) and cause-specific death (secondary outcome). We also explored the joint association of obesity and GV with these outcomes and site-specific cancer. We expressed GV using HbA1c variability score (HVS) defined as percentage of HbA1c values varying by 0.5% compared with values in preceding visit.

Findings

We included 15,286 patients (type 2 diabetes: n=15,054, type 1 diabetes: n=232) with ≥10 years of diabetes and ≥3 years of observation (51.7% men, age (mean±SD): 61.04±10.73 years, HbA1c: 7.54±1.63%, body mass index [BMI]: 25.65±3.92 kg/m², all-site cancer events: n=928, cancer death events: n=404). There were non-linear relationships between HVS and outcomes but there was linearity within the high and low HVS groups stratified by the median (IQR) value of HVS (42.31 [27.27, 56.28]). In the high HVS group, the adjusted hazard ratios (aHR) of each SD of HVS was 1.15 (95% CI: 1.04, 1.26) for all-site cancer (n=874). The respective aHRs for breast (n=77), liver (n=117) and colorectal (n=184) cancer were 1.44 (1.07, 1.94), 1.37 (1.08, 1.74), and 1.09 (0.90, 1.32). In the high GV group, the respective aHRs were 1.21 (1.06, 1.39), 1.27 (1.15, 1.40), and 1.15 (1.09, 1.22) for cancer, vascular, and noncancer nonvascular death. When stratified by obesity (BMI ≥25 kg/m²), the high HVS & obese group had the highest aHRs of 1.42 (1.16, 1.73), 2.44 (1.24, 4.82), and 2.63 (1.45, 4.74) respectively for all-site, breast, and liver cancer versus the low GV & non-obese group. The respective aHRs were 1.45 (1.07, 1.96), 1.47 (1.12, 1.93), and 1.35 (1.16, 1.57) for cancer, vascular, and noncancer nonvascular death.

Interpretation

Obesity and high GV were associated with increased risk of all-site, breast, liver cancer, and cancer-specific death in T2D.

Funding

The Chinese University of Hong Kong Diabetes Research Fund

Association between being metabolically healthy/unhealthy and metabolic syndrome in Iranian adults

Introduction

The prevalence of metabolically healthy obesity (MHO) varies based on different criteria. We assessed the prevalence of MHO and metabolic unhealthiness based on body mass index (BMI) and their association with metabolic syndrome (MetS) in a nation-wide study.

Methods

Data were taken from the STEPs 2016 study, from 18,459 Iranians aged ≥25 years. Demographic, metabolic, and anthropometric data were collected. Subjects were stratified by BMI, metabolic unhealthiness, and having MetS. The latter was defined based on National Cholesterol Education Program Adult Treatment Panel III 2004 (NCEP ATP III), was then assessed.

Results

The prevalence of MHO and metabolic unhealthiness in obese subjects was 7.5% (about 3.6 million) and 18.3% (about 8.9 million), respectively. Most of the metabolic unhealthy individuals were female (53.5%) or urban residents (72.9%). Low physical activity was significantly and positively associated (Odds Ratio: 1.18, 95% CI: 1.04–1.35) with metabolic unhealthiness, while being a rural residence (0.83, 0.74–0.93), and having higher education (0.47, 0.39–0.58) significantly but negatively affected it. Dyslipidemia was the most frequent MetS component with a prevalence rate of 46.6% (42.1–51.1), 62.2% (60.8–63.6), 76.3% (75.1–77.5), and 83.4% (82.1–84.6) among underweight, normal weight, overweight and obese phenotypes, respectively.

Conclusion

BMI aside, an additional set of criteria such as metabolic markers should be taken into account to identify normal weight but metabolically unhealthy individuals. Given the highest prevalence of dyslipidemia among obese subjects, further interventions are required to raise public awareness, promote healthy lifestyles and establish lipid clinics.

Impact of BMI on Long-Term Outcomes in Patients with ST-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

AIM

Obesity paradox remains a point of debate in ST-segment elevation myocardial infarction (STEMI) patients. The aim of this study was to examine the relationship between body mass index (BMI) and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

METHODS

Outcomes were assessed in 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing. Patients were classified into 6 groups according to age (the younger and elderly groups consisting of patients ≤65 and > 65 years old) and baseline BMI (normal weight, BMI < 24 kg/m²; overweight, 24 kg/m² ≤BMI < 28 kg/m²; obese, BMI ≥ 28 kg/m²). The primary outcome was death, acute myocardial infarction (AMI), or revascularization.

RESULTS

On long-term follow-up (mean follow-up of 59 months), 13.9% of patients experienced the adverse event. Multivariate logistic regression analyses showed that low BMI was a significant predictor of the primary outcome only in the younger group. The odds ratio for overweight in comparison with normal weight was 0.741 (95% CI: 0.413-0.979; p = 0.038), the odds radio for obesity in comparison with normal-weight patients was 0.508 (95% CI: 0.344-0.750; p = 0.016) in the younger group. In the elderly group, diabetes, hypertension, triple disease, regular exercise, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs) use after discharge, and bleeding complication were associated with primary outcome.

CONCLUSION

The obesity paradox was recognized only in the younger age group in STEMI patients undergoing PPCI.

Comorbidity and quality of life in obesity-a comparative study with the general population in Gothenburg, Sweden

CONTEXT

Obesity is considered to have a detrimental impact on health-related quality of life (HRQoL).

OBJECTIVE

To compare HRQoL in a well-defined group of people with obesity with a population-based control group from the general public.

DESIGN

Observational cross-sectional cohort study with a reference population.

SETTING

The Regional Obesity Center at the Department of Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden.

PARTICIPANTS

People with obesity (n = 1122) eligible for surgical and non-surgical obesity treatment in routine care were included consecutively between 2015 and 2017 into the BASUN study. Men and women from the WHO-MONICA-GOT project were used as a reference population (n = 414).

MAIN OUTCOME MEASURES

HRQoL was measured with the RAND-36/Short Form-36 questionnaire (SF-36) and a Visual Analogue Scale (VAS) for self-related health (SRH). Prescription drugs for hypertension, diabetes mellitus, depression, and anxiety were taken as a proxy for these conditions.

RESULTS

People with obesity rated their overall HRQoL lower than the reference population according to the SRH-VAS. Lower scores were reported on physical and social functioning, vitality, general and mental health after adjustment for age and use of prescription drugs (considered a proxy for burden of disease, or comorbidities) using the RAND-36/SF-36 questionnaire. Use of some psychopharmacological agents was more common in patients with obesity.

CONCLUSION

People with obesity seeking help with weight reduction are more likely to have lower physical and mental self-reported HRQoL than the general population.

Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Diabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients.

AIM

To assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM.

PATIENTS AND METHODS

This work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score.

RESULTS

Patients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001).

CONCLUSION

The presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.

Effects of diabetes and obesity on cognitive impairment and mortality in older mexicans

BACKGROUND

Diabetes is a risk factor for dementia and mortality, while obesity later in life is associated with a reduced risk. Their co-occurrence, diabesity, is common, but its association with dementia and mortality is unclear.

METHODS

Using data from the Mexican Health and Aging Study, we used multinomial logistic regression to examine the associations of diabetes and body mass index (BMI), and diabesity, in 2012, with cognitive impairment and mortality in 2018, among participants aged ≥60 years with normal cognition at baseline (n = 7,885).

