Health Effects of Overweight and Obesity in 195 Countries over 25 Years

The importance of genotyping within the climate-smart plant breeding value chain - integrative tools for genetic enhancement programs

The challenges faced by today's agronomists, plant breeders, and their managers encompass adapting sustainably to climate variability while working with limited budgets. Besides, managers are dealing with a multitude of issues with different organizations working on similar initiatives and projects, leading to a lack of a sustainable impact on smallholder farmers. To transform the current food systems as a more sustainable and resilient model efficient solutions are needed to deliver and convey results. Challenges such as logistics, labour, infrastructure, and equity, must be addressed alongside adapting to increasingly unstable climate conditions which affect the life cycle of transboundary pathogens and pests. In this context, transforming food systems go far beyond just farmers and plant breeders and it requires substantial contributions from industry, global finances, transportation, energy, education, and country developmental sectors including legislators. As a result, a holistic approach is essential for achieving sustainable and resilient food systems to sustain a global population anticipated to reach 9.7 billion by 2050 and 11.2 billion by 2100. As of 2021, nearly 193 million individuals were affected by food insecurity, 40 million more than in 2020. Meanwhile, the digital world is rapidly advancing with the digital economy estimated at about 20% of the global gross domestic product, suggesting that digital technologies are increasingly accessible even in areas affected by food insecurity. Leveraging these technologies can facilitate the development of climate-smart cultivars that adapt effectively to climate variation, meet consumer preferences, and address human and livestock nutritional needs. Most economically important traits in crops are controlled by multiple loci often with recessive alleles. Considering particularly Africa, this continent has several agro-climatic zones, hence crops need to be adapted to these. Therefore, targeting specific loci using modern tools offers a precise and efficient approach. This review article aims to address how these new technologies can provide a better support to smallholder farmers.

High prevalence of overweight/obesity and central obesity among women in a rural district of Nepal in 2012-2013: a population-based study

Background

The prevalence of overweight is rapidly escalating, especially in South-Asia. We aimed to estimate the prevalence of overweight/obesity and central obesity, and associated risk factors among women in a rural setting of Nepal.

Methods

A cross-sectional study addressing reproductive health and non-communicable diseases (NCDs) was conducted 2012-2013 in a rural district of Nepal. Married, non-pregnant women ≥15 years of age were included. Height, weight, and waist circumference (WC) were measured, and body mass index (BMI) calculated. WHO cut-offs for Asians were used to assess the prevalence of overweight (23.0-27.4 kg/m2), obesity (≥ 27.5 kg/m2) and central obesity (WC ≥ 80 cm). Data concerning socioeconomic and lifestyle factors were collected.

Results

Altogether, 1,391 women 43.1 ± 14.4 years of age were included. The majority belonged to the Adhivasi/Janajati ethnicity, were uneducated and worked in agriculture. Altogether, 30.5% were overweight, 12.0% obese, and 34.2% centrally obese; 25.7% were both overweight/obese and centrally obese. Underweight (< 18.5 kg/m2) was observed in 9.6%. Among women with normal weight or underweight, 14.9 and 15.3% had central obesity, respectively. Hypertension was observed in 13.4% and was associated with both overweight/obesity and central obesity. Instant noodle intake ≥2 times weekly was associated with increased prevalence of central obesity and overweight/obesity.

Conclusion

We observed a high prevalence of overweight/obesity and central obesity among women in a rural district of Nepal, which entails an increased risk of metabolic complications and NCDs. Our findings underscore the need for public health programs addressing nutritional patterns and physical activity to prevent obesity.

Adipose tissue-derived microRNA-450a-5p induces type 2 diabetes mellitus by downregulating DUSP10

Type 2 diabetes mellitus (T2DM) has rapidly increased worldwide, emerging as the fifth leading cause of death. The treatment of T2DM is challenging due to the side effects of oral hypoglycemic drugs and the limited efficacy of long-term insulin therapy, which can lead to insulin resistance (IR). Consequently, there is significant in discovering new drugs that have minimal side effects and a pronounced hypoglycemic effect. In obesity, microRNA levels have been implicated in glucose metabolism disorders and T2DM, although many aspects remain unresolved. Here, we confirmed that visceral adipose tissue and serum microRNA-450a-5p content increased under obesity and T2DM, and it was significantly positively associated with fasting blood glucose, triglycerides, cholesterol, low-density lipoproteins-cholesterol levels of the subjects. In high-fat diet (HFD)-induced obese mice, microRNA-450a-5p expression was increased in the serum, liver, and white adipose tissue. Moreover, the adipose Dicer-knockout mouse model was constructed to identify adipose tissue as the main source of microRNA-450a-5p. microRNA-450a-5p could inactivate the insulin signal pathway by targeting the inhibited Dual Specificity Phosphatase 10 (DUSP10) and inducing IR and glucose metabolism disorders in vitro cultured hepatocytes and adipocytes. Additionally, microRNA-450a-5p was found to regulate DUSP10 expression and insulin signaling activity, influencing glucose tolerance and insulin sensitivity across various models, including normal diet, HFD-induced obese, adipose tissue-specific microRNA-450a-5p-knockout, and db/db mice. Furthermore, gallic acid might play a potential role in inhibiting glucose levels by decreasing microRNA-450a-5p expression. Thus, microRNA-450a-5p emerges as an attractive therapeutic target for addressing obesity, IR, and T2DM.

Vitamin D Enhancement of Adipose Biology: Implications on Obesity-Associated Cardiometabolic Diseases

Vitamin D is activated into 1α,25(OH)2D through two hydroxylation steps that are primarily catalyzed by 25-hydroxylase in the liver and 1α-hydroxylase in the kidneys. The active form of vitamin D regulates myriads of cellular functions through its nuclear receptor, vitamin D receptor (VDR). Vitamin D metabolizing enzymes and VDR are expressed in adipose tissues and vitamin D regulates multiple aspects of adipose biology including the recruitment and differentiation of adipose stem cells into adipocytes and metabolic, endocrine, and immune properties. Obesity is associated with low vitamin D status, which is thought to be explained by its sequestration in large mass of adipose tissues as well as dysregulated vitamin D metabolism. Low vitamin D status in obesity may negatively impact adipose biology leading to adipose tissue dysfunctions, the major pathological factors for cardiometabolic diseases in obesity. In this review, the current understanding of vitamin D metabolism and its molecular mechanisms of actions, focusing on vitamin D-VDR regulation of adipose biology with their implications on obesity-associated diseases, is discussed. Whether improving vitamin D status leads to reductions in adiposity and risks for cardiometabolic diseases is also discussed.

Cardiovascular Hospitalizations Among Older Adults in the US and Denmark

Importance

Cardiovascular disease is the leading cause of death in the US. However, it remains unclear how the burden of cardiovascular events in the US compares with that of other high-income countries with distinct health care systems like Denmark, both overall and by income.

Objective

To compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke) and associated outcomes among adults 65 years or older, overall and by income, between the US and Denmark.

Design, Setting, and Participants

This population-based cross-sectional study used national data from the US and Denmark from January 1, 2021, to January 1, 2022. The study population included all Medicare beneficiaries 65 years or older in the US and all adults 65 years or older in Denmark.

Main Outcomes and Measures

The primary outcome was age- and sex-standardized hospitalization rates for MI, HF, and ischemic stroke, as well as 30-day all-cause mortality rates.

Results

The US study population included 58 614 110 adults 65 years or older (mean [SE] age, 74.6 [7.7] years; 32 179 146 female [54.9%]) of whom 1 171 058 (2.0%) were hospitalized for a cardiovascular event. The Danish study population included 1 176 542 adults 65 years or older (mean [SE] age, 75.3 [7.1] years; 634 217 female [53.9%]) of whom 16 305 (1.4%) were hospitalized with a cardiovascular event. The overall age- and sex-standardized cardiovascular hospitalization rate was significantly higher in the US compared with Denmark (risk ratio [RR], 1.50; 95% CI, 1.47-1.52), as were associated 30-day all-cause mortality rates (RR, 1.12; 95% CI, 1.06-1.17). Across conditions, the risk of hospitalization for MI (RR, 1.56; 95% CI, 1.51-1.61) and HF (RR, 2.37; 95% CI, 2.31-2.43) was significantly higher in the US compared with Denmark, whereas hospitalizations for ischemic stroke were lower (RR, 0.90; 95% CI, 0.88-0.93). Overall cardiovascular hospitalization rates in the US were more than 2-fold higher among low-income adults compared with higher-income adults (RR, 2.38; 95% CI, 2.25-2.47), whereas the magnitude of income-based disparities was smaller in Denmark (RR, 1.45; 95% CI, 1.39-1.50).

Conclusions and Relevance

In this international cross-sectional study, cardiovascular hospitalization rates were significantly higher in the US compared with Denmark. There were income-based differences in the burden of cardiovascular hospitalizations in both countries, although the magnitude of these disparities was much greater in the US.

Cellular and Molecular Evidence of the Synergistic Antitumour Effects of Hydroxytyrosol and Metformin in Prostate Cancer

Prostate cancer (PCa) is the tumour pathology with the second highest incidence among men worldwide. PCa is strongly influenced by obesity (OB), which increases its aggressiveness. Hence, some metabolic drugs like metformin have emerged as potential anti-tumour agents against several endocrine-related cancers. Likewise, a high adherence to the Mediterranean diet has been associated with lower rates of OB and a reduction in PCa aggressiveness since this diet contains phenolic bioactive compounds such as hydroxytyrosol (HT) that is mainly present in extra virgin olive oil. Thus, we decided to analyse the therapeutic potential of the combination of HT + metformin in different PCa cell models. Specifically, combinations of different doses of HT and metformin were evaluated by analysing the proliferation rate of LNCaP, 22Rv1, DU-145, and PC-3 cells using the SynergicFinder method. The results revealed a synergistic effect of HT + metformin in significantly reducing proliferation, especially in LNCaP cells. This anti-tumour effect of HT + metformin was also confirmed in migration and tumoursphere formation assays in LNCaP. The effects on the cell cycle and apoptosis were also assessed by flow-cytometry, and a cycle arrest in the G1 phase and an increase in late apoptosis were observed with the combination of HT + metformin. The phosphorylation levels of critical components of different oncogenic pathways were measured which revealed that the combination of HT + metformin significantly reduced the activity of multiple components of the MAPK, AKT, and TGF-β pathways. Overall, the combination of HT + metformin might represent a new therapeutic avenue for the management of PCa patients, an observation that certainly warrants further investigation through a well-designed clinical trial.

Moderating carbohydrate digestion rate in mice promotes fat oxidation and metabolic flexibility revealed through a new approach to assess metabolic substrate utilization

PURPOSE

Superior metabolic flexibility, or the ability to efficiently switch between oxidation of carbohydrate and fat, is inversely associated with obesity and type 2 diabetes. The influence of dietary factors on metabolic flexibility is incompletely understood. This study examined the impact of dietary carbohydrate digestion rate on metabolic flexibility and metabolic substrate utilization.

METHODS

We employed percent relative cumulative frequency (PRCF) analyses coupled with a new application of modeling using the Mixed Weibull Cumulative Distribution function to examine respiratory exchange ratio (RER) data from adult wild-type mice and mice lacking the mucosal maltase-glucoamylase enzyme (Mgam) under different dietary carbohydrate conditions, with diets matched for total carbohydrate contents and containing different ratios of slowly digestible starch (SDS) and resistant starch (RS), or that were high in sucrose or fat. Fungal amyloglucosidase (AMG) was administered in drinking water to increase carbohydrate digestion rate. We devised a Metabolic Flexibility Factor (MFF) to quantitate metabolic flexibility for each dietary condition and mouse genotype, with higher MFF indicating higher metabolic flexibility.

RESULTS

Diets high in SDS exhibited lower average RER and higher metabolic flexibility (MFF) than diets high in resistant starch, sucrose, or fat. Diets containing high and intermediate amounts of SDS led to a more complete shift to fat oxidation. While mouse genotype had minimal effects on substrate oxidation and MFF, AMG supplementation shifted substrate utilization to carbohydrate oxidation and generally decreased MFF.

CONCLUSIONS

Consumption of slowly digestible carbohydrates improved measures of metabolic substrate utilization at the whole-body level in adult mice.

Global trends and projections of high BMI burden and its independent impact on atrial fibrillation and flutter

BACKGROUND

This study evaluates changes in the burden of high body mass index (BMI) and its impact on atrial fibrillation and flutter (AF/AFL) using the 2021 Global Burden of Disease database.

METHODS

Mortality and disability-adjusted life years rates were analysed globally, considering age, sex, geography and the Socio-demographic Index (SDI). Decomposition and frontier analyses assessed the impact of epidemiological drivers and SDI on the burden. The nordpred model validated the predictions.

RESULTS

The burden of high BMI is now 2.5 times greater than 30 y ago and will continue to increase over the next 20 y, heavily impacting cardiovascular and metabolic diseases. High BMI-related AF/AFL also poses a significant burden, especially in developed regions. Men's burden grows faster than women's. Decomposition analysis shows epidemiological changes mainly drive burden increases, while in women, population growth is more significant. Frontier analysis indicates that the gap between actual burden and theoretical optimal value has widened with increasing SDI, except in countries such as Bulgaria and the Czech Republic.

CONCLUSIONS

Over the past 30 y, the overall burden of high BMI and its impact on AF/AFL have increased significantly, highlighting the need for targeted public health strategies.

Associations between caregivers' health behaviours and overweight/obesity among children aged 2-6 years in Beijing, China: a cross-sectional study

OBJECTIVE

To investigate the correlation between caregivers' health-related behaviours and the prevalence of overweight/obesity among children aged 2-6 years in Beijing city in China.

DESIGN

Cross-sectional study.

SETTING

Two kindergartens and two community health service centres in Beijing city, China.

PARTICIPANTS

A total of 1967 children aged 2-6 years were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Children's height and weight were measured and body mass index was computed. The caregivers' exercise health behaviours and dietary health behaviours were assessed using a questionnaire, encompassing the frequency of exercise and the duration of each exercise session, as well as the frequency of consumption of desserts, late-night snacks, and fast food, regular eating habits, and the proportion of meat and vegetables consumed daily. Logistic regression analysis was performed to identify relationships between caregivers' health-related behaviours and overweight/obesity in children.

RESULTS

Having caregivers who exercised ≥3 times/week (OR 0.643, 95% CI 0.417 to 0.990) was a protective factor against childhood overweight/obesity compared with having caregivers who exercised <1 time/week; caregivers' frequent encouragement of children's participation in physical activity was also a protective factor (OR 0.513, 95% CI 0.352 to 0.749). Additionally, children whose caregivers consumed sweets 2-3 times/week (OR 1.535, 95% CI 1.133 to 2.081) or ≥4 times/week (OR 1.916, 95% CI 1.258 to 2.918), as well as children whose caregivers consumed fast food ≥4 times/week (OR 2.298, 95% CI 1.349 to 3.914), were more likely to be overweight and obesity than children whose caregivers consumed these foods ≤1 time/week. Furthermore, caregivers' irregular eating habits were positively associated with the occurrence of overweight and obesity in children (OR 1.485, 95% CI 1.056 to 2.089).

CONCLUSION

Caregivers' health-related behaviours were significantly associated with overweight/obesity among children in China. Substantial measures should be implemented to address caregivers' health-related behaviours to prevent and control childhood overweight/obesity.

Safety, pharmacokinetics and pharmacodynamics of multiple-dose noiiglutide (SHR20004), a novel GLP-1 receptor agonist, in Chinese obese subjects without diabetes mellitus

AIMS

This study aimed to assess the safety, pharmacokinetics and pharmacodynamics of noiiglutide (SHR20004), a novel glucagon-like peptide-1 receptor agonist, in Chinese obese participants without diabetes mellitus (DM).

MATERIALS AND METHODS

This phase 1, randomised, double-blind, placebo-controlled study enrolled adult participants with body mass index (BMI) ≥28 kg/m2. The study used a titration method, each subject received daily noiiglutide injection for 3-6 weeks, until reaching the final dose of 0.18, 0.24, 0.30 or 0.36 mg per day. Each dose group consisted of 10 participants, with eight receiving noiiglutide and two receiving placebos. Safety assessments were conducted throughout the study, and pharmacokinetics and pharmacodynamics were evaluated.

RESULTS

Most treatment-emergent adverse events were of mild to moderate in severity, with no serious adverse event or adverse event led to withdraw. Blood concentration of noiiglutide reached a steady state after daily administration for 4 days, with no significant accumulation. Mean elimination half-life (t1/2) was between 9.90 and 11.8 h at steady state. At the end of treatment, the mean weight loss compared to baseline for the placebo group and each treatment group was -1.89, -3.26, -5.45, -4.35 and -7.46 kg respectively. The weight and BMI reductions observed in each noiiglutide treatment group were greater than those in the placebo group and exhibited an increasing trend with extended administration duration.

CONCLUSIONS

Daily administration of noiiglutide using a titration method was well tolerated by Chinese obese participants without DM and showed potential therapeutic effect for weight loss.

Intentional weight reduction before surgery - A systematic review

INTRODUCTION

Obesity may increase complexity of surgical procedures and increase the risk of perioperative complications. Weight reduction by the use of low energy diet (LED, ≤1200 kcal/day) or very low energy diet (VLED, ≤800 kcal/day) can reduce postoperative complications after bariatric surgery, but for most other types of surgery the evidence for its use remains uncertain. The aim of this systematic review was therefore to evaluate the scientific evidence in general for this routine.

METHODS

The Medline, Embase, Web of Science and Cochrane databases were searched up until November 20, 2024 using the Cochrane risk of bias assessment tool for observational studies and the NIH quality assessment of controlled intervention studies for randomized trials. Operation time, surgeon's perceived difficulty, intraoperative complications, postoperative complications and relevant efficacy measures for specific procedures were considered as endpoints. A random-effects model was used to pool effect sizes for the main analyses.

RESULTS

A total of 7053 studies were identified. After screening by title and abstract, followed by full text, 18 studies (9 RCTs and 9 observational studies) remained for the analyses including 854 patients who received the intervention and 979 controls. Preoperative LED/VLED resulted in an overall shorter operation time (standard mean difference 0.36, 95 % CI 0.14-0.59, p = 0.002), and reduced risk of postoperative complications after bariatric surgery, cholecystectomy, colorectal surgery and hernia repair (pooled RR 0.63, 95%CI 0.51-0.79, p < 0.001). Heterogeneity between studies was high for operation time but very low for complications. No difference was seen for intraoperative complications, while the data did not allow further analyses on perceived difficulty of surgery or efficacy outcomes.

CONCLUSION

The results support the use of LED/VLED for short-term preoperative weight reduction in patients with obesity planned for bariatric surgery and for those undergoing cholecystectomy, colorectal surgery and hernia repair. Further studies including a comparable control group are needed to evaluate its routine use for other surgical procedures.

REGISTRATION

The protocol of this study was preregistered at the International Prospective Register of Systematic Reviews, PROSPERO.

Does obesity matter in patients receiving venoarterial extracorporeal membrane oxygenation? The U-shaped relationship between body mass index and mortality after extracorporeal cardiopulmonary resuscitation

BACKGROUND

The impact of obesity on the prognosis of patients receiving venoarterial extracorporeal membrane oxygenation remains unclear. This study examines the association between body mass index and in-hospital mortality among patients on venoarterial extracorporeal membrane oxygenation support.

METHODS

This retrospective study enrolled adult patients who received venoarterial extracorporeal membrane oxygenation support, which included extracorporeal cardiopulmonary resuscitation, at National Taiwan University Hospital between 2010 and 2021. Patients were classified as follows: underweight (body mass index <18.5), normal weight (18.5≤ body mass index <24), overweight (24≤ body mass index <27), class I obesity (27≤ body mass index <30), class II obesity (30≤ body mass index <35), and class III obesity (body mass index ≥35). Multivariable Cox regression with spline models was employed.