RESULTS

Diabetes was associated with cognitive impairment, compared to not having diabetes (RRR=1.83, 95% CI=1.48-2.26). BMI was not associated with cognitive impairment. Regarding mortality, diabetes was associated with an increased risk (RRR=2.28, 95% CI=1.98-2.63) and being overweight or having obesity was associated with a reduced risk (RRR=0.74, 95% CI=0.65-0.86; RRR=0.79, 95% CI= 0.66-0.95). When BMI and diabetes were combined, having diabetes only (RRR=2.01, 95% CI=1.40-2.87), being overweight with diabetes (RRR=1.42, 95% CI=1.02-1.97) or having diabesity (RRR=1.50, 95% CI=1.08-2.06) were associated with cognitive impairment, compared to having a normal BMI without diabetes. Diabetes, regardless of BMI, was associated with an increased risk of mortality, while being overweight or having obesity was associated with a reduced risk of mortality.

CONCLUSIONS

With the increase in the prevalence of obesity and diabetes among Mexicans, it is important to understand how these conditions and their co-occurrence impact cognitive impairment and mortality. Among older Mexicans, diabesity is associated with 6-year mortality and cognitive impairment onset, likely driven by the effect of diabetes.

Revisiting the Obesity Paradox in Health Care Expenditures Among Adults With Diabetes

Recent studies of diabetes suggest an obesity paradox: mortality risk increases with weight in people without diabetes but decreases with weight in people with diabetes. A recent study also reports the paradox more generally with health care utilization. Whether this paradox in health care utilization and spending is causal or instead the result of empirical biases and confounding factors has yet to be examined in detail. This study set out to examine changes in the relationship between BMI and health care expenditures in populations with versus without diabetes, controlling for confounding risk factors. It found that the obesity paradox does not exist and is the result of statistical biases such as confounding and reverse causation. Obesity is not cost-saving for people with diabetes. Thus, insurers and physicians should renew efforts to prevent obesity in people with diabetes.

Association of anthropometric measures of obesity and physical activity with cardio-vascular diseases among older adults: Evidence from a cross-sectional survey, 2017-18

BACKGROUND

With the increase in elderly population, the risk of cardiovascular diseases (CVD) among Indian older adults is also increasing. The present paper tries to assess how different anthropometric measures of obesity and physical activity affects cardiovascular disease risk among older adults in India.

METHODS

The data from Longitudinal Ageing Study in India (LASI) has been used. The total sample size for the present study is 31,464 older adults aged 60 years and above. Chi-square test and binary logistic regression has been used to measure the association of obesity measures and CVD prevalence.

RESULTS

About 35.2% (n = 11,058) of the older adults suffered from CVD. Moreover, 22.2% (n = 6,217) of the older adults were obese/overweight, 23.7% (n = 6,651) had high risk waist circumference and 77.0% (n = 21,593) had high risk waist-Hip ratio. The likelihood of CVD was 60%, 50%, and 34% significantly higher among older adults who were obese/overweight [Adjusted odds ratio (AOR): 1.60; CI: 1.48-1.72], had high risk waist circumference [AOR: 1.50; CI: 1.39-1.62] and high risk waist-Hip ratio [AOR: 1.34; CI: 1.25-1.44], respectively compared to older adults with normal BMI and those who do not have a high risk waist circumference and high risk waist hip ratio. Moreover, older adults who never did physical activity had 22 per cent higher risk of CVD than those who did frequent [AOR: 1.22; CI: 1.13-1.32] physical activity.

CONCLUSION

The burden of overweight and obesity along with physical inactivity increases the risk of CVD in older adults. These findings highlight the urgent need for framing direct and indirect strategies to control obesity in order to reduce the burden of CVD among older adults in India.

Self-harm hospitalization following bariatric surgery in adolescents and young adults

BACKGROUND

While bariatric surgery has demonstrated physical and psychological benefits, a risk of suicide and non-fatal self-harm has also been shown. The aim of this study was to compared the rate of hospitalization for self-harm during a three-year observational follow-up period between adolescents/young adults who underwent bariatric surgery in France in 2013-2014 and two control groups.

METHODS

All individuals aged 12-25 years old who underwent bariatric surgery in France between January 1st, 2013, and December 31st, 2014, were identified with a validated algorithm from the French national hospital database, and compared to a healthy sample of the general population matched for age and gender. Information relative to hospitalizations, including for self-harm (ICD-10 codes X60-84), were extracted i) between 2008 and the surgery, and ii) for a three-year follow-up period. A second unmatched control group with obesity but no bariatric surgery was also identified. Survival analyses with adjustments for confounding variables were used.

RESULTS

In 2013-2014, 1984 youths had bariatric surgery in France. During follow-up, 1.5% were hospitalized for self-harm vs. 0.3% for controls (p < 0.0001). After adjustment, subsequent hospitalization for self-harm was associated with bariatric surgery (HR 3.64, 95% CI 1.70-7.81), prior psychiatric disorders (HR 7.76, 95% CI 3.76-16.01), and prior self-harm (HR 4.43, 95% CI 1.75-11.24). When compared to non-operated youths with obesity, bariatric surgery was not associated with self-harm while prior mental disorders and self-harm were. Mortality reached 0.3% after surgery.

CONCLUSIONS

Bariatric surgery is associated with an increased risk of self-harm, mainly in relation to preexisting psychological conditions. Vigilance and appropriate care are thus warranted in vulnerable individuals.

Clinical cost evaluation and health benefits of post-bariatric intervention for patients with type 2 diabetes living in the UK

To assess associated healthcare costs and risk of developing obesity-related comorbidities among patients with type 2 diabetes with severe obesity and receiving insulin treatment, following bariatric surgery (BS). A retrospective cohort study was conducted from a UK electronic primary care database. Propensity score matching (1:1) was performed for BS with non-BS cohort. Follow-up was over 5 years (694 person-years), comparing drug utilization with clinical cost differences, such as visits to General practitioners (GPs), hospitalization, and laboratory use. Cox proportional regression was used to compute differences in the risk of obesity-related comorbidities and chi-square analysis to explore differences in insulin independency and diabetes remission proportions during follow-up. Eighty patients who received BS were matched to 80 non-BS (N = 160). The baseline mean age was 48.3 years (SD: 12.9) (61% female), and body mass index was 39.3 kg/m² (SD: 9.3). During follow-up, antidiabetic drug cost was significantly lower in the BS group than in the non-BS (median cost/person [£]: 527.77 [interquartile range (IQR): 1196.11] vs. 1564.13 [IQR: 1576.01]; p < 0.001). Overall, aggregate cost analysis showed a significant total healthcare cost reduction in the BS group (median cost/person [£]: 1597.96 [IQR: 2631.84] vs. 2440.12 [IQR: 2242.95]; p = 0.050). BS significantly protected against obesity-related comorbidities compared with the non-BS (adjusted hazard ratio: 0.56; 95% confidence interval: 0.32-0.96; p = 0.036) and increased insulin independency throughout all follow-up points: at year 5: 48.1% versus 28.9%; p = 0.044, respectively. While BS shows evidence of cost efficiency, cost saving was not identified. The efficiency is evident by the protective effect against crude obesity-related comorbidities associated with increased insulin independency.

The effect of BMI on COVID-19 outcomes among older patients in South Korea: a nationwide retrospective cohort study

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused deaths and shortages in medical resources worldwide, making the prediction of patient prognosis and the identification of risk factors very important. Increasing age is already known as one of the main risk factors for poor outcomes, but the effect of body mass index (BMI) on COVID-19 outcomes in older patients has not yet been investigated. Aim: We aimed to determine the effect of BMI on the severity and mortality of COVID-19 among older patients in South Korea. Methods: Data from 1272 COVID-19 patients (≥60 years old) were collected by the Korea Centers for Disease Control and Prevention. The odds ratios (ORs) of severe infection and death in the BMI groups were analyzed by logistic regression adjusted for covariates.Results: The underweight group (BMI<18.5 kg/m2) had a higher OR for death (adjusted OR = 2.23, 95% confidence interval [95% CI] = 1.06-4.52) than the normal weight group (BMI, 18.5-22.9 kg/m2). Overweight (BMI, 23.0-24.9 kg/m2) was associated with lower risks of both severe infection (adjusted OR = 0.55, 95% CI = 0.31-0.94) and death (adjusted OR = 0.50, 95% CI = 0.27-0.91). Conclusions: Underweight was associated with an increased risk of death, and overweight was related to lower risks of severe infection and death in older COVID-19 patients in Korea. However, this study was limited by the lack of availability of some information, including smoking status.KEY MESSAGESUnderweight is an independent risk factor of death in older COVID-19 patients.Overweight patients have a lower risk of death and severe infection than normal-weight patients.

Metformin Improves Stemness of Human Adipose-Derived Stem Cells by Downmodulation of Mechanistic Target of Rapamycin (mTOR) and Extracellular Signal-Regulated Kinase (ERK) Signaling

Adipose tissue plays an important role in regulating metabolic homeostasis by storing excess fat and protecting other organs from lipotoxicity. Aging is associated with central fat redistribution, culminating in a decrease in insulin-sensitive subcutaneous and an increase in insulin-resistant visceral adipose depots. Adipose-derived stem cells (ASCs) play an important role in the regeneration of adipose tissue. Aged ASCs show decreased stemness and regenerative potential due to the accumulation of oxidative stress and mitochondrial dysfunction-related cell damage. Metformin is a well-established anti-diabetic drug that has shown anti-aging effects in different organisms and animal models. In this study, we analyzed the effect of metformin treatment on the stemness of human ASCs in cell culture and whole adipose tissue culture models. Our results demonstrate that metformin improves the stemness of ASCs, reducing their rate of proliferation and adipocyte differentiation. Investigating the possible underlying mechanism, we observed a decrease in the mTOR and ERK activity in metformin-treated ASCs. In addition, we observed an increase in autophagy activity upon metformin treatment. We conclude that metformin treatment improves ASCs stemness by reducing mTOR and ERK signaling and enhancing autophagy. Future in vivo evaluations in animal models and humans will pave the way for the clinical adaptation of this well-established drug for reviving the stemness of aged stem cells.

Artificial neural network model effectively estimates muscle and fat mass using simple demographic and anthropometric measures

BACKGROUND & AIMS

Lean muscle and fat mass in the human body are important indicators of the risk of cardiovascular and metabolic diseases. Techniques such as dual-energy X-ray absorptiometry (DXA) accurately measure body composition, but they are costly and not easily accessible. Multiple linear regression (MLR) models have been developed to estimate body composition using simple demographic and anthropometric measures instead of expensive techniques, but MLR models do not explore nonlinear interactions between inputs. In this study, we developed simple demographic and anthropometric measure-driven artificial neural network (ANN) models that can estimate lean muscle and fat mass more effectively than MLR models.

METHODS

We extracted the demographic, anthropometric, and body composition measures of 20,137 participants from the National Health and Nutrition Examination Survey conducted between 1999 and 2006. We included 13 demographic and anthropometric measures as inputs for the ANN models and divided the dataset into training and validation sets (70:30 ratio) to build and cross-validate the models that estimate lean muscle and fat mass, which were originally measured using DXA. This process was repeated 100 times by randomly dividing the training and validation sets to eliminate any effect of data division on model performance. We built additional models separately for each sex and ethnicity, older individuals, and people with underlying diseases. The coefficient of determination (R²) and standard error of estimate (SEE) were used to quantify the goodness of fit.

RESULTS

The ANN models yielded high R² values between 0.923 and 0.981. These values were significantly higher than those of the MLR models (p < 0.001) in all cases. The percentage difference in R² between the ANN and MLR models ranged between 0.40% ± 0.02% and 2.65% ± 0.27%. The SEE values of the ANN models, which were below 2 kg for all cases, were significantly lower than those of MLR models (p < 0.001). The percentage difference in SEE values between the ANN and MLR models ranged between -5.67% ± 0.39% and -22.32% ± 1.98%.

CONCLUSIONS

We developed and validated an inexpensive but effective method for estimating body composition using easily obtainable demographic and anthropometric data.

A systematic review and meta-analysis evaluating the impact of obesity on outcomes of abdominal aortic aneurysm treatment

OBJECTIVE

We sought to evaluate the impact of obesity on perioperative mortality and complication rates in patients undergoing endovascular aortic repair (EVAR) and open surgical repair (OSR) for abdominal aortic aneurysms (AAA).

METHODS

A systematic review of all studies reporting AAA treatment perioperative (30 day) outcomes in obese patients (body mass index ≥30 kg/m²). The primary outcome was 30 day mortality. Secondary outcomes included: cardiac complications, respiratory complications, wound complication, renal complications, and neurological complications at 30 days. These outcomes were pooled for meta-analysis. Analysis first compared obese versus nonobese patients undergoing EVAR and OSR then compared EVAR to OSR in obese patients.

RESULTS

We identified 7 observational studies with 14,971 patients (11,743 EVAR, 3228 OSR). Obese patients undergoing EVAR had lower 30 day mortality (1.5%) compared to nonobese patients (2.2%) (OR 0.69; 95% CI 0.50-0.96; p=0.03; I²= 0%; Grade of evidence: low). In OSR, obese patients (5.0%) had similar 30 day mortality to nonobese patients (5.7%) (OR 0.92; 95% CI 0.70-1.20; p=0.54; I²=0%; Grade of evidence: low). Wound complications were higher in obese patients undergoing OSR (OR 2.30; 95% CI 1.74-3.06; p<0.001; I²=0%; Grade of evidence: low). EVAR was associated with a lower 30 day mortality (1.5%) compared to OSR (5.0%) in obese patients (OR 0.23; 95% CI 0.12-0.46; p<0.001; I²= 38%; Grade of evidence: low). Cardiac, respiratory, wound, renal and neurological complications were also reduced in EVAR.

CONCLUSIONS

Obese patients have lower 30 day mortality in EVAR compared to nonobese patients. In OSR, obese patients had similar 30 day mortality but higher wound complications compared to nonobese patients. Obese patients otherwise have similar cardiopulmonary complication rates compared to nonobese patients in both EVAR and OSR. EVAR offers lower 30 day mortality and morbidity compared to OSR in obese patients. This study suggests that EVAR is superior to OSR in obese patients.

Effect of laparoscopic sleeve gastrectomy on drug pharmacokinetics

INTRODUCTION

Given its feasibility and efficacy, laparoscopic sleeve gastrectomy (LSG) has become a widely accepted bariatric surgery for patients with clinically diagnosed severe obesity. LSG induces anatomical changes and subsequent weight loss which may affect drug pharmacokinetics (PK) and consequently impact dosing regimens. This review aims to examine the effect of LSG on drug PK and identify relevant gastrointestinal physiological alterations.

AREAS COVERED

PubMed, Embase, Scopus, and the Cochrane Library were searched for articles related to drug PK and LSG from inception to July 2021. Moreover, literature concerning postoperative physiological conditions in the gastrointestinal tract, such as gastric pH, gastric emptying, and small bowel transit time, etc., which may affect the PK profile of drug products was also reviewed.