RESULTS

The study included 1,329 patients; of these, 670 underwent extracorporeal cardiopulmonary resuscitation, and the overall mortality rate was 61.6%. Multivariable Cox regression revealed that class III obesity was significantly associated with higher mortality (hazard ratio 2.11, 95% confidence interval 1.48-3.02, P = .001), particularly in the extracorporeal cardiopulmonary resuscitation subgroup (hazard ratio 2.71, 95% confidence interval 1.71-4.29, P < .001). No significant association was observed in the non-extracorporeal cardiopulmonary resuscitation subgroup (hazard ratio 1.29, 95% confidence interval 0.70-2.36, P = .415). Although underweight patients initially exhibited higher mortality (hazard ratio 1.77, 95% confidence interval 1.12-2.80, P = .015), this effect was attenuated after adjusting the confounders (hazard ratio 1.46, 95% confidence interval 0.91-2.35, P = .119). Kaplan-Meier analysis indicated that class III obesity was associated with the highest in-hospital mortality, followed by the underweight group (log-rank P = .009).

CONCLUSION

Obesity increased mortality in patients who underwent venoarterial extracorporeal membrane oxygenation, but this was primarily due to a nonlinear U-shaped distribution between body mass index and in-hospital mortality observed in patients receiving extracorporeal cardiopulmonary resuscitation. Further studies are needed to clarify the causal factors underlying these associations.

Trajectories of general and central obesity beyond middle age in relation to late-life cognitive decline and dementia

OBJECTIVE

The objective was to evaluate the longitudinal patterns of central and general obesity, identify their genetic and behavioral risk determinants, and investigate the association of distinct obesity trajectories beyond middle age with subsequent cognitive decline and the risk of developing dementia in late life.

METHODS

Using a nationally representative, longitudinal, community-based cohort, we examined trajectory patterns of obesity over a 14-year span beyond middle age employing latent mixture modeling. We then evaluated their relationship with subsequent cognitive decline through linear mixed models and with the risk of developing dementia using Cox models, adjusting for confounding variables.

RESULTS

Among the 4751 eligible participants (mean age, 58.7 [SD 8.1] years; 57% female), our analysis identified five distinct BMI trajectories and four WC trajectories spanning a 14-year period. In comparison with individuals in the low-stable BMI group, characterized by a consistent and healthy body weight (range, 22.8-22.9 kg/m2), those in the high-stable group, maintaining a stable obesity status (range, 34.3-35.4 kg/m2), exhibited an elevated risk of developing dementia (odds ratio [OR], 1.43; 95% CI: 1.02 to 2.00) and experienced a more accelerated cognitive decline over 6 years (difference in 6-year decline, -0.11 SD [95% CI: -0.18 to -0.03]). Similarly, when compared with participants in the low-stable WC group, indicating a stable and healthy WC (range, 76-79 cm), those in the high-increasing WC group, showing an increasing trend (range, 115-122 cm), demonstrated an increased risk of developing dementia (OR, 1.57, 95% CI: 1.01 to 2.49) and experienced a swifter cognitive decline (OR: -0.18 [95% CI: -0.28 to -0.07]).

CONCLUSIONS

General and central obesity trajectories beyond midlife with persistently high or increasing patterns were significantly associated with an increased risk of developing cognitive decline and dementia in late life. Longitudinal obesity patterns may assist in precise identification of older adults at risk of developing cognitive impairment for targeted intervention.

Novel neural pathways targeted by GLP-1R agonists and bariatric surgery

The glucagon-like peptide 1 receptor (GLP-1R) agonist semaglutide has revolutionized the treatment of obesity, with other gut hormone-based drugs lined up that show even greater weight-lowering ability in obese patients. Nevertheless, bariatric surgery remains the mainstay treatment for severe obesity and achieves unparalleled weight loss that generally stands the test of time. While their underlying mechanisms of action remain incompletely understood, it is clear that the common denominator between GLP-1R agonists and bariatric surgery is that they suppress food intake by targeting the brain. In this Review, we highlight recent preclinical studies using contemporary neuroscientific techniques that provide novel concepts in the neural control of food intake and body weight with reference to endogenous GLP-1, GLP-1R agonists, and bariatric surgery. We start in the periphery with vagal, intestinofugal, and spinal sensory nerves and then progress through the brainstem up to the hypothalamus and finish at non-canonical brain feeding centers such as the zona incerta and lateral septum. Further defining the commonalities and differences between GLP-1R agonists and bariatric surgery in terms of how they target the brain may not only help bridge the gap between pharmacological and surgical interventions for weight loss but also provide a neural basis for their combined use when each individually fails.

The impact of weight loss interventions on disordered eating symptoms in people with overweight and obesity: a systematic review & meta-analysis

Background

It is unclear whether weight loss interventions worsen disordered eating in people living with overweight/obesity. We aimed to systematically evaluate the association between weight loss interventions and disordered eating.

Methods

Six databases were searched from inception until September 2024. Trials of weight loss interventions in people with overweight/obesity were included if they reported a validated score for disordered eating on either the Eating Disorder Examination Interview or the Eating Disorder Examination Questionnaire pre- and post-intervention. Interventions included behavioural weight loss programmes (BWL) and pharmacotherapy licenced for weight loss, with or without concurrent psychological support, provided for at least 4 weeks. Pooled standardised mean differences (SMD) in scores of disordered eating were calculated using random effects meta-analyses. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool and the Newcastle-Ottawa scale for randomised and single-arm trials, respectively (PROSPERO ID: CRD42023404792).

Findings

Thirty-eight studies with 66 eligible arms (61 interventions: 29 BWL, 11 BWL + pharmacotherapy, 20 BWL + psychological intervention, 1 pharmacotherapy + psychological intervention) and 3364 participants in total were included. The mean weight change was -4.7 kg (95% CI: -5.7, -3.7). Compared with baseline, disordered eating scores improved by -1.47 SMD units (95% CI: -1.67, -1.27, p < 0.001, I2 = 94%) at intervention completion (median of 4 months). Seven randomised trials that directly compared a weight loss intervention to no/minimal intervention reported an improvement of -0.49 SMD units (95% CI, -0.93, -0.04, p = 0.0035, I2 = 73%). Sub-group analyses showed: (a) disordered eating scores improved more in people with an eating disorder at baseline compared with people without high scores, (b) no clear evidence that the association depended upon intervention type, and (c) disordered eating scores improved more in trials rated at low overall RoB.

Interpretation

Despite heterogeneity in effect size, weight loss interventions consistently improved disordered eating scores. These findings provide reassurance that weight loss interventions might not worsen disordered eating and may improve it.

Funding

Novo Nordisk UK Research Foundation Doctoral Fellowship in Clinical Diabetes.

Pre-operative DNA methylation marks as predictors of weight loss outcomes after sleeve gastrectomy

OBJECTIVE

Although DNA methylation has been suggested to be a potential predictor of the progression of obesity and obesity-related diseases, little is known about its potential role as predictive marker of successful weight loss after bariatric surgery.

METHODS

20 patients who underwent sleeve gastrectomy were classified according to the percentage of excess weight loss (%EWL) 1 year after bariatric surgery, using 60% as the cut-off point. Blood DNA methylation was analyzed prior to surgery using the Infinium Methylation EPIC Bead Chip array-based platform.

RESULTS

A total number of 76,559 differentially methylated positions (DMPs) (p < 0.05) were found between <60% EWL and >60% EWL groups. Of them, 59,308 DMPs were annotated to genes. KEGG enrichment analysis showed that pathways involved in the signalling of MAPK, Wnt, mTor, FoxO and AMPK, among others, were involved in weight loss trajectory. A stepwise logistic regression using the DMPs with an absolute Δβ >0.2 showed that higher methylation levels in the CpG sites cg02405213 (mapping to JAK2) (OR: 1.20098, [0.9586, 1.5044]) and cg01702330 (OR: 2.4426, [0.5761, 10.3567]), were shown to be associated with a higher probability of achieving >60 %EWL after sleeve gastrectomy, whereas higher methylation levels in the CpG site cg04863892 (mapping to HOXA5) were associated with lower probability of achieving >60 %EWL after sleeve gastrectomy (OR: 0.7966, [0.5637, 1.1259]).

CONCLUSIONS

Our results show a different pre-surgery methylation pattern according to %EWL. We identified three CpG sites (cg04863892, cg02405213, cg01702330) with potential value as predictor markers of weight loss response to bariatric surgery.

Exploring the global impact of obesity and diet on dementia burden: the role of national policies and sex differences

Obesity is a significant modifiable risk factor for dementia. This study aims to quantify the global impact of obesity on dementia burden and examine how national strategies for managing overweight/obesity and dietary factors influence dementia prevalence and mortality, with a focus on sex-specific differences. We used data from the Global Burden of Disease (GBD) and World Health Organization (WHO) to evaluate the association between obesity age-standardized prevalence rate (ASPR) and dementia age-standardized mortality rate (ASMR) and ASPR across 161 countries. A two-step multivariate analysis adjusted for socioeconomic and lifestyle factors was performed. Temporal trends in dementia were analyzed based on the presence of national obesity management strategies and varying dietary scores. A 1% increase in national obesity prevalence was associated with a 0.36% increase in dementia mortality (OR: 1.0036; 95% CI: 1.0028-1.0045) in males and 0.12% in females (OR: 1.0012; 95% CI: 1.0007-1.0018). A 1% increase in national obesity ASPR was associated with an increase in ASPR of dementia by 0.26% for males (OR: 1.0026, 95% CI: 1.0024-1.0028) and 0.05% for females (OR: 1.0005, 95% CI: 1.0004-1.0006). Males exhibited a higher susceptibility to obesity-related dementia. Countries with national obesity management strategies showed a significantly greater reduction in dementia mortality, particularly among females (P = 0.025). Higher dietary scores were associated with a more significant decrease in dementia prevalence across both sexes. Rising obesity prevalence is linked to increased dementia burden globally, with males being more vulnerable to this relationship. National management of overweight/obesity and healthier dietary habits may help mitigate the dementia burden, emphasizing the need for integrated public health interventions.