EXPERT OPINION

Although LSG is classified as having restrictive property without malabsorptive bypass, postoperative changes in gastrointestinal physiology and subsequent weight loss may also lead to increased, decreased or unaltered drug exposure levels. General monitoring on drug efficacy or safety using biomarkers is proposed. In addition, therapeutic drug monitoring for those drugs when it is applicable and available is recommended to ensure efficient drug dosing and avoid adverse effects. Further research into many individual drugs are warranted.

Impact of Low Body Mass Index on Features of Coronary Culprit Plaques and Outcomes in Patients With Acute Coronary Syndrome

The mechanisms behind poorer cardiac outcomes in underweight patients with acute coronary syndrome (ACS) are not understood and features of coronary culprit lesions in underweight ACS patients have not been fully examined. A total of 1,683 patients with ACS were divided into 4 groups according to body mass index (BMI): <18.5 (n = 73), 18.5 to 24.9 (n = 995), 25 to 29.9 (n = 488), and ≥30 (n = 117). Angiography and optical coherence tomography (OCT) images were analyzed for 1,428 of these patients who had primary percutaneous coronary intervention (PCI) and 838 who had primary PCI with OCT guidance, respectively. Diabetes (p <0.001), hypertension (p <0.001), and dyslipidemia (p <0.001) were less prevalent in BMI <18.5. Statin prescription at discharge was less frequent in the BMI <18.5 group (p <0.001). Quantitative coronary angiography analyses revealed smaller reference vessel (p = 0.001) and minimum lumen diameters after PCI (p = 0.019) and OCT revealed longer lipidic plaque length (p = 0.029) in the BMI <18.5 group. Kaplan-Meier analyses revealed higher rates of cardiac mortality (p <0.001) and major bleeding (p = 0.034) during the 2-year follow-up in the BMI <18.5 group. After adjusting for traditional cardiovascular risk factors, BMI <18.5 independently predicted 2-year cardiac mortality (hazard ratio 1.917 [95% confidence interval [1.082 to 3.397], p = 0.026). In conclusion, being underweight contributed to poorer cardiac outcomes in established ACS population. Smaller minimum lumen diameter after PCI and further progressed atherosclerosis at the culprit lesions despite their lower prevalence of comorbid metabolic risk factors may be related partly to poorer cardiac outcomes.

Habitual sleep, sleep duration differential, and weight change among adults: Findings from the Wisconsin Sleep Cohort Study

OBJECTIVES

Assess longitudinal associations between diary-measured sleep duration and clinically assessed body mass index (BMI).

DESIGN

Multilevel growth curve analyses examined how within-person changes and between-person differences in habitual sleep duration were associated with BMI trajectories.

SETTING

Sleep diaries across 2-6 consecutive weekday and weekend nights at each data collection point, repeatedly collected at approximate 4-year intervals, for an average of 9.2 (standard deviation [SD] = 3.6) years between 1989 and 2011.

PARTICIPANTS

About 784 participants (47% women) enrolled in the Wisconsin Sleep Cohort Study (mean [SD] age = 51.1 [8.0] years at baseline).

MEASUREMENTS

The outcome variable was BMI (kg/m²). Key predictors were habitual sleep duration (defined as average weekday nighttime sleep duration) and sleep duration differential (defined as the difference between average weekday and average weekend nighttime sleep duration) at each data collection wave.

RESULTS

Men with shorter habitual sleep duration on weekdays had higher BMI than men with longer habitual sleep duration on weekdays (β = -0.90 kg/m²/hour, se = 0.34, p = .008). Participants with larger differentials between weekday and weekend sleep duration experienced more rapid BMI gain over time for both men (β = 0.033 kg/m²/year per hour differential, se = 0.017, p = .044) and women (β = 0.057 kg/m²/year per hour differential, se = 0.027, p = .036).

CONCLUSION

This study suggests that habitual short sleep is associated with higher BMI levels in men and that a larger weekday-weekend sleep differential is associated with increasing BMI trajectories among both men and women in mid-to-late life.

Rodent diet aids and the fallacy of caloric restriction

Understanding the molecular mechanisms of normal aging is a prerequisite to significantly improving human health span. Caloric restriction (CR) can delay aging and has served as a yardstick to evaluate interventions extending life span. However, mice given unlimited access to food suffer severe obesity. Health gains from CR depend on control mice being sufficiently overweight and less obese mouse strains benefit far less from CR. Pharmacologic interventions that increase life span, including resveratrol, rapamycin, nicotinamide mononucleotide and metformin, also reduce body weight. In primates, CR does not delay aging unless the control group is eating enough to suffer from obesity-related disease. Human survival is optimal at a body mass index achievable without CR, and the above interventions are merely diet aids that shouldn't slow aging in healthy weight individuals. CR in humans of optimal weight can safely be declared useless, since there is overwhelming evidence that hunger, underweight and starvation reduce fitness, survival, and quality of life. Against an obese control, CR does, however, truly delay aging through a mechanism laid out in the following tumor suppression theory of aging.

Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND

Acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery is associated with significant morbidity and mortality. This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.

METHODS

A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression analysis was used to determine the independent predictors of AKI, and the predictive ability of the model was determined using a receiver operating characteristic (ROC) curve.

RESULTS

The incidence of cardiac surgery–associated acute kidney injury (CSA-AKI) was 24.17%, and 0.53% of AKI patients required dialysis (AKI-D). Among the derivation cohort, multivariable logistic regression showed that age ≥ 70 years, body mass index (BMI) ≥ 25 kg/m², estimated glomerular filtration rate (eGFR) ≤ 60 mL/min per 1.73 m², ejection fraction (EF) ≤ 45%, use of statins, red blood cell transfusion, use of adrenaline, intra-aortic balloon pump (IABP) implantation, postoperative low cardiac output syndrome (LCOS) and reoperation for bleeding were independent predictors. The predictive model was scored from 0 to 32 points with three risk categories. The AKI frequencies were as follows: 0−8 points (15.9%), 9−17points (36.5%) and ≥ 18 points (90.4%). The area under of the ROC curve was 0.730 (95% CI: 0.691−0.768) in the derivation cohort. The predictive index had good discrimination in the validation cohort, with an area under the curve of 0.735 (95% CI: 0.655−0.815). The model was well calibrated according to the Hosmer-Lemeshow test (P = 0.372).

CONCLUSION

The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients, and could improve the early prognosis and clinical interventions.

Lower Lean Mass Is Associated with Greater Arterial Stiffness in Patients with Lower Extremity Artery Disease

Background: Arterial stiffness is independently associated with lower extremity artery disease (LEAD). Although obesity is already known as an independent cardiovascular risk factor, it was found that, paradoxically, in patients diagnosed with cardiovascular disease, an increase in body mass index (BMI) was associated with a decrease in mortality. However, the underlying mechanism of this paradoxical association remain uncertain. In this study, we firstly hypothesize that arterial stiffness correlates with body mass; secondly, the underlying mechanism of the association for patients with LEAD is individual body composition, in particular, lean mass. Methods: The present study was performed as a single-center, prospective, observational analysis. A total of 412 patients with current or previously diagnosed LEAD (Rutherford Classification 2–4) were included, the cfPWV and AIx were measured as indices of arterial stiffness, and a body composition assessment was performed. Results: In male patients, there was a significantly negative correlation between the AIx and lean mass coefficient (p = 0.004, 95% CI: −0.28 (−0.48–0.09)). Conclusion: For patients with peripheral arterial disease, our data show that lower lean mass in male patients is associated with increased arterial stiffness as measured by the AIx. Therefore, progressive resistance training may be beneficial for the reduction in arterial stiffness in PAD patients in secondary prevention.