Medial orbitofrontal cortex structure, function, and cognition associates with weight loss for laparoscopic sleeve gastrectomy

OBJECTIVE

The objective of this study was to investigate underlying mechanisms of long-term effective weight loss after laparoscopic sleeve gastrectomy (LSG) and effects on the medial orbitofrontal cortex (mOFC) and cognition.

METHODS

A total of 18 individuals with obesity (BMI ≥ 30 kg/m2) underwent LSG. Clinical data, cognitive scores, and brain magnetic resonance imaging scans were evaluated before LSG and 12 months after LSG. We employed voxel-based morphometry analysis and seed-based resting-state functional connectivity (RSFC) analysis to assess LSG-induced structural and functional changes in mOFC. Partial correlation analysis and univariate and multivariate linear regression models were used to explore associations among biochemical indexes, neuroimaging, cognition, and weight loss.

RESULTS

No significant improvement in general cognition was found after LSG. Decreases in gray matter volume of the bilateral mOFC and increases in RSFC of the right mOFC were observed 12 months after LSG. Weight loss was associated with RSFC, general cognitive scores, and triglyceride changes. Multivariate linear regression model revealed gray matter volume of the left mOFC and working memory scores at baseline explained 55.2% of the variation in weight loss.

CONCLUSIONS

These findings suggest that mOFC imaging and cognitive scores could serve as biomarkers for predicting persistent weight loss after LSG, which provides a solid foundation for a potential target for neuromodulation research.

The influence of Mediterranean diet and physical activity-related energy expenditure on weight status and cardiometabolic risk. What "weights" more? The HERMEX study

In this cross-sectional study, we explored the influence of Mediterranean Diet (MD) adherence and physical activity-related energy expenditure on weight status and cardiometabolic risk in a large sample of 2.833 young, middle-aged and older adults. A food frequency questionnaire was employed, and MD Score to assess MD adherence. Physical activity-related energy expenditure was reported through the Minnesota Leisure Time Physical Activity Questionnaire. Anthropometry, blood pressure, lipid and glycaemic markers were measured. Most of the participants were overweight or obese and had a medium-high MD adherence. The obesity group showed lower energy expenditure and a greater clustered cardiometabolic risk. Overweight and obese had a greater clustered cardiometabolic risk compared to the high MD adherence and normo-weight. Obese showed the greatest clustered cardiometabolic risk with independence of MD adherence. Increasing energy expenditure through physical activity better than restrictive diets might be one of the key components for reducing cardiometabolic risk among obese people.

Safety, Tolerability, and Pharmacokinetics of a Novel Anti-obesity Agent, S-309309, in Healthy Adults with or Without Obesity

BACKGROUND

Anti-obesity medications are recommended for patients who do not achieve and maintain weight loss despite lifestyle interventions. S-309309 is a novel oral inhibitor of monoacylglycerol O-acyltransferase 2 being developed as a treatment for obesity.

OBJECTIVE

The objective of the study was to investigate the safety, clinical pharmacology, pharmacokinetics and pharmacodynamic biomarker of S-309309.

METHODS

A phase I, single-center, two-part, randomized, double-blind, placebo-controlled study of S-309309 following oral administration of a single-ascending dose (part 1) and a multiple dose (part 2) in healthy adults with or without obesity was conducted. We also assessed the effect of food on the pharmacokinetics of S-309309 and the effect of S-309309 on electrocardiogram parameters, the pharmacokinetics of midazolam (a cytochrome P450 3A substrate), and the pharmacodynamic biomarker of monoacylglycerol O-acyltransferase 2 inhibition.

RESULTS

In part 1 (N = 50), a single-ascending dose of S-309309 in healthy adults demonstrated dose proportionality and comparable exposure of S-309309 between the fasted and fed states. In part 2 (N = 24), no clinically meaningful difference was observed in the pharmacokinetics of multiple doses between healthy adults with or without obesity. S-309309 did not affect the pharmacokinetics of the cytochrome P450 3A substrate. The pharmacodynamic biomarker of monoacylglycerol O-acyltransferase 2 inhibition, dicarboxylic acid (18:1), was significantly increased after S-309309 administration in healthy adults with or without obesity. Overall, S-309309 demonstrated acceptable safety and tolerability without any serious adverse events or discontinuations because of adverse events, and did not have a clinically relevant effect on the heart rate or cardiac conduction. An effect on the placebo-corrected change-from-baseline corrected QT interval, corrected for heart rate using the Fridericia method, exceeding 10 ms can be excluded.

CONCLUSIONS

S-309309 was well tolerated as single-dose (up to 300 mg) and multiple-dose (50 mg once daily for 14 days) oral administration. The pharmacokinetic characteristics remained unaffected by obesity and food intake. S-309309 did not affect the pharmacokinetics of the cytochrome P450 3A substrate. Overall, S-309309 had an acceptable safety profile and favorable pharmacokinetic and pharmacodynamic characteristics.

CLINICAL TRIAL REGISTRATION

NCT05247970, date of registration: 8 February, 2022.

Assessment of the Potential Clinical and Economic Impact of Weight Loss in the Adult Population with Obesity and Associated Comorbidities in Spain

INTRODUCTION

Obesity and its complications are associated with high morbidity/mortality and a significant healthcare cost burden in Spain. It is therefore essential to know the potential clinical and economic benefits of reducing obesity. The objective of this study is to predict the decrease in rates of onset of potential complications associated with obesity and the cost savings after a weight loss of 15% over 10 years in Spain.

METHODS

Data were combined in an adapted version of a weight loss benefit simulation model. Sources with demographic information on the Spanish population and the distribution of obesity and type 2 diabetes mellitus (T2DM) were used to obtain the data for the model. In addition, use was made of prevalence data on obesity-associated complications from a cohort of patients with obesity in the United Kingdom (UK). These data were combined by age and sex to create a Spanish synthetic cohort.

RESULTS

The simulation showed that, for a cohort of 100,000 individuals with a body mass index (BMI) of 30-50 kg/m2, a weight loss of 15% is estimated to lead to relevant relative risk reductions in obstructive sleep apnoea (OSA) (- 56.4%), T2DM (- 39.2%), asthma (- 20.2%) and arterial hypertension (- 18.7%). The estimated overall savings were €105 million for a cohort of 100,000 individuals, mainly resulting from the decrease in T2DM and arterial hypertension (23% and 22% of the total savings at year 10, respectively), as well as osteoarthritis and chronic kidney disease (CKD) (16% and 13%, respectively).

CONCLUSIONS

Sustained weight loss could significantly reduce the burden derived from future complications associated to obesity in Spain, as well as the excess economic cost associated with its treatment.

The global burden of disease attributable to high body mass index in 204 countries and territories from 1990 to 2021 with projections to 2050: An analysis of the Global Burden of Disease Study 2021

AIMS

Understanding the global burden of disease attributable to high body mass index (BMI) is essential for informing public health strategies and interventions to mitigate the impact of obesity-related conditions.

METHODS AND RESULTS

The global deaths and disability-adjusted life years (DALYs) caused by high BMI were examined based on age, sex, year, and geographical location as well as socio-demographic index. Globally in 2021, the deaths and DALYs attributable to high BMI have risen 2.54-fold and 2.68-fold for both sexes when compared to 1990. The number of global deaths linked to high BMI has risen for females from 828 147.16 (95% uncertainty interval [UI] 407 103.20-1 302 480.38) in 1990 to 2 013 089.03 (95% UI 979 000.37-3 076 044.71) in 2021, and for males from 631 386.07 (95% UI 315 452.97-988 213.75) in 1990 to 1 695 974.32 (95% UI 861 972.49-2 635 343.31) in 2021. The number of DALYs related to high BMI worldwide has risen for females from 26 097 463.34 (95% UI 11 042 501.33-42 206 794.07) in 1990 to 67 213 785.86 (95% UI 28 417 735.35-105 552 568.89) in 2021, and for males from 21 944 645.99 (95% UI 10 106 039.21-35 110 379.12) in 1990 to 61 306 297.23 (95% UI 27 566 755.49-94 931 874.52) in 2021. However, the age-standardized rate of high-BMI-related deaths for females increased by 4.06% and 15.06% for males between 1990 and 2021, while the age-standardized rate of high-BMI-related DALYs increased by 21.60% for females and 31.22% for males. Across the 21 Global Burden of Disease regions, in 2021, the highest age-standardized rates of high-BMI-related deaths and DALYs were observed in Southern Sub-Saharan Africa (125.12, 95% UI 71.21-183.13) and Oceania (3712.97, 95% UI 1666.49-5765.84), respectively.

CONCLUSION

Efforts to promote healthy weight management, lifestyle modifications, and early intervention for obesity-related health complications are essential in reducing the morbidity and mortality associated with obesity and improving overall population health.

Evaluation of Pulmonary Function in Long-Term Follow-Up After Laparoscopic Sleeve Gastrectomy

BACKGROUND

Obesity is one of the most important health problems in the world. It affects all systems, especially the respiratory and cardiovascular systems. Laparoscopic sleeve gastrectomy is an effective method in the treatment of obesity and can improve respiratory functions. We aimed to evaluate the effects of surgery on pulmonary function in patients with obesity.

METHODS

A retrospective analysis was conducted on a group of patients who underwent sleeve gastrectomy. This study assessed pre-operative and long-term pulmonary function in patients who underwent laparoscopic sleeve gastrectomy between 2009 and 2015, with a minimum follow-up of 10 years. Patients were stratified based on smoking status and presence of comorbidities.

RESULTS

The study included 51 patients (82.4% female) with a mean age of 51.90 ± 11.57 years. Significant weight loss and reductions in BMI were observed postoperatively. Mean pre-operative BMI was 47.53 ± 6.95 and significantly decreased to 37.75 ± 6.02 post-operatively, BMI reduction rate was %22 (p < 0.001). Pulmonary function tests demonstrated significant improvements in FEV1 (2.65 ± 0.69 to 2.76 ± 0.67, p = 0.044), FEV1% (92.07 ± 15.31 to 97.98 ± 14.45, p = 0.001), PEF (74.01 ± 18.12 to 91.53 ± 24.16, p < 0.001), and MEF25-75 (77.17 ± 22.07 to 108.57 ± 28.11 p < 0.001) after surgery. These improvements were consistent across different subgroups, including smokers, non-smokers, and patients with and without comorbidities. Non-smokers exhibited a greater percentage increase in FEV1 compared to smokers. While there was an increase in FEV1 among patients with comorbidities, this difference was not statistically significant. Conversely, patients without comorbidities demonstrated a significant improvement in FEV1.