Explaining the obesity paradox in healthcare utilization among people with type 2 diabetes

Background

Several studies of diabetes suggest an obesity paradox: persons without diabetes have an increased risk of death due to obesity, whereas obesity decreases the risk of death for people with diabetes. A recent study finds the same obesity paradox with the number of healthcare visits. Whether empirical biases and confounding lead to this paradox is yet to be determined.

Objective

To examine changes in the relationship between BMI and number of visits in diabetic vs nondiabetic populations, controlling for confounding risk factors.

Methods

Using adults in the nationally representative Medical Expenditure Panel Survey (MEPS) from 2008 to 2016, N = 210,317, we examine the proposed relationship using six measures of healthcare visits with zero-inflated negative binomial regressions controlling for age, gender, race/ethnicity, income, education, region, health insurance, chronic conditions, and smoking. We excluded persons with type 1 diabetes and gestational diabetes.

Results

We find an obesity paradox among people with diabetes for three measures. That is, relative to people without diabetes, normal weight people with diabetes have more emergency room visits, inpatient, and office-based physician visits than do the obese with diabetes. However, we do not find an obesity paradox in any of the six measures once we exclude smokers and persons ever diagnosed with cancer or cardiovascular disease.

Conclusion

The obesity paradox does not exist at the utilization level and is due to the presence of statistical biases such as confounding and reverse causation. Physicians should continue to focus on efforts to prevent obesity in patients with diabetes.

Effect of Financial Incentives and Environmental Strategies on Weight Loss in the Healthy Weigh Study: A Randomized Clinical Trial

IMPORTANCE

Modest weight loss can lead to meaningful risk reduction in adults with obesity. Although both behavioral economic incentives and environmental change strategies have shown promise for initial weight loss, to date they have not been combined, or compared, in a randomized clinical trial.

OBJECTIVE

To test the relative effectiveness of financial incentives and environmental strategies, alone and in combination, on initial weight loss and maintenance of weight loss in adults with obesity.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was conducted from 2015 to 2019 at 3 large employers in Philadelphia, Pennsylvania. A 2-by-2 factorial design was used to compare the effects of lottery-based financial incentives, environmental strategies, and their combination vs usual care on weight loss and maintenance. Interventions were delivered via website, text messages, and social media. Participants included adult employees with a body mass index (BMI; weight in kilograms divided by height in meters squared) of 30 to 55 and at least 1 other cardiovascular risk factor. Data analysis was performed from June to July 2021.

INTERVENTIONS

Interventions included lottery-based financial incentives based on meeting weight loss goals, environmental change strategies tailored for individuals and delivered by text messages and social media, and combined incentives and environmental strategies.

MAIN OUTCOME AND MEASURES

The primary outcome was weight change from baseline to 18 months, measured in person.

RESULTS

A total of 344 participants were enrolled, with 86 participants each randomized to the financial incentives group, environmental strategies group, combined financial incentives and environmental strategies group, and usual care (control) group. Participants had a mean (SD) age of 45.6 (10.5) years and a mean (SD) BMI of 36.5 (7.1); 247 participants (71.8%) were women, 172 (50.0%) were Black, and 138 (40.1%) were White. At the primary end point of 18 months, participants in the incentives group lost a mean of 5.4 lb (95% CI, -11.3 to 0.5 lb [mean, 2.45 kg; 95% CI, -5.09 to 0.23 kg]), those in the environmental strategies group lost a mean of a 2.2 lb (95% CI, -7.7 to 3.3 lb [mean, 1.00 kg; 95% CI, -3.47 to 1.49 kg]), and the combination group lost a mean of 2.4 lb (95% CI, -8.2 to 3.3 lb [mean, 1.09 kg; 95% CI, -3.69 to 1.49 kg]) more than participants in the usual care group. Financial incentives, environmental change strategies, and their combination were not significantly more effective than usual care. At 24 months, after 6 months without an intervention, the difference in the change from baseline was similar to the 18-month results, with no significant differences among groups.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, across all study groups, participants lost a modest amount of weight but those who received financial incentives, environmental change, or the combined intervention did not lose significantly more weight than those in the usual care group. Employees with obesity may benefit from more intensive individualized weight loss strategies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02878343.

Metabolic and cardiovascular adaptations to an 8-wk lifestyle weight loss intervention in younger and older obese men

The number of older obese adults is increasing worldwide. Whether obese adults show similar health benefits in response to lifestyle interventions at different ages is unknown. The study enrolled 25 obese men (body mass index: 31-39 kg/m²) in two arms according to age (30-40 and 60-70 yr old). Participants underwent an 8-wk intervention with moderate calorie restriction (∼20% below individual energy requirements) and supervised endurance training resulting in ∼5% weight loss. Body composition was measured using dual energy X-ray absorptiometry. Insulin sensitivity was assessed during a hypersinsulinemic-euglycemic clamp. Cardiometabolic profile was derived from blood parameters. Subcutaneous fat and vastus lateralis muscle biopsies were used for ex vivo analyses. Two-way repeated-measure ANOVA and linear mixed models were used to evaluate the response to lifestyle intervention and comparison between the two groups. Fat mass was decreased and bone mass was preserved in the two groups after intervention. Muscle mass decreased significantly in older obese men. Cardiovascular risk (Framingham risk score, plasma triglyceride, and cholesterol) and insulin sensitivity were greatly improved to a similar extent in the two age groups after intervention. Changes in adipose tissue and skeletal muscle transcriptomes were marginal. Analysis of the differential response to the lifestyle intervention showed tenuous differences between age groups. These data suggest that lifestyle intervention combining calorie restriction and exercise shows similar beneficial effects on cardiometabolic risk and insulin sensitivity in younger and older obese men. However, attention must be paid to potential loss of muscle mass in response to weight loss in older obese men.NEW & NOTEWORTHY Rise in obesity and aging worldwide are major trends of critical importance in public health. This study addresses a current challenge in obesity management. Do older obese adults respond differently to a lifestyle intervention composed of moderate calorie restriction and supervised physical activity than younger ones? The main conclusion of the study is that older and younger obese men similarly benefit from the intervention in terms of cardiometabolic risk.

The impact of clinical and social factors on the physical health of people with severe mental illness: Results from an Italian multicentre study

Our manuscript aims to: 1) assess physical health in a sample of patients with severe mental disorders; and 2) identify the psychopathological and psychosocial characteristics associated with an increased likelihood of having a poor physical health. The study, funded by the Italian Ministry of Education, has been carried out in psychiatric outpatient units of six Italian University sites. All recruited patients have been assessed through standardized assessment instruments. Moreover, anthropometric parameters have been obtained at recruitment and a blood samples have been collected to assess cardiometabolic parameters. Four-hundred and two patients with a primary diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were recruited. Internalized stigma, psychosocial functioning, quality of life, psychiatric hospitalizations, depressive/anxiety and manic symptoms and cognition were those domains more strongly associated with poor metabolic parameters, including high body mass index, HOMA and Framingham indexes and waist circumference. There were no statistically significant differences among the three diagnostic groups. Our findings highlight the importance of perceived stigma and quality of life on patients' physical health. This should be taken into account when developing plans for reducing the mortality rate in patients with severe mental disorders.

Risk factors and health status among older adults in Europe: a socioeconomic analysis

The risk of developing a major non-communicable disease is critically affected by lifestyle choices. This study examined the consequences of factors that might predict a change in the self-rated health of older adults and aimed to assess their monetary costs. In particular, two predisposing risk factor moderators were studied: high blood pressure and high cholesterol. The effects of these on two serious adverse cardiovascular events - heart attack and stroke - were estimated. Using data from the Survey of Health, Aging and Retirement in Europe (SHARE) carried out in 2014, a two-stage procedure was applied as well as pairwise comparison. The results revealed the significant role of socioeconomic status in health outcomes. Behavioural risk factors were found to be significant predictors for heart attack and stroke. The findings support the claim that variables such as age, wealth and behavioural risk factors are additional predictors of a change in these two diseases. The monetary consequences can reach up to 12.8 thousand Euros for older adults per unit of predisposing risk factor. Since national health budgets are limited, health policies might be prioritized.

Mortality and Obesity Among U.S. Older Adults: The Role of Polygenic Risk

OBJECTIVES

To examine the relationship between obesity and mortality as a function of polygenic risk for obesity among older U.S. adults.

METHOD

Using data from the 1994-2014 Health and Retirement Study in conjunction with genome-wide data, we evaluated the risk of mortality as a function of obesity classification, an individual's polygenic risk score (PGS) for obesity, and their interaction, stratified by sex. We conducted our analyses using cox proportional hazard models.

RESULTS

Among those with an average PGS for obesity (8,143 [68.8%]), obese I (hazard ratio [HR] = 0.79, p = .336) adults show no difference in their risk for mortality and obese II/III (HR = 3.17, p = .000) adults present higher risk of mortality relative to non-obese adults. The interaction of obesity classification and PGS suggests that obese II/III respondents with low PGS in the total sample (HR = 2.71, p = .006) and among women (HR = 3.02, p = .023) are at significantly higher risk of death when compared to obese II/III respondents with average or high PGS.

DISCUSSION

We posit that these findings suggest that the pathway to obesity, in this case, more socio-behavioral rather than genetic, may influence subsequent risk of death in older adults. We suggest that practitioners and population researchers be mindful of these pathways as to better identify and understand mortality risk.

Does "obesity paradox" apply for patients undergoing transcatheter aortic valve replacement?

BACKGROUND

Data is controversial regarding the existence of an "obesity paradox" in patients undergoing Transcatheter Aortic Valve Replacement (TAVR). We sought to investigate the prognostic value of the body mass index (BMI) on outcomes following TAVR.

METHODS

This is an observational, single-center study involving all patients who underwent TAVR from 2009 to 2019. BMI was calculated in all patients before TAVR. The cohort was subdivided into four groups: underweight (<20 kg/m²), normal weight (≥20 to <25 kg/m²), overweight (≥25 to <30 kg/m²) and obese (≥30 kg/m²). The main endpoint was all-cause 30-day and one-year mortality.

RESULTS

A total of 412 patients (mean age 79.6 ± 7.8 years, mean STS score 5.3 ± 3.6) were included. Patients were grouped as follows: underweight (n = 35, 8.5%), normal weight (n = 121, 29.4%), overweight (n = 140, 34%) and obese (n = 116, 28.1%). Obese patients were younger, included more females and had lower STS score than the rest of the cohort whereas underweight patients were older, had higher STS score, more chronic kidney disease, more left ventricular dysfunction and more often underwent non-transfemoral TAVR. BMI predicted 30-day survival (AUC:0.692 [95%CI 0.522-0.862]; p = 0.030) with an optimal cut-off of 24.4 (sensitivity = 66.6%, specificity = 63.6%). On multivariate analysis, higher BMI trended toward lower 30-day mortality (HR = 0.87 [95%CI 0.75-1.01]; p = 0.071). Thirty-day mortality was higher in the underweight group (8.3%) in comparison with other BMI subgroups (normal weight 2.5%, overweight 1.4%, obese 0.9%; p = 0.045). However, no significant difference was found after adjustment of confounders (all p = NS). BMI did not predict one-year mortality. No significant difference in one-year survival was observed between the four BMI subgroups (log rank p = 0.925).

CONCLUSION

BMI could represent an interesting prognostic tool for short-term mortality in patients undergoing TAVR. BMI < 20 kg/m² was associated with higher 30-day mortality. Symptoms improved similarly in obese patients compared to lower BMI patients. For 30-day survivors, no evidence of the existence of an obesity paradox was observed in this cohort.

Impact of Adjunctive Pharmacotherapy With Intragastric Balloons for the Treatment of Obesity

BACKGROUND

We conducted this study to compare the weight loss outcome of intragastric balloons (IGBs) in conjunction with pharmacotherapy vs IGB and intensive lifestyle changes alone.

METHODS

This was a multicenter, non-randomized, retrospective study involving 4 academic hospitals. Patients underwent IGB placement with or without concomitant anti-obesity pharmacotherapy. The primary outcome was percent total weight loss (TBWL) after IGB placement at 6 and 12 months.

RESULTS

This study included 102 patients, with 23 patients (mean age 46.6 years, 82.6% female) treated with IGB/pharmacotherapy and 79 patients (mean age 46.0 years, 88.6% female) treated with IGB/lifestyle modifications. Patients had a 100% follow-up rate at 6 and 12 months. At 6 months following IGB placement, both groups achieved a similar %TBWL. At 12 months, %TBWL was greater in the IGB/pharmacotherapy group (12.6% ± 1.2 vs 9.7% ± 0.7, P = .04). 65.2% of patients achieved ≥10% TBWL at 12 months in the IGB/pharmacotherapy group, compared to 38.0% in the IGB/lifestyle group (P < .05). The proportion of patients that achieved ≥15% weight loss at 12 months was also significantly different between the IGB/pharmacotherapy and IGB/lifestyle groups (30.4% vs 20.3%, P < .05).

DISCUSSION

IGB with concomitant use of pharmacotherapy did not improve weight loss while the IGB was in place compared to IGB and lifestyle changes. However, patients receiving IGB with pharmacotherapy did have greater weight loss and diminished weight regain after balloon removal compared to those receiving just IGB and lifestyle changes.

Perioperative impact of body mass index on upper urinary tract and renal robot-assisted surgery: a single high-volume centre experience

To assess the impact of body mass index (BMI) on peri-operative outcomes of kidney and upper tract robot-assisted surgery. Medical audit of patients who underwent robot-assisted kidney and upper tract cancer surgery at a single institution between 2017 and 2019, categorized on BMI into obese patients with a BMI ≥ 30 kg/m² and a control group with BMI < 25 kg/m². Patient and tumour characteristics, surgery time, intraoperative blood loss, intraoperative adverse events (AE) according to the European Association of Urology Intraoperative Adverse Incidents Classification (EAUiaiC), conversion- to-open/radical rate as well as 30-day postoperative AE according to Clavien-Dindo (CD) and length of inpatient stay were analyzed. 366 patients were identified, 141 with a BMI < 25 (normal-weight) and 225 BMI ≥ 30 (obesity). There were no significant differences between the groups in terms of age, gender, comorbidities, tumour size, TNM stage and type of surgery. Obese patients had a higher estimated blood loss (198.05 ml), surgery time (171.75 min), intraoperative AE (all grades) (14.67%, 95% CI (0.10-0.19) as well as adherent perinephric fat (APF) (14.22%, 95% CI (0.09-0.19)) in contrast to the control group (86.85 ml, 148.29 min, 7.04% and 2.12%, respectively). Hospital stay, major intraoperative AE (≥ 3) and major postoperative AE (CD > 2) distributed equally between groups. Robotic kidney and upper tract surgery in obese patients showed an increase in surgery time and blood loss potentially related to APF. However, obesity was not associated with conversion to open surgery or radical nephrectomy in nephron-sparing procedures, length of stay, major intraoperative AE or postoperative complications.