CONCLUSION

Bariatric surgery is associated with significant improvements in pulmonary function in obese patients, regardless of smoking status or comorbidities.

Study of penehyclidine for the prevention of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy under general anesthesia: a randomized, prospective, double-blind trial

PURPOSE

To investigate the efficacy of penehyclidine (PHC) for preventing postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) under general anesthesia.

MATERIALS AND METHODS

In this prospective study, 219 patients who were scheduled to undergo LSG were randomly assigned to three cohorts: the control cohort (received normal saline), the infusion cohort (administered 0.25 mg of PHC intravenously followed by an additional 0.25 mg through an intravenous analgesia pump for 48 h after LSG), and the bolus cohort (received a single intravenous dose of 0.5 mg of PHC). The study outcomes included the incidence of PONV within the first 48 h postoperatively, the severity and intensity of PONV, side effects and postoperative recovery outcomes. Univariate and multivariate logistic analyses were performed to identify independent risk factors associated with PONV.

RESULTS

Compared with the control cohort, both the infusion and bolus cohorts presented considerably lower incidences of PONV (61.64% vs. 12.33% vs. 38.36%, P < 0.05), as well as significantly decreased PONV severities (P < 0.05) and intensities (P < 0.05). There were no significant differences in side effects and postoperative recovery outcomes among the three cohorts, with the exception of dry mouthand the administration of rescue antiemetic therapy (P < 0.05). Additionally, the Apfel risk score and PHC intervention were identified as independent risk factors associated with PONV incidence following LSG (P < 0.05).

RESULTS

PHC effectively prevented PONV occurrence and reduced its severity in LSG patients without decreasing postoperative recovery outcomes, particularly in the infusion cohort.

Anti-obesity treatment preferences of healthcare providers and people living with obesity: A survey-based study

A cross-sectional, online survey was conducted in the United Kingdom, France, Germany, and the United States (14 November-22 December 2022) to investigate preferences for anti-obesity medication (AOM) among people with obesity (PwO) and healthcare providers (HCPs). Eligibility: Adult PwO who self-defined their body type as overweight/obese, were trying to lose weight and had BMI ≥30.0 or 27.0-29.9 kg/m2 with ≥1 obesity-related complication; HCPs had to see ≥30 PwO in a typical month and be a decision-maker regarding their weight loss. The survey included 2500 PwO and 500 HCPs. Exercise (96%) and diet (90%) were the most common weight management methods; AOM use was low (8%). Key barriers to use of prescribed AOMs among PwO were not wanting to take AOM (34%), side effects concerns (33%), and not trusting AOM (26%). Most HCPs (79%) had prescribed/recommended AOMs. Efficacy was the most common reason for preferring one of the shown product profiles among PwO (60%) and HCPs (86%); improving cardiovascular risk was also important to 95% of HCPs when deciding which AOM to prescribe. AOM preference is largely driven by efficacy. Increasing knowledge could help to address barriers to AOM use and improve outcomes for PwO.

A review on drug repurposing applicable to obesity

Obesity is a major public health concern and burden on individuals and healthcare systems. Due to the challenges and limitations of lifestyle adjustments, it is advisable to consider pharmacological treatment for people affected by obesity. However, the side effects and limited efficacy of available drugs make the obesity drug market far from sufficient. Drug repurposing involves identifying new applications for existing drugs and offers some advantages over traditional drug development approaches including lower costs and shorter development timelines. This review aims to provide an overview of drug repurposing for anti-obesity medications, including the rationale for repurposing, the challenges and approaches, and the potential drugs that are being investigated for repurposing. Through advanced computational techniques, researchers can unlock the potential of repurposed drugs to tackle the global obesity epidemic. Further research, clinical trials, and collaborative efforts are essential to fully explore and leverage the potential of drug repurposing in the fight against obesity.

Efficacy and safety of the subcutaneous implantable cardioverter-defibrillator in patients with and without obesity: A meta-analysis

BACKGROUND

The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for prevention of sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals.

OBJECTIVE

The purpose of this study was to perform a meta-analysis to evaluate the efficacy and safety of the S-ICD in patients with obesity by assessing the relationship between body mass index (BMI) and clinical outcomes.

METHODS

A comprehensive search of multiple databases was conducted for English-language peer-reviewed studies reporting clinical outcomes in S-ICD recipients with (BMI ≥30 kg/m2) and without obesity (BMI <30 kg/m2). Data on preimplantation screening failure, defibrillation testing, complications, appropriate and inappropriate shocks, and survival were analyzed using standard, random-effects, meta-analytical techniques.

RESULTS

Twenty-nine studies involving 20,486 patients were included. There was no statistically significant difference in mean BMI values of patients with failed or successful preimplantation screening (mean difference -0.60 kg/m2; 95% confidence interval [CI] -2.06 to 0.86). Obesity was associated with higher rates of failed defibrillation testing at ≤65 J (odds ratio [OR] 2.16; 95% CI 1.39-3.35), and malpositioning/suboptimal positioning occurred more frequently in obese compared to nonobese patients (OR 3.37; 95% CI 1.76-6.44). Increased BMI as a continuous variable (per increase in 1 kg/m2 BMI) was associated with elevated defibrillation thresholds (OR 1.05; 95% CI 1.03-1.08); higher risk of complications (hazard ratio [HR] 1.04; 95% CI 1.02-1.05); a trend toward an increased number of appropriate shocks (HR 1.02; 95% CI 1.00-1.04); and no significant increase in the risk of inappropriate shocks (HR 1.01; 95% CI 0.99-1.03).

CONCLUSION

This meta-analysis underscores the importance of considering obesity in S-ICD implantation decisions. Although S-ICD remains effective in obese patients, attention to potential technical challenges and higher complication rates is warranted.

Ketogenic diet combined with intermittent fasting: an option for type 2 diabetes remission?

With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.

Waitlisting and liver transplantation for MetALD in the United States: An analysis of the UNOS national registry

BACKGROUND AND AIMS

The new steatotic liver disease (SLD) nomenclature introduced metabolic and alcohol-associated liver disease (MetALD), describing the intersection of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease. Waitlisting and liver transplantation for MetALD are not well defined. We aimed to develop and validate an algorithm for identifying SLD phenotypes and assessing trends in waitlisting and transplant outcomes.

APPROACH AND RESULTS

We conducted a retrospective cohort study using the United Network for Organ Sharing registry, supplemented with detailed single-center data. We developed 5 candidate algorithms for SLD classification and calculated their diagnostic performance. Trends in waitlist registrations and transplants were estimated, and competing risk analyses and Cox regression models were conducted to assess waitlist removal and posttransplant outcomes among SLD phenotypes. The best-performing algorithm demonstrated substantial agreement (weighted kappa, 0.62) for SLD phenotypes, with acceptable sensitivity (73%) for MetALD. Between 2002 and 2022, waitlist registrations and transplants for MetALD increased 2.9-fold and 3.3-fold, respectively. Since 2013, there has been a significant increase in the absolute number of waitlist registrations (122 per year; 95% CI, 111-133) and transplants (107 per year; 95% CI, 94-120) for MetALD. Patients with MetALD experienced higher waitlist removal (adjusted subdistribution hazard ratio, 1.10; 95% CI, 1.03-1.17), all-cause mortality (adjusted hazard ratio, 1.13; 95% CI, 1.03-1.23), and graft failure (adjusted hazard ratio, 1.12; 95% CI, 1.03-1.21) than those with alcohol-associated liver disease.

CONCLUSIONS

We developed and validated an algorithm for identifying SLD phenotypes in UNOS. MetALD is the third leading etiology among those waitlisted and underwent transplantation, exhibiting worse pretransplantation and posttransplantation outcomes compared to alcohol-associated liver disease. Identifying and addressing factors determining poor outcomes is crucial in this patient population.

Contemporary treatment patterns of overweight and obesity: insights from the Mass General Brigham health care system

OBJECTIVE

The objective of this study was to describe the prevalence of obesity, obesity-related conditions (ORCs), and antiobesity medication (AOM) eligibility and prescribing practice among eligible patients in a large health care system.

METHODS

In this cross-sectional analysis of the multicenter Mass General Brigham health care system (Boston, Massachusetts) spanning 2018 to 2022, adults eligible for AOMs (BMI ≥ 30 kg/m2 or BMI 27-29.9 kg/m2 with ≥1 ORC) were identified. Among those AOM-eligible, the prevalence of prescriptions for AOMs approved for long-term weight management was evaluated.

RESULTS

Of 2,469,474 adults (mean [SD], age 53 [19] years; 57% female; BMI 28.1 [6.3] kg/m2), a total of 1,110,251 (45.0%) were eligible for AOMs. Of these, 69.4% (31.2% of overall cohort) had BMI ≥ 30 kg/m2. AOM prescription was observed in 15,214 (1.4%) of all eligible patients, with female sex, younger age, higher BMI, commercial insurance, and greater ORC burden associated with higher prevalence of AOM prescriptions. Musculoskeletal disorders (54%) were the most common ORCs, with ≥2 ORCs observed in 62% of patients. Liraglutide 3.0 mg and semaglutide 2.4 mg were the most frequently prescribed AOMs (58% and 34% of all AOMs, respectively).

CONCLUSIONS

Although nearly one-half of all patients in a large health care system were AOM-eligible by guidelines and regulatory labeling, only 1% of those who were eligible were prescribed AOMs.

US Population Eligibility and Estimated Impact of Semaglutide Treatment on Obesity Prevalence and Cardiovascular Disease Events

BACKGROUND

Semaglutide 2.4 mg benefits weight loss and reduction of cardiovascular disease (CVD) risk factors in adults with obesity. We estimated the US population eligibility for semaglutide 2.4 mg (based on the weight management indication) and the impact on obesity and CVD events.