A systematic review of weight-related communication trainings for physicians

Obesity is a leading cause of preventable death in the USA. Given the high number of adults seeking routine health care services, physicians have an opportunity to address weight loss during routine clinical encounters. It's often reported that physicians lack the training to address weight. Training programs are implemented in medical settings to prepare physicians to have conversations with patients. Yet, the degree of consistency among training programs and factors associated with better outcomes is unclear. The purpose of this study is to systematically review literature in physician communication trainings related to weight-to compare the content, outcomes, and implementation of existing studies examining weight-related communication training programs for physicians and determine factors associated with physician and patient outcomes. Articles were extracted from PubMed, Proquest, and Embase. Search terms included: health communication, physician training, weight, and obesity. Studies implementing a training program addressing weight among physicians were included. Trainings using either motivational interviewing (MI) or 5 As (Ask, Advise, Assess, Assist, and Arrange) framework found improvements in physicians' communication skills. A small number of trainings including experiential components were also associated with improvements in positive physician outcomes. Findings suggest trainings based in MI or 5 As framework improve physicians' communication skills, but few programs affected patient outcomes. Gaps remain with trainings that can demonstrate weight loss in patients. While work is needed to enhance the effects of these trainings on patient outcomes, data suggest that trainings should be longer in duration and include an experiential component.

Transversus Abdominis Plane Block Versus Intraperitoneal Local Anesthetics in Bariatric Surgery: A Systematic Review and Network Meta-analysis

BACKGROUND

Transversus abdominis plane (TAP) block and intraperitoneal local anesthetics (IPLA) are widely investigated techniques that potentially improve analgesia after bariatric surgery. The analgesic efficacy of TAP block has been shown in previous studies, but the performance of TAP block can be difficult in patients with obesity. We performed a systematic review and meta-analysis to compare the analgesic efficacy of TAP block and IPLA. An alternative technique is useful in clinical setting when TAP block is not feasible.

METHODS

We searched PubMed, Embase, and CENTRAL from inception until August 2020 for randomized controlled trials comparing both techniques. The primary outcome was cumulative morphine consumption at 24 h. Secondary pain-related outcomes included pain score at rest and on movement at 2, 6, 12, and 24 h; postoperative nausea and vomiting; and length of hospital stay.

RESULTS

We included 23 studies with a total of 2,178 patients. TAP block is superior to control in reducing opioid consumption at 24 h, improving pain scores at all the time points and postoperative nausea and vomiting. The cumulative opioid consumption at 24 h for IPLA is less than control, while the indirect comparison between IPLA with PSI and control showed a significant reduction in pain scores at rest, at 2 h, and on movement at 12 h, and 24 h postoperatively.

CONCLUSIONS

Transversus abdominis plane block is effective for reducing pain intensity and has superior opioid-sparing effect compared to control. Current evidence is insufficient to show an equivalent analgesic benefit of IPLA to TAP block.

Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults

BACKGROUND

The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings.

METHODS

In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5-22·9 kg/m2], upper-normal [23·0-24·9 kg/m2], overweight [25·0-29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region.

FINDINGS

Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6-27·8), of obesity was 21·0% (19·6-22·5), and of diabetes was 9·3% (8·4-10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5-22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35-44 years and in men aged 25-34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean.

INTERPRETATION

The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines.

FUNDING

Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.

Leptin Receptor Blockade Attenuates Hypertension, but Does Not Affect Ventilatory Response to Hypoxia in a Model of Polygenic Obesity

Background

Obesity can cause hypertension and exacerbates sleep-disordered breathing (SDB). Leptin is an adipocyte-produced hormone, which increases metabolic rate, suppresses appetite, modulates control of breathing, and increases blood pressure. Obese individuals with high circulating levels of leptin are resistant to metabolic and respiratory effects of leptin, but they appear to be sensitive to hypertensive effects of this hormone. Obesity-induced hypertension has been associated with hyperleptinemia. New Zealand obese (NZO) mice, a model of polygenic obesity, have high levels of circulating leptin and hypertension, and are prone to develop SDB, similarly to human obesity. We hypothesize that systemic leptin receptor blocker Allo-aca will treat hypertension in NZO mice without any effect on body weight, food intake, or breathing.

Methods

Male NZO mice, 12–13 weeks of age, were treated with Allo-aca (n = 6) or a control peptide Gly11 (n = 12) for 8 consecutive days. Doses of 0.2 mg/kg were administered subcutaneously 2×/day, at 10 AM and 6 PM. Blood pressure was measured by telemetry for 48 h before and during peptide infusion. Ventilation was assessed by whole-body barometric plethysmography, control of breathing was examined by assessing the hypoxic ventilatory response (HVR), and polysomnography was performed during light-phase at baseline and during treatment. Heart rate variability analyses were performed to estimate the cardiac autonomic balance.

Results

Systemic leptin receptor blockade with Allo-aca did not affect body weight, body temperature, and food intake in NZO mice. Plasma levels of leptin did not change after the treatment with either Allo-aca or the control peptide Gy11. NZO mice were hypertensive at baseline and leptin receptor blocker Allo-aca significantly reduced the mean arterial pressure from 134.9 ± 3.1 to 124.9 ± 5.7 mmHg during the light phase (P < 0.05), whereas the control peptide had no effect. Leptin receptor blockade did not change the heart rate or cardiac autonomic balance. Allo-aca did not affect minute ventilation under normoxic or hypoxic conditions and HVR. Ventilation, apnea index, and oxygen desaturation during NREM and REM sleep did not change with leptin receptor blockade.

Conclusion

Systemic leptin receptor blockade attenuates hypertension in NZO mice, but does not exacerbate obesity and SDB. Thus, leptin receptor blockade represents a potential pharmacotherapy for obesity-associated hypertension.

Association of BMI with cardiovascular disease incidence and mortality in patients with type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of cohort studies

AIMS

The relation of body mass index (BMI) with cardiovascular disease (CVD) and mortality has been extensively investigated in the general population but is less clear in individuals with type 2 diabetes mellitus (T2DM). We performed a meta-analysis of cohort studies to quantitatively evaluate the association of BMI with CVD incidence and mortality in patients with T2DM.

DATA SYNTHESIS

PubMed and Embase databases were searched for relevant cohort articles published up to June 8, 2020. Restricted cubic splines were used to evaluate the potential linear or non-linear dose-response associations. We identified 17 articles (21 studies) with 1,349,075 participants and 57,725 cases (49,354 CVD incidence and 8371 CVD mortality) in the meta-analysis. We found a linear association between BMI and risk of CVD incidence (P_{non-linearity} = 0.182); the pooled RR for CVD incidence was 1.12 (95% CI, 1.04-1.20) with a 5-unit increase in BMI. We found an overall nonlinear relationship between BMI and CVD mortality (P_{non-linearity} < 0.001). The lowest risk was at BMI about 28.4 kg/m², with increased mortality risk for higher BMI values; the RR with a 5-unit increase in BMI was 0.87 (95% CI, 0.79-0.96) and 1.11 (95% CI, 1.04-1.18) for BMI ≤28.4 kg/m² and BMI >28.4 kg/m², respectively.

CONCLUSIONS

In individuals with T2DM, BMI may have a positive linear association with risk of CVD incidence but a nonlinear association with CVD mortality. Our results can provide evidence for weight control and lifestyle intervention for preventing and managing cardiovascular disease in T2DM.