METHODS

We applied STEP 1 trial eligibility criteria to US adults aged ≥ 18 years in the US National Health and Nutrition Examination Survey (NHANES) 2015-2018 to estimate the US eligible population. Semaglutide weight changes in STEP 1 were applied to estimate the population impact on weight changes and obesity prevalence. We also estimated 10-year CVD risks utilizing the BMI-based Framingham CVD risk scores. The difference in estimated risks with and without semaglutide "treatment" multiplied by the eligible NHANES weighted population represented the estimated "preventable" CVD events.

RESULTS

We identified 3999 US adults weighted to an estimated population size of 93.0 million [M] (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3 M) and 50.5% (47.0 M) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0 M) reduction in obesity (BMI ≥ 30 kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% "before" and 8.34% "after" semaglutide "treatment" reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over 10 years.

CONCLUSION

Semaglutide treatment in eligible US adults may substantially reduce obesity prevalence and CVD events, which may dramatically impact associated healthcare costs.

Cashew nut consumption reduces waist circumference and oxidative stress in adolescents with obesity: A randomized clinical trial

Previous evidence suggests that certain types of nuts, when included in a healthy diet pattern, may provide health benefits. Therefore, we hypothesize that the consumption of cashew nuts associated with a healthy diet may enhance antioxidant defenses and improve anthropometric and body composition parameters in individuals with obesity. We conducted a 12-week randomized clinical trial, divided into 4 sessions, involving adolescents randomly assigned to receive either 30 g of roasted cashew nuts together with nutrition education (cashew nut group-CNG) or only nutrition education (control group-CG). The total number of participants who started the study was 142, with 77 in the CNG and 65 in the CG. Data on anthropometry, body composition, and oxidative stress were collected at baseline (0-week) and endpoint (12-week). The main post-intervention findings in the CNG showed decreases in waist circumference (WC), thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC) at 60 minutes in the CNG, while neck circumference (NC) increased. However, the CG showed an increase in TBARS and percentage of lean body mass (LBM), along with reduction in TAC at 60 minutes. After 12 weeks, the consumption of cashew nuts seemed to assist in WC reduction, even without a decrease in other anthropometric parameters, thereby decreasing the cardiometabolic risk. Furthermore, the consumption of cashew nuts demonstrated the ability to decrease overall oxidative damage as assessed by TBARS, a finding that reinforces the effects of this nut consumption against systemic oxidative stress associated with obesity.

Factors affecting gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method: a retrospective analysis of a large cohort of 966 cases in Japan

OBJECTIVE

To evaluate the usefulness of gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method.

METHODS

In GRP-LM, after lifting the abdominal wall by a subcutaneous abdominal wall lifting method, a 1.5-cm incision is made in the lateral abdomen, Lap Protector® is placed. The operation is performed by two surgeons, one who inserts multiple forceps from the Lap Protector and performs the operation, and an assistant who operates the laparoscope and uterine manipulator. The surgical outcome of GRP-LM and the factors that affect it were investigated.

RESULTS

GRP-LM was performed in 966 patients. Complications (0.5%) and blood transfusions (0.3%) were remarkably rare, and there were no cases of conversion to open surgery. With regard to the correlation between the number of fibroids extracted and each factor, the number of fibroids extracted correlated with fibroid weight and operation time, but not with blood loss. The average number of sutures per case was 21, and the average suture and ligation time per suture was 77 s. Comparing the cost of GRP-LM with that of the conventional insufflation LM, a saving of $875 was possible with GRP-LM.

CONCLUSION

GRP-LM is a suitable for multiple fibroids, and is cosmetic and economical, because it allows rapid and reliable suture and ligation, despite having only one port for the procedure.

Sex differences in the relationship between body composition and cardiac structure and function

AIMS

The purpose of this study was to characterize sex differences in the relationship between body composition and cardiac structure and function. In secondary analyses, we explored pathophysiologic mediators of these relationships.

METHODS AND RESULTS

In a cross-sectional analysis of 25 063 UK Biobank participants (54% female, median age 55 years), the sex-specific associations of visceral adipose tissue volume (VAT), appendicular lean mass (ALM), and muscle fat infiltration (MFI) with cardiac magnetic resonance (CMR) measures of cardiac structure and function were assessed using linear regression models. Using causal mediation analysis, 10 biomarkers were explored as mediators of the relationship between adipose depots and cardiac parameters. VAT was associated with increased left ventricular mass (LVM; βwomen = 0.54, βmen = 0.00, Pint = 0.01) and wall thickness (βwomen = 0.12, βmen = 0.08, Pint < 0.001) in women only. A similar sex-specific pattern was observed for MFI effects on LVM (βwomen = 0.44, βmen = 0.03, Pint < 0.001). ALM was associated with increased LVM and LV volumes in both women and men. In mediation analyses, insulin resistance as measured by triglycerides/high-density lipoprotein ratio was a potential partial mediator of VAT effects on chamber dimensions.

CONCLUSION

In the largest and most rigorous analyses of body composition and cardiac parameters to date, we demonstrated that VAT is associated with increased LVM and wall thickness in women but not in men. MFI association with cardiac parameters was similar to VAT, significant in women but not in men.

PFKFB3 Connects Glycolytic Metabolism with Endothelial Dysfunction in Human and Rodent Obesity

Obesity and type 2 diabetes (T2D) increase cardiovascular risk, largely due to altered metabolic state. An early consequence of T2D/obesity is the loss of endothelial function and impaired nitric oxide (NO) signaling. In blood vessels, endothelial nitric oxide synthase (eNOS) synthesizes NO to maintain vessel homeostasis. The biological actions of NO are compromised by superoxide that is generated by NADPH oxidases (NOXs). Herein we investigated how altered metabolism affects superoxide/NO balance in obesity. We found that eNOS expression and NO bioavailability are significantly decreased in endothelial cells (ECs) from T2D patients and animal models of obesity. In parallel, PFKFB3, a key glycolytic regulatory enzyme, is significantly increased in ECs of obese animals. EC overexpression of wild-type and a cytosol-restricted mutant PFKFB3 decreased NO production due to increased eNOS-T495 phosphorylation. PFKFB3 also blunted Akt-S473 phosphorylation, reducing stimulus-dependent phosphorylation of S1177 and the activation of eNOS. Furthermore, PFKFB3 enhanced the activities of NOX1 and NOX5, which are major contributors to endothelial dysfunction. Prolonged exposure of ECs to high glucose or TNFα, which are hallmarks of T2D, leads to increased PFKFB3 expression. These results demonstrate a novel functional relationship between endothelial metabolism, ROS, and NO balance that may contribute to endothelial dysfunction in obesity.

Psychological well-being factors and the likelihood of transitioning from overweight and obesity to normal weight at population level: Evidence from two cohort studies of UK adults

We examined the prospective associations between psychological well-being related factors (depressive symptoms, life satisfaction, self-efficacy) and transitioning from overweight and obesity to normal body weight (vs persistence of overweight and obesity) and change in body mass index (BMI). We used multiple baselines and follow-ups from the National Child and Development Study (NCDS; 8513 observations) and the British Cohort Study (BCS; 11,113 observations). A proportion (8%-9%) of participants with overweight and obesity (BMI ≥25) at baseline transitioned into normal weight (BMI 18.5-<25) by follow-ups. There was no evidence of better psychological well-being related factors (e.g. lower depressive symptoms) being significantly associated with a transition from overweight and obesity to normal weight or reduced BMI in each cohort and pooled cohort analyses. However, age and gender were associated with transition. At population level, better psychological well-being may not be associated with likelihood of weight loss once obesity is developed in adulthood.

Effect of weight loss following Roux-en-Y gastric bypass on cancer risk: A Mendelian randomization study

Cancer incidence and development are strongly correlated with obesity, however there is insufficient data to support a causal relationship between intentional weight loss and the prevention or promotion of cancer. We investigated the causal relationship between weight loss following Roux-en-Y gastric bypass (RYGB) and the incidence of 18 cancers using Mendelian randomization (MR). A genome-wide association studies (GWAS) data related to weight loss following RYGB from the GWAS catalog database were used as exposure, and GWAS data related to 18 cancers from the Medical Research Council integrative epidemiology unit open GWAS project were used as outcomes. In order to investigate the causal relationship between exposure and results, we used a two-sample MR approach. The primary analysis technique was inverse variance weighting, with weighted median, and MR-Egger regression utilized as supplemental techniques to confirm the findings. Heterogeneity and horizontal pleiotropy were investigated using a variety of sensitivity studies, including the Cochran Q test, MR-Egger regression pleiotropy test, MR pleiotropy residual sum and outlier, and leave-one-out analysis. We included a total of 4 single-nucleotide polymorphisms as instrumental variables through rigorous quality control screening. Under the limitations of Bonferroni correction threshold (P < 2.78 × 10-3), our results suggest that the weight loss following RYGB has a significant causal relationship with a reduced risk of breast (odds ratio [OR]: 0.784; 95% confidence interval [CI]: 0.762-0.808; P = 2.167e-58) and lung cancer (OR: 0.992; 95% CI: 0.987-0.997; P = .0023), and a potential causal relationship with a decreased risk of hematological cancer (OR: 0.9998462; 95% CI: 0.9997088-0.9999836; P = .028) and an increased risk of cervical cancer (OR: 1.000123; 95% CI: 1.0000313-1.000215; P = .009). Sensitivity analysis confirms the robustness of our analysis results. Genetically predicted weight loss following RYGB has significant causal effects in reducing the risk of breast and lung cancer. It also has potential benefits in lowering the risk of hemotological cancers and increasing the risk of cervical cancer. Considering the limitations of our study, the reliability of its results and the underlying mechanisms require further investigation.

Multiomics unravels the complexity of male obesity: a prospective observational study

BACKGROUND

Obesity is associated with varying degrees of metabolic dysfunction. In this study, we aimed to discover markers of the severity of metabolic impairment in men with obesity via a multiomics approach.

METHODS

Thirty-two morbidly men with obesity who were candidates for Roux-en-Y gastric bypass (RYGB) surgery were prospectively followed. Nine healthy adults served as controls. Deep phenotyping, including targeted metabolomics, transcriptomics, and brain magnetic resonance imaging (MRI), was performed.

RESULTS

Testosterone emerged as a key contributor to phenotypic variability via principal component analysis and was therefore used to further categorize obese patients as having or not having hypogonadotropic hypogonadism (HH). Despite having comparable body mass indices, obese individuals with HH presented with worse metabolic defects than obese individuals without HH, including higher insulin resistance, as well as MRI signs of hypothalamic inflammation and a specific blood transcriptomics signature. The upregulated genes were involved mainly in inflammation, mitochondrial function, and protein translation. Integration of gene expression and clinical data revealed high FGF21 and low cortisol levels as the top markers correlated with the transcriptomic signature of metabolic risk. Following RYGB-induced substantial weight loss, testosterone levels markedly increased in both obese individuals with and without HH, challenging the current definition of hypogonadism. A longitudinal study in a subset of men with obesity following bariatric surgery revealed a unique FGF21 trajectory with a sharp peak at one month post-RYGB that correlated with metabolic and reproductive improvements.

CONCLUSIONS

Combining clinical, biochemical, and molecular markers allows adequate stratification of metabolic risk in men with obesity and provides novel tools for personalized care.

Knowledge and Awareness of Obesity-Related Breast Cancer Risk Among Women in the Qassim Region, Saudi Arabia: A Cross-Sectional Study

Background: Breast cancer (BC) is a major health concern globally and the second leading cause of cancer-related mortality in women in Saudi Arabia. Although peoples' awareness of BC risk factors has been previously examined, studies on obesity-related BC awareness in the Qassim region are inconclusive. We aimed to evaluate knowledge and awareness of obesity-related BC risk among Saudi women in the Qassim region. Methods: This is a cross-sectional study with a stratified random sampling technique of 400 Saudi women randomly selected from the Qassim region through an online platform and community health centers. An online closed-ended pretested validated structured questionnaire was completed by the participants using a Google Forms link. The categorical variables were frequency and percentage. The chi-square test was used to study the relationship between the dependent and independent variables. Results: There is moderate to poor knowledge regarding breast cancer risk factors. The results showed poor knowledge about obesity after menopause as a risk factor for BC (49%). Over half of the participants (51.0%) did not consider obesity a BC risk factor. The need for self-examinations and mammogram screenings showed moderate (59.6%) and poor awareness levels (4.75%). Conclusions: The findings highlight a noticeable gap in knowledge and awareness about obesity-related BC risks, as well as a limited awareness of the need for breast self-examinations and mammogram screenings. These results underscore the urgent need for targeted awareness campaigns and educational programs in the Qassim region to address this critical health issue. Promoting breast self-examination practices, weight management, and regular mammogram screenings could significantly enhance early detection, improve prognosis, and reduce BC-related mortality among Saudi women in the Qassim region.

The burden and temporal trend of early onset pancreatic cancer based on the GBD 2021

In the context of the global increase in early-onset tumours, investigating the global disease burden caused by early-onset pancreatic cancer (EOPC) is imperative. Data on the burden of EOPC were obtained from the Global Burden of Disease Study 2021. A joinpoint regression model was used to analyse the temporal trend of the EOPC burden, and an age‒period‒cohort (APC) model was used to analyse the influence of age, period, and birth cohort on burden trends. Globally, the number of EOPC cases increased from 24,480 to 42,254, and the number of deaths increased from 17,193 to 26,996 between 1990 and 2021. The results of the APC model showed that the burden of EOPC increases with increasing age, whereas the variations in period and cohort effects exhibited a complex pattern across different sociodemographic index regions. Consequently, the disease burden of EOPC is increasing worldwide, highlighting the need for effective interventions.

Effect of soluble dietary fiber extracted from Lentinula edodes (Berk.) Pegler on lipid metabolism and liver protection in mice on high-fat diet

With the increasing annual production of Lentinula edodes, the residues of Lentinus edodes are mass produced and wasted every year. In order to further explore the added value and effective utilization of Lentinus edodes, we studied the lipid-lowering efficacy and liver protective effect of Lentinus edodes soluble dietary fiber in mice on high-fat diet. Project team from Lentinus edodes extracted soluble dietary fiber, and its physicochemical properties, selected 30 male mice, randomly divided into normal group (N), high fat diet group (F), add low dose dietary fiber high fat diet (FL), add medium dose dietary fiber high fat diet group (FM), add high dose dietary fiber high fat diet group (FH) five groups. After 4 weeks, we assessed general state, organ conditions, liver status, blood parameters, expression of hepatic lipid metabolism genes, mRNA levels of key hepatic lipid metabolism genes. The results showed that the molecular weight of soluble dietary fiber is about 17.029 kDa, and the monosaccharides such as galactose, glucose and mannitol are connected by β-glycosidic bond. The soluble dietary fiber of Lentinus edodes can effectively slow the weight growth due to high-fat diet, delay liver tissue lesions, reduce the levels of ALT, AST, ACP, LDL-C, TG, TV, FFA, SOD, GSH and MDA, and increase the levels of γ-GT, HDL-C and CAT in blood. Lentinus edodes soluble dietary fiber decreased the expression of AMPKα and SREBP-2 in the liver, and increased the expression of PPARα, ACS, CPT1a, CYP7A1. It is proved that the soluble dietary fiber of Lentinus edodes can alleviate the organ fat accumulation caused by high-fat diet to some extent, effectively combat the liver injury, oxidative stress pressure and lipid metabolism disorder caused by high-fat diet, and provide an experimental basis for the subsequent effective use of soluble dietary fiber of Lentinus edodes in fat reduction.

Ultra-Processed Food Consumption and Obesity: A Narrative Review of Their Association and Potential Mechanisms

Obesity is a major global health concern, with diet playing a crucial role in its development and treatment. Ultra-processed foods (UPFs) have become prevalent in diets due to changes in the food environment. These foods are energy-dense; high in fat, sugars, or salt; and low in fiber, protein, vitamins, and minerals, raising concerns about their effects on health. In addition to traditional research focused on nutrients, food, and dietary quality, growing evidence has linked UPF consumption to obesity. Therefore, this study provides a comprehensive review of the levels and trends of UPF consumption, current epidemiological evidence on the association between UPF consumption and obesity, and UPFs' potential role in the etiology of obesity and weight gain. Additionally, this study reviews strategies for reducing UPF consumption and outlines future studies of the link between UPF consumption and obesity.

Separating the Effects of Early-Life and Adult Body Size on Chronic Kidney Disease Risk: A Mendelian Randomization Study

Background

Whether there is a causal relationship between childhood obesity and increased risk of chronic kidney disease (CKD) remains controversial. This study sought to explore how body size in childhood and adulthood independently affects CKD risk in later life using a Mendelian randomization (MR) approach.

Methods

Univariate and multivariate MR was used to estimate total and independent effects of body size exposures. Genetic associations with early-life and adult body size were obtained from a genome-wide association study of 453,169 participants in the U.K. Biobank, and genetic associations with CKD were obtained from the CKDGen and FinnGen consortia.

Results

A larger genetically predicted early-life body size was associated with an increased risk of CKD (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.14 to 1.41; P=1.70E-05) and increased blood urea nitrogen (BUN) levels (β=0.010; 95% CI, 0.005 to 0.021; P=0.001). However, the association between the impact of early-life body size on CKD (OR, 1.12; 95% CI, 0.95 to 1.31; P=0.173) and BUN level (β=0.001; 95% CI, -0.010 to 0.012; P=0.853) did not remain statistically significant after adjustment for adult body size. Larger genetically predicted adult body size was associated with an increased risk of CKD (OR, 1.37; 95% CI, 1.21 to 1.54; P=4.60E-07), decreased estimated glomerular filtration rate (β=-0.011; 95% CI, -0.017 to -0.006; P=5.79E-05), and increased BUN level (β=0.010; 95% CI, 0.002 to 0.019; P=0.018).

Conclusion

Our research indicates that the significant correlation between early-life body size and CKD risk is likely due to maintaining a large body size into adulthood.

Association of long-term weight management pharmacotherapy with multiple health outcomes: an umbrella review and evidence map

BACKGROUND

Multiple meta-analyses (MAs) have demonstrated that six pharmacotherapies, including orlistat, liraglutide, phentermine/topiramate, naltrexone/bupropion, semaglutide, and tirzepatide, improve weight loss and weight maintenance. However, few studies have synthesized and evaluated the quality of this evidence.

OBJECTIVE

To identify the relevant MAs of randomized clinical trials (RCTs) that explored the association between the six pharmacotherapies and obesity-related health outcomes and adverse events (AEs).

METHODS

A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from database inception up to January 2024. We calculated the effect size as the mean difference and risk ratio using the random-effects model. The quality of MAs was evaluated using "A Measurement Tool to Assess Systematic Reviews 2".

RESULTS

Sixteen MAs comprising 235 RCTs that described 115 unique associations between the six pharmacotherapies and various health outcomes were included. Overall, 101 statistically significant associations (88%) had beneficial outcomes on body weight, weight loss, waist circumference, body mass index, total cholesterol, triglycerides, both low-density and high-density lipoprotein cholesterol, blood pressure, and glycemic profile. The pharmacotherapies were associated with significant weight loss and partial improvements in the lipid profile, blood pressure, and glycemic control among individuals with overweight or obesity. Notable AEs were associated with liraglutide, naltrexone/bupropion, semaglutide, and orlistat. The methodological quality of the included MAs requires improvement.

CONCLUSIONS

This umbrella review identified significant beneficial associations between pharmacotherapies and anthropometric measures, lipid profile, blood pressure, glycemic profile, and quality-of-life outcomes in individuals with overweight or obesity. In addition, the umbrella review highlighted safety considerations. The findings affirm the efficacy of the six pharmacotherapies in promoting weight loss in this demographic. Further clinical trials with long-term follow-up are essential to evaluate the effects of these pharmacotherapies on clinical outcomes, including cancer, cardiovascular events, and mortality.