Environmental Influences on the Human Microbiome and Implications for Noncommunicable Disease

The human microbiome contributes metabolic functions, protects against pathogens, educates the immune system, and through these basic functions, directly or indirectly, affects most of our physiologic functions. Here, we consider the human microbiome and its relationship to several major noncommunicable human conditions, including orodigestive tract cancers, neurologic diseases, diabetes, and obesity. We also highlight the scope of contextual macroenvironmental factors (toxicological and chemical environment, built environment, and socioeconomic environment) and individual microenvironmental factors (smoking, alcohol, and diet) that may push the microbiota toward less healthy or more healthy conditions, influencing the development of these diseases. Last, we highlight current uncertainties and challenges in the study of environmental influences on the human microbiome and implications for understanding noncommunicable disease, suggesting a research agenda to strengthen the scientific evidence base.

Associations of Body Composition and Physical Activity Level With Multiple Measures of Epigenetic Age Acceleration

Epigenetic clocks use DNA methylation to estimate biological age. Whether body composition and physical activity are associated with these clocks is not well understood. Using blood samples collected at enrollment (2003-2009) from 2,758 women in the US nationwide Sister Study, we calculated 6 epigenetic age acceleration metrics using 4 epigenetic clocks (Hannum, Horvath, PhenoAge, GrimAge). Recreational physical activity was self-reported, and adiposity measures were assessed by trained medical examiners (body mass index (BMI), waist-to-hip ratio (WtH), waist circumference). In cross-sectional analyses, all adiposity measures were associated with epigenetic age acceleration. The strongest association was for BMI and PhenoAge, a measure of biological age that correlates with chronic disease (BMI of ≥35.0 vs. 18.5-24.9, β = 3.15 years, 95% confidence interval (CI): 2.41, 3.90; P for trend < 0.001). In a mutual-adjustment model, both were associated with PhenoAge age acceleration (BMI of ≥35.0 vs. 18.5-24.9, β = 2.69 years, 95% CI: 1.90, 3.48; P for trend < 0.001; quartile 4 vs.1 WtH, β = 1.00 years, 95% CI: 0.34, 1.65; P for trend < 0.008). After adjustment, physical activity was associated only with GrimAge (quartile 4 vs. 1, β = -0.42 years, 95% CI: -0.70, -0.14; P for trend = 0.001). Physical activity attenuated the waist circumference associations with PhenoAge and GrimAge. Excess adiposity was associated with epigenetic age acceleration; physical activity might attenuate associations with waist circumference.

Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss

BACKGROUND AND AIMS

Endoscopic sleeve gastroplasty (ESG) has been shown to be effective for inducing weight loss. The efficacy of liraglutide, a glucagon-like peptide-1 agonist, to augment weight loss after ESG is unknown. This study aims to evaluate the efficacy of ESG and liraglutide (ESG-L) compared with ESG alone.

METHODS

This was a retrospective study of prospectively collected data from patients undergoing ESG at 3 outpatient clinics in Brazil between November 2017 and July 2018. Liraglutide was offered to all patients 5 months after ESG. Patients who opted to take liraglutide (ESG-L) were matched 1:1 to patients who declined it (ESG). The primary outcome was percent total body weight loss (%TBWL), and percent excess weight loss (%EWL) 7 months after initiation of liraglutide (12 months after ESG). The secondary outcome was change in percent body fat 12 months after ESG. ESG technique and postprocedure follow-up were identical at all 3 sites.

RESULTS

Propensity score matching yielded 26 matched pairs. Adjusted comparisons between the 2 groups showed that patients who opted to take liraglutide had a superior mean %TBWL 7 months after initiation of liraglutide (ESG-L) compared with those who declined it (ESG) (24.72% ± 2.12% vs 20.51% ± 1.68%, respectively; P < .001). ESG-L had a statistically greater reduction in percent body fat compared with ESG (7.85% ± 1.26% vs 10.54% ± 1.88%, respectively; P < .001) at 12 months.

CONCLUSIONS

Addition of liraglutide at 5 months results in superior weight loss and improved efficacy as demonstrated by decreased body fat 12 months after ESG. Further studies are imperative to determine optimal dose, timing, and duration of liraglutide.

Validity of "One-size-fits-all" Approaches for the National Health Screening and Education Program: A Large-scale Cohort Study of Corporate Insurance Beneficiaries

Objective Metabolic syndrome represents a unified condition of atherosclerotic diseases caused by abdominal obesity. The aims of this study were to examine the applicability of the prevalent fixed cut-off values of the abdominal circumference (AC) and body mass index (BMI) to age and gender groups and to identify suitable lifestyle modification factors. Methods We defined an outcome as having ≥ 2 risk components that are necessary to diagnose metabolic syndrome and examined the cross-sectional association of the AC and BMI with the outcome. We also assessed the effects of time-updated lifestyle information on metabolic traits using longitudinal data. Patients We enrolled 22,953 beneficiaries of a corporate health insurance scheme who underwent annual health examinations between January 2004 and December 2014. Results The AC [per 5-cm increase, odds ratio (OR) 1.17, 95% confidence interval (CI) 1.12-1.24] and BMI (OR 1.10, 95% CI 1.07-1.13) were significantly associated with the outcome, adjusted for age, gender, current smoking status, drinking habits, and other lifestyle information. The association between the outcome and AC was modified by gender (p for interaction = 0.033), and the association between the outcome and BMI was modified by age group (p for interaction = 0.049). In the longitudinal analysis, current smoking, drinking habits, and unhealthy eating habits were associated with an increased AC and BMI, whereas regular physical activity was associated with a decreased AC and BMI. Conclusion We showed that the association between the AC or BMI and metabolic syndrome was modified by gender or age group. Further studies will be needed to customize the national health screening and education programs.

Predictors of change in BMI over 10 years among midlife and older adults: Associations with gender, CVD risk status, depressive symptoms, and social support

RATIONALE

Change in BMI is recognized as a key health indicator among midlife and older adults, though predictors of BMI change in this group have received little attention.

OBJECTIVE

The aim of this study was to examine relations between hypothesized predictors (i.e., gender, cardiovascular disease [CVD] risk status, depressive symptoms, social support) and BMI change over 10 years, among midlife and older adults.

METHODS

Participants were adults ages 50-74 at baseline (N = 5,688, 64% women) who completed four assessments over 10 years. Gender, CVD risk status (i.e., diagnosis of hypertension, type 2 diabetes, or both), depressive symptoms, and perceived social support were assessed at baseline, and BMI was calculated from height and weight reports at all assessments. Multilevel models tested for concurrent and prospective relations between predictors and BMI change (effect size estimates as semipartial correlation coefficients, sr), as well as whether observed relations were further moderated by baseline BMI category (underweight, healthy weight, overweight, or obese).

RESULTS

Baseline BMI was higher among those with (vs. without) CVD risk, higher (vs. lower) depressive symptoms, and lower (vs. higher) social support; all of these relations were moderated by gender (ps < 0.05, srs 0.03-0.32). Moreover, BMI showed significant change over 10 years, and BMI variability during this time was higher among women (vs. men) and those with (vs. without) CVD risk (ps < 0.0001). BMI change also differed by CVD risk status, and this relation was moderated by gender, baseline depressive symptoms, and baseline BMI category (ps < 0.05, srs 0.03-0.08).

CONCLUSIONS

Although the predictors of interest were not associated with steady BMI decreases (which are associated with long term health risks for older adults), findings reveal unique patterns of change in BMI among subgroups of midlife and older adults, and may allow for early identification of those with noteworthy BMI changes after age 50.