Clinical Data Mega-Collection of Obesity and Obesity-Related Trials: Primary Inclusion Criteria from All Studies and Highlights of Clinical Efficacy Analysis of GLP-1 Drugs

Background/Objectives: Obesity is heterogeneous and considered a chronic epidemic with significant un-met needs for management, treatment, and prevention. Methods: In this study, we used LizAI's software TAITAN (alpha version) for the mega-collection and analysis of clinical data from 10,407 trials addressing obesity and obesity-related diseases and their associated publications, mainly on PubMed. Results: We report an intensive growth of clinical trials until the end of 2024 and highlight the use of the body mass index (BMI) as a critical criterion in clinical participant selection despite its limitations. The significant disparities in races, regions, and the sites of trials across all studies have not been addressed, posing the possibility of research in the far future on the applications of precision medicine in weight management. In the latter parts of this paper, we analyze and discuss the clinical efficacy, mainly focusing on the primary endpoints and benchmarks of the recently FDA-approved once-weekly injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) drugs, including semaglutide and tirzepatide. Both drugs have functioned comparably when considering the 5% weight loss FDA threshold. Tirzepatide outperforms semaglutide and impacts fewer participants as the weight loss level increases from 5 to 20% and has greater effects in different populations, especially in people with type 2 diabetes (T2D). Conclusions: We would, however, like to highlight that (i) the weight loss level should be dependent on the clinically relevant needs of patients, and faster and greater weight loss might not be a win, and (ii) the clinical benefits, safety, and quality of life of patients should be carefully assessed when the weight loss is significant in a short period. In our search, we found that the specificities and impacts of weight loss therapies on organs like the kidneys and heart, different muscle types, bones, and fat accumulation in different parts of body were not investigated or disclosed during the clinical study period and longer term monitoring. In light of scientific needs and remarkable public interest in weight loss, our report provides findings on the buzz around losing weight in clinical trials, and our TAITAN software continues to collect data in real time and enrich its knowledge for future updates.

The role of celastrol in inflammation and diseases

Celastrol is one of the main active ingredients extracted from the plant Tripterygium wilfordii Hook F. A growing number of studies have shown that celastrol has various pharmacological effects, including anti-inflammation, anti-rheumatism, treatment of neurodegenerative diseases, and anti-tumor. This article systematically summarized the mechanism and role of celastrol in lipid metabolism and obesity, rheumatoid arthritis (RA), osteoarthritis (OA), gouty arthritis, inflammatory bowel disease, neurodegenerative diseases, and cancer and other diseases (such as diabetes, respiratory-related diseases, atherosclerosis, psoriasis, hearing loss, etc.). The celastrol played roles in inflammation response, cell apoptosis, autophagy, ferroptosis, and lipid metabolism mainly by acting on chondrocytes, macrophages, mitochondria, and endoplasmic reticulum (ER) through NF-κB, STAT, MAPK, TLR, PI3K-AKT-mTOR, and other signal pathways. This review could provide a reference for the clinical application and further development and utilization of celastrol.

Effects of Aerobic Exercise on Blood Lipids in People with Overweight or Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study aimed to investigate the effects of aerobic exercise (AE) on triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels in people with overweight or obesity. Searches were performed in PubMed, Scopus, Cochrane, and Web of Science, covering data up to 27 October 2023. A meta-analysis was conducted to determine the standardized mean difference (SMD) and 95% confidence interval. Nineteen studies met the inclusion criteria. AE significantly improved blood lipids in people with overweight or obesity (TG: SMD = -0.54; p < 0.00001; TC: SMD = -0.24; p = 0.003; HDL: SMD = 0.33; p = 0.003; LDL: SMD = -0.42; p = 0.0005). Both moderate-intensity and vigorous-intensity AE demonstrated significant impacts in reducing TC, TG, and LDL, whereas only moderate-intensity exercise significantly elevated HDL. Additionally, AE significantly optimized blood lipids in those with overweight, with TG being the only parameter showing improvement in individuals with obesity. Moreover, continuous AE notably improved HDL and TG, while interval AE significantly reduced TG, TC, and LDL. Lastly, a clear positive correlation emerged between the duration of the intervention and the decrease in LDL, and a distinct negative correlation was observed between session duration and the reduction of LDL.

Are associations of adulthood overweight and obesity with all-cause mortality, cardiovascular disease, and obesity-related cancer modified by comparative body weight at age 10 years in the UK Biobank study?

OBJECTIVE

Adults living with overweight or obesity do not represent a single homogenous group in terms of mortality and disease risks. The aim of our study was to evaluate how the associations of adulthood overweight and obesity with mortality and incident disease are modified by (i.e., differ according to) self-reported childhood body weight categories.

METHODS

The sample comprised 191,181 men and 242,806 women aged 40-69 years (in 2006-2010) in the UK Biobank. The outcomes were all-cause mortality, incident cardiovascular disease (CVD), and incident obesity-related cancer. Cox proportional hazards regression models were used to estimate how the associations with the outcomes of adulthood weight status (normal weight, overweight, obesity) differed according to perceived body weight at age 10 years (about average, thinner, plumper). To triangulate results using an approach that better accounts for confounding, analyses were repeated using previously developed and validated polygenic risk scores (PRSs) for childhood body weight and adulthood BMI, categorised into three-tier variables using the same proportions as in the observational variables.

RESULTS

In both sexes, adulthood obesity was associated with higher hazards of all outcomes. However, the associations of obesity with all-cause mortality and incident CVD were stronger in adults who reported being thinner at 10 years. For example, obesity was associated with a 1.28 (1.21, 1.35) times higher hazard of all-cause mortality in men who reported being an average weight child, but among men who reported being a thinner child this estimate was 1.63 (1.53, 1.75). The ratio between these two estimates was 1.28 (1.17, 1.40). There was also some evidence that the associations of obesity with all-cause mortality and incident CVD were stronger in adults who reported being plumper at 10 years. In genetic analyses, however, there was no evidence that the association of obesity (according to the adult PRS) with mortality or incident CVD differed according to childhood body size (according to the child PRS). For incident obesity-related cancer, the evidence for effect modification was limited and inconsistent between the observational and genetic analyses.

CONCLUSIONS

Greater risks for all-cause mortality and incident CVD in adults with obesity who perceive themselves to have been a thinner or plumper than average child may be due to confounding and/or recall bias.

Prevalence of complications and comorbidities associated with obesity: a health insurance claims analysis

BACKGROUND

Despite the substantial burden of obesity in the United States (US), data on the comprehensive range of comorbidities in different age groups is limited. This study assessed the prevalence of various comorbidities among people diagnosed with obesity (as per ICD-10 diagnosis code) across age cohorts and compared how they differ from people without obesity.

METHODS

This cross-sectional study analyzed individuals from all four regions (Midwest, Northeast, South, and West) of the US who had continuous insurance coverage from 2018 to 2020, using a large health insurance claims database (Merative™ MarketScan®). Identification of disorders relied on ICD-10 diagnosis code in patient claims and their prevalence was calculated.

RESULTS

Of 6,935,911 individuals, people with a diagnosis of obesity accounted for 22.0%, 33.6%, and 34.4% in the 18-39 years, 40-64 years, and ≥ 65 years age groups, respectively. Within age strata, the mean age of people with obesity was comparable with those without obesity. Comorbidity burden was significantly higher among people with obesity, but increased with age in both obesity and non-obesity groups. Comorbidities with highest prevalence in people with obesity included: (i) hypertension (18-39 years: 29.0%, 40-64 years: 66.2%, ≥ 65 years: 89.4%), (ii) dyslipidemia (18-39 years: 28.1%, 40-64 years: 65.4%, ≥ 65 years: 88.0%), (iii) depression or anxiety (18-39 years: 44.1%, 40-64 years: 39.0%, ≥ 65 years: 38.9%), and (iv) prediabetes (18-39 years: 17.1%, 40-64 years: 32.2%, ≥ 65 years: 35.3%). Notably, increased prevalence of cardiometabolic risk factors such as hypertension and dyslipidemia began at an earlier age in people with obesity as compared with those without obesity. Ratio of prevalence between obesity and non-obesity groups was highest for the 18-39 years age group, as compared to older groups. Disorders such as obstructive sleep apnea, osteoarthritis, type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, coronary heart diseases (CHD), and chronic kidney diseases also exhibited substantial burden among those with obesity.

CONCLUSIONS

In this claims study, hypertension and dyslipidemia were the leading comorbidities in people with obesity, with an increasing prevalence with age. The burden of cardiometabolic comorbidities among the younger age group suggested potential risk for early onset of CHD in later life. Understanding the range of obesity-related comorbidities seen in this claims data may encourage healthcare professionals and healthcare systems to systematically diagnose and better manage these disorders. Further research using additional data sources can offer a more accurate view of the prevalence of obesity and its impact.

Interrupting T cell memory ameliorates exaggerated metabolic response to weight cycling

People frequently experience cycles of weight gain and loss. This weight cycling has been demonstrated, in humans and animal models, to increase cardiometabolic disease and disrupt glucose homeostasis. Obesity itself - and to an even greater extent weight regain - causes adipose tissue inflammation, resulting in metabolic dysfunction. Studies show that even after weight loss, increased numbers of lipid associated macrophages and memory T cells persist in adipose tissue and become more inflammatory upon weight regain. These findings suggest that the immune system retains a "memory" of obesity, which may contribute to the elevated inflammation and metabolic dysfunction associated with weight cycling. Here, we show that blocking the CD70-CD27 axis, critical for formation of immunological memory, decreases the number of memory T cells and reduces T cell clonality within adipose tissue after weight loss and weight cycling. Furthermore, while mice with impaired ability to create obesogenic immune memory have similar metabolic responses as wildtype mice to stable obesity, they are protected from the worsened glucose tolerance associated with weight cycling. Our data are the first to target metabolic consequences of weight cycling through an immunomodulatory mechanism. Thus, we propose a new avenue of therapeutic intervention by which targeting memory T cells can be leveraged to minimize the adverse consequences of weight cycling. These findings are particularly timely given the increasing use of efficacious weight loss drugs, which will likely lead to more instances of human weight cycling